Anatomic Acromioclavicular Joint Reconstruction With Semitendinosus Allograft: Surgical Technique Rachel M. Frank, M.D., Eamon D. Bernardoni, M.S., Eric.

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Anatomic Acromioclavicular Joint Reconstruction With Semitendinosus Allograft: Surgical Technique Rachel M. Frank, M.D., Eamon D. Bernardoni, M.S., Eric J. Cotter, B.S., Nikhil N. Verma, M.D. Arthroscopy Techniques Volume 6, Issue 5, Pages e1721-e1726 (October 2017) DOI: 10.1016/j.eats.2017.06.045 Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 1 Intraoperative fluoroscopic anterior-posterior image showing a type III right acromioclavicular joint separation. Arthroscopy Techniques 2017 6, e1721-e1726DOI: (10.1016/j.eats.2017.06.045) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 2 Intraoperative photograph of the semitendinosus allograft prepared with a simple whipstitch to allow for ease of graft passing. Arthroscopy Techniques 2017 6, e1721-e1726DOI: (10.1016/j.eats.2017.06.045) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 3 Intraoperative photograph of the right shoulder showing identification and dissection of the underlying deltotrapezial fascia and exposure of the clavicular edges. Arthroscopy Techniques 2017 6, e1721-e1726DOI: (10.1016/j.eats.2017.06.045) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 4 Intraoperative photograph of the right shoulder showing the exposure of the distal end of the clavicle after debridement of any scar tissue preventing the reduction of the joint. Arthroscopy Techniques 2017 6, e1721-e1726DOI: (10.1016/j.eats.2017.06.045) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 5 Intraoperative photograph of the right shoulder showing visualization of the coracoid after meticulous dissection. Arthroscopy Techniques 2017 6, e1721-e1726DOI: (10.1016/j.eats.2017.06.045) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 6 Intraoperative photograph of the right shoulder after passing FiberTape underneath the coracoid process that will be used to pass the semitendinosus graft. Arthroscopy Techniques 2017 6, e1721-e1726DOI: (10.1016/j.eats.2017.06.045) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 7 Intraoperative photograph of the right shoulder showing the semitendinosus graft passed under the coracoid and clavicle. Arthroscopy Techniques 2017 6, e1721-e1726DOI: (10.1016/j.eats.2017.06.045) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 8 Intraoperative photograph of the right shoulder showing the drill hole was placed in the clavicle, at the approximately 30-mm point, in a posterior-to-anterior and superior-to-inferior direction. Arthroscopy Techniques 2017 6, e1721-e1726DOI: (10.1016/j.eats.2017.06.045) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 9 Intraoperative photograph of the right shoulder showing the Arthrex Dog Bone implant placement on top of the clavicle and attached to FiberTapes that are passed through the hole previously drilled in the clavicle. Arthroscopy Techniques 2017 6, e1721-e1726DOI: (10.1016/j.eats.2017.06.045) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 10 Intraoperative FluoroScan of the right shoulder showing provisionally reduced clavicle with the Dog Bone implant in place before tying of the FiberTapes. Arthroscopy Techniques 2017 6, e1721-e1726DOI: (10.1016/j.eats.2017.06.045) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 11 Intraoperative photograph of the right shoulder showing the graft being tied in a knot before over-sewing it with multiple no. 2 high-strength nonabsorbable sutures. Arthroscopy Techniques 2017 6, e1721-e1726DOI: (10.1016/j.eats.2017.06.045) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 12 Intraoperative photograph of the right shoulder showing over-sewing the semitendinosus graft with multiple no. 2 high-strength nonabsorbable sutures. Arthroscopy Techniques 2017 6, e1721-e1726DOI: (10.1016/j.eats.2017.06.045) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 13 Intraoperative FluoroScan of the right shoulder showing successful reduction of the acromioclavicular joint after open reconstruction using a semitendinosus allograft. Arthroscopy Techniques 2017 6, e1721-e1726DOI: (10.1016/j.eats.2017.06.045) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 14 Intraoperative photograph of the right shoulder after the deltotrapezial interval was closed with multiple, interrupted no. 2 Ethibond sutures. Arthroscopy Techniques 2017 6, e1721-e1726DOI: (10.1016/j.eats.2017.06.045) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions