Fibular Strut Allograft Reconstruction for Distal Clavicle Bone Loss in Revision Acromioclavicular Joint Instability
Collin N. Nguyen, Brenden B. Ronna, Jack H. Drake, David Goodspeed, Eric J. CotterBackground:
Distal clavicle bone loss after failed acromioclavicular (AC) joint stabilization presents a challenging reconstructive problem. Loss of clavicular length and bone stock may compromise both coracoclavicular (CC) and AC stability, limiting the utility of standard revision techniques. Structural graft reconstruction can restore clavicular length, provide cortical support, and create a stable platform for revision ligament reconstruction.
Indications:
This technique is indicated for patients with symptomatic recurrent AC joint instability and substantial distal clavicular bone loss after a prior failed AC/CC reconstruction or distal clavicular resection. It is particularly useful when residual clavicular deficiency prevents reliable fixation or restoration of stability with soft-tissue reconstruction alone.
Technique Description:
The patient is positioned supine, and the previous superior clavicular incision is used. After careful dissection, retained suture material and hardware are removed, and the distal clavicle defect is identified. The clavicle is excised to healthy bone, and a fibular strut allograft is prepared to match the segmental defect and restore clavicular length. The graft is secured to the native clavicle using a matching step cut, a lag screw, and an anterior clavicle plate. CA reconstruction with hamstring autograft is then performed to restore vertical stability, followed by clavicle hook plate and AC reconstruction to address horizontal instability. Final fixation is assessed with fluoroscopy to confirm restoration of alignment and stability.
Results:
This technique is intended to restore clavicular length, improve structural support, and provide a stable foundation for combined AC and CC ligament reconstruction. Previous literature suggests that revision reconstruction can improve pain and stability after failed AC joint procedures. However, persistent dysfunction, recurrent instability, graft-related complications, and reoperation remain important considerations, particularly in the setting of previous distal clavicle excision. In the setting of severe distal clavicle deficiency, structural grafting may expand reconstructive options when standard revision techniques are inadequate.
Discussion/Conclusion:
Distal clavicle reconstruction with fibular strut allograft combined with revision AC/CC reconstruction is a useful salvage option for recurrent instability with clavicular bone loss. Careful graft preparation, restoration of clavicular length, and attention to both vertical and horizontal stability are critical technical principles. In appropriately selected patients, this technique provides a reproducible method for addressing a challenging form of revision AC joint instability.
Patient Consent Disclosure Statement:
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.