Reconstruction of coracoclavicular ligament by excision and semi-inversion of conjoined tendon at the distal clavicle and allograft tendon transfer for treatment of acromioclavicular separation

Abstract

Objective To investigate the mid- and long-term outcomes of reconstruction of coraco-clavicular ligament by excision and semi-inversion of conjoined tendon at the distal clavicle and allograft tendon transfer in the treatment of acromioclavicular separation. Methods From January 2006 to January 2008, 54 patients with acromioclavicular separation were treated by reconstruction of coracoclavicular ligament by excision and semi-inversion of conjoined tendon at the distal clavicle and allograft tendon transfer. They were 34 men and 20 women, with a mean age of 40. 4 years (range, from 21.7 to 64.1 years). The mean time from injury to surgery was 12.2 days (range, from 3 to 20 days). According the Rockwood classification, 6 cases were type Ⅲ, 6 type Ⅳ and 42 type Ⅴ. All the patients were routinely followed up after the surgery. The visual analogue scale (VAS), American Shoulder and Elbow Surgeons (ASES) and Constant-Murley scores were used to evaluate the postoperative shoulder function. Postoperative radiograph was taken for each patient to evaluate the loss of reduction of the acromioclavicular joint. Results The mean follow-up time was 64.2 months (range, from 48.6 to 92.2 months). At the final follow-up, the average forward elevation was 170.0° (range, from 160° to 180°), external rotation 57.8° (range, from 40° to 80°) and internal rotation T8 level (range, from T2 to T12), respectively. The average VAS, ASES and Constant-Murley scores were 0.7 (range, from 0 to 4), 90.4 (range, from 81.7 to 100.0) and 90.9 (range, from 83.0 to 100.0), respec-tively. Tenderness on the distal clavicle was found in 12 patients (22.2% ). Partial loss of reduction was found in 6 patients with type V fracture (11.1% ). No complete loss of reduction was found in any case. Conclusion Most patients may obtain good shoulder function and no loss of reduction at mid- and long-term follow-ups after their acromioclavicular separation has been treated by reconstruction of coracoclavicular ligament by excision and semi-inversion of conjoined tendon at the distal clavicle and allograft tendon transfer. Key words: Acromioclavicular joint dislocation; Reconstructive surgical procedures; Trans-plantation; Allograft