Anatomic Reconstruction of Acromioclavicular Joint Injuries
Bradley P. Jaquith
Anthony A. Mascioli
Thomas (Quin) Throckmorton
Preoperative Evaluation
• Routine physical examination of the shoulder
• Standard radiographic shoulder series
• Anteroposterior.
• True anteroposterior (Grashey).
• Axillary lateral—necessary for diagnosis of type IV acromioclavicular (AC) separation (Fig. 19-2).
• Bilateral Zanca view (beam directed 10-15 degrees cephalad) may be useful.
• MRI is not typically obtained unless other shoulder pathology is suspected.
Sterile Instruments/Equipment
• Sterile drapes, including impervious stockinette and 4-in elastic bandage wrap for forearm and hand
• Three strands of large braided suture, for example, FiberTape or SutureTape (Arthrex Inc., Naples, FL)
• Nitinol wire
• Guide wires and reamers
• PEEK screws
 Figure 19-1 | Rockwood classification of acromioclavicular joint dislocations. |
 Figure 19-2 | Type IV acromioclavicular separation demonstrating posterior displacement of the clavicle referable to the acromion. |
Patient Positioning
• Beach-chair position (Fig. 19-3)
 Figure 19-3 | Beach-chair position. |
• Entire ipsilateral extremity prepared and draped circumferentially to allow freedom of movement and facilitate reduction
• Padded Mayo stand available to rest arm on
Surgical Approach
• Incision is made from lateral end of the clavicle to the coracoid (Fig. 19-4).
• Sharp dissection is carried down to the deltotrapezial fascia, and medial and lateral flaps are raised (Fig. 19-5).
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