Feasibility of acromial periosteal flap technique for enhanced reconstruction of acromioclavicular joint dislocations: a cadaveric study

AIMS: The aim of this study was to test the feasibility of mobilizing an acromial periosteal flap (APF) and to evaluate its potential to provide locally available, additional biological autologous augmentation for acute and chronic acromioclavicular joint (ACJ) injuries. METHODS: Ten cadaveric upper extremities (5 right, 5 left; 3 female, 7 male) with an average age of 82 ± 3.7 years were used. A direct surgical approach to the ACJ was performed, and the APF was mobilized from three sides of the acromion, leaving the side closest to the clavicle intact. The flap was folded over onto the clavicle and secured with a transosseous suture. Measurements of flap length, width, and clavicular overlap were recorded. RESULTS: Mobilization of the APF was successfully achieved in all specimens. The flaps appeared clinically stable and tear-resistant, with an average length of 2.3 ± 0.5 cm, width of 1.75 ± 0.5 cm, and clavicular overlap of 1.29 ± 0.6 cm. CONCLUSION: Our study demonstrated the anatomical feasibility of preparing an acromial periosteal flap (APF). This anatomical proof of concept may provide the basis for potential future clinical applications as an additional option for biological augmentation in ACJ reconstruction. However, further biomechanical investigations and clinical studies are necessary to evaluate whether this technique can translate into improved stability and functional outcomes. LEVEL OF EVIDENCE: V.