Acta Ortopédica Mexicana

García-García R, Mercado-Colín JM
Coracoclavicular ligaments reconstruction with short lateral peroneal autologous tendon graft
Acta Ortop Mex 2019; 33 (2)

Language: Español
References: 62
Page: 88-95
PDF: 283.13 Kb.

[Fulltext - PDF]


Introduction: In the dislocation acromioclavicular unstable vertically, the surgical treatment is elementary by the plasty of the ligaments coracoclaviculares, with the purpose of recovering its stability and normal function. There are techniques of a single tunnel in the clavicle or two tunnels (anatomical), with biological or synthetic material. Material and methods: It is a longitudinal prospective experimental study; we included 33 patients between 20 and 50 years of age with diagnosis of complete acromioclavicular dislocation with vertical instability. Reconstruction was performed only of the coracoclavicular ligaments with Mazzoca’s technique of using autologous tendon graft of the short lateral peroneus. The evaluation of results was with the PENN test. Results: 100% of patients are painless and with an arch of normal shoulder mobility one year after surgery. Radiographically, the coracoclavicular distance compared to the healthy side had an average difference of 1.0 mm at rest and 0.9 mm under load. Discussion: The reconstruction of the coracoclavicular ligaments with anatomical technique by autologous tendon graft of the short lateral peroneus, allows to recover the acromioclavicular stability and the normal function of the shoulder.

Key words: Dislocation, unstable, graft, reconstruction, treatment.


  1. Kapandji AI. La articulación acromioclavicular. Función de los ligamentos coracoclaviculares. Fisiología Articular. Tomo I, Miembro superior. Quinta Edición, 1998, 58-63.

  2. Bannister GC, Wallace WA, Stableforth PG, Hutson MA. A classification of acute acromioclavicular dislocation: a clinical a radiological and anatomical study. Injury. 1992; 23(3): 194-6.

  3. Fernández RA. Fondo de Cultura Económica. Dinámica clásica, México, D.F. 2005, 131-133.

  4. Costic RS, Labriola JE, Rodosky MW, Debski RE. Biomechanical rationale for development of anatomical reconstructions of coracoclavicular ligaments after complete acromioclavicular joint dislocations. Am J Sports Med. 2004; 32(8): 1929-36.

  5. Ludewig PM, Behrens SA, Meyer SM, Spoden SM, Wilson LA. Three-dimensional clavicular motion during arm elevation: reliability and descriptive data. J Orthop Sports Phys Ther. 2004; 34(3): 140-9.

  6. Bearn JG. Direct observations on the function of the capsule of the sternoclavicular joint in clavicular support. J Anat. 1967; 101(Pt 1): 159-70.

  7. Meirovichm L. Methods of analytical dynamics. New York: McGraw-Hill, 1970.

  8. Lee SJ, Keefer EP, McHugh MP, Kremenic IJ, Orishimo KF, Ben-Avi S, et al. Cyclical loading of coracoclavicular ligament reconstructions: a comparative biomechanical study. Am J Spots Med. 2008; 36(10): 1990-7.

  9. Williams GR Jr., Shakil M, Klimkiewicz J, Iannotti JP. Anatomy of the scapulothoracic articulation. Clin Orthop Relat Res. 1999; 359: 237-46.

  10. Namdari S, Yagnik G, Ebaugh DD, Nagda S, Ramsey ML, Williams GR Jr, et al. Defining functional shoulder range of motion for activities of daily living. J Shoulder Elbow Surg. 2012; 21(9): 1177-83.

  11. Jari R, Costic RS, Rodosky MW, Debski RE. Biomechanical function of surgical procedures for acromioclavicular joint dislocations. Arthroscopy. 2004; 20(3): 237-45.

  12. Ruiz S, Ruiz S, Platero R. Diagnóstico y tratamiento en la patología del manguito rotador. 2007, 1-95.

  13. Taboadela CH. Goniometría: una herramienta para la evaluación de las incapacidades laborales. Buenos Aires: Asociart ART, 2007.

  14. Goldstein H. Mecánica clásica. 2ª ed. Reverte, Barcelona, 1987.

  15. Fukuda K, Craig EV, An KN, Cofield RH, Chao EY. Biomechanical study of the ligamentous system of the acromioclavicular joint. J Bone Joint Surg Am. 1986; 68(3): 434-9.

  16. Debski RE, Parsons IM 4th, Woo SL, Fu FH. Effect of capsular injury on acromioclavicular joint mechanics. J Bone Joint Surg. 2001; 83-A(9): 1344-51.

  17. Deshmukh AV, Wilson DR, Zilberfarb JL, Perlmutter GS. Stability of acromioclavicular joint reconstruction: biomechanical testing of various surgical techniques in a cadaveric model. Am J Sports Med. 2004; 32(6): 1492-8.

