Open Access Open Badges Research article

Comparison of single and two-tunnel techniques during open treatment of acromioclavicular joint disruption

Zhiyong Hou1*, Jove Graham2, Yingze Zhang1, Kent Strohecker2, Daniel Feldmann2, Thomas R Bowen2, Wei Chen1 and Wade Smith3

Author Affiliations

1 Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, China

2 Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, PA 17822, USA

3 Mountain Orthopaedic Trauma Surgeons at Swedish, 701 East Hampden Avenue Suite 515, Englewood, CO 80113, USA

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BMC Surgery 2014, 14:53  doi:10.1186/1471-2482-14-53

Published: 15 August 2014



Coracoclavicular (CC) ligament reconstruction with semitendinosus tendon (ST) grafts has become more popular and has achieved relatively good results; however optimal reconstruction technique, single-tunnel or two-tunnel, still remains controversial. This paper is to compare the clinical and radiographic data of allogenous ST grafting with single- or two-tunnel reconstruction techniques of the AC joint.


The outcomes of 21 consecutive patients who underwent anatomical reduction and ST grafting for AC joint separation were reviewed retrospectively. Patients were divided into two groups: single-tunnel group (11) and two-tunnel group (10). All patients were evaluated clinically and radiographically using a modified UCLA rating scale.


The majority of separations (18 of 21) were Rockwood type V, with one each in type III, IV and VI categories. The overall mean follow-up time was 16 months, and at the time of the latest follow-up, the overall mean UCLA rating score was 14.1 (range 8–20).

The percentage of good-to-excellent outcomes was significantly higher for patients with the two-tunnel technique than for those with the one-tunnel technique (70% vs. 18%, respectively, p = 0.03). Within the single-tunnel group, there was no statistically significant difference in percentage of good-to-excellent outcomes between patients with vs. without tightrope augmentation (17% vs 20%, p > 0.99). Similarly, within the two-tunnel group, there was no significant difference in the percentage of good-to-excellent outcomes between the graft only and augment groups (67% vs. 75%, p > 0.99).


Anatomical reduction of the AC joint and reconstruction CC ligaments are crucial for optimal joint stability and function. Two-tunnel CC reconstruction with an allogenous ST graft provides superior significantly better radiographic and clinical results compared to the single-tunnel reconstruction technique.

Acromioclavicular joint; Single-tunnel; Two-tunnel; Reconstruction; Augmentation