Acromioclavicular Joint Reconstruction Using Peroneus Brevis Tendon Allograft

We describe the use of a double-strand peroneus brevis allograft to reconstruct the coracoclavicular and acromioclavicular (AC) joint ligaments. Through sharp dissection, the distal clavicle, the AC joint, and the torn superior AC and coracoacromial ligaments are identified. The coracoid process and injured coracoclavicular ligaments are identified with blunt dissection. A 1-cm segment of the lateral clavicle is resected. Vertical and connecting horizontal tunnels are created (4.5 mm) in the lateral clavicle and in the medial acromion process. The 5.5- to 6.0-mm-diameter allograft is looped around the coracoid process, and both strands are passed through the vertical clavicle tunnel with a nitinol wire loop. One strand passes through the vertical clavicle tunnel, and the other strand passes through the horizontal tunnel, exiting through the lateral end. The allograft strand passed through the vertical clavicle tunnel is then passed inferiorly through the superior vertical acromion tunnel, and the strand passed completely through the horizontal clavicle tunnel is passed laterally through the medial horizontal acromion tunnel. After both strands exit inferiorly through the vertical acromion tunnel, they are tensioned and sutured with AC joint reduction. Soft tissue closure uses No. 0 and No. 2-0 absorbable sutures with No. 3-0 nylon sutures at the skin.