Borbas P, et al. - A literature search was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines by the researchers in order to systematically review the clinical outcomes of 3 main categories of acromioclavicular joint (ACJ) reconstruction for high-grade chronic instability. A total of 27 studies comprising 590 subjects divided into 1 of 3 groups met the inclusion criteria. The complication rates were comparable among the 3 groups ie,15%, 15% and 17% for nonbiological fixation, for biological reconstruction, and for ligament and/or tendon transfer, with failure rates of 8%, 7%, and 5%, respectively. The mean Constant score was 87.2, 92.4 and 87.4 points for nonbiological fixation (n=89), biological reconstruction (n=86), and ligament and/or tendon transfer (n=49), respectively, in terms of functional outcomes. Hence, all techniques exhibited comparable complication rates, on comparison of the outcomes of 3 various ACJ reconstruction methods. ACJ reconstruction with a tendon graft demonstrated superior outcomes among the level II studies.