Anatomic Coracoclavicular Ligament Reconstruction Research Articles

Reconstruction of Coracoclavicular Ligaments with Semitendinosus Autograft and Temporary Kirschner Wires is a good option for Chronic Acromioclavicular Joint Instability.

This study reports the results of surgical anatomic reconstruction of torn coracoclavicular ligaments with an autogenous semitendinosus graft and temporary Kirschner wires (K-wires) in chronic acromioclavicular (AC) joint dislocations. Nineteen shoulders underwent surgical anatomic reconstruction of torn coracoclavicular (CC) ligaments with an autogenous semitendinosus tendon graft and temporary K-wires for Rockwood grade III, IV and V chronic AC joint dislocations. Pre-operative data included patients' demographic characteristics, injury characteristics and surgical histories. The primary outcome measures were the University of California Los Angeles (UCLA) shoulder rating scale and visual analogue pain scoring (VAS), and the complications were noted for each patient. Surgical anatomic reconstruction of torn CC ligaments was performed in 19 patients with a mean age of 41.6±16 years (range 21-72 years). All of the patients were satisfied and felt better after CC ligament reconstruction. The average UCLA shoulder rating scale score was good/excellent: 29.4 (range 23-34) out of 35 points. The average pre-operative VAS score was 7.7 points out of 10 and improved to 1.1 points post-operatively (p<0.05). None of the patients experienced failure during the follow-up. One patient had a mild subluxation, but the patient was satisfied with the result. This technique is simple, reliable, and biologic without major complications. It is also a cost-effective procedure since it can be performed with Kirschner wires and autogenous grafts. It has a major advantage of leaving no implants inside the joint, which can lead to hardware complications, and it can be performed in basic operating room settings.

Current Concepts in Management of Acromioclavicular Joint Injury.

Background: The management of acromioclavicular joint injuries requires a thorough understanding of the anatomy and biomechanics of the joint, as well as knowledge of the pertinent physical exam findings and classification to determine an appropriate treatment approach, whether operative or nonoperative. In this article, we present a narrative review of the current state of understanding surrounding these issues. Although there are a large number of options for operative intervention, we additionally present our experience with anatomic coracoclavicular ligament reconstruction (ACCR) with imbrication of the deltoid fascia. Methods: A retrospective review of prospectively collected data on a total of 45 patients who had undergone ACCR between 2003 and 2016 were collected. Results: We found that improvements were seen in American Shoulder and Elbow Surgeons Score (ASES) (53 ± 19 to 81 ± 23), Simple Shoulder Test (SST) (6 ± 3 to 12 ± 13), Constant-Murley (CM) (60 ± 18 to 92 ± 8), and Rowe (67 ± 14 to 89 ± 11) and the mean post-operative SANE score was 86 ± 17. Conclusions: ACCR has the advantage of addressing both horizontal and vertical stability with good outcomes.

Long-Term Functional Outcomes and Athletic Ability in Shoulder Sports After Anatomic Coracoclavicular Ligament Reconstruction for Chronic Type 3 and 5 Acromioclavicular Joint Injuries.

