title: Coracoid bypass procedure: surgical technique for coracoclavicular reconstruction with coracoid insufficiency.
abstract: BACKGROUND
  Failed acromioclavicular (AC) joint reconstruction secondary to a coracoid fracture or insufficiency of the coracoid is an uncommon but challenging clinical situation. We describe a surgical technique of revision coracoclavicular (CC) reconstruction, the coracoid bypass procedure, and report short-term results with this technique in 3 patients.
  
  
  METHODS
  In the coracoid bypass procedure, reconstruction of the CC ligaments is performed by passing a tendon graft through a surgically created bone tunnel in the scapular body (inferior to the base of the coracoid) and then fixing the graft around the clavicle or through bone tunnels in the clavicle. Three patients treated with this technique were retrospectively reviewed.
  
  
  RESULTS
  AC joint reconstruction performed for a traumatic AC joint separation failed in the 3 patients reported in this series. The previous procedures were an anatomic CC reconstruction in 2 patients and a modified Weaver-Dunn procedure in 1 patient. The coracoid fractures were detected postoperatively, and the mean interval from the index surgery to the coracoid bypass procedure was 8 months. The patients were a mean age of 44 years, and average follow-up was 21 months. At the last follow-up, all 3 patients were pain free, with full range of shoulder motion, preserved CC distance, and a stable AC joint.
  
  
  CONCLUSIONS
  The coracoid bypass procedure is a treatment option for CC joint reconstruction during revision AC joint surgery in the setting of a coracoid fracture or coracoid insufficiency.
authors.affiliation: Division of Shoulder & Elbow, Department of Orthopaedic Surgery, New York University Langone Medical Center and Hospital for Joint Diseases, New York, NY, USA.
authors.forename: Mandeep S
authors.initials: MS
authors.lastname: Virk
authors.affiliation: The Orthopedic Clinic Association, Phoenix, AZ, USA.
authors.forename: Evan
authors.initials: E
authors.lastname: Lederman
authors.affiliation: Tucson Orthopaedic Institute, Tucson, AZ, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Stevens
authors.affiliation: Division of Shoulder & Elbow and Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA. Electronic address: anthony.romeo@rushortho.com.
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Romeo
mesh_terms: D000173:Acromioclavicular Joint / Q000293:injuries / Q000601:surgery*; D000328:Adult; D002968:Clavicle / Q000601:surgery*; D000070597:Coracoid Process / Q000293:injuries / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000601:surgery; D006801:Humans; D008023:Ligaments, Articular / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D011184:Postoperative Period; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D013710:Tendons / Q000637:transplantation
keywords: acromioclavicular separation; coracoclavicular reconstruction; coracoid bypass procedure; coracoid fracture; coracoid insufficiency; revision acromioclavicular reconstruction