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Dr. Garcia demonstrates his cutting edge technique for revision AC reconstruction surgery.
Dr. Garcia specializes in complex knee, shoulder and elbow sports surgeries. He has prepared a number of surgical videos below to help patients better understand their procedures. He is frequently updating his surgical video database so check back soon for further updates.
This video showcases an advanced, custom surgical technique for a revision AC (Acromioclavicular) joint reconstruction in a 24-year-old patient. Because the patient had a prior coracoid bone non-union, the coracoid process could not safely be used for standard ligament anchoring. To solve this, Dr. Garcia implements a unique hybrid solution using a 2 mm thick dermal allograft patch combined with an ultra-low-profile internal brace construct.
The reconstruction is performed across several key clinical stages:
- Graft Preparation & Mapping: The dermal allograft is sized to 25 mm in width and 20 mm in length to bridge the gap between the acromion and clavicle. Dr. Garcia uses a bone saw to rough up the superior bone surfaces to enhance biological healing. The graft is pre-threaded along its borders with a heavy FiberTape baseball stitch—carefully entering and exiting from the top surface so it pulls completely flush against the bone when tensioned.
- Triple-Point Acromial Fixation: To avoid drilling large bone tunnels in the thin, fracture-prone acromion (which is only 10 to 12 mm thick), Dr. Garcia opts for a low-profile alternative. He drills angled pilot holes and secures the medial edge of the graft using a 3.75 mm SwiveLock anchor alongside two tiny 2.5 mm mini PushLock anchors.
- Clavicular Tunnel Routing: On the collarbone side, a single bone tunnel is drilled from anterior to posterior (front to back). The baseball-stitched strands of the dermal graft are pulled through this tunnel, wrapping the patch tightly around the clavicle and locking it down using alternating half-hitches.
- Overlying Internal Brace Integration: To prevent the clavicle from migrating upward, the remaining FiberTape strands from the acromial side are pulled across the top of the patch like a safety net. They are rigidly anchored into the superior clavicle cortex using a final SwiveLock anchor, compressing the entire construct down.
To finish the procedure, local fascial tissue is layered over the top of the construct for extra biological padding. A manual stability check confirms that this low-profile technique successfully eliminates all pathological shifting, restoring absolute multi-directional stability to the shoulder joint.
