Chronic Acromioclavicular Joint Research Articles

Concomitant Glenohumeral Pathologies in Patients with Acromioclavicular Joint Dislocations: How Do Acute and Chronic Instabilities Differ?

Background: Concomitant glenohumeral pathologies may be present in patients with acromioclavicular joint (ACJ) dislocations. This study aims to record and compare the prevalence and treatment of CGP in cases with acute and chronic ACJ dislocations. Methods: This retrospective cross-sectional binational, bicentric study included patients that underwent arthroscopically assisted stabilization for acute (group A) and chronic (group C) ACJ dislocations. Intraoperatively, CGPs and eventual treatments (debridement and reconstructive measures) were recorded. Results: The study included 540 patients (87% men; mean age 39.4 years), with 410 (75.9%) patients in group A and 130 (24.1%) in group C. Patients in group C were older (p < 0.001). The CGP prevalence was 30.7%, without a difference between groups A and C (p = 0.19). Supraspinatus tendon (SSP) and labral lesions were most common. Within group C, CGPs were more prevalent in surgery-naïve patients (p = 0.002). Among 49 patients with previous surgical treatment, CGPs tended to be more common in patients with prior open surgery than arthroscopically assisted surgery (p = 0.392). Increased CGP prevalence was associated with higher age (r = 0.97; p = 0.004) (up to 63% in the oldest age group, but also 17% for youngest age group) and higher in cases with Rockwood type-IIIB injuries compared to type-V injuries (p = 0.028), but type-IIIB injuries included more group C cases (p < 0.001). The most frequently found CGPs were treated by debridement rather than reconstructive interventions (SSP and labrum: p < 0.001, respectively). Conclusions: This study shows that one in three patients with ACJ instabilities has a CGP, especially elderly patients. Most of the CGPs were treated by debridement rather than constructive interventions.

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.

Functional reconstruction of chronic acromioclavicular joint separation using a double suture technique combined with semitendinosus autograft.

We present the functional and clinical results of a combined surgical technique that functionally restores chronic Acromioclavicular Joint Instability (AJI). The method combines a double-looped suture fixation augmented with a semitendinosus autograft. Between 2017 and 2021, 15 patients were treated using the surgical technique. All patients suffered an Acromioclavicular Joint Separation that remained untreated for at least 6 (6-16) weeks after the initial injury. Four Ethibond sutures were passed below the coracoid process and through a 4.5 drill hole in the clavicle. The sutures provided adequate horizontal and vertical reduction and stabilization of the clavicle. A semitendinosus autograft was passed below the coracoid process and looped around the clavicle. The remaining graft limbs were used to reconstruct the acromioclavicular capsule. Patients were radiologically evaluated with bilateral anteroposterior (AP), Zanca, and Alexander views. The clinical evaluation was based on the Acromioclavicular Joint Instability Score and the Constant-Murley Score. The mean follow-up period was 31.2months (17-61). The mean last ACJIS and CMS scores were 96 (90-100) and 97.67 (87-100), respectively. Reduction of the clavicle was radiologically confirmed in all cases throughout the follow-up period. AC arthritis was reported in 1 case without associated clinical symptoms. No significant complications were reported, and all patients returned to the pre-injury activity level. The presented functional reconstruction of the AC joint disruption in chronic cases is an effective and secure method with low complication rates and good clinical results. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Coracoclavicular and acromioclavicular ligament reconstruction with a double-bundle semitendinosus autograft and cortical buttons for chronic acromioclavicular joint dislocations: clinical and imaging outcomes

BackgroundThere are few clinical and radiographic studies of coracoclavicular (CC) ligament reconstruction in chronic acromioclavicular (AC) joint dislocation. Additionally, reported AC joint reduction rates vary. HypothesisArthroscopically assisted double-bundle semitendinosus tendon autografts with CC and AC ligament reconstruction for AC joint reconstruction provide AC joint stability and improved function at the final visit. MethodsIn this retrospective study of prospectively collected data, 21 patients surgically treated for chronic AC joint dislocation (Rockwood III–V) were assessed clinically and radiographically preoperatively, and at day 1, 3 months, 12 months, and at a final visit (> 24 months) postoperatively. Clinical assessments included Constant and ASES scores. The CC vertical distance (CCD) on the affected and unaffected sides [CCD ratio (%)] on the anterosuperior view were measured. AC joint vertical reduction loss was defined as an increase in the CCD ratio of > 25%. Horizontal AC joint instability was evaluated on axillary views. Pearsons’ correlation coefficients were generated to examine the relationships among postoperative clinical scores, CCD ratio, interval from injury to surgery, and age at the time of surgery. ResultsTwenty-one shoulders in 21 patients (mean age, 40.0 years at the time of surgery; 16 men, 5 women) were evaluated with a mean 31.7-month follow-up period. The mean Constant scores, ASES scores, and CCD ratios significantly improved from preoperatively to the final visit [57.4 ± 10.1, 49.1 ± 12.1, 101.6 ± 64.1 preoperatively; 89.6 ± 5.3, 96.5 ± 4.2, 9.9 ± 34.5 at the final visit, respectively (P < 0.001 for all)]. Vertical AC and horizontal AC joint instability were observed in four shoulders (19.0%) and in one shoulder (4.8%), respectively. However, there was no significant correlation between the increase in CCD and clinical scores at the final visit (Constant score; r = 0.179, P = .438: ASES score; r = -0.260, P = .256) or the interval from injury to surgery (r = 0.099, P = .669) or age at the time of surgery (r = 0.019, P = .935). No clinical complications were associated with clinical symptoms. ConclusionsPatients who underwent the index procedure achieved significant improvement in shoulder function without complications related clinical symptom after a mean follow-up interval of 31.7 months. In contrast, the rates of total ACJ instability in the vertical and horizontal planes were unsatisfactory but compatible with those in previous studies.