Promising short- and midterm outcomes have been seen after anatomic coracoclavicular ligament reconstruction (ACCR) for chronic acromioclavicular joint (ACJ) injuries. To evaluate long-term outcomes and shoulder-related athletic ability in patients after ACCR for chronic type 3 and 5 ACJ injuries. It was hypothesized that these patients would maintain significant functional improvement and sufficient shoulder-sport ability at a long-term follow-up. Case series; Level of evidence, 4. Included were 19 patients (mean age, 45.9 ± 11.2 years) who underwent ACCR for type 3 or 5 ACJ injuries between January 2003 and August 2014. Functional outcome measures included the American Shoulder and Elbow Surgeons (ASES), Rowe, Constant-Murley, Simple Shoulder Test (SST), and Single Assessment Numeric Evaluation (SANE) scores as well as the visual analog scale (VAS) for pain, which were collected preoperatively and at the final follow-up. Postoperative shoulder-dependent athletic ability was assessed using the Athletic Shoulder Outcome Scoring System (ASOSS). Shoulder activity level was evaluated using the Shoulder Activity Scale (SAS), while the Subjective Patient Outcome for Return to Sports (SPORTS) score was collected to assess the patients' ability to return to their preinjury sporting activity. The mean follow-up time was 10.1 ± 3.8 years (range, 6.1-18.8 years). Patients achieved significant pre- to postoperative improvements on the ASES (from 54.2 ± 22.6 to 83.5 ± 23.1), Rowe (from 66.6 ± 18.1 to 85.3 ± 19), Constant-Murley (from 64.6 ± 20.9 to 80.2 ± 22.7), SST (from 7.2 ± 3.4 to 10.5 ± 2.7), SANE (from 30.1 ± 23.2 to 83.6 ± 26.3), and VAS pain scores (from 4.7 ± 2.7 to 1.8 ± 2.8) (P < .001 for all), with no significant differences between type 3 and 5 injuries. At the final follow-up, patients achieved an ASOSS of 80.6 ± 32, SAS level of 11.6 ± 5.1, and SPORTS score of 7.3 ± 4.1, with no significant differences between type 3 and 5 injuries. Four patients (21.1%) had postoperative complications. Patients undergoing ACCR using free tendon allografts for chronic type 3 and 5 ACJ injuries maintained significant improvements in functional outcomes at the long-term follow-up and achieved favorable postoperative shoulder-sport ability, activity, and return to preinjury sports participation.

Evaluation of Functional and Radiological Outcome of Arthroscopic-Assisted Anatomical Coracoclavicular (CC) and Acromioclavicular (AC) Ligament Reconstruction in Chronic AC Joint Dislocation

Evaluation of Functional and Radiological Outcome of Arthroscopic-Assisted Anatomical Coracoclavicular (CC) and Acromioclavicular (AC) Ligament Reconstruction in Chronic AC Joint Dislocation

Finite element analysis of different reconstruction methods of coracoclavicular ligament for acromioclavicular joint dislocation

This study aims to examine the biomechanical effects of different reconstruction methods, including single-bundle, double-bundle anatomical reconstruction, and double-bundle truly anatomical reconstruction of the coracoclavicular ligament on the acromioclavicular joint using finite element analysis, to provide a theoretical basis for the clinical application of truly anatomical coracoclavicular ligament reconstruction. One volunteer, aged 27 years old, with a height of 178 cm and a weight of 75 kg, was selected for CT scanning of the shoulder joint. Three-dimensional finite element models of single-bundle reconstruction, double-bundle anatomical reconstruction, and double-bundle truly anatomical reconstruction of coracoclavicular ligament were established by using Mimics17.0, Geomagic studio 2012, UG NX 10.0, HyperMesh 14.0 and ABAQUS 6.14 software. The maximum displacement of the middle point of the distal clavicle in the main loading direction and the maximum equivalent stress of the reconstruction device under different loading conditions were recorded and compared. The maximum forward displacement and the maximum backward displacement of the middle point of the distal clavicle in the double-bundle truly anatomic reconstruction were the lowest, which were 7.76 mm and 7.27 mm respectively. When an upward load was applied, the maximum displacement of the distal clavicle midpoint in the double-beam anatomic reconstruction was the lowest, which was 5.12 mm. Applying three different loads forward, backward, and upward, the maximum equivalent stress of the reconstruction devices in the double-beam reconstruction was lower than that in the single-beam reconstruction. The maximum equivalent stress of the trapezoid ligament reconstruction device in the double-bundle truly anatomical reconstruction was lower than that in the double-bundle anatomical reconstruction, which was 73.29 MPa, but the maximum equivalent stress of the conoid ligament reconstruction device was higher than that of the double-bundle anatomical reconstruction. The truly anatomical reconstruction of coracoclavicular ligament can improve the horizontal stability of acromioclavicular joint and reduce the stress of the trapezoid ligament reconstruction device. It can be a good method for the treatment of acromioclavicular joint dislocation.

Anatomic coracoclavicular ligament reconstruction with triple flip-buttons leads to good functional outcomes and low reduction loss: a case series.

