Dog bone

The AC joint was manually reduced and held while a 2.4-mm drill bit was passed vertically through the center of the clavicle, 30 mm from the distal end, and through the coracoid at its base. A Nitinol wire was passed through both tunnels in an antegrade fashion, with the loop exiting under the coracoid. A cortical button (Dog-Bone; Arthrex Inc) was preloaded with 2 strands of 2-mm suture tape (FiberTape; Arthrex Inc) and the suture tails shuttled through the bone tunnels in a retrograde fashion with the Nitinol wire. The cortical button was pulled under the coracoid process and positioned to obtain maximal bone contact. The tails of the 2 suture tapes were then threaded through a second cortical button, which was reduced onto the superior surface of the clavicle and positioned for optimal cortical contact. Each suture tape was then tied over the clavicular button with 6 half-hitch throws to fix the reduced AC joint.

This was an institutional review board (no. 422/19-S)-approved Level IV retrospective outcome study of prospectively collected data. Review of our institutional data bank was performed to identify patients meeting the following inclusion criteria: patients who underwent arthroscopically assisted AC-joint stabilization to address acute Rockwood type IV and V ACJI at the senior author’s (A.B.I.) institution between January 2009 and July 2017 with a minimum of 2 years postoperative follow-up. Only patients with an acute ACJI, defined as an interval of 3 weeks between trauma and surgery, treated with a CC stabilization technique with a single suspensory fixation system (DogBone; Arthrex, Naples, FL) with or without concomitant AC stabilization by AC cerclage were included. Interventions were randomized by assigning patients to 2 intervention groups (isolated CC stabilization and CC stabilization + AC cerclage) according to the weekday of their first consultation at the outpatient clinic of the senior authors institution and thus the surgeon in charge on that day respectively. Patients were excluded if AC-joint injury was chronic, treated with another surgical technique, or if additional shoulder surgery unrelated to the AC joint on the ipsilateral shoulder was performed, to avoid confounding of the outcome assessment.