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      References
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      ic-info i To cite, select the checkbox next to the associated reference and click “Cite Reference(s)“.
       
      • 1-Ângelo A.C., Maia Dias C., de Campos Azevedo C., Combined vertical, horizontal, and rotational acromioclavicular joint stabilization: “Closing the circle” technique Arthrosc Teche1479-e14862022
        1-Ângelo A.C., Maia Dias C., de Campos Azevedo C., Combined vertical, horizontal, and rotational acromioclavicular joint stabilization: “Closing the circle” technique Arthrosc Tech 2022 e1479-e1486
        Citation:1-

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      • 2-Saier T., Venjakob A.J., Minzlaff P., Value of additional acromioclavicular cerclage for horizontal stability in complete acromioclavicular separation: A biomechanical study Knee Surg Sports Traumatol Arthrosc1498-15052015
        2-Saier T., Venjakob A.J., Minzlaff P., Value of additional acromioclavicular cerclage for horizontal stability in complete acromioclavicular separation: A biomechanical study Knee Surg Sports Traumatol Arthrosc 2015 1498-1505
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      • 3-Peeters I., Braeckevelt T., Herregodts S., Palmans T., De Wilde L., Van Tongel A., Kinematic alterations in the shoulder complex in Rockwood V acromioclavicular injuries during humerothoracic and scapulothoracic movements: A whole-cadaver study Am J Sports Med3988-40002021
        3-Peeters I., Braeckevelt T., Herregodts S., Palmans T., De Wilde L., Van Tongel A., Kinematic alterations in the shoulder complex in Rockwood V acromioclavicular injuries during humerothoracic and scapulothoracic movements: A whole-cadaver study Am J Sports Med 2021 3988-4000
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      • 4-Dyrna F., Imhoff F.B., Haller B., Primary stability of an acromioclavicular joint repair is affected by the type of additional reconstruction of the acromioclavicular capsule Am J Sports Med3471-34792018
        4-Dyrna F., Imhoff F.B., Haller B., Primary stability of an acromioclavicular joint repair is affected by the type of additional reconstruction of the acromioclavicular capsule Am J Sports Med 2018 3471-3479
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      • 5-Celik H., Chauhan A., Flores-Hernandez C., Vertical and rotational stiffness of coracoclavicular ligament reconstruction: A biomechanical study of 3 different techniques Arthroscopy1264-12702020
        5-Celik H., Chauhan A., Flores-Hernandez C., Vertical and rotational stiffness of coracoclavicular ligament reconstruction: A biomechanical study of 3 different techniques Arthroscopy 2020 1264-1270
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      • 6-Martetschläger F., Horan M.P., Warth R.J., Millett P.J., Complications after anatomic fixation and reconstruction of the coracoclavicular ligaments Am J Sports Med2896-29032013
        6-Martetschläger F., Horan M.P., Warth R.J., Millett P.J., Complications after anatomic fixation and reconstruction of the coracoclavicular ligaments Am J Sports Med 2013 2896-2903
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      • 7-White C.C, Cincere B.A., Acromioclavicular joint reconstruction with acromioclavicular ligament augmentation using a knotless, all-suture anchor construct Arthrosc Tech2024
        7-White C.C, Cincere B.A., Acromioclavicular joint reconstruction with acromioclavicular ligament augmentation using a knotless, all-suture anchor construct Arthrosc Tech 2024
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        • Fig 2
          The patient is placed in the beach-chair setup with the upper limb at the side in neutral flexion for operative exposure of the clavicle, coracoid, and acromion and in an anterior direction.

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        • Fig 3
          Surgical site preparation and skin incision marking using a dermographic pen in the right shoulder: superolateral view.

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        • Fig 4
          Intraoperative exposure of soft-tissue disruptions in stage IIIB acromioclavicular joint dislocation. There is partial detachment of the deltoid muscle, as well as complete dislocation of the acromioclavicular joint, on a superior view of the right shoulder, with partial detachment of the trapezius at its clavicular insertion.

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        • Fig 5
          Surgical approach to the coracoid process in a right shoulder. The separated lateral clavicle that has been dislocated occurs naturally in association with an anterior deltoid detachment. Immediate visualization of the coracoid base is performed.

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        • Fig 6
          Positioning of all-suture self-punching anchors at the coracoid base. Insertion is carried out under jaws’ direct visualization via medial-to-lateral placement on the coracoid, without penetration of the inferior cortex. Pre-drilling with a 2-mm drill bit is used in hard bone to prevent slippage.

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        • Fig 7
          Drilling of bone tunnels in the clavicle and acromion using a 2.5-mm drill bit. In all, 4 tunnels are prepared: 2 medial vertical (VM) and lateral vertical (VL) tunnels in the clavicle, 1 horizontal tunnel at the end of the clavicle (HC), and 1 oblique tunnel in the acromion (OA), which provides for passage of suture limbs for coracoclavicular and acromioclavicular ligament reconstruction.

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        • Fig 8
          Suture tape passage for coracoclavicular and acromioclavicular ligament reconstruction in a stepwise manner. Medially, 2 suture tapes traverse from inferior to superior through the vertical tunnels in the clavicle, which are crossed to reconstruct the coracoclavicular ligament.

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        • Fig 9
          Lateral view of the right shoulder, showing the correctly oriented clavicle.

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        • Fig 10
          Verification of coracoclavicular-acromioclavicular reducibility after tunnel drilling. An intraoperative superior view of a completed reconstruction is shown with anatomic alignment of the acromioclavicular joint and secure suture ribbons to keep them reducible.

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        • Fig 11
          Final construct of coracoclavicular-acromioclavicular complex using the all-suture technique. The deltotrapezial (DT) fascia is approximated firmly with nonabsorbable sutures. Plication of the acromioclavicular joint’s dorsal capsule (green lines) then restores horizontal stability and improves joint integrity.

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        • Fig 12
          Closure of deltotrapezial fascia and acromioclavicular joint capsule. A postoperative follow-up radiograph shows maintained acromioclavicular joint alignment with a reduced coracoclavicular distance, thus confirming that the repair is structurally intact.

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        • Fig 1
          In the left shoulder, there is increased distance between the 2 coracoids. On the right, the distance is 2.35 cm, whereas on the left, the distance is 1.15 cm, indicating that the separation is almost twice as great. The patient is upright.

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        Tables
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        • Table 1
          Pearls and Pitfalls of AC-DC 3D All-Suture Technique

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        • Table 2
          Advantages and Disadvantages of AC-DC 3D All-Suture Technique for ACJ Stabilization

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