Weaver-dunn acromioclavicular reconstruction

Abstract

The patient and surgical site were identified in the preoperative holding area. After transport to the operating suite, antibiotic prophylaxis was administered intravenously. After adequate anesthesia was obtained, the patient was placed in a semi-sitting beach chair position. The head and neck were safely stabilized and all bony prominences were well padded and protected. The forequarter was prepped and draped in standard sterile fashion. A strap incision in Langer's skin line was made from the posterior aspect of the distal clavicle toward the coracoid, approximately 1 cm medial to the AC joint. Full-thickness subcutaneous flaps were developed. The distal 2 cm of the clavicle was exposed subperiosteally. The deltoid attachment to the anterior aspect of the clavicle in this region was detached, and this flap of deltoid was retracted laterally. The abundant scar tissue was removed. The coracoid was identified as was the coracoacromial ligament, both the anterior and posterior bands. With the arm abducted and deltoid retracted, the coracoacromial ligament attachment under the acromion was noted. This was divided sharply. Number 1 Ethibond sutures were placed on the acromial aspect of the detached CA ligament. Mersilene tape was then passed under the coracoid and looped around the distal clavicle to act as a stabilization device prior to transfer of this coracoacromial ligament.