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Reconstruction of the Acromioclavicular Joint With 360-degree Control

Hoy, Gregory MBBS, FRACS, FAOrthA, FACSP*,†,‡; Yalizis, Matthew B. Pharm, MBBS, FRACS (Orth)§,∥; Smith, Mitchell MBBS, BMedSci, FRACS*; Anderson, Hamish BA, BSc (Occ Thy); Warby, Sarah A. PhD, BPhysio (Hon)*,‡,#

Techniques in Shoulder & Elbow Surgery: September 2019 - Volume 20 - Issue 3 - p 96–103
doi: 10.1097/BTE.0000000000000167

Background: The TightRope/Endobutton techniques achieve good vertical reduction of the acromioclavicular joint, however anteroposterior and mediolateral stability may persist.

Aims: The primary aim is to present our modification of the twin-tailed Dog Bone technique, using FibreTape and divergent clavicular limbs. The secondary aim is to report postsurgical outcomes.

Hypothesis: By separating these divergent limbs widely the overall stability of the construct will be improved, limiting undesired mobility in all planes and assisting favorable postoperative outcomes.

Materials and Methods: Included participants sustained acute Rockwood III to V acromioclavicular joint dislocations. Outcomes included the Oxford Shoulder Score (OSS), Nottingham Clavicle Score (NCS), the Specific Acromioclavicular Score (SACs), and return to sport time frames. Data were analyzed with descriptive statistics.

Results: Forty-nine patients underwent this technique. Twenty-six patients returned their postoperative outcomes. Favorable results were shown by all outcomes after surgery (mean score: OSS, 46.3; NCS, 81.8; SACs, 15.9). The mean return to sport time was 17.5 weeks (contact sport) and 32.7 weeks (noncontact sport). There were no infections, no fractures, and 3 complications.

Discussion/Conclusion: This modification of the twin-tailed Dog Bone technique using FibreTape resulted in a high patient self-rating of their shoulder function and a low rate of complications.

*Melbourne Orthopaedic Group, Windsor

Department of Surgery, Monash University, Clayton

The Austin Hospital, Heidelberg

Melbourne Shoulder Group, Prahran, Melbourne

#La Trobe University, Bundoora, Vic.

§Sydney Shoulder and Elbow Surgeons

St Vincent’s Clinic, Darlinghurst, Sydney, NSW, Sydney, Australia

G.H. was the developer of the technique described in this manuscript, and receives institutional support from Arthrex and Johnson and Johnson.

The authors declare no conflict of interest.

Reprints: Sarah A. Warby, PhD, BPhysio (Hon), Melbourne Shoulder Group, 305 High Street, Prahran, Melbourne 3181, Australia (e-mail:

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.