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Chronic Acromioclavicular Joint Instability: Outcomes after Stabilization without Tendon Graft Augmentation.

Andreas Klonz¹, Sebastian Schmitt¹

¹Sportchirurgie Heidelberg, ATOS Klinik Heidelberg, Heidelberg, Germany.

Journal of Orthopaedic Case Reports

|July 10, 2026

Summary

Surgical stabilization of chronic acromioclavicular joint instability without tendon grafts yields favorable outcomes. This graft-free approach offers a viable alternative to traditional augmentation techniques for chronic ACJ dislocations.

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Area of Science:

Orthopedic surgery
Sports medicine
Shoulder reconstruction

Background:

Chronic acromioclavicular joint (ACJ) instability can cause significant pain and impairment, necessitating surgical intervention.
Tendon-graft augmentation is commonly recommended for coracoclavicular (CC) ligament reconstruction in these cases.
The necessity of graft use in all chronic ACJ instability cases remains debated.

Purpose of the Study:

To evaluate the clinical and radiographic outcomes of open reduction and stabilization for chronic ACJ dislocations without using tendon grafts.
To determine if graft-free reconstruction is a viable alternative to graft-augmented techniques.

Main Methods:

A cohort of 16 patients with chronic, symptomatic ACJ instability underwent delayed surgical stabilization without tendon grafts.

Keywords:

AC-joint Chronic instability acromioclavicular joint minar surgery technique tendon graft

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The modified open MINAR® technique with a cortical button construct was employed for CC stabilization.

Temporary K-wire transfixation of the AC joint was used to ensure anatomical reduction and stability.

Main Results:

At a mean follow-up of 51 months, patients showed favorable outcomes with a mean Subjective Shoulder Value (SSV) of 87%, ACJ Instability Score (ACJIS) of 85.5, and Taft score of 11.1.
No complications or revision surgeries were reported.
While some residual radiographic displacement was observed, it did not negatively impact clinical outcomes.

Conclusions:

Open reduction and stabilization without tendon grafts provide favorable mid-term results for chronic ACJ dislocations, comparable to graft-augmented methods.
Tendon-graft augmentation may not be essential for all chronic ACJ instability cases.
Successful graft-free reconstruction relies on adequate CC space preparation, anatomic reduction, and rigid fixation.