The management of acromioclavicular (AC) joint dislocation remains controversial. Recently, anatomic coracoclavicular (CC) fixation with a double clavicular tunnel and three flip-buttons has shown promising results. This study aimed to evaluate functional and radiological outcomes in patients with high-grade AC joint dislocation treated with anatomic CC fixation using double clavicular tunnels and three flip-buttons. A retrospective, unicentric study was performed. The study included patients with high-grade AC joint dislocation who underwent surgery with anatomic CC fixation using double clavicular tunnels and three flip-buttons. Demographic data were obtained from medical records. A functional evaluation using subjective shoulder value (SSV), visual analog scale (VAS), and disabilities of the arm, shoulder, and hand (DASH) questionnaires was performed, and an evaluation of preoperative and postoperative comparative Zanca view images was performed. Factors associated with functional outcomes and radiological AC reduction were analyzed. A total of 83 patients completed follow-up and were included in the analysis. The mean SSV, VAS, and DASH scores were 92.8, 0.8, and 6.4, respectively. Patients who had complications experienced significantly worse functional outcomes (DASH: P=0.037). Suboptimal final AC reduction was observed in nine patients (11.1%), and significantly more frequently in patients older than 40 years (P=0.031) and in surgeries performed more than 7 days after injury (P=0.034). There were two reoperations (2.4%). Anatomic CC fixation with a double clavicular tunnel and three flip-buttons leads to good functional outcomes, low complication rates, and high rates of optimal AC reduction. Level of Evidence: Level IV; Case series.

Functional and radiographic outcomes after allograft anatomic coracoclavicular ligament reconstruction

Functional and radiographic outcomes after allograft anatomic coracoclavicular ligament reconstruction

Functional and Radiological Outcome after Anatomic Coracoclavicular Ligament Reconstruction for Type III to Type V Acromioclavicular Joint Dislocation Using Semitendinous Autograft

INTRODUCTION: Acromioclavicular joint dislocation is a commonly encountered shoulder injury. Various surgical methods are available for the treatment of complete ACJ dislocation (type III to VI), however, optimal surgical treatment is still controversial. The purpose of this study was to evaluate the radiological and functional outcome of anatomic coracoclavicular reconstruction (ACCR) using semitendinosus autograft with suture augmentation for type III to V ACJ dislocation. MATERIALS AND METHODS: It was a single centered, cross sectional, observational study conducted at Department of Orthopedics and Traumatology, Dhulikhel Hospital. Twenty-three consecutive patients who underwent ACCR with semitendinosus autograft from Jan 2017 to Dec 2019 were included in the study. Patients below 18 years of age and patients with previous ipsilateral shoulder injury were excluded. The radiological outcome was assessed using coracoclavicular (CC) distance and functional outcome using DASH score and Constant score. Paired t-test and Pearson correlation were used for inferential analysis. RESULTS: Mean age of the patient was 33.83 ± 7.08 years. Mean duration of follow up was 28.17 ± 6.19 months. Mean CC distance at final follow up was 9.93 ± 1.12 mm. Mean DASH score was 5.60 ± 5.35 and mean Constant score was 88.04 ± 12.13. There were 12 (52.17%) excellent outcomes, 6 (26.08%) good outcomes, 2 (8.69%) fair outcomes and 3 (13.04%) poor outcomes based on Constant scores. CONCLUSIONS: ACCR with suture augmentation is an effective method for management of type III to V acromioclavicular joint dislocation.

Biomechanical Efficacy of Tape Cerclage as an Augment or Stand-alone for Coracoclavicular Ligament Reconstruction