  18. Dewar FP, Barrington TW. The treatment of chronic acromio-clavicular dislocation. J Bone Joint Surg. 1965; 47: 32-5.

  19. Favard L, Berhouet J, Bacle G. Traumatisme de l’épaule et de la ceinture scapulaire. EMC (Elsevier Masson SAS, Paris), Appareil Locomoteur. 2009; 4-035-A-10.

  20. Urist MR. Complete dislocation of the acromioclavicular joint: The nature of traumatic lesion and effective methods of treatment with an analysis of 4 cases. J Bone Joint Surg. 1946; 28(4): 813-37.

  21. Tossy JD, Mead NC, Sigmond HM. Acromioclavicular separations: useful and practical classification for treatment. Clin Orthop Relat Res. 1963; 28: 111-9.

  22. Allman FL Jr.. Fractures and ligamentous injuries of the clavicle and its articulation. J Bone Joint Surg Am. 1967; 49 (4): 774-84.

  23. Rockwood CJ, Williams GR, Young D. Trastornos de la articulación acromioclavicular. Tratamiento quirúrgico. En: Rockwood CJ, Matsen FA. El hombro. 2a ed. Editorial McGraw-Hill Interamericana, 2000, 504-12.

  24. Galatz R, Williams G. Lesiones de la articulación acromioclavicular. En: Bucholz RW, Green’s, Rockwood, Heckman JD. Fracturas en el adulto. 5ta ed., Editorial Madrid: Marbán. 2003, 1209-42.

  25. Simovitch R, Sanders B, Ozbaydar M, Lavery K, Warner JJ. Acromioclavicular joint injuries: diagnosis and management. J Am Acad Orthop Surg. 2009; 17(4): 207-19.

  26. Johansen JA, Grutter PW, McFarland EG, Petersen SA. Acromioclavicular joint injuries: Indications for treatment and treatment options. J Shoulder Elbow Surg. 2011; 20(2 Suppl): S70-82.

  27. Fraschini G, Ciampi P, Scotti C, Ballis R, Peretti GM. Surgical treatment of chronic acromioclavicular dislocation: Comparison between two surgical procedures for anatomic reconstruction. Injury. 2010; 41: 1103-06.

  28. Walz L, Salzmann GM, Fabbro T, Eichhorn S, Imhoff AB. The anatomic reconstruction of acromioclavicular joint dislocations using 2 TightRope devices: a biomechanical study. Am J Sports Med. 2008; 36(12): 2398-406.

  29. Carofino BC, Mazzocca AD. The anatomic coracoclavicular ligament reconstruction: surgical technique and indications. J Shoulder Elbow Surg. 2010; 19: 37-46.

  30. Zalles-Auchen F, Chávez-Chuquimia D. Luxación acromioclavicular, tratamiento quirúrgico resección del extremo lateral de la clavícula en la luxación acromioclavicular grado III de Tossy. Rev Bol de Ortop y Traum. 2007; 17(1): 18-21.

  31. Mumford EB. Acromioclavicular dislocation: a new operative treatment. J Bone Joint Surg. 1941; 23(4): 799-802.

  32. Neviaser JS. Acromioclavicular dislocation treated by transference of the coracoacromial ligament: a long-term follow-up in a series of 112 cases. Clin Orthop Relat Res. 1968; 58: 57-68.

  33. Cadenat F. The treatment of dislocations and fractures of the outer end of the clavicle. Int Clin. 1917; 1: 145-69.

  34. Vargas L. Repair of complete acromioclavicular dislocation utilizing the short head of the biceps. J Bone Joint Surg. 1942; 24(4): 772-73.

  35. Weaver JK, Dunn HK. Treatment of acromioclavicular injuries, especially complete acromioclavicular separation. J Bone Joint Surg Am. 1972; 54(6): 1187-94.

  36. Beitzel K, Obopilwe E, Chowaniec DM, Niver GE, Nowak MD, Hanypsiak BT, et al. Biomechanical comparison of arthroscopic repairs for acromioclavicular joint instability: suture button systems without biological augmentation. Am J Sports Med. 2011; 39(10): 2218-25.

  37. Bosworth BM. Acromioclavicular separation: new method of repair. Surg Gynecol Obst. 1941; 73: 866-71.

  38. Bruchmann G. Luxación acromioclavicular. Técnica de las cuatro suturas. Rev Asoc Argent Ortop Traumatol. 2009; 74 (1): 40-7.

  39. Chernchujit B, Tischer T, Imhoff AB. Arthroscopic reconstruction of the acromioclavicular joint disruption: surgical technique and preliminary results. Arch Orthop Trauma Surg. 2006; 126(9): 575-81.

  40. Hegazy G, Safwat H, Seddik M, Al-Shal EA, Al-Sebai I, Negm M. Modified Weaver-Dunn procedure versus the use of semitendinosus autogenous tendon graft for acromioclavicular joint reconstruction. Open Orthop J. 2016; 10: 166-78.

