31/05/2026
Mastering the Mazzocca Anatomic CC Reconstruction:
To the young surgeons looking to elevate their shoulder game: chronic, high-grade AC separations can be a tricky beast. When conservative management fails or you're dealing with a complex revision, the Mazzocca technique is a powerful, reliable tool in your armamentarium for restoring true anatomic stability.
Let’s break down the why, the how, and the trade-offs of this procedure. You can follow along with the anatomic breakdown in the attached image.
INDICATIONS
Chronic Separations: Symptomatic, chronic AC joint dislocations (typically Types IV, V, and heavy-laborer Type IIIs).
Revisions: Failed prior non-anatomic AC joint repairs (e.g., a failed Weaver-Dunn).
High-Demand Patients: Young athletes or laborers needing robust, biologic biomechanical restoration.
KEY STEPS
Exposure: Adequately expose the distal clavicle and the base of the coracoid. Always respect the medial neurovascular structures.
Tunnel Placement: Drill two clavicular tunnels anatomically corresponding to the footprints of the conoid and trapezoid ligaments. As highlighted in image.png, these are typically placed 15 mm and 35 mm from the distal clavicle.
Graft Passage: Shuttle your free tendon graft (often a semitendinosus allograft) carefully under the base of the coracoid.
Configuration: Pass the limbs superiorly through the clavicular tunnels. As noted in the textbook text in image, crossing the limbs can create a figure-of-eight, or passing them directly creates a circular construct.
Reduction & Fixation: Reduce the clavicle to the acromion (always verify your reduction with a C-arm Zanca view). Tension the graft and secure the limbs within the clavicle tunnels using soft-tissue interference screws.
PROS
Biomechanical Superiority: It reconstructs both the conoid and trapezoid ligaments, restoring both vertical and horizontal stability.
Biologic Scaffolding: Unlike rigid hardware (like hook plates) that requires removal, a tendon graft provides a long-term biologic healing solution.
Durability: Demonstrates high load-to-failure strength, closely mimicking the native complex.
CONS
Steep Learning Curve: It is a technically demanding procedure. Managing the graft passage, tensioning, and simultaneous screw placement requires absolute finesse and an extra set of skilled hands.
Fracture Risk: Drilling two large tunnels in the distal clavicle creates stress risers, increasing the risk of an iatrogenic clavicle fracture if not spaced correctly.
Graft/Hardware Issues: Interference screws can occasionally back out, or the graft can stretch out over time if the patient is non-compliant with the strict 6-week postoperative brace protocol mentioned in the text of image.png.
Mastering this technique takes reps, but the anatomical stability it provides your patients is well worth the effort in the OR.
What specific step do you find most daunting when performing or studying anatomic CC reconstructions?
