AC Joint Reconstruction | Shoulder Arthroscopy

In this video, shoulder surgeon Dr. Peter Millett discusses AC joint reconstruction. AC joint injuries account for 9-12% of all shoulder injuries and surgery is indicated in grades IV-VI and in select patients grade III dislocations. Complications have been reported, particularly with large drill hoes in the clavicle.

In a study by Dr. Millett published in the Journal of Arthroscopy 31 shoulders were anatomically reconstructed with tendon grafts through bone tunnels. The mean age was 43.9 year ranging from 21-71. 7 patients (22.6%) had complications. There was a minimum of a 2 year follow-up on 20 of the remaining 24 patients. The ASES scores imporved from 58.9 to 93.8. The median patient satisfaction was a 9 out of 10.

Current technique minimizes risk of clavicle fixation by looping graft around the coracoid and tying above the clavicle rather than placed through the large bone tunnels.

During the AC joint reconstruction, shoulder arthroscopy is utilized. The under-surface of the coracoid is decorticated. Radiofrequency is used to remove the soft-tissues. It is important when drilling to make sure that you are in the center portion of the clavicle and that you exit at the center portion of the coracoid.

A graft is run posteriorly on the clavicle to medial on the coracoid, on the lateral side of the coracoid and then up anteriorly on the clavicle and then the graft will be secured to itself to secure the entire construct.

Post-operative rehabilitation is abduction sling for the first 4-6 weeks to reduce tension on the reconstruction. Supine passive range of motion starts immediately. Strengthening exercises start at 8 weeks. Full activity at 16 weeks post-operatively.

Over 40 cases with shoulder surgeon Dr. Peter Millett have had no clavicle or coracoid fractures in the last 3 years using this technique. Surgical pearls with this technique use a 70 degree arthroscope from the posterior portal to visualize the coracoid undersurface. Make the anterior portal more inferior and lateral than normal. Avoid disturbing the soft tissue distal to the tip of the coracoid.

This technique maximizes the ability to reduce the joint and provides a very strong initial construct and decreases the risk of complications such as coracoid fracture and clavicle fractures.