All-Arthroscopic Weaver-Dunn-Chuinard Procedure With Double-Button Fixation for Chronic Acromioclavicular Joint Dislocation

Principles of all-arthroscopic WDC procedure with Double-Button fixation. (A) The CA ligament is harvested with a bone block from the tip of the acromion and rerouted in the distal end of the clavicle. (The arthritic distal clavicle has been resected and a socket drilled in its medullary canal.) (B) The bone-ligament transfer is protected for the time of bone healing by maintaining the reduction with the help of the Double-Button (2 titanium buttons connecting the clavicle and the coracoid with 4 strands of suture).

Five portals used for AC joint reconstruction (A) in a drawing and (B) marked on a shoulder: posterior (P), lateral (L), anterolateral (AL), AM, and superior (S).

Resection of tip of acromion and cavitation of distal end of clavicle. (A) The osteotomy of the tip of the acromion is performed with a bur introduced through the lateral portal; (B) a socket is then drilled inside the distal clavicle to receive the CA ligament with the acromial bone block.

Double-Button fixation. (A) The proximal titanium button is placed over the clavicle, and (B) the inferior button is placed under the base of the coracoid process.

Fixation of bone-tendon graft inside socket of distal clavicle. (A) The CA ligament with the tip of the acromion is rerouted inside the distal end of the clavicle; (B) the same suture used for the Double-Button is rerouted inside the medullary canal through a hole drilled on the superior cortex of the clavicle; (C) the probe is on the superficial side of the rotator cuff, and the acromion (on the left) and the reduced clavicle (on the right) are perfectly aligned.

Three-dimensional computed tomography images showing perfect reduction of AC dislocation. The clavicle is perfectly aligned with the acromion in both (A) the vertical plane and (B) the horizontal plane. (C) A lateral view shows the reduction with one button over the clavicle and the other button under the coracoid process.

Both shoulders showed good cosmesis at 6 months.

Radiographs showing proximal migration of subcoracoid EndoButton. (A) The radiograph at 3 months shows the subcoracoid EndoButton in a slightly lateral position and an oblique trajectory toward the supraclavicular button, and (B) the radiograph at 6 months shows proximal migration of the EndoButton, probably due to cutout of the sutures through the lateral border of the coracoid.