Clavicular Fractures Following Coracoclavicular Ligament Reconstruction with Tendon Graft

Abstract

The ideal method of surgical treatment of severe acromioclavicular joint separations remains controversial, with more than sixty techniques described in the literature. Recently, there has been increased interest in the use of free tendon grafts to reconstruct the coracoclavicular ligaments. To our knowledge, the first published case report of reconstruction with a semitendinosus tendon autograft appeared in 20011. Numerous techniques have subsequently been developed in an effort to improve clinical results. An anatomic method of reconstruction, which focuses specifically on recreating both the conoid and the trapezoid coracoclavicular ligament, has been described2. This construct is particularly appealing because the ligaments act synergistically to limit displacement of the acromioclavicular joint. Therefore, an anatomic reconstruction of both ligaments may improve the stability of the acromioclavicular joint and enhance clinical outcomes. There have been few reports, however, focusing on complications of these newer procedures. We report on a small series of patients in whom tendon graft reconstructions placed through two distinct clavicular bone tunnels resulted in fracture of the clavicle. We have identified factors of which surgeons should be aware to avoid these complications. The surgical technique involved a modification of the procedure originally described by Mazzocca et al.2. The patient was placed in the beach-chair position after receiving an interscalene block and general anesthesia. An incision was created in the Langer lines approximately 4 cm medial to the acromioclavicular joint and extending from the clavicle toward the coracoid. The deltotrapezial fascia was incised and elevated subperiosteally. A T-extension of the fascia incision was created to expose the coracoid process. Distal clavicular resection was not performed. The technique modification consisted of the use of a bioabsorbable suture anchor placed in the coracoid base for supplemental fixation. Two bone tunnels, typically 6 mm in diameter to accommodate the …