Modified Internal Fixation Technique for Acromio-Clavicular (AC) joint dislocation: the “Hidden KnotTechnique”

Acromioclavicular (ac) joint injuries are common and often seen in contact athletes, resulting from a fall on the shouldertip with adducted arm. this joint is stabilized by both static and dynamic structures including the coracoclavicular (cc)ligament. most reconstruction techniques focus on cc ligament augmentation as the primary stabilizer of the ac joint.the best surgical technique for some ac joint dislocations is still controversial. in this study, we explained a modificationof the cc ligament reconstruction technique described by wellmann. the method is based on minimally invasive ccligament augmentation with a flip button/polydioxanone (pds) repair, typically used for extracortical acl graft fixation.patients commonly complain that heavy sutures under the skin in subcutaneous tissue irritate the skin and sometimesrequire reoperation for suture removal. we present an augmentation technique that resolves this issue by changing thesuture knot location to the sub-clavicular position.