Background: Loss of initial reduction of the acromioclavicular joint after coracoclavicular (CC) ligament reconstruction remains a challenge for various repair techniques. Previous studies using polydioxanone suture cerclage augments for CC ligament reconstruction demonstrated poor clinical and biomechanical outcomes. Tape-style sutures have recently gained popularity because of their added stiffness and strength relative to traditional sutures. These tape cerclage systems have yet to be biomechanically studied in CC ligament reconstruction. Purpose: To determine the efficacy of a tape cerclage system as an augment to CC ligament reconstruction. Study Design: Controlled laboratory study. Methods: A total of 24 human cadaveric shoulders were utilized. These were divided into 4 repair groups: anatomic CC ligament reconstruction (ACCR), ACCR with a tape cerclage augment (ACCR + C), tendon graft sling with a cerclage augment (TGS + C), or tape cerclage sling alone (CS). The repairs underwent superior/inferior cyclic loading to evaluate for displacement. Specimens were visually inspected for cortical erosion by the tape cerclage after cyclic loading. Finally, the constructs underwent superior plane load-to-failure testing. Results: Less displacement after cyclic loading was observed in the ACCR + C (mean ± SD, 0.42 ± 0.32 mm), TGS + C (0.92 ± 0.42 mm), and CS (0.93 ± 0.39 mm) groups as compared with the ACCR group (4.42 ± 3.40 mm; P = .002). ACCR + C (813.3 ± 257.5 N), TGS + C (558.0 ± 120.7 N), and CS (759.5 ± 173.7 N) demonstrated significantly greater load at failure relative to ACCR (329.2 ± 118.2 N) (P < .001). ACCR + C (60.88 ± 17.3 N/mm), TGS + C (44.97 ± 9.15 N/mm), and CS (54.52 ± 14.24 N/mm) conferred greater stiffness than ACCR (27.43 ± 6.94 N/mm) (P = .001). No cortical erosion was demonstrated in any specimen after cyclic loading. Conclusion: In a cadaveric model at time zero, repairs utilizing a tape cerclage system confer significantly greater load to failure and stiffness, as well as decreased displacement with cyclic loading, when compared with traditional ACCR repair. Clinical Relevance: Tape cerclage augmentation may provide a useful augment for CC ligament reconstruction.

Semitendinosus vs Gracilis Grafts With 1- vs 2-Tunnel Techniques for Coracoclavicular Ligament Reconstruction: A Biomechanical Study

Background: Despite the evolution of acromioclavicular joint surgery to a more anatomic coracoclavicular (CC) ligament reconstruction, no definitive guidance regarding the number and position of bone tunnels in the clavicle, as well as the ideal graft choice, is established. Purpose/Hypothesis: The purpose of this study was to biomechanically compare the reconstruction of the CC ligament complex between gracilis- and semitendinosus-tendon grafts in 1- and 2-tunnel techniques. It was hypothesized that the gracilis tendon graft will provide comparable primary stability in both tunnel techniques while utilizing a smaller tunnel diameter. Study Design: Controlled laboratory study. Methods: A total of 24 cadaveric shoulders (13 men, 11 women; 66 ± 7.5 years) were randomly allocated to 4 repair groups: gracilis with 1 tunnel (GT-1), gracilis with 2 tunnels (GT-2), semitendinosus with 1 tunnel (ST-1), and semitendinosus with 2 tunnels (ST-2). First, specimens were tested for native anterior, posterior, and superior translations. Then, specimens were randomly assigned to 1 of the 4 CC reconstruction groups before undergoing the same testing, followed by cyclic loading and load to failure (LTF). Results: The GT-2 reconstruction demonstrated significantly less translation when compared with ST-2 in anterior (P = .024) and posterior (P = .048) directions. GT-1 and ST-2 both showed significantly less translation than ST-1 in anterior and superior directions (P < .001). All reconstructions demonstrated less superior translation compared with native testing, with GT-1 and ST-2 significantly less than ST-1 (P < .001). There were no significant differences for peak displacement and LTF between groups. Conclusion: Gracilis tendon grafts using a 1- or 2-tunnel technique for CC ligament reconstruction provided comparable translation, displacement, and LTF as corresponding semitendinosus grafts. Therefore, the gracilis tendon should be considered as a biomechanical equivalent graft choice for the reconstruction of the CC ligament complex. Clinical Relevance: In a cadaveric model, the gracilis tendon demonstrated adequate fixation with minimal translation in CC ligament reconstruction while utilizing smaller diameter bone tunnels, which may help minimize the risk of complications such as loss of reduction and fracture.

Arthroscopically Assisted Double-Loop Suture Repair for Acute Acromioclavicular Joint Disruption

The surgical management of acute high-grade acromioclavicular (AC) joint (ACJ) injuries has evolved during the last decades. Numerous surgical techniques exist and recently arthroscopically assisted or all endoscopic techniques have gained popularity due to certain advantages. The goals of the new anatomic coracoclavicular ligament reconstruction techniques are to achieve anatomic reduction of the ACJ to allow and facilitate primary healing of AC and coracoclavicular (CC) ligaments, and also to minimize the risk of associated complications. We regularly use the open repair with double-loop sutures for the acute ACJ disruption, as described by Dimakopoulos et al. at 2006. In this surgical technique article, we present the arthroscopically assisted technique for the double-loop suture repair.

