Technical advance

Acromioclavicular joint reconstruction with coracoacromial ligament transfer using the docking technique

Peter J Millett^{* 1} , Sepp Braun¹ , Reuben Gobezie^{* 2} and Iván H Pacheco^{* 2,3}

¹Steadman Hawkins Research Foundation, 181 West Meadow Drive, Suite 1000, Vail, CO, USA

²The Case Shoulder & Elbow Service, Case Western Reserve University School of Medicine, 10900 Euclid Ave, Cleveland, OH, USA

³Harvard Shoulder Service, Harvard Medical School, Brigham and Women's Hospital, 75 Francis St, Massachusetts General Hospital, Boston, MA, USA

author email corresponding author email* Contributed equally

BMC Musculoskeletal Disorders 2009, 10:6doi:10.1186/1471-2474-10-6

Published:	14 January 2009

Abstract

Background

Symptomatic Acromioclavicular (AC) dislocations have historically been surgically treated with Coracoclavicular (CC) ligament reconstruction with transfer of the Coracoacromial (CA) ligament. Tensioning the CA ligament is the key to success.

Methods

Seventeen patients with chronic, symptomatic Type III AC joint or acute Type IV and V injuries were treated surgically. The distal clavicle was resected and stabilized with CC ligament reconstruction using the CA ligament. The CA ligament was passed into the medullary canal and tensioned, using a modified 'docking' technique. Average follow-up was 29 months (range 12–57).

Results

Postoperative ASES and pain significantly improved in all patients (p = 0.001). Radiographically, 16 (94%) maintained reduction, and only 1 (6%) had a recurrent dislocation when he returned to karate 3 months postoperatively. His ultimate clinical outcome was excellent.

Conclusion

The docking procedure allows for tensioning of the transferred CA ligament and healing of the ligament in an intramedullary bone tunnel. Excellent clinical results were achieved, decreasing the risk of recurrent distal clavicle instability.