Study Results of a U.S. Patented AC Joint Separation Surgery over the past 10 Years

Share Article

Dr. Steven Struhl shares his AC Joint Separation Procedure and results of a study group of 35 patients over past 10 years at AANA (Arthroscopy Association of North America) event. The "Closed-Loop Double Endobutton Repair" for AC Joint Separation or "continuous loop" Procedure has shown superior results when compared to non-operative procedures.

AFTER: X-ray of Jason's Grade 5 AC Joint Separation

My right AC Joint was 300% higher than normal, and NOW it is perfect!

Dr Steven Struhl, MD, an NYU faculty accomplished Orthopedic Surgeon in Westchester County and NYC, specializing in AC Joint Separation, and armed with his patented "Closed-Loop Double Endobutton Repair" technique was asked to present his clinical results of "Closed-Loop Double Endobutton Repair" for AC Joint Dislocation at the national AANA (Arthroscopy Association of North America) annual event.

Figures show that there are 60,000 new complete AC Joint Separations that occur each year. It is a common shoulder injury that requires clinical attention by an Orthopedic Shoulder Specialist.

Traditional Methods…”Wait and See”

Unfortunately, most of the injuries will be treated non-operatively. Without operating, these AC Joint Separations will suffer:

  •     All will have cosmetic defects.
  •     50% will have residual symptoms.
  •     Nearly 1/4 will have unsatisfactory outcomes.

It is very common to be advised to adopt a ‘wait and see’ approach. This stance will likely turn an acute injury into a chronic injury. The patient will then be requiring reconstruction, most likely with a graft, and most certainly inferior outcomes.

U.S. Patented AC Joint Separation Procedure with RESULTS

The "Closed-Loop Double Endobutton Repair" for Joint AC Dislocation or "Continuous Loop" Procedure has shown superior results when compared to non-operative procedures. The "loop" was found to be strong, durable and reliable; shows effective healing and large load-bearing grafts were avoided.

Study Group with comprehensive evaluations

The study group consisted of 35 patients, who were followed for 4 to 10 years. Most of the patients were chronic and standard; validated outcome scoring systems were used. For each patient, X-rays were done and quantitated comparing normal with the operative CC interval. Follow up information was obtained on all 35 patients and comprehensive evaluations were done on 31.

Goals and Objectives

The goals were to demonstrate a strong, durable fixation; allow for normal physiologic movement; be surgeon friendly; minimize complication risk and plan for long-term biologic stability.

Patented Technique

The surgical design was to use a continuous loop to eliminate knot breakage and slippage, follow the bio-mechanical principals and always create a biologic connection between the coracoid and the clavicle.

The technique is open, the joint is reduced, a hole is drilled, the channel length is measured and the appropriate loop size is chosen and prepared with sutures. Retrograde passage is facilitated by curved suture retriever and the loop is pulled up through the clavicle and a second button slid into the loop and secured with sutures. The procedure is then completed by tying the second stitch, followed by either repair of the ruptured ligament or (in chronic cases) transfer of the CA ligament and finally, imbrication of the AC capsule.

Loops come in 5 mm increments. When the measured channel is within 1mm, a standard endobutton is used. When the measurement is in between, a larger loop is chosen, which leaves excess loop that is filled with an extended button that is thicker and wider and compensates for the extra loop.

The Results

Across the board positivescores!

At follow up, the average constant score was 98 (0-100), the UCLA score was 33.5 (0-35), ASES score was 98 (0-100) and the SST score was 11.3 (0-12). The average CC interval was increased by 1.2 mm.

There was no tendency for loss of reduction over a 10 year period. Cosmetic appearance of both the incision and the shoulder was quite good. One patient did re-dislocate after an acute trauma; there was one asymptomatic late fracture and one patient required a late distal clavicle excision for pain. MRIs were done on 10 patients and validated the use of the graft. All studies showed a wide band of thick scar tissue that developed over time. Arthroscopic appearance correlates well with the MRI and probed well.


Dr. Steven Struhl’s recognized patented AC Joint Separation procedure has athletes able to return to their active lifestyles quickly and successfully, where previous treatments offered less astounding results. In fact, Jason B. who suffered a Stage 5 shoulder separation traveled from Vermont to see Dr. Struhl when the other doctors had no positive prognosis in sight. Prior to Jason’s successful surgery, his right AC Joint was 300% higher than normal, and now it is perfect! Jason says that, “this is the best decision I have ever made.”


With office locations in both New York and Westchester, Dr. Struhl is able to welcome new patients looking to experience a safe effective procedure that will transport them back into their active lifestyles quickly.

For further information, or to schedule an appointment with Dr. Steven Struhl, you may contact him through his New York office (212) 207-1990, Westchester office (914) 328-4111 or visit his website

Share article on social media or email:

View article via:

Pdf Print

Contact Author

Steven Struhl, MD

Stan Evans
The Conversion Group
Email >
since: 07/2010
Follow >
Follow us on
Visit website