Table 2.

Pearls and pitfalls when considering anatomic acromioclavicular reconstruction with tendon grafts

Pearls

Pitfalls

• Assure adequate clearance of soft tissue, including residual capsule and scar tissue, to allow for complete joint reduction • The use of anatomic clavicular tunnels restores CC ligament footprints and more closely restores native biomechanics • Consider one tunnel if AP clavicular width is <18 mm to reduce clavicular fracture risk • Avoid coracoid tunnels, particularly >6 mm to reduce coracoid fracture risk • Maximize the use of provisional reduction techniques to facilitate graft fixation • Augmentation or reconstruction of the AC ligaments and capsule improves post-operative joint mechanics

• Incomplete distal clavicle resection  - Incomplete resection posteriorly and superiorly is most common  - Resect minimum of 10 mm to assure clearance with crossed adduction maneuvers  - Must view from multiple portals to ensure adequate clearance, including the direct anterior position  - Consider open resection in cases of significant deformity or large chest wall • Excessive resection and instability  - Excessive CC ligament resection results in superior clavicular instability  - Excessive AC ligament resection results in anterior-posterior instability