Hook plates and arthroscopic flip button techniques are currently the most commonly used procedures for AC-joint reconstruction. Minimally invasive AC-joint reconstruction (MINAR), a mini open flip button technique was introduced as an alternative to the arthroscopic technique as it is a straight forward procedure and no experience in arthroscopy is needed. Methods: Between 2011 and 2015, 53 patients with acute AC-joint separations Type Rockwood III, IV and V were stabilized by MINAR. 45 were

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... ailable for follow-up. In 15 patients a 1m m polyester suture was used, in the remaining 30 patients a No. 5 Fiberwire. All patients had a follow-up examination at a minimum one year after surgery. The Constant score (CS), the American Shoulder Elbow score (ASES) and the subjective shoulder value (SSV) were evaluated. All patients had a calibrated bilateral stress view of the AC-joints and a bilateral axial view. The coraco-clavicular (cc) distance was measured on the injured and contralateral side. Furthermore, the width of the clavicular tunnel was measured and compared with the initial diameter (4.5 mm). Results: The mean age of the patients was 37.6 years (range 17 -64), patients were operated after an average of 7.2 (range 1 -20) days after trauma. After a mean of 25.3 months (range 12 -53 months) the mean absolute CS was 96.6 (range 87 -100), the mean ASES 98.0 (range 60 -100) and the mean SSV was 92.3 (range 60 -100). The cc-distance was 10.0 mm on the injured side and 8.1 mm on the uninjured side (p < 0.001). Only 14 patients (31.1%) had a perfect reduction in the vertical plane defined as a cc-distance on the injured side of ± 10% compared to the contralateral side. 20% of the patients with polyester suture and 56.7% of patients with Fiberwire had a widening of the clavicular tunnel with an average tunnel of 3.5 mm and 5.0 mm, p = 0.016. Conclusion: Despite excellent clinical results and an average side-to-side difference of the cc-distance comparable to other techniques MINAR failed to restore the AC joint anatomically in the vertical plane. Therefor a modification of the originally described technique is advisable.