Anatomic Acromioclavicular Joint Reconstruction With Semitendinosus Allograft: Surgical Technique

Acromioclavicular joint separations are common shoulder injuries in the active patient population. Nonoperative management is recommended for Rockwood type I and II injuries, whereas surgical reconstruction is recommended for type IV and VI separations. The management for type III and V injuries is more controversial and is determined on a case-by-case basis. A multitude of surgical reconstruction techniques exist, and there is little evidence to support one technique over another. The anatomic technique aims at reconstructing the coracoclavicular ligaments and bringing the clavicle back into its anatomic position. When the anatomic technique is augmented with a graft, biomechanical studies have shown superior reconstruction strength and stability compared with standard nonanatomic techniques. Additionally, anatomic reconstruction allows for better cosmesis and functional outcome measures at midterm follow-up compared with nonanatomic techniques. In this Technical Note, we describe our preferred technique for anatomic repair of acromioclavicular joint separation using a semitendinosus allograft.