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



1 Knee and Sport Medicine Research Center, Milad hospital, Tehran, Iran

2 University of Social Welfare and Rehabilitation Sciences Knee and Sport Medicine Research Center, Milad hospital, Tehran, Iran

3 Department of Sports Medicine, Shahid Beheshti University of Medical Sciences,Tehran, Iran


Acromioclavicular (AC) joint injuries are common and often seen in contact athletes, resulting from a fall on the shoulder
tip 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 modification
of the CC ligament reconstruction technique described by Wellmann. The method is based on minimally invasive CC
ligament 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 sometimes
require reoperation for suture removal. We present an augmentation technique that resolves this issue by changing the
suture knot location to the sub-clavicular position.


Main Subjects