Chronic acromioclavicular joint reconstruction with twin tail tightrope and hamstring autograft augmentation: Case report and review of literature

Acromioclavicular (AC) joint dislocation is a complex and multifactorial condition. The incidence of ACJ dislocation is 1.8 per 10000. It develops secondary to trauma, mainly during sports. There is no consensus on optimal surgical treatment in chronic cases of symptomatic instability. The treatment options include open reduction and internal fixation with plate or endobutton fixation with possible augmentation using a graft. A 63-year-old male presented with persistent left shoulder discomfort for 12 weeks after a motor vehicle accident without evidence of shoulder pathology. There was noticeable skin tenting over the left AC joint but no range of motion limitations. Imaging revealed a missed Rockwood type V AC joint dislocation. The dislocation was reduced and reconstructed using the Twin-Tail TightRope button and semitendinosus tendon autograft augmentation. At the final follow-up, the patient resumed active shoulder exercises with the ability to return to recreational activities and swimming. This aim of this case report is to present the technique of Twin-Tail TightRope button augmented with hamstring autograft as an effective method for reconstructing chronic AC joint dislocation and improving functional and radiographic outcomes and symptoms of instability and provide an overview on the pearls and pitfalls of this technique and the associated outcomes and complications.