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.

Acromioclavicular Joint Reconstruction with Modified Weaver–Dunn Operation Versus Hamstring Tendon Autograft Comparative Study

Abstract Background: The dislocation of the acromioclavicular joint (ACJ) is recognized as one of the most frequently occurring injuries most often after either direct or indirect force is applied to the affected shoulder. The best method of AC reconstruction is still controversial. Modified Weaver–Dunn operation (WD) is one of the popular operations. Recent ACJ reconstruction methods include the usage of the gracilis, semitendinosus auto grafts, synthetic grafts, end buttons, nonabsorbable sutures, suture anchors, and tight-rope system. Aim and Objectives: Clinical and radiological results of hamstring autograft versus modified WD operation for reconsrtuction of coracoclavicular and acromioclavicular ligaments. Patients and Methods: This prospective study was carried out at the orthopedic department of Benha University Hospital carried out on 30 cases with chronic ACJ dislocation. They divided into two groups. The modified WD technique was employed on 15 patients, whereas an autogenous semitendinosus tendon graft was used on the other 15. There was a comparison of radiographs taken before and after surgery. Results: Mean surgical time and coracoclavicular (CC) distance differed statistically between groups. Neither demographic data nor postoperative information (pain, range of motion, and postop) showed a difference of statistical significance between the groups. Constant score and post operative American Shoulder and Elbow Surgeons Score (ASES) and post operative complications show no statistically significant difference. Conclusion: Both AC and CC reconstruction by hamstring tendon autograft showed good-to-excellent outcomes with no implant-related complications as some other treatment methods, also more anatomical procedure more than WD operation with better biomechanical vertical and horizontal stability.

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

EXTERNAL FIXATION COMBINED WITH A MODIFIED MINIMALLY INVASIVE AC JOINT RECONSTRUCTION SYSTEM IN ACUTE AND CHRONIC ACROMIOCLAVICULAR DISLOCATIONS

Background: Acromioclavicular joint (ACJ) dislocations are among one of the most common injuries of the shoulder and still a challenge for surgeons. We propose a technique that combines the advantages of external fixation (to obtain a stable reduction of ACJ) and a modified suspension device system (for minimally invasive ACJ reconstruction) in acute dislocations. We tend to add associate augmentation of autologous semitendinosus graft to supply a biological reconstruction of the coracoclavicular (CC) ligaments in chronic dislocations. Material and Methods: We enrolled 8 patients, 6 with acute and 2 with chronic injuries. Inclusion criteria were the following: types IV, V, and VI ACJ dislocations; type III ACJ dislocations in high-demand patients. Exclusion criteria were the following: asymptomatic chronic ACJ dislocation without functional impairment, previous coracoid or clavicle fracture, nonparticipating patients, alcohol abusers, previous infection, and neurological problems. The external fixator was removed at 40 days after surgery and patients were followed up clinically (through Constant Score and Simple Shoulder Test Questionnaires) and radiologically for the first three months, at six months and one year after surgery. Results: In all cases, radiographic ACJ reduction was maintained at a minimum one-year follow-up. Steel wire breakage occurred in one patient but the retained tip in the clavicle was asymptomatic; we report no further complications. Shoulder active and passive range of motion was painless in all patients; the Constant score (CS) was 85/100 and the Simple Shoulder Test (SST) score was 9/10 on average at one year of follow-up. Conclusions: Our technique demonstrated stable joint reduction and good functional outcomes at one-year follow-up and it seems to be promising, but more clinical and biomechanical studies are required to confirm these encouraging results.

[Minimally Invasive Techniques for the Treatment of Acute and Chronic Acromioclavicular Joint Instabilities].

Acromioclavicular joint instabilities are one of the most common injuries of the shoulder girdle. Diagnostic measures include the vertical and horizontal components of instability. The main goals of treatment include pain reduction, joint stabilization, and return to physical activity. For operative treatment, there are numerous techniques available. Recently, minimally-invasive techniques were developed and showed equal results as with open approach. These procedures facilitate simultaneous treatment of concomitant shoulder lesions and reduce soft tissue trauma as well as the risk of infection. This article presents an overview of such minimally-invasive techniques for both acute and chronic instabilities. Both techniques address the aspect