Long head of the biceps as a local autograft for surgical treatment of high-grade acromioclavicular dislocations: a clinical anatomy and feasibility study

doi:10.1016/j.xrrt.2025.02.003

. 2025 Mar 8;5(3):389-394.

doi: 10.1016/j.xrrt.2025.02.003. eCollection 2025 Aug.

Long head of the biceps as a local autograft for surgical treatment of high-grade acromioclavicular dislocations: a clinical anatomy and feasibility study

Nuno Sevivas^{1

2

3

4}, Mariana Pinto^{1

2}, Ana Catarina Ângelo^{5

6}, Clara Azevedo^{5

6}, Manuel Ribeiro da Silva⁷, Rui Claro⁸, João Espregueira-Mendes^{1

2

9}, Hélder Pereira^{1

2

10

11}

Affiliations

¹ Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, Braga, Portugal.
² ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal.
³ Shoulder and Elbow Unit, Orthopaedics Department, ULSAM Médio Ave, Famalicão, Portugal.
⁴ Shoulder and Elbow Unit, Orthopaedics Department, Trofa Saúde Hospital Braga Sul, Braga, Portugal.
⁵ Shoulder and Elbow Unit, Department of Orthopaedic Surgery, Hospital dos SAMS de Lisboa, Lisbon, Portugal.
⁶ Shoulder and Elbow Unit, Orthopaedics Department, Joaquim Chaves Saúde, Carcavelos, Portugal.
⁷ Shoulder and Elbow Unit, Orthopaedic and Musculoskeletal Centre, Cuf Porto Hospital, Porto, Portugal.
⁸ Shoulder and Elbow Unit, Orthopaedics Department, Centro Hospitalar Santo António, Porto, Portugal.
⁹ Clínica Espregueira Mendes, Porto, Portugal.
¹⁰ Orthopaedics Department, Centro Hospitalar Póvoa de Varzim/Vila do Conde, Póvoa de Varzim, Portugal.
¹¹ Ripoll y De Prado Sports Clinic: Murcia-Madrid FIFA Medical Centre of Excellence, Madrid, Spain.

PMID: 40697291
PMCID: PMC12277751
DOI: 10.1016/j.xrrt.2025.02.003

Long head of the biceps as a local autograft for surgical treatment of high-grade acromioclavicular dislocations: a clinical anatomy and feasibility study

Nuno Sevivas et al. JSES Rev Rep Tech. 2025.

. 2025 Mar 8;5(3):389-394.

doi: 10.1016/j.xrrt.2025.02.003. eCollection 2025 Aug.

Authors

Affiliations

¹ Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, Braga, Portugal.
² ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal.
³ Shoulder and Elbow Unit, Orthopaedics Department, ULSAM Médio Ave, Famalicão, Portugal.
⁴ Shoulder and Elbow Unit, Orthopaedics Department, Trofa Saúde Hospital Braga Sul, Braga, Portugal.
⁵ Shoulder and Elbow Unit, Department of Orthopaedic Surgery, Hospital dos SAMS de Lisboa, Lisbon, Portugal.
⁶ Shoulder and Elbow Unit, Orthopaedics Department, Joaquim Chaves Saúde, Carcavelos, Portugal.
⁷ Shoulder and Elbow Unit, Orthopaedic and Musculoskeletal Centre, Cuf Porto Hospital, Porto, Portugal.
⁸ Shoulder and Elbow Unit, Orthopaedics Department, Centro Hospitalar Santo António, Porto, Portugal.
⁹ Clínica Espregueira Mendes, Porto, Portugal.
¹⁰ Orthopaedics Department, Centro Hospitalar Póvoa de Varzim/Vila do Conde, Póvoa de Varzim, Portugal.
¹¹ Ripoll y De Prado Sports Clinic: Murcia-Madrid FIFA Medical Centre of Excellence, Madrid, Spain.

