Arthroscopic Coracoclavicular Ligament Reconstruction Using a Synthetic Polycaprolactone-Based Polyurethane Urea Tendon Graft: A Report of 5 Cases

Surg Innov. 2018 Jun;25(3):224-229. doi: 10.1177/1553350618756150. Epub 2018 Feb 6.


Background: Several techniques have been introduced to treat acromioclavicular (AC) separation using the semitendinosus tendon as a graft for coracoclavicular (CC) ligament reconstruction. However, the tendon may have been used previously or the patient may not want it harvested. Hence, synthetic tendon transfers have become increasingly popular.

Methods: Five patients with chronic AC separations were treated. A synthetic polyurethane urea tendon graft (Artelon Tissue Reinforcement [ATR]) was chosen for its ability to partially transform into connective tissue. The patient follow-up period lasted 45 to 60 months.

Results: The mean preoperative Constant Score increased from 64.8 to 100 postoperatively. The mean preoperative Simple Shoulder Test increased from 7.2 to 12 postoperatively. The mean postoperative increase of the CC distance was 1.5 mm. The mean expansion of the clavicular drill hole from the original was 2.1 mm. According to the postoperative magnetic resonance imaging, the grafts had healed well and the cross-sections of the grafts were up to 10.5 mm between the coracoid and the clavicle.

Discussion: The synthetic ATR tendon strip was a practical method for reconstructing a torn CC ligament complex. The ATR graft appears promising for future CC ligament reconstructions.

Keywords: AC joint dislocation; AC joint separation; arthroscopic coracoclavicular ligament reconstruction; polycaprolactone-based polyurethane urea; synthetic tendon graft.

Publication types

  • Case Reports

MeSH terms

  • Acromioclavicular Joint / surgery*
  • Adult
  • Arthroscopy* / instrumentation
  • Arthroscopy* / methods
  • Biocompatible Materials / therapeutic use
  • Humans
  • Ligaments, Articular / surgery*
  • Male
  • Middle Aged
  • Orthopedic Procedures / instrumentation
  • Orthopedic Procedures / methods
  • Polyesters / therapeutic use*
  • Polyurethanes / therapeutic use*
  • Reconstructive Surgical Procedures* / instrumentation
  • Reconstructive Surgical Procedures* / methods
  • Young Adult


  • Biocompatible Materials
  • Polyesters
  • Polyurethanes
  • polycaprolactone
  • polyetherurethane urea