Abstract
Introduction: The optimal surgical treatment for acromioclavicular joint (ACJ) injuries remains controversial. The modified Weaver-Dunn (WD) procedure is one of the frequently used techniques. Recently when it was compared with anatomical autogenous tendon graft reconstruction procedures, the results were inferior. However, these anatomical procedures are technically more demanding with small margin of error and they have tendency for postoperative pain because of extra donor site incision.Materials and Methods: Forty patients with type IV to VI ACJ dislocations were treated by modified WD procedure using non-absorbable synthetic suture passed through the base of coracoid process for augmentation of transferred coraco-acromial (CA) ligament. Functional outcome was assessed using the Oxford Shoulder Score, Nottingham Clavicular Score and Visual Analog Score (VAS) at the final follow-up after surgery.Results: The mean pre-operative Oxford Shoulder Score improved from 25.22±2.64 (range 20 to 30) to 44.75±1.99 (range 40 to 48) and mean pre-operative Nottingham Shoulder Score improved from 49.25±4.91 (range 39 to 58) to 87.27±4.39 (range 79 to 96) at last follow-up after surgery with p-value <0.001. Thirty-five (87.5%) patients had excellent outcomes, four (10%) patients had good outcomes and one (2.5%) patient had fair outcome. Thirty-eight (95%) patients had no pain while two (5%) had moderate pain based on VAS score.Conclusion: Modified Weaver-Dunn is a simple well established technique for grade IV to VI ACJ dislocation. We cannot consider this procedure as old and outdated on the argument that the long term functional outcomes are not suboptimal.
Highlights
The optimal surgical treatment for acromioclavicular joint (ACJ) injuries remains controversial
The mean pre-operative Oxford Shoulder Score improved from 25.22±2.64 to 44.75±1.99 and mean pre-operative Nottingham Shoulder Score improved from 49.25±4.91 to 87.27±4.39 at last follow-up after surgery
The mean pre-operative Oxford Shoulder Score improved from 25.22±2.64 to 44.75±1.99 and mean pre-operative Nottingham Shoulder Score improved from 49.25±4.91 to 87.27±4.39 at last follow-up after surgery with p-value
Summary
The optimal surgical treatment for acromioclavicular joint (ACJ) injuries remains controversial. The modified Weaver-Dunn (WD) procedure is one of the frequently used techniques When it was compared with anatomical autogenous tendon graft reconstruction procedures, the results were inferior. Conclusion: Modified Weaver-Dunn is a simple well established technique for grade IV to VI ACJ dislocation We cannot consider this procedure as old and outdated on the argument that the long term functional outcomes are not suboptimal. The modified WD procedure was compared with synthetic ligament as well as autogenous tendon graft reconstruction revealing its inferior results in both clinical and biomechanical studies because many non-anatomical methods, even though restore the vertical stability lack in antero-posterior stability as compared to the anatomic reconstruction of CC ligaments[4,5,6]. Costic et al compared the anatomical reconstruction of semitendinosus tendon (ST) graft with the intact CC ligament showing the reconstructed ligament had the mechanical strength close to the intact ligament[7]
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