PMID: 40697291
PMCID: PMC12277751
DOI: 10.1016/j.xrrt.2025.02.003

No abstract available

Keywords: Acromioclavicular dislocation; Acromioclavicular ligamentoplasty; Autograft; Chronic dislocation; Clinical anatomy study; Long head of the biceps; Surgical treatment.

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Figures

**Figure 1**
The patient is placed in the beach chair position with the affected limb at the side, optionally held by a mechanical arm holder.

**Figure 2**
LHB tenotomy and subpectoral tenodesis: (A) The LHB is tenotomized 1 cm proximal to the myotendinous junction (near zone 3 in this image). (B) The proximal stump of the LHB graft was rerouted proximally, maintaining its original insertion into the supraglenoid tubercle and superior labrum. (C) The distal stump of LHB is tenodesed with an all-suture anchor (Y-Knot RC 2.8 mm; Conmed, Largo, FL, USA). *LHB*, long head of the biceps.

**Figure 3**
LHB graft preparation: (A) The proximal stump of the LHB graft is rerouted proximally, maintaining its original insertion in the supraglenoid tubercle and superior labrum, and retrieved through the RI. The tendon diameter is verified using a calibrated sizer and trimmed to 4-4.5 cm. (B) The prepared tendon was then secured with two sutures in a *Krackow* fashion. *LHB*, long head of the bicep; RI, rotator interval.

**Figure 4**
Coracoclavicular (CC) tunnel: A 4.5 mm tunnel is drilled, connecting the superior border of the clavicle (3.5 cm medial to the AC joint) and exiting at the inferior border of the coracoid process using a drill guide. A 2.4 mm guide wire is then passed, ideally at the midpoint of the coracoid process, and fluoroscopic confirmation is obtained before creating the tunnel with a 4.5 mm drill. AC, acromioclavicular.

**Figure 5**
CC graft passage and fixation: A suture passer is used to shuttle both suture strands, holding the free end of the tendon and suspensory system through the tunnel. The AC joint was reduced, and the system was locked with the superior button apposed to the upper border of the clavicle, providing vertical stability. CC, coracoclavicular; AC, acromioclavicular.

**Figure 6**
Acromion tunnel and fixation: 1 cm laterally to the AC joint, a 3 mm tunnel parallel to the joint line is drilled in the acromion. The remaining LHB tendon is passed from posterior to anterior and fixed using a Knotless anchor. If possible, the AC joint posterosuperior ligament and capsule are reinforced with side-to-side stitches to the graft. *LHB*, long head of the bicep; AC, acromioclavicular.

See this image and copyright information in PMC

References

1. Aliberti G.M., Kraeutler M.J., Trojan J.D., Mulcahey M.K. Horizontal instability of the acromioclavicular joint: a systematic review. Am J Sports Med. 2020;48:504–510. doi: 10.1177/0363546519831013. - DOI - PubMed
1. Aliberti G.M., Mulcahey M.K., Brown S.M., O'Brien M.J. Restoring horizontal stability of the acromioclavicular joint: open acromioclavicular ligament reconstruction and repair with semitendinosus allograft. Arthrosc Tech. 2020;9:e1619–e1626. doi: 10.1016/j.eats.2020.07.002. - DOI - PMC - PubMed
1. Ângelo A.C., Dias C.M., de Campos Azevedo C. Combined vertical, horizontal, and rotational acromioclavicular joint stabilization:“closing the circle” technique. Arthrosc Tech. 2022;11:e1479–e1486. doi: 10.1016/j.eats.2022.03.039. - DOI - PMC - PubMed
1. Beitzel K., Mazzocca A.D., Bak K., Itoi E., Kibler W.B., Mirzayan R., et al. ISAKOS upper extremity committee consensus statement on the need for diversification of the Rockwood classification for acromioclavicular joint injuries. Arthroscopy. 2014;30:271–278. doi: 10.1016/j.arthro.2013.11.005. - DOI - PubMed
1. Boffano M., Mortera S., Wafa H., Piana R. The surgical treatment of acromioclavicular joint injuries. EFORT Open Rev. 2017;2:432–437. doi: 10.1302/2058-5241.2.160085. - DOI - PMC - PubMed

