The long head of the biceps tendon as a pedicled autograft for acromioclavicular joint reconstruction: development of an arthroscopic technique

Acromioclavicular joint (ACJ) dislocation is a frequent shoulder injury, and high-grade cases often require surgical reconstruction. Although multiple techniques have been described, no single method has achieved consensus as the gold standard. The long head of the biceps tendon (LHBT) represents an attractive autologous option, as it is anatomically adjacent to the ACJ, preserves vascularity when used as a pedicled graft, and reduces donor-site morbidity. Building on prior anatomical studies, this cadaveric investigation describes and validates an arthroscopic technique for ACJ reconstruction using the LHBT. The graft is mobilized while maintaining its supraglenoid origin, passed through a clavicular tunnel under endoscopic and fluoroscopic guidance, and reinforced vertically with a suspensory (suture-button) device passing independently through a coracoclavicular tunnel, and with an acromioclavicular cerclage to enhance horizontal stability. The procedure proved feasible, reproducible, and safe with respect to anatomical landmarks and adjacent structures. Clinical relevance: This technique offers a biologically sound, minimally invasive alternative for ACJ reconstruction that may reduce morbidity and improve reproducibility compared with conventional graft-based procedures.