الفهرس 
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Abstract
Acromioclavicular (AC) joint dislocation involves 12% of shoulder joint injuries and is usually caused by direct or indirect force. This type of injury can involve individuals of all age groups and is a common injury as a result of accidents related to traffic, sports (especially falls during skiing and in contact sports with an incidence of 41% among football players), military training, and falls. Rockwood’s classification (grades I to VI) is commonly used for grading the AC joint and is based on the degree of injuries. Treatment of grade I and II AC joint dislocations can be performed conservatively. However, surgical intervention is required for patients with grades III (especially individuals who are workers with heavy manual occupations, overhead throwing athletes, and so on) and IV–VI (because of their common characteristics including instability in the horizontal and vertical direction of both due to AC ligament and coracoclavicular (CC) ligament disruption. Different methods were suggested to manage acute AC joint dislocation. More than 70 methods have been suggested for management of complete AC joint separation. However, according to the literature the rate of complications is high with these methods. Fixation or CCL reconstruction: surgical techniques for fixation were associated with high incidence of early and late postoperative complications. 32% technical failure rate was reported after Bosworth screw fixation. 43% early postoperative complications and 32% late instability were reported after tension band fixation. 58% early postoperative complications and 50% late instability were reported after kook plate fixation. 17% early postoperative complications and 34% late instability were reported after PDS suspension. The CCL repair, reconstruction or substitution has evolved over the last several decades. CCL repair or reconstruction: Open or arthroscopic, early or delayed CCL reconstruction is recommended for high grade AC dislocation and for double disruptions of superior shoulder suspensory complex and in conditions associated with soft-tissue or neurovascular injury. The CCL repair is reserved for low grade AC dislocation. The CC ligament plays an important role in restraining force to the vertical translation and horizontal limitation is applied by the joint capsule and AC ligament. The biomechanics of CC ligament complex has been studied in previous researches and their results have shown the unique role of this complex in the anterior and superior displacement of the clavicle. Biomechanical studies have demonstrated the importance of an anatomic reconstruction of both the conoid and trapezoid ligaments. This importance relies on the fact that they have different functions that depend of their native anatomic locations. In order to reproduce the anatomic orientation of both the conoid and trapezoid ligaments, and thus improve the biomechanics of the fixation, arthroscopic techniques that incorporate a second CC suspension device have been developed. Most of the clinical and radiological outcomes of the published series of patients managed by means of CC suspension devices can be considered as good or excellent. The biomechanical evidence currently available supports the performance of an anatomic reconstruction of the torn CC ligaments when managing unstable ACJ injuries in the acute setting, in order to restore the biomechanical role of the CC connection to the dynamic of the shoulder girdle. The role of the AC augmentation to control the horizontal instability is actually clear. In the present study, 20 patients with AC joint dislocation who underwent surgical treatment by the double endobutton technique were evaluated. In this technique, two titanium buttons with sutures were used on the superior and inferior sides. Subsequently, the load on the joint was disturbed equally; therefore, preventing the sawing effects of the sutures. According to the DASH, VAS, ASES and constant shoulder score results, this technique has good results for patients with AC joint dislocation. Post-operative DASH and VAS scores were lower and constant shoulder score was higher than pre-operation results. This showed the patients were satisfied with this technique, the mean CC distance from the operated shoulder was more thanthat of the CC distance from the normal side by average 2 mm 6 months post-operative. During the follow-up, two cases with Shoulder stiffness were recorded. • According to the results of the present study, the double-button fixation system does minimal damage to the soft tissues surrounding the CC ligaments and is a suitable technique for the management of acute acromioclavicular joint dislocation.