Purpose: Acromioclavicular (AC) joint disruptions are a common injury in young, active, athletic individuals, usually resulting from a direct axial load or trauma to an adducted shoulder. AC joint disruption may become a source of chronic pain and AC joint instability, limiting a patient’s normal activities. Although many AC joint injuries can be managed nonsurgically with good results, surgical management is indicated in patients with severe injury and patients in whom nonsurgical treatment fails. Although many techniques have been described to manage AC joint disruption, recurrent dislocations are a major complication. Various techniques have been developed to restore normal joint anatomy and reconstruct torn ligaments to stabilize the AC joint. This video presents a surgical technique for arthroscopic AC joint reconstruction with the use of a semitendinosus allograft and dog-bone suture technique, which restores normal joint anatomy in patients with an AC joint separation.

Methods: The video discusses the case study of a 53-year-old man who sustained a Rockwood type III AC joint separation after falling off his bicycle 3.5 years ago. He experienced limited motion and persistent pain in his shoulder that improved with physical therapy and nonsurgical management. He re-injured his shoulder by running into a door frame while carrying a box. The patient has persistent sharp pain and a sense of instability in the left shoulder. The video reviews his physical examination findings, which included tenderness to palpation over the left AC joint and pain with horizontal adduction. Prominence was noted in the left shoulder with laxity. The patient's radiographs revealed a type IV AC joint separation. The video presents the technique for arthroscopic AC joint reconstruction with the use of allograft and suspensory button fixation.

Results: After demonstrating the surgical technique, the video reviews the final construct arthroscopically and compares the patient’s preoperative and postoperative radiographs. On most recent physical examination, the patient had full painless range of shoulder motion.

Conclusion: AC joint separations are a cause of morbidity. Techniques that adequately restore joint anatomy, such as reconstruction with the use of semitendinosus allograft and suspensory button fixation, may help prevent recurrent separation, provide pain relief, and restore function.