Minimally Invasive Acromioclavicular Joint Stabilization Using an Adjustable Endobutton: A Report of Two Cases

Acromioclavicular joint dislocations (ACJD) are frequent shoulder injuries in young, active patients and athletes and can lead to pain, functional impairment, and cosmetic deformity if not adequately treated. Surgical management of high‑grade ACJD remains controversial, with numerous techniques described and no clear gold standard, particularly regarding the balance between stability, invasiveness, and the need for hardware removal. This study of two cases (Rockwood types III and IV) evaluated a novel minimally invasive technique using an adjustable Endobutton (Smith & Nephew, London, UK) with a single clavicular tunnel via a mini-open deltopectoral approach. At the six‑ and 12‑month follow‑up, both patients showed excellent anatomic reduction maintained over time, no loss of reduction or major complications, and near‑complete functional recovery as assessed by the Oxford Shoulder Score. The technique restores vertical stability, limits surgical morbidity, avoids secondary hardware removal, and adheres to anatomic principles by recreating coracoclavicular ligament function. While these results are encouraging, the small sample size and retrospective design limit the generalizability of the findings, and larger prospective comparative studies are needed to confirm the effectiveness and safety of this approach.