Acromioclavicular Joint Reconstruction with Double-Bundle Constructs Provide Improved Maintenance of Reduction but Comparable Clinical Outcomes Versus Single-Bundle Constructs.

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Abstract

Treatment of acute acromioclavicular (AC) joint separations is dependent on a variety of factors including severity, acuity, patient demographics, activity level, and surgeon preferences. For more severe or unstable separations (Rockwood types IIIB, IV, V, and VI), surgical intervention is typically recommended. Over 160 surgical techniques have been described, but none have emerged as a gold standard. Arthroscopic-assisted or all-arthroscopic fixation of the coracoclavicular (CC) ligaments with suture buttons has become increasingly popular due to lower complication rates compared to more rigid fixation. Configurations include single-bundle (SB) constructs and double-bundle (DB) configurations that more anatomically reconstruct the conoid and trapezoid ligaments but with longer operative times. Clinical studies with short-term follow-up have demonstrated improved maintenance of fixation for DB compared to SB constructs, but no significant differences in clinical outcomes. In our experience, single bundle suture-button-only constructs lead to unacceptable failures due to loss of reduction. We recommend either a single suture-button construct augmented with allograft or double bundle suture-button constructs for the treatment of acute AC joint separations.

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