  41. Gollwitzer M. Surgical management of complete acromioclavicular joint dislocation (Tossy III) with PDS cord cerclage. Aktuelle Traumatologie. 1993; 23(8): 366-70.

  42. Gonzalez R, Damacen H, Nyland J, Caborn D. Acromioclavicular joint reconstruction using peroneus brevis tendon allograft. Arthroscopy. 2007; 23(7): 788-e1-4.

  43. Jones HP, Lemos MJ, Schepsis AA. Salvage of failed acromioclavicular joint. Reconstruction using autogenous semitendinosus tendon from the knee surgical technique and case report. Am J Sports Med. 2001; 29(2): 234-7.

  44. Jeon IH, Dewnany G, Hartley R, Neumann L, Wallace WA. Chronic acromioclavicular separation: the medium term results of coracoclavicular ligament reconstruction using braided polyester prosthetic ligament. Injury. 2007; 38(11): 1247-53.

  45. Turman KA, Miller CD, Miller MD. Clavicular fractures following coracoclavicular ligament reconstruction with tendon graft. J Bone Joint Surg (Am). 2010; 92(6): 1526-32.

  46. Wellmann M, Kempka JP, Schanz S, Zantop T, Waizy H, Raschke MJ, et al. Coracoclavicular ligament reconstruction: biomechanical comparison of tendon graft repairs to a synthetic double bundle augmentation. Knee Surg Sports Traumatol Arthrosc. 2009; 17(5): 521-8.

  47. Wellmann M, Zantop T, Petersen W. Minimally invasive coracoclavicular ligament augmentation with a flip button/polydioxanone repair for treatment of total acromioclavicular joint dislocation. Arthroscopy. 2007; 23(10): 1132.e1-e5.

  48. Mazzocca AD, Arciero RA, Bicos J. Evaluation and treatment of acromioclavicular joint injuries. Am J Sports Med. 2007; 35(2): 316-29.

  49. Mazzocca AD, Conway JE, Johnson S, Rios CG, Dumonski ML, Santangelo SA, et al. The anatomic coracoclavicular ligament reconstruction. Oper Tech Sports Med. 2004; 12: 56-61.

  50. Mazzocca AD, Santangelo SA, Johnson ST, Rios CG, Dumonski ML, Arciero RA. A biomechanical evaluation of an anatomical coracoclavicular ligament reconstruction. Am J Sports Med. 2006; 34(2): 236-46.

  51. Morales SL, Murcia RM. Luxación acromioclavicular. Tratamiento quirúrgico mediante cerclaje con cinta de dacrón (Cervi-set). Rev Colomb Ortop Traumatol. 2004; 18(2): 23-30.

  52. Moseley HF. Athletic injuries of the shoulder region. Am J Surg. 1959; 98: 401-22.

  53. Grutter PW, Petersen SA. Anatomical acromioclavicular ligament reconstruction: a biomechanical comparison of reconstructive techniques of the acromioclavicular joint. Am J Sports Med. 2005; 33(11): 1723-8.

  54. Motta P, Maderni A, Bruno L, Mariotti U. Suture rupture in acromioclavicular joint dislocations treated with flip buttons. Arthroscopy. 2011; 27(2): 294-8.

  55. Salzmann GM, Walz L, Buchmann S, Glabgly P, Venjakob A, Imhoff AB. Arthroscopically assisted 2-bundle anatomical reduction of acute acromioclavicular joint separations. Am J Sports Med. 2010; 38(6): 1179-87.

  56. Erak S, Pelletier MH, Woods KR, Smith PN, Walsh WR. Acromioclavicular reconstructions with hamstring tendon grafts: a comparative biomechanical study. J Shoulder Elbow Surg. 2008; 17(5): 772-8.

  57. Lee SJ, Nicholas SJ, Akizuki KH, McHugh MP, Kremenic IJ, Ben-Avi S. Reconstruction of the coracoclavicular ligaments with tendon grafts. A comparative biomechanical study. Am J Sports Med. 2003; 31(5): 648-55.

  58. Taft TN, Wilson FC, Oglesby JW. Dislocation of the acromioclavicular joint. An end-result study. J Bone Joint Surg Am. 1987; 69(7): 1045-51.

  59. Tauber M, Gordon K, Koller H, Fox M, Resch H. Semitendinosus tendon graft versus a modified Weaver-Dunn procedure for acromioclavicular joint reconstruction in chronic cases: A prospective comparative study. Am J Sports Med. 2009; 37(1): 181-90.

  60. Zanca P. Shoulder pain: involvement of the acromioclavicular joint. (Analysis of 1,000 cases). Am J Roentgenol Radium Ther Nucl Med. 1971; 112(3): 493-506.

  61. Leggin BG, Michener LA, Shaffer MA, Brenneman SK, Iannotti JP, Williams GR Jr. The Penn shoulder score: reliability and validity. J Orthop Sports Phys Ther. 2006; 36(3): 138-51.