Revision Rockwood Grade V Acromioclavicular Reconstruction Quadruple Repair

Case: A 30-year-old woman presented with persistent pain and instability after failed suture-button fixation for a Rockwood V Acromioclavicular (AC) separation. Revision surgery used a “quadruple repair” combining suture-button fixation, semitendinosus allograft reconstruction, coracoacromial ligament transfer, and hook-plate augmentation. Imaging confirmed anatomic alignment with progressive healing. She returned to unrestricted activity after hook-plate removal at 6 months, and her most recent follow-up (15 months) revealed complete range of motion and maintained reduction. Conclusion: This case highlights the effectiveness of combined biologic and mechanical stabilization for complex AC joint revision reconstruction.