Combined Repair and Reconstruction of Coracoclavicular and Acromioclavicular Ligaments for Acute and Chronic AC Joint Dislocations: A Technical Note and Prospective Case Series

<b>Background/Objectives:</b> Dislocation of the acromioclavicular joint (ACJ) is a common injury for which numerous operative fixation and reconstructive techniques have been described. This technique combines a coracoclavicular ligament (CC) repair with an acromioclavicular ligament (AC) and CC reconstruction with an additional ACJ internal brace to address both horizontal and vertical instability. <b>Methods:</b> The surgery is performed through a superior approach in the following sequence: (1) CC ligaments are repaired using a TightRope construct, (2) CC reconstruction is performed using a peroneus longus tendon allograft, (3) AC ligaments are repaired using an internal brace, and (4) AC reconstruction is performed with a second peroneus longus tendon allograft. The results of consecutive patients with grade IIIB, IV, and V AC joint dislocations were included. <b>Results:</b> Six patients with acute and six patients with chronic injuries were eligible for inclusion. The Constant-Murley Score improved significantly from 27.6 (8.0-56.5) to 61.5 (42.0-92.0) (<i>p</i> = 0.006 paired <i>t</i>-test) at 12 months of follow-up. There was one complication (frozen shoulder) from which the patient recovered spontaneously; no other complications were observed with this technique. The coracoclavicular distance (CCD) was reduced from 18.7 mm (13.0-24.0) to 10.0 mm (6.0-16.0, <i>p</i> < 0.001) and 10.5 mm (8.0-14.0, <i>p</i> = 0.002) at 12 weeks and 12 months, respectively. <b>Conclusions:</b> This study describes a new technique to treat acute and chronic Rockwood stage IIIB-V ACJ dislocations with promising short-term clinical and radiological results. The results suggest that the combined repair and reconstruction of the AC and CC ligaments is a safe procedure with low complication risk in experienced hands. Addressing the vertical and horizontal stability in ACJ dislocation is key to achieving optimal long-term results. Further, follow-up is required to investigate the long-term outcomes.