Truly anatomic coracoclavicular ligament reconstruction with 2 EndoButton devices for acute Rockwood type V acromioclavicular joint dislocations: 5-year findings.

To date, mid-term clinical and radiologic outcomes of treatment for acute Rockwood type V acromioclavicular (AC) joint dislocations using 2 EndoButton devices (Smith & Nephew, Andover, MA, USA) have not been reported in the literature. We reviewed 25 patients (15 men and 10 women) with acute AC joint separations who were treated with truly anatomic coracoclavicular ligament reconstruction using 2 EndoButton devices between May 2013 and October 2015. Clinical assessments consisted of the visual analog scale score and the Constant score. Radiologic evaluation was achieved by measuring the coracoclavicular distance and AC distance. Previously, this same patient cohort was reviewed after 2 years of follow-up using similar methods. All 25 patients were available for mid-term follow-up 5 years after the operation. The mean duration of follow-up was 76 ± 7 months (range, 66-90 months). Of the patients, 23 (92%) continued to be satisfied or very satisfied with the treatment results. The visual analog scale score and Constant score improved significantly when compared with the baseline scores (0 ± 0 and 96 ± 3, respectively, at 5-year follow-up vs. 5 ± 1 and 45 ± 6, respectively, postoperatively) and remained essentially unchanged when compared with the 2-year follow-up data (0 ± 0 and 96 ± 3, respectively, at 5-year follow-up vs. 0 ± 1 and 95 ± 3, respectively, at 2-year follow-up). On the 5-year radiographs, 3 patients (12%) demonstrated loss of reduction and 5 patients (20%) had calcifications noted. There was, however, no significant difference in clinical outcomes or patient satisfaction when comparing patients with radiographically abnormal findings vs. patients with anatomic reduction. Truly anatomic coracoclavicular ligament reconstruction using 2 EndoButton devices results in satisfactory functional outcomes at 5 years postoperatively. In contrast to baseline, all cases improved significantly.

Comparison of Locking Plate Fixation and Coracoclavicular Ligament Reconstruction for Neer Type 2B Distal Clavicle Fractures.

Background:There remains no consensus regarding which repair technique provides the most optimal results for unstable distal clavicle fractures.Purpose:To compare radiologic and clinical outcomes between locking plate fixation and anatomic coracoclavicular (CC) ligament reconstruction for patients with unstable distal clavicle fractures.Study Design:Cohort study; Level of evidence, 3.Methods:The study included 41 patients with Neer type 2B distal clavicle fracture. In group A (n = 15), patients were treated using CC ligament reconstruction with autologous palmaris longus tendon, artificial tape, and Steinmann pin fixation; in group B (n = 26), patients were treated using anatomic locking plate fixation. All patients had a minimum 2 years of follow-up. CC distance and arthrosis of the acromioclavicular joint were assessed radiographically. Clinical outcomes—including range of motion, visual analog scale for pain, American Shoulder and Elbow Surgeons rating scale, and Constant score—were compared between the groups using the paired Student t test and Fisher exact test.Results:Bone union was attained in all patients. In both groups, the CC distance decreased significantly from presurgery to final follow-up: group A, from 16.25 ± 4.75 to 7.66 ± 2.61 mm (P < .001); group B, from 17.3 ± 4.07 to 9.33 ± 2.01 mm (P < .001). The final CC distance was significantly greater in group B (7.66 vs 9.33 mm in groups A and B, respectively; P = .028). Osteoarthritis of the acromioclavicular joint occurred in 13 of 41 patients (3 in group A and 10 in group B). At final follow-up, there was no statistical significance between the groups in range of motion, and clinical outcome scores were satisfactory in both groups, with no statistical difference between them.Conclusion:Anatomic locking plate and anatomic reconstruction of the CC ligament showed good clinical results, so both techniques can be considered reliable for restoring stability. However, CC ligament reconstruction had better CC distance on radiologic assessment and did not require removal surgery, so it may be the preferable surgical option to treat unstable distal clavicle fractures (Neer type 2B).

Anatomic Acromioclavicular Joint Reconstruction with and without Acromioclavicular Ligament Reconstruction: A Comparative Biomechanical Study.

