Revision Acromioclavicular-Coracoclavicular Reconstruction: Use of Precontoured Button and 2 Allografts Daniel B. Haber, M.D., Robert C. Spang, M.D.,

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Revision Acromioclavicular-Coracoclavicular Reconstruction: Use of Precontoured Button and 2 Allografts Daniel B. Haber, M.D., Robert C. Spang, M.D., George Sanchez, B.S., Anthony Sanchez, B.S., Márcio B. Ferrari, M.D., CAPT Matthew T. Provencher, M.D., M.C., U.S.N.R. Arthroscopy Techniques Volume 6, Issue 6, Pages e2283-e2288 (December 2017) DOI: 10.1016/j.eats.2017.08.039 Copyright © 2017 Terms and Conditions

Fig 1 After the exposure of the lateral third of the clavicle in the left shoulder, 2 tunnels (arrows) in an anterior-to-posterior direction are drilled to anatomically reconstruct the coracoclavicular ligaments. In a revision setting of an anatomic procedure, the previously formed tunnels must be identified. Then, by use of electrocautery, the fibrotic tissue and graft inside these tunnels must be removed. Arthroscopy Techniques 2017 6, e2283-e2288DOI: (10.1016/j.eats.2017.08.039) Copyright © 2017 Terms and Conditions

Fig 2 The coracoid tunnel must be drilled with a 2.4- or 3-mm drill, approximately 25 to 30 mm posterior to the anterior tip of the coracoid (arrow) in the left shoulder. We find that this distance from the tip of the coracoid decreases the risk of fracture and maintains the anatomic position of the coracoclavicular ligament insertion on the coracoid. Arthroscopy Techniques 2017 6, e2283-e2288DOI: (10.1016/j.eats.2017.08.039) Copyright © 2017 Terms and Conditions

Fig 3 Once the tunnels in the clavicle and coracoid are drilled, attention is turned to the acromion in the left shoulder. The first tunnel (arrow) is drilled approximately 7 to 10 mm lateral to the acromioclavicular joint on the anterior aspect of the acromion. This tunnel will accommodate the Dog Bone Button construct with FiberTape and suture anchor to secure the graft to the acromion. Arthroscopy Techniques 2017 6, e2283-e2288DOI: (10.1016/j.eats.2017.08.039) Copyright © 2017 Terms and Conditions

Fig 4 The Dog Bone Button (arrow) used to fix the FiberTape in the coracoid and posterior clavicle (i.e., conoid ligament) tunnels during anatomic reconstruction of the acromioclavicular and coracoclavicular ligaments is shown in the left shoulder. Arthroscopy Techniques 2017 6, e2283-e2288DOI: (10.1016/j.eats.2017.08.039) Copyright © 2017 Terms and Conditions

Fig 5 After preparation of the tunnels in the clavicle, acromion, and coracoid process, attention is turned to the passage of the 2 anterior tibialis grafts (arrows) in the left shoulder. For grafts, we suggest using a semitendinosus allograft or autograft or anterior tibialis allograft. Arthroscopy Techniques 2017 6, e2283-e2288DOI: (10.1016/j.eats.2017.08.039) Copyright © 2017 Terms and Conditions

Fig 6 The completed anatomic reconstruction of the coracoclavicular and acromioclavicular ligaments is shown in the left shoulder. The Dog Bone Button is seen on the superior aspect of the clavicle (white arrow) while graft passage (yellow arrow) medial to the Dog Bone Button, located on the clavicle, is visualized. Arthroscopy Techniques 2017 6, e2283-e2288DOI: (10.1016/j.eats.2017.08.039) Copyright © 2017 Terms and Conditions