Acromioclavicular Joint Reconstruction With Acromioclavicular Ligament Augmentation Using a Knotless, All-Suture Anchor Construct

Many techniques and combinations of procedures exist for reconstruction of an injured acromioclavicular (AC) joint. Recently, there has been a focus on controlling anterior and posterior translation of the AC joint after the reduction of superior translation and coracoclavicular (CC) ligament stabilization. Diagnosis and treatment of anterior and posterior instability of the AC joint is critical, yet when AC/CC ligament reconstruction fails, this is often the result of recurrent superior migration of the clavicle relative to the acromion. We present a technique using knotless, all-suture anchor technology intended for higher-grade, operative AC joint injuries in “high-risk” patients, i.e., those returning to a collision sport such as football, rugby, hockey, or wrestling. Consideration also could be given to those performing a high-demand occupation, such as overhead work or manual labor. In addition, this technique could be employed in patients at risk for delayed or nonhealing, such as those with diabetes or who are smokers, those at risk of noncompliance, and revision cases. The all-suture anchor, knotless “suture staple” technique can be implemented easily to provide backup fixation of the AC joint directly as an augmentation to CC reconstruction, preferably arthroscopic-assisted reduction, and fixation with a cortical button and, when indicated, concomitant allograft reconstruction.