The coracoclavicular ligament connects the coracoid process to the inferior clavicle via two distinct bands: the cone-shaped conoid posteromedially and the quadrilateral trapezoid anterolaterally. The conoid is the main restraint to superior clavicular displacement, while the trapezoid mainly resists horizontal displacement and compression at the acromioclavicular joint. Together they suspend the scapula and upper limb from the clavicle, and their disruption defines the higher grades of AC joint separation.
| Origin | Coracoid process of the scapula (conoid near the base of the coracoid, trapezoid on its upper surface) |
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| Insertion | Inferior surface of the clavicle: conoid tubercle (conoid ligament) and trapezoid line (trapezoid ligament) |
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Suspends the scapula and upper limb from the clavicle and provides the main vertical stability of the acromioclavicular joint.
AC joint injuries are classified using the Rockwood system: grades I and II leave the CC ligaments intact or only sprained, grade III involves complete CC ligament rupture with up to about 100% superior displacement, and grades IV to VI involve complete rupture with posterior, gross superior or inferior displacement. The coracoclavicular distance on comparative radiographs reflects the degree of disruption. Grades I and II are treated non-operatively, grade III is usually treated non-operatively but surgery may be considered in overhead athletes or manual workers, and grades IV to VI are generally reconstructed. Anatomical reconstruction recreating both conoid and trapezoid limbs, often with a tendon graft looped around or through the coracoid, controls rotational as well as vertical instability.
Tearing of the conoid and trapezoid bands during a fall onto the point of the shoulder, producing superior clavicular displacement classified by the Rockwood system, with surgical reconstruction for grades IV through VI and selected grade III injuries.
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