The acromioclavicular joint (ACJ) is situated on top of the shoulder joining the clavicle (the collar bone) to the acromion (the tip of the shoulder blade).

There are two ligaments which hold the collar bone in place. The acromioclavicular (AC) ligament attaches the clavicle to the scapula and prevents motion in the horizontal plane. The Coracoclavicular (CC) ligaments go from the coracoid process on the scapula to the clavicle and provide vertical stability.

In a ACJ dislocation, one or both of the above ligaments are torn. 

Symptomatic chronic ACJ separation (after 4 weeks from the injury) can be reconstructed with the transfer of the Coracoacromial ligament to the distal end of the collar bone.

Typically 4 small skin incisions are used. The technique, performed entirely arthroscopically, consists of two steps.

• A few mms of the distal clavicle is excised and a socket is created in the distal end. The tip of the coracoacromial ligament is harvested from the acromion and the ligament is rerouted into the recess of the distal clavicle. The ligament is now attached to the clavicle with sutures through drillholes.
• The construct is augmented with the insertion of the Tightrope system between the clavicle and the coracoid.