The coracoclavicular ligament complex connects the coracoid process to the undersurface of the clavicle through its two components (conoid and trapezoid), providing the primary vertical stability of the acromioclavicular joint and clavicle.
The primary stabiliser of the clavicle relative to the scapula — resists superior clavicular migration and provides the primary vertical constraint of the AC joint. The conoid resists posterior clavicular displacement while the trapezoid resists anterior displacement.
CC ligament reconstruction is the cornerstone of Grade III-VI AC separation surgery. The anatomic double-bundle reconstruction (Carofino modification and others) reconstructs both conoid and trapezoid using gracilis or semitendinosus graft. CC ligament distance on radiograph defines AC separation grade — more than 100% increase indicates complete CC ligament disruption.
Both conoid and trapezoid disruption producing complete AC joint vertical instability with clavicular superior migration exceeding 100% of normal CC distance, managed by anatomic CC ligament reconstruction.
Post-traumatic ossification of the CC ligament complex following AC separation producing a bony bridge between the coracoid and clavicle — often asymptomatic but occasionally tender.
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