The purpose of this study was to determine if adding a reconstructed superior acromioclavicular (AC) joint ligament adds significant biomechanical stability to the AC joint over anatomic coracoclavicular (CC) ligament reconstruction alone. Fourteen cadaver shoulders were used for the comparison of biomechanical stability among the anatomic CC ligament reconstruction alone, CC and AC ligament reconstruction, and the intact groups by measuring the displacement under cyclic loads. A load to failure test was then performed in the vertical direction at a loading rate of 2 mm /sec to determine surgical-repair joints' tolerance to the maximum failure load. The average peak-to-peak displacement induced by cyclic load in the sagittal axis and vertical axis direction was not significantly different between CC ligament reconstruction, CC and AC ligament reconstruction, and intact groups. The maximum failure load for the CC reconstruction (224.9 ± 91.8 N (Mean ± SEM)) was lower than CC/AC reconstruction groups (326.2 ± 123.3 N). The CC/AC reconstruction group failed at a significantly higher load (t test, p = 0.016) than the CC reconstruction group. CC/AC reconstruction surgical technique yielded a better shoulder stability than CC ligament alone reconstruction that may better maintain reduction of the AC joint.Level of Evidence: Level II.

Functional outcome study of anatomical coraco-clavicular and acromio-clavicular ligament reconstruction for chronic unstable acromio-clavicular joint dislocations: A prospective mid-term follow up study

The Acromioclavicular joint represents the link between the clavicle and scapula, which is responsible for synchronized dynamics of the shoulder girdle. Traumatic injuries to acromioclavicular joint (AC joint) are commonly sustained by contact-sports athletes in high impact collisions or falls. Rockwood classified these injuries into types I through VI. Type I to type III injuries are treated conservatively and type IV -VI injuries require surgical management. Injuries of grade III - V require reconstruction of AC and CC ligaments. We present a surgical technique involving harvesting of semintendinosus autograft from hamstrings and using it to anatomically reconstruct the conoid and trapezoid portions of the coraco-clavicular ligament and the superior acromio-clavicular ligament/capsule. This technique is beneficial because it provides both horizontal and vertical stability. The purpose of our study was to find out the functional outcome of the procedure performed in mid-term follow-up. In our study the result was good functional outcome at 5 year follow up and subsequent followups provided proper placement of clavicular and acromian tunnels at the time of surgery.

Mid-Term Outcomes of Arthroscopically-Assisted Anatomic Coracoclavicular Ligament Reconstruction Using Tendon Allograft for High-Grade Acromioclavicular Joint Dislocations

The purposes of this study were to assess clinical and radiographic outcomes of arthroscopically-assisted, anatomic coracoclavicular ligament reconstruction using tendon allograft (AA-ACCR) for the treatment of Rockwood type III-V injuries at minimum 2-year follow-up and to perform subgroup analyses of clinical and radiographic outcomes for acute versus chronic and type III versus type IV-V injuries. In this retrospective study of prospectively collected data, patients who underwent primary AA-ACCR for the treatment of type III-V dislocations and had minimum 2-year follow-up were included. Preoperative and postoperative patient-reported outcome scores (PROs) were collected, including American Shoulder and Elbow Surgeons score, Single Numeric Assessment Evaluation score, Short Form-12 Physical Component Summary, Quick Disabilities of the Arm Shoulder and Hand score, and patient satisfaction. Preoperative and postoperative coracoclavicular distance (CCD) was obtained. PROs and CCD were reported for the total cohort and for the subgroups. Complication and revision rates were demonstrated. In total, 102 patients (10 women, 92 men) with a mean age of 45.0 years (range, 18-73 years) were included. There were 13 complications (12.7%) resulting in revision surgery. After exclusion of revised patients, PROs were available for 69 (77.5%). At mean follow-up of 4.7 years (range, 2.0-12.8 years), all PROs improved significantly (P < .001). Median patient satisfaction was 9.0 (interquartile range, 8.0-10.0). Median preoperative to postoperative CCD decreased significantly (P < .001). Subgroup analyses revealed significant improvements in all PROs and CCD from preoperative to postoperative for both acute and chronic, and type III and type IV-V dislocations (P < .05) with no significant differences in postoperative PROs and satisfaction between (P > .05). AA-ACCR for high-grade acromioclavicular joint injuries resulted in high postoperative PROs and patient satisfaction with significant improvements from before to after surgery in those who did not undergo revision surgery. Furthermore, subgroup analyses revealed that acute and chronic, and type III and type IV-V injuries benefitted similarly from AA-ACCR. Level IV; therapeutic case series.

