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AC Joint Stabilisation

intermediate Level

Primary Indication

Acute high-grade AC joint separation (Rockwood Type III in heavy laborers/overhead athletes, Type IV-VI), chronic symptomatic AC separation, or failed non-operative treatment of Type III

Danger Structures

  • Supraclavicular nerves
  • Brachial plexus (inferior to coracoid)
  • Musculocutaneous nerve (medial to coracoid)
  • Subclavian vessels
  • Coracoid (fracture risk)
  • Clavicle (fracture through tunnels)

Visual Atlas

No anatomy Images Yet

We're currently sourcing high-quality anatomy diagrams for this procedure.

Step-by-Step Technique

1

Position beach chair with arm draped free, mark AC joint, coracoid, and clavicle

Surgeon's Tip
EXAM KEY: Strap incision (following Langer's lines) gives excellent cosmesis vs vertical scar
Danger Zone
  • Poor cosmesis with vertical incision
  • Inadequate exposure
2

Make transverse incision centered over AC joint, extending medially over distal clavicle

Surgeon's Tip
EXAM KEY: Incision typically 4-6cm, can extend as needed for exposure
Danger Zone
  • Supraclavicular nerves
  • AC joint malposition from wrong incision placement
3

Elevate skin flaps, identify AC joint and distal clavicle

Surgeon's Tip
EXAM KEY: Deltoid and trapezius attachments to clavicle - decide on repair vs elevation strategy
Danger Zone
  • Deltotrapezial fascia damage
  • Inadequate exposure of AC joint
4

Assess AC joint - excise distal clavicle if significant arthrosis (8-10mm maximum resection)

Surgeon's Tip
EXAM KEY: Excessive distal clavicle excision causes horizontal instability. 8-10mm max if needed.
Danger Zone
  • Over-resection causing instability
  • Leaving arthritic joint if symptomatic
5

If using hook plate: select appropriate plate size, hook depth based on anatomy

Surgeon's Tip
EXAM KEY: Hook plate provides immediate stability. Hook goes under acromion, not into subacromial space.
Danger Zone
  • Hook malposition
  • Acromial erosion (requires removal at 3-4 months)
6

Reduce AC joint anatomically - use reduction clamp or manual pressure

Surgeon's Tip
EXAM KEY: Restore normal AC joint alignment - anteroposterior translation must also be corrected
Danger Zone
  • Accepting malreduction
  • Missing posterior displacement
7

For hook plate: insert hook under acromion, apply plate to superior clavicle, fix with screws

Surgeon's Tip
EXAM KEY: Hook plate is load-sharing device - allows early ROM. MUST be removed at 3-4 months.
Danger Zone
  • Acromial osteolysis if not removed
  • Hook migration
8

For CC reconstruction: expose base of coracoid through deltopectoral interval or arthroscopically

Surgeon's Tip
EXAM KEY: Drill coracoid base carefully - small bone at risk of fracture
Danger Zone
  • Coracoid fracture
  • Musculocutaneous nerve injury medial to coracoid
9

Drill tunnels in clavicle at conoid and trapezoid footprint positions

Surgeon's Tip
EXAM KEY: Conoid is posteromedial (25mm from AC joint), trapezoid is anterolateral (15mm from AC joint)
Danger Zone
  • Clavicle fracture through drill holes
  • Incorrect tunnel position
10

Pass suture button devices or tendon graft through coracoid and clavicle tunnels

Surgeon's Tip
EXAM KEY: Suture button (TightRope, DogBone) provides CC fixation. Can add free tendon graft for augmentation.
Danger Zone
  • Button toggle failure
  • Suture breakage
11

Reduce AC joint and tension CC reconstruction while maintaining reduction

Surgeon's Tip
EXAM KEY: Reduction and tensioning is critical step - confirm fluoroscopically
Danger Zone
  • Over-reduction (painful)
  • Under-reduction (persistent instability)
12

Consider augmentation of AC capsule and ligaments with suture or graft

Surgeon's Tip
EXAM KEY: AC capsule repair adds horizontal stability - important adjunct to CC reconstruction
Danger Zone
  • Neglecting AC joint horizontal stability
  • Over-tightening
13

If using anatomic CC reconstruction: attach graft at conoid and trapezoid positions for dual bundle

Surgeon's Tip
EXAM KEY: Anatomic dual-bundle reconstruction mimics native CC ligament anatomy
Danger Zone
  • Graft failure
  • Tunnel convergence
14

Final fluoroscopy: confirm symmetric reduction comparing to opposite side

Surgeon's Tip
EXAM KEY: Comparison views to contralateral side - should have symmetric CC distance
Danger Zone
  • Accepting asymmetric reduction
  • Missing hardware complications
15

Close deltotrapezial fascia, close skin, apply sling

Surgeon's Tip
EXAM KEY: Sling for 6 weeks, no lifting >5kg for 3 months. ROM exercises start at 2 weeks.
Danger Zone
  • Early aggressive rehab causing failure
  • Wound complications