Table 2.

Comparison of the advantages and disadvantages of the three approaches in reconstructing the acromioclavicular joint: anatomical reduction; coracoclavicular ligament reconstruction; and anatomical reconstruction

Reconstruction approach	Advantages	Disadvantages
Anatomical reduction	Stability in vertical plane and to axial rotation equivalent to native complex [12]	Results in significantly less stability in horizontal plane [12] Requires two procedures for implantation and removal 81% maintained reduction at 1 year [3]
Coracoclavicular ligament reconstruction	Vertical stability equivalent to native complex [12] Single procedure Suggestion of good clinical outcomes for double TightRope technique, although data are limited [6, 21]	Results in significantly less stability in horizontal plane [12] Only three papers have investigated biomechanical outcomes, with limited ability for comparison [8, 18, 19] Various techniques described with little data comparing them
Anatomical reconstruction	Achieves overall biomechanical results most comparable to native complex [7] Only approach that restores horizontal stability [28] Promising early clinical outcomes [30] with some indication of improved results when compared with isolated CC reconstruction [31]	Techniques described thus far require further optimisation Current studies on clinical outcomes are inconclusive with the absence of data for long-term outcomes Increased technical difficulty