Abstract
RATIONALE: Excessive distal clavicle resection can result in severe bone loss and disruption of the coracoclavicular (CC) ligament attachment, leading to significant vertical instability of the acromioclavicular joint. The optimal surgical approach in such cases remains controversial due to the technical challenges associated with achieving anatomical fixation. PATIENT CONCERNS: A 40-year-old male construction worker presented with persistent shoulder pain, limited range of motion, and visible clavicular prominence 1 year and 7months after undergoing distal clavicle resection at an outside hospital following a traumatic fracture. DIAGNOSES: Radiography and physical examination revealed substantial bone loss in the distal clavicle and vertical instability, with a CC distance of 15.16 mm, confirming CC ligament insufficiency. INTERVENTIONS: The patient underwent a single-tunnel arthroscopically assisted CC ligament reconstruction with allograft augmentation using the TightRope system and a peroneus brevis tendon allograft. OUTCOMES: At the 60-month follow-up, radiographs demonstrated maintained joint stability. The CC distance was reduced to 6.01 mm immediately postoperatively and was 9.30 mm at the final follow-up. Clinical scores significantly improved (Visual Analog Scale: 6→1, American Shoulder and Elbow Surgeons: 13→95, and University of California at Los Angeles: 9→35), and the patient returned to heavy manual labor 6 months postoperatively, maintaining full function. LESSONS: In patients with severe distal clavicle bone loss, single-tunnel arthroscopically assisted CC ligament reconstruction with allograft augmentation can yield excellent long-term clinical and radiological outcomes, serving as a viable and effective treatment option.