Acromioclavicular Joint Repair and Reconstruction With a Tensionable Cerclage System Using a Single Clavicular Drill Hole

Acromioclavicular (AC) joint injuries occur with an incidence of 9.2 per 1,000 person-years. There are a variety of indicated surgical techniques, with no clear superior method. The use of suspensory fixation with cortical buttons has increased in popularity. Despite advancements in AC joint reconstruction, the procedure carries a significant complication risk, including coracoid fracture rates as high as 20%. We describe a technique using suspensory fixation that reduces the risk of complications, primarily coracoid and clavicular fracture. This technique provides anatomic reduction of the AC joint using a suture cerclage-tensioner system that (1) does not require coracoid drilling, (2) uses a single drill hole on the clavicle, (3) allows adjustable tensioning of the sutures, and (4) simplifies biological augmentation with an allograft.