The overall self-reported complication rate for arthroscopic knee procedures was 4.7%. Knee arthroscopy is not a benign procedure, and patients should be aware of the risk of complications.

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T he ideal method of surgical treatment of severe acromiociavicuiar joint separations remains controversial, with more than sixty techniques described in the literature. Recently, there has been increased interest in the use of free tendon grafts to reconstruct the coracoclavicular ligaments. To our knowledge, the first published case report of reconstruction with a semitendinosus tendon autograft appeared in 2001', Numerous techniques have subsequently been developed in an effort to improve clinical results. An anatomic method of reconstruction, which focuses specifically on recreating both the conoid and the trapezoid coracoclavicular ligament, has been described\ This construct is particularly appealing because the ligaments act synergistically to limit displacement ofthe acromiociavicuiar joint. Therefore, an anatomic reconstruction of both ligaments may improve the stability of the acromiociavicuiar joint and enhance clinical outcomes.There have been few reports, however, focusing on complications of these newer procedures. We report on a small series of patients in whom tendon graft reconstructions placed through two distinct clavicular bone tunnels resulted in fracture of the clavicle. We have identified factors of which surgeons should be aware to avoid these complications. Surgical TechniqueT he surgical technique involved a modification of the procedure originally described by Mazzocca et al,'. The patient was placed in the beach-chair position after receiving an interscalene block and general anesthesia. An incision was created in the Langer lines approximately 4 cm medial to the ¿lcromioclavicular joint and extending from the clavicle toward the coracoid. The deltotrapezial fascia was incised and elevated sub periostea] ly. AT-extension ofthe fascia incision was created to expose the coracoid process. Distal clavicular resection was not performed. The technique modification consisted ofthe use of a bioabsorbable suture anchor placed in the coracoid base for supplemental fixation. Two bone tunnels, typically 6 mm in diameter to accommodate the graft, were created in the clavicle. The first was located 45 mm medial to the acromiociavicuiar joint and in the posterior half of the clavicle. The second tunnel was placed approximately 13 mm lateral to the first and in the center ofthe clavicle. These tunnel positions were chosen in an attempt to recreate the anatomic insertions of the conoid and trapezoid ligaments, respectively', A libialis anterior allograft or semitendinosus autograft (chosen on the basis of patienl and surgeon preference) was then looped beneath the coracoid, and the free ends were passed through the clavicular tunnels. One suture strand from the suture anchor was passed posterior to the clavicle, and the other suture strand was passed anterior to the clavicle. After each strand was passed and the acromiociavicuiar joint was reduced, the suture ends were secured in a cerclage fashion atop the clavicle (Fig, 1), With the joint reduced and the graft ends tensioned, two bioabsorbable tenode...

We observed significantly increased tibial aperture size and shape after transtibial femoral drilling with a medial tibial starting point. Medial tibial tunnels, compared with more central tunnels, resulted in a more acute tibial tunnel in the coronal plane and less acute tibial tunnels relative to the sagittal plane. Medial tibial tunnels started farther from the tibial tubercle but ended farther from the medial joint line and closer to the anterior edge of the tibia in comparison to central tunnels Clinical Relevance Femoral tunnel placements may be best accomplished using a technique other than transtibial drilling through a medial tibial tunnel. Tibial tunnel angle, intra-articular position, and femoral tunnel placement are affected by the choice of extra-articular starting position.

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