Acromioclavicular joint reconstruction. A, Drill guide is used to drill through four cortices of the clavicle and coracoid. Drill sleeve is removed and Nitinol wire or Arthrex FiberStick is retrieved out low anterolateral portal. B, Cortical button is guided into position on inferior portion of coracoid using a KingFisher grasper. C, Graft passage around clavicle is facilitated with help of dilation using switching stick and arthroscopic cannula dilator. D, Graft passage around clavicle is facilitated with the help of dilation using a switching stick and arthroscopic cannula dilator. E, Graft is being shuttled around lateral aspect of coracoid process. F, Graft overlies cortical button and is seated flush on inferior surface of coracoid process. G, Graft is secured to itself using multiple nonabsorbable sutures. Graft overlies “top hat” seated on the superior cortex of clavicle decreasing risk of implant irritation. H, Final postoperative radiograph showing completed arthroscopically assisted AC joint reconstruction. Note anatomic alignment of AC joint. SEE TECHNIQUE 52.27.