More Fixation, Better Outcome? Evaluating the Role of Additional Acromioclavicular Ligament Reconstruction in AC Joint Injuries: A Multicenter Analysis

Background/Objectives: Acromioclavicular (AC) joint injuries account for 9–12% of shoulder injuries, predominantly affecting young male athletes. While conservative treatment is established for Rockwood type I–II injuries and surgery is widely regarded as indicated for type V–VI, management of type III–IV injuries remains controversial. Biomechanical studies have shown superior results in combined reconstruction of the coracoclavicular and AC ligament complex, however clinical data is scarce. Therefore, the present study aimed to assess whether the addition of an acromioclavicular ligament reconstruction to an isolated coracoclavicular repair offers superior clinical and radiographic outcomes in the treatment of acute AC joint dislocations. Methods: A retrospective multicenter study was conducted on patients with Rockwood type III–VI AC joint injuries who underwent surgical treatment between 2019 and 2024. Patients were divided into two groups: isolated CC reconstruction (group I) and combined CC and AC ligament reconstruction (group II). Clinical outcome was assessed using patient-reported outcome measures (American Shoulder and Elbow Surgeons Score, Simple Shoulder Test, Single Assessment Numeric Evaluation, Visual Analogue Scale) and radiographic evaluations were performed regularly up to 6 months postoperatively. Results: Fifty-five patients (94.5% male, mean age 33.5 ± 10.9 years) were included in the present study. High patient satisfaction (group I: ASES 96.3 ± 7.9, SST 99.2 ± 3.3, SANE 95.3 ± 7.0; group II: ASES 95.8 ± 8.8, SST 96.8 ± 8.2, SANE 93.6 ± 12.8) was documented in both groups, but no significant differences were observed. The median coracoclavicular loosening ratio was 24.7% in the CC group and 32.6% in the CC and AC ligament reconstruction group (p = 0.830). Five complications occurred: two infections and three revision surgeries due to excessive secondary dislocations. Conclusions: Both surgical techniques demonstrated excellent clinical outcomes. In this study combined CC and AC ligament reconstruction did not yield superior clinical or radiological results compared to isolated coracoclavicular reconstruction. Our findings suggest that a routine AC ligament augmentation may not be necessary in all patients. Further randomized controlled trials are needed to validate these results.