We present the case of a 57-year-old male patient who, after a fall on a scooter, suffered an acromioclavicular dislocation of his previously healthy right shoulder.

After assessing the patient’s baseline condition, which is very active from a sporting point of view, as well as the degree of type III injury, surgical intervention is indicated to restore the original anatomy and thus recover full function. This type of injury still generates controversy in the scientific community regarding its management, but our philosophy is to carry out a personalised treatment taking into account the needs of the patient and the biological substrate, so that at 57 years of age, it is perfectly justified to intervene with the aim of obtaining the best results in a short period of time.

He underwent surgery to repair the torn acromioclavicular ligaments, which are the ligaments that hold the shoulder girdle in place. It is a common misconception that, with this type of injury typical of cyclists in a sideways fall, what happens is that the clavicle is dislocated and moves upwards, when in fact what happens is that the bone remains in place and what moves downwards is the entire shoulder.

There are a multitude of techniques with which to approach this problem, the most important being to provide a sufficiently solid repair to allow the ligaments sufficient time to heal. In this case we performed an approach in the deltopectoral groove to adequately expose the coracoid, which is the part of the scapula where these ligaments are inserted. A single tunnel technique was performed from the clavicle to the coracoid, relying on the tunnel guide for cruciate ligamentoplasty, as well as arthroscopic control of the exit point in the caudal part of the coracoid. This is very important because the tunnel has to be perfect as there is not much space, otherwise it would not be possible to repair the ligaments.

The joint is reduced and held with K-wires to keep the construct stable for tunnelling. Then the system is passed on, which incorporates small buttons that act as brakes for the two bones, connected by high-strength straps that allow the height and position of the reduction to be controlled. In addition, a reinforcing band is added on the outside to provide greater stability to the assembly and protect the repair. The wound is closed in planes and the patient is hospitalised overnight for postoperative monitoring.

This image shows the cruciate ligament guide placed to make the single tunnel that goes from the cranial part of the clavicle to the most caudal part of the coracoid with the specific drills. Two Kirschner wires have been previously placed to keep everything stable before making the tunnel, controlling the reduction with scopia.

In this image, at the end of the procedure, the button can be seen above the clavicle with the ribbons passed and knotted with the appropriate tension before cutting the ropes.

Intraoperative radiograph at the end of the procedure showing correct reduction of the acromioclavicular joint with the two buttons resting well on the bone in the proper position along with the two additional K-wires.

The immediate postoperative period was uneventful. The K-wires were removed in consultation after 6 weeks and unrestricted mobilisation was practically complete. She only needed home exercises without the need for physiotherapy at a centre. Within 48 hours she was back at work in her office.

After 3 months he started golf, as well as playing the piano. Since then he has regained all his sporting activities and has full range of motion without pain or limitations of any kind.