Chronic Acromioclavicular Joint Reconstruction With Semitendinosus Allograft: The X's Technique

The acromioclavicular (AC) and coracoclavicular (CC) joints provide anteroposterior and superoinferior stability, respectively, of the scapula in relation to the lateral clavicle. Chronic or high-grade (≥IIIB) AC dislocations should be treated with a structured rehabilitation program, and if symptoms persist, they typically require reconstruction to restore alignment, relieve pain, and improve scapular function.

This technique is indicated for chronic AC joint dislocations that are Rockwood grade IIIB-VI injuries that have failed conservative management. Patients should demonstrate both horizontal and vertical AC instability to use this technique.

The senior author's "X's" technique for AC joint reconstruction using semitendinosus (ST) allograft is detailed here. This arthroscopically assisted open approach uses diagnostic arthroscopy first to identify joint landmarks. The undersurface of the acromion is identified, and a brief bursectomy is performed. A tensionable button construct (TightRope and DogBone) is utilized to reduce the AC joint. Four all-suture anchors are used to form an X configuration and stabilize the AC joint. The ST allograft is passed through the anterolateral portal, looped around the coracoid, and secured over the top of the clavicle for additional fixation of the joint.

This technique does not yet have specific outcome data; however, similar techniques have demonstrated that ST allograft and autograft augmentation improve patient-reported outcomes and load resistance. Additionally, reconstructing the AC joint, in addition to the CC joint, improves patient horizontal instability. Allograft and autograft reconstruction techniques have low failure rates and help patients return to sport at their preinjury level.

AC joint reconstruction with an ST allograft using the "X's" technique is a novel method of AC and CC joint treatment for patients with chronic AC joint dislocations that are Rockwood grade IIIB-VI, providing improved patient vertical and horizontal fixation via the 3 "X" constructs: the tensionable button construct, "X" of the all-suture anchors across the AC joint, the "X" of the ST graft around the coracoid and clavicle, and an optional "X" across the AC joint with the ST graft.

The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.