Acromioclavicular Joint Reconstruction Using Peroneus Brevis Tendon Allograft


      We describe the use of a double-strand peroneus brevis allograft to reconstruct the coracoclavicular and acromioclavicular (AC) joint ligaments. Through sharp dissection, the distal clavicle, the AC joint, and the torn superior AC and coracoacromial ligaments are identified. The coracoid process and injured coracoclavicular ligaments are identified with blunt dissection. A 1-cm segment of the lateral clavicle is resected. Vertical and connecting horizontal tunnels are created (4.5 mm) in the lateral clavicle and in the medial acromion process. The 5.5- to 6.0-mm-diameter allograft is looped around the coracoid process, and both strands are passed through the vertical clavicle tunnel with a nitinol wire loop. One strand passes through the vertical clavicle tunnel, and the other strand passes through the horizontal tunnel, exiting through the lateral end. The allograft strand passed through the vertical clavicle tunnel is then passed inferiorly through the superior vertical acromion tunnel, and the strand passed completely through the horizontal clavicle tunnel is passed laterally through the medial horizontal acromion tunnel. After both strands exit inferiorly through the vertical acromion tunnel, they are tensioned and sutured with AC joint reduction. Soft tissue closure uses No. 0 and No. 2-0 absorbable sutures with No. 3-0 nylon sutures at the skin.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Shearman C.M.
        • El-Khoury G.Y.
        Pitfalls in the radiologic evaluation of extremity trauma.
        Fam Physician. 1998; 57: 995-1002
        • Costic R.S.
        • Labriola J.E.
        • Rodosky M.W.
        • Debski R.E.
        Biomechanical rationale for development of anatomical reconstructions of coracoclavicular ligaments after complete acromioclavicular joint dislocations.
        Am J Sports Med. 2004; 32: 1929-1936
        • Lemos M.J.
        The evaluation and treatment of the injured acromioclavicular joint in athletes.
        Am J Sports Med. 1998; 26: 137-144
        • Rockwood Jr, C.A.
        • Williams G.R.
        • Young D.C.
        Disorders of the acromioclavicular joint.
        in: Rockwood C.A. Matsen F.A. The shoulder. Ed 2. WB Saunders, Philadelphia1998: 483-553
        • Harris R.I.
        • Wallace A.L.
        • Harper G.D.
        • et al.
        Structural properties of the intact and the reconstructed coracoclavicular ligament complex.
        Am J Sports Med. 2000; 28: 103-108
        • Lee S.J.
        • Nicholas S.J.
        • Akizuki K.H.
        • et al.
        Reconstruction of the coracoclavicular ligaments with tendon grafts: A comparative biomechanical study.
        Am J Sports Med. 2003; 31: 648-654
        • Grutter P.W.
        • Petersen S.A.
        Anatomical acromioclavicular ligament reconstruction: A biomechanical comparison of reconstructive techniques of the acromioclavicular joint.
        Am J Sports Med. 2005; 33: 1723-1728
        • Laprade R.F.
        • Hilger B.
        Coracoclavicular ligament reconstruction using semitendinosus graft for failed acromioclavicular separation surgery.
        Arthroscopy. 2005; 21: 1277e1-1277e5
        • Hamner D.L.
        • Brown Jr, C.H.
        • Steiner M.E.
        • Hecker A.
        • Hayes W.C.
        Hamstring tendon grafts for reconstruction of the anterior cruciate ligament: Biomechanical evaluation of the use of multiple strands and tensioning techniques.
        J Bone Joint Surg Am. 1999; 81: 549-557
        • Bohnsack M.
        • Surie B.
        • Kirsch L.
        • Wulker N.
        Biomechanical properties of commonly used autogenous transplants in the surgical treatment of chronic lateral ankle instability.
        Foot Ankle. 2002; 23: 661-664