Anatomic reconstruction of the coracoclavicular and acromioclavicular ligaments with semitendinosus tendon graft for the treatment of chronic acromioclavicular joint dislocation provides good clinical and radiological results.

To evaluate clinical and radiographic outcomes of anatomical reconstruction of the coracoclavicular and acromioclavicular ligaments with single-strand semitendinosus tendon graft for the treatment of chronic acromioclavicular joint dislocation. Patients affected by chronic type III-V acromioclavicular joint dislocations were included. Exclusion criteria were: age under 18years, concomitant rotator cuff tears, previous surgery to the same shoulder, degenerative changes of the glenohumeral joint, infections, neurologic diseases, patients with a previous history of ligament reconstruction procedures that had required harvesting of the semitendinosus tendon from the ipsilateral or contralateral knee. All patients underwent the same surgical technique and rehabilitation. Primary outcome was the normalized Constant score. Secondary outcomes were: DASH score, radiographic evaluation of loss of reduction and acromioclavicular joint osteoarthritis. Thirty patients with a mean age of 28.9 ± 8.3years were included. Mean time to surgery was 12.8 ± 10months. Mean follow-up was 28.1 ± 2.4months (range: 24-32). Comparison between pre- and postoperative functional scores showed significant clinical improvement (p < 0.001). Time to surgery was independently associated with a poorer Constant score (p < 0.0001). On radiographs, 4 patients (13.3%) showed asymptomatic partial loss of reduction. Anatomic reconstruction of coracoclavicular and acromioclavicular ligaments using a semitendinosus tendon graft for the treatment of chronic acromioclavicular joint dislocation provided good clinical and radiological results at minimum 2-year follow-up. Level III.

Minimum 10-Year Outcomes After Revision Anatomic Coracoclavicular Ligament Reconstruction for Acromioclavicular Joint Instability.

Background:Revision surgery in cases of previously failed primary acromioclavicular (AC) joint stabilization remains challenging mainly because of anatomic alterations or technical difficulties. However, anatomic coracoclavicular ligament reconstruction (ACCR) has been shown to achieve encouraging biomechanical, clinical, and radiographic short-term to midterm results.Purpose:To evaluate the clinical and radiographic long-term outcomes of patients undergoing revision ACCR after failed operative treatment for type III through V AC joint injuries with a minimum 10-year follow-up.Study Design:Case series; Level of evidence, 4.Methods:A retrospective chart review was performed on prospectively collected data within an institutional shoulder registry. Patients who underwent revision ACCR for type III through V AC joint injuries between January 2003 and December 2009 were analyzed. Clinical outcome measures included the American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test (SST), and Single Assessment Numeric Evaluation (SANE). The coracoclavicular distance (CCD) was measured for radiographic analysis immediately postoperatively and at last postoperative follow-up.Results:A total of 8 patients with a mean age at the time of surgery of 44.6 ± 10.6 years and a mean follow-up of 135.0 ± 17.4 months (range, 120-167 months) were eligible for inclusion in the study. The time from initial AC joint stabilization until revision surgery was 10.2 ± 12.4 months (range, 0.5-36 months); 62.5% of the patients had undergone more than 2 previous AC joint surgical procedures. The ASES score improved from 43.9 ± 22.4 preoperatively to 80.6 ± 28.8 postoperatively (P = .012), the SST score improved from 4.4 ± 3.6 preoperatively to 11.0 ± 2.2 postoperatively (P = .017), and the SANE score improved from 31.4 ± 27.3 preoperatively to 86.9 ± 24.1 postoperatively (P = .018) at final follow-up. There was no significant difference in the CCD (P = .08) between the first (7.6 ± 3.0 mm) and final (10.6 ± 2.8 mm) radiographic follow-up (mean, 50.5 ± 32.7 months [range, 18-98 months]).Conclusion:Patients undergoing revision ACCR after failed operative treatment for type III through V AC joint injuries maintained significant improvement in clinical outcomes at a minimum 10-year follow-up.