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[1] Aliberti G.M., Kraeutler M.J., Trojan J.D., Mulcahey M.K. Horizontal instability of the acromioclavicular joint: a systematic review. Am J Sports Med. 2020;48:504–510. doi: 10.1177/0363546519831013. - DOI - PubMed

[2] Aliberti G.M., Kraeutler M.J., Trojan J.D., Mulcahey M.K. Horizontal instability of the acromioclavicular joint: a systematic review. Am J Sports Med. 2020;48:504–510. doi: 10.1177/0363546519831013. - DOI - PubMed

[3] Aliberti G.M., Mulcahey M.K., Brown S.M., O'Brien M.J. Restoring horizontal stability of the acromioclavicular joint: open acromioclavicular ligament reconstruction and repair with semitendinosus allograft. Arthrosc Tech. 2020;9:e1619–e1626. doi: 10.1016/j.eats.2020.07.002. - DOI - PMC - PubMed

[4] Aliberti G.M., Mulcahey M.K., Brown S.M., O'Brien M.J. Restoring horizontal stability of the acromioclavicular joint: open acromioclavicular ligament reconstruction and repair with semitendinosus allograft. Arthrosc Tech. 2020;9:e1619–e1626. doi: 10.1016/j.eats.2020.07.002. - DOI - PMC - PubMed

[5] Ângelo A.C., Dias C.M., de Campos Azevedo C. Combined vertical, horizontal, and rotational acromioclavicular joint stabilization:“closing the circle” technique. Arthrosc Tech. 2022;11:e1479–e1486. doi: 10.1016/j.eats.2022.03.039. - DOI - PMC - PubMed

[6] Ângelo A.C., Dias C.M., de Campos Azevedo C. Combined vertical, horizontal, and rotational acromioclavicular joint stabilization:“closing the circle” technique. Arthrosc Tech. 2022;11:e1479–e1486. doi: 10.1016/j.eats.2022.03.039. - DOI - PMC - PubMed

[7] Beitzel K., Mazzocca A.D., Bak K., Itoi E., Kibler W.B., Mirzayan R., et al. ISAKOS upper extremity committee consensus statement on the need for diversification of the Rockwood classification for acromioclavicular joint injuries. Arthroscopy. 2014;30:271–278. doi: 10.1016/j.arthro.2013.11.005. - DOI - PubMed

[8] Beitzel K., Mazzocca A.D., Bak K., Itoi E., Kibler W.B., Mirzayan R., et al. ISAKOS upper extremity committee consensus statement on the need for diversification of the Rockwood classification for acromioclavicular joint injuries. Arthroscopy. 2014;30:271–278. doi: 10.1016/j.arthro.2013.11.005. - DOI - PubMed

[9] Boffano M., Mortera S., Wafa H., Piana R. The surgical treatment of acromioclavicular joint injuries. EFORT Open Rev. 2017;2:432–437. doi: 10.1302/2058-5241.2.160085. - DOI - PMC - PubMed

[10] Boffano M., Mortera S., Wafa H., Piana R. The surgical treatment of acromioclavicular joint injuries. EFORT Open Rev. 2017;2:432–437. doi: 10.1302/2058-5241.2.160085. - DOI - PMC - PubMed

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Long head of the biceps as a local autograft for surgical treatment of high-grade acromioclavicular dislocations: a clinical anatomy and feasibility study

Affiliations

Long head of the biceps as a local autograft for surgical treatment of high-grade acromioclavicular dislocations: a clinical anatomy and feasibility study

Authors

Affiliations

Figures

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References

LinkOut - more resources

Full Text Sources