Tunnelless Acromioclavicular (AC) Joint Reconstruction and Repair is a technique developed by Dr. Chudik that restores the disrupted ligaments of the AC joint without creating large bone tunnels in the clavicle or coracoid. Conventional AC joint reconstruction techniques drill tunnels through these bones to anchor reconstructed ligaments, which carries a risk of late clavicle fracture and surgical failure. Dr. Chudik’s tunnelless approach reconstructs the same ligaments using anchor and suture fixation that preserves bone integrity, and is the procedure of choice for high-grade AC separations and chronic symptomatic AC injuries.
What Is Tunnelless AC Joint Reconstruction and Repair?
Acromioclavicular joint sprains, commonly called shoulder separations, are injuries to the ligaments at the joint where the clavicle (collarbone) attaches to the acromion (the roof of the shoulder formed by the scapula). The joint is stabilized by two ligament complexes:
- Acromioclavicular ligaments: directly connect the clavicle to the acromion
- Coracoclavicular ligaments (trapezoid and conoid): connect the clavicle to the coracoid process below, holding the clavicle down against the acromion
AC joint separations are graded I through VI from least to most severe. Grades IV through VI and some Grade III injuries require early surgery. Grade I through III injuries that fail proper non-operative management with persistent symptoms also require surgery.
The goal of surgery is to restore the normal relationship of the clavicle to the acromion and to repair or reconstruct the damaged ligaments. Dr. Chudik developed a technique that achieves these goals without creating large bone tunnels in the clavicle and coracoid as commonly required by conventional AC reconstruction.
Development Rationale
Conventional AC joint reconstruction techniques drill bone tunnels through both the clavicle and the coracoid process to anchor reconstructed coracoclavicular ligaments. The tunnels provide a path for tendon grafts and a substrate for fixation. These tunnels also create real risks:
- Late clavicle fracture through the drilled tunnel hole
- Late coracoid fracture
- Tunnel widening that loosens the reconstruction
- Surgical failure from tunnel-related bone weakening
- Hardware-related complications from screws or buttons placed within tunnels
Dr. Chudik developed the tunnelless technique to eliminate the bone-tunnel-related risks while still achieving anatomic ligament reconstruction:
- Properly positions the clavicle relative to the acromion
- Reconstructs the coracoclavicular ligaments with a tendon graft
- Repairs the acromioclavicular ligaments directly
- Reinforces the repair with internal fixation using a small anchor and high-strength sutures
- Preserves clavicle and coracoid bone integrity by avoiding tunnels
The combination of biologic ligament reconstruction (with tendon graft) and mechanical reinforcement (with anchor and suture) maintains proper alignment of the AC joint while the reconstructed ligaments heal.
Who Is a Candidate?
Candidates typically have:
- High-grade AC joint separations (Grade IV, V, or VI) requiring early surgery
- Some Grade III separations, particularly in active patients or overhead athletes
- Lower-grade (I-III) AC injuries that have failed proper non-operative management with persistent symptoms
- Chronic AC injuries (greater than six weeks old) with continued instability or pain
Contraindications include ongoing infection, which may need to be cleared with surgery and antibiotics before AC reconstruction can proceed.
How the Procedure Is Performed
The procedure is performed as outpatient surgery under general anesthesia with an interscalene block. Dr. Chudik approaches the AC joint through a small incision over the top of the shoulder.
The clavicle is positioned anatomically relative to the acromion. Dr. Chudik then reconstructs the coracoclavicular ligaments (the trapezoid and conoid) using a tendon graft, typically a hamstring tendon harvested from the same-side knee. The graft is routed and secured to recreate the anatomic ligament path between the coracoid and the clavicle, without drilling tunnels through either bone.
The acromioclavicular ligaments are repaired directly. The repair and reconstruction are reinforced with internal fixation: a small anchor is placed in the bone, and high-strength sutures (as strong as wire) are used to maintain proper AC joint alignment while the reconstructed ligaments heal.
For chronic injuries (greater than six weeks old) and cases with damaged AC joint cartilage, Dr. Chudik performs an additional step: removal of just under 1 cm of bone from the lateral end of the clavicle to prevent painful bone-on-bone rubbing at the joint surface.
Recovery and Rehabilitation
Recovery follows a protected protocol designed to allow the reconstructed ligaments to heal:
- Sling at all times for six weeks except for bathing, dressing, and exercises (this prohibits driving)
- Sleeping upright on a couch or recliner is often more comfortable
- Wound care: clean and dry for 10 to 14 days following the small open exposure; light showering after 14 days; no submersion under water for three weeks
- Driving typically resumes at six weeks and once out of the sling
- Return to school or sedentary work in one to two weeks while in the sling, with limited use of the operative extremity
- Physical therapy begins two to three days after surgery and continues for four to six months
- Strengthening must be delayed nine to 12 weeks after surgery to allow the ligaments to heal properly
Return to sport or strenuous labor requires at least four to six months and full restoration of shoulder motion and strength.
Risks and Outcomes
Specific surgical risks include:
- Infection
- Rare nerve injury (numbness, weakness, paralysis) of the shoulder, arm, forearm, or hand
- Reconstructed ligaments stretching out, with loss of reduction and recurrence of the deformity
- Breakage of internal fixation devices
- Erosion or fracture of the clavicle (lower risk than with tunneled techniques)
- Uncommon shoulder stiffness
- Persistent pain with overhead activities
- Need for revision surgery
By avoiding tunnels through the clavicle and coracoid, the tunnelless technique reduces the risk of late bone fracture and tunnel-related surgical failure that affects conventional AC reconstruction. Outcomes depend on the grade of the original injury, the chronicity at the time of repair, and adherence to the protected post-operative protocol.
Why Dr. Chudik for Tunnelless AC Joint Reconstruction and Repair
Dr. Chudik developed the tunnelless AC joint reconstruction technique. The approach combines anatomic ligament reconstruction with mechanical reinforcement while preserving bone integrity, addressing the late fracture and tunnel widening risks of conventional reconstruction. For active patients with high-grade AC separations who would otherwise face conventional tunneled reconstruction, the technique provides comparable structural restoration without the bone-tunnel complications. Dr. Chudik also holds patents in AC joint repair technology, reflecting his ongoing innovation in this area of shoulder surgery.