Conversion to anatomic coracoclavicular ligament reconstruction (ACCR) shows similar clinical outcomes compared to successful non-operative treatment in chronic primary type III to V acromioclavicular joint injuries.

To compare the clinical outcomes of patients who underwent successful nonoperative treatment for type III-V acromioclavicular joint (ACJ) injuries to those who eventually required conversion to anatomic coracoclavicular ligament reconstruction (ACCR)at a minimum 5-year follow-up. Patients with primary, chronic type III-V ACJ injuries who either underwentsuccessful conservative treatment or conversion to ACCR after failing a trail of conservative management between 2003 and 2014 with a minimum 5-year follow-up were included in the study. Clinical outcome measures comprised the American Shoulder and Elbow Surgeons (ASES) and Simple Shoulder Test (SST) score, collected preoperatively and at final visit for the ACCR group. Outcome scores for patients with successful conservative treatment were only collected at final visit. A Self- Assessment Numeric Evaluation (SANE) score was obtained at terminal follow-up for both groups. Twenty-twopatients (mean age: 40.1 ± 15.6 years) with successful nonoperative treatment and twenty-one patients (mean age: 43.6 ± 12.0 years) who required conversion to ACCR were included in the study. At final follow-up, patients with successful non-operative treatment achieved similar ASES (93.0±12.0NonOPvs. 86.1±16.8ACCR), SST (11.2±1.4NonOPvs. 10.7±2.0ACCR) and SANE scores (80.9±19.7NonOPvs. 90.5±14.7ACCR) compared to those who were converted to ACCR. Additionally, patients who underwent conversion to ACCR showed significant improvement in ASES (49.8±18.1prevs. 86.1±16.8post; Δ36.3±19.7) and SST scores (6.5±3.2prevs. 10.7±2.0post; Δ4.2±4.0) from pre- to postoperative. At a minimum 5-year follow-up, patients with successful non-operative treatment for type III-V ACJ injuries achieved similar clinical outcomes compared to those who were converted to ACCR. In patients with chronic severe ACJ dislocation a trial of conservative treatment may be attempted, astime from injuryto eventual conversion to ACCR had no significant influence on postoperative clinical outcomes. Level IV.

Anatomic coracoclavicular ligament reconstruction (ACCR) using free tendon allograft is effective for chronic acromioclavicular joint injuries at mid-term follow-up.

To evaluate the clinical and radiographic outcomes of patients undergoing anatomic coracoclavicular ligament reconstruction (ACCR) using free tendon allografts for the treatment of chronic acromioclavicular joint (ACJ) injuries with a minimum 1-year follow-up. Patients who underwent ACCR for chronic ACJ injuries between 2003 and 2017 were analyzed. Clinical outcome measures included American Shoulder and Elbow Surgeons (ASES), Constant-Murley (CM), Simple Shoulder Test (SST), and Single Assessment Numerical Evaluation (SANE) scores. Radiographic loss of reduction during follow-up was evaluated by calculating the difference (mm) in the coracoclavicular distance (CCD) of the involved side immediately postoperatively and at terminal follow-up. Forty-two patients (mean age: 42.7 ± 12.8years) were included in the study with an average follow-up of 3.8 ± 3.1years (range: 1.1-11.5years). Patients achieved significant improvement in ASES (50.2 ± 20.1 pre to 85.2 ± 16.3 post), CM (60.2 ± 18.5 pre to 88.2 ± 9.1 post), SST (6.1 ± 3.2 pre to 9.5 ± 3.7 post), and SANE (24.0 ± 25.7 pre to 89.0 ± 12.7 post) scores (P < 0.001, respectively). There were no significant differences in functional improvement when comparing type III and V injuries (n.s.). Mean increase in CCD of the involved side from immediately postoperative to final radiographic follow-up was 4.1 ± 3.9mm, with no significant correlation to clinical outcomes scores. Complications occurred in 33.3% of cases, with postoperative heterotopic ossification being most frequent (14.3%). Patients undergoing ACCR using free tendon allografts for chronic ACJ injuries achieved significant improvement in shoulder function at a mean follow-up of 3.8years. No correlation was observed between the amount of loss of reduction and clinical outcome scores. Free tendon allografts may be a reliable alternative to autografts in the treatment of chronic ACJ dislocations. IV.