When the severity of the dislocation and the motivation of the subject (sports, heavy work) require it, rather than choosing a nonoperative treatment (as in other cases, with acromioclavicular dedicated sling for four weeks), we give a surgical indication: we achieve intraoperative reduction of the articulation with orthopedic maneuvers, and in acute cases we stabiliza it by placing it in mechanical quiet until joint capsule and conoid and trapezoid legaments heal, utilizing an arthroscopic technique (‘dog bone’ implants or ‘tight-rope’ non absorbable implants); in chronic cases, always arthroscopically we perform an ‘augmentation’ with semitendinosus tendon (autologous or donor: ‘graft-rope’ technique), or alternatively implanti artificial ligaments (LARS or LIGASTIC) that stabilize the clavicle passing under the coracoid.

Clinical results are similar to those obtained with traditional open surgical techniques, but in the arthroscopy technique postoperative is better, more cosmetic and with earlier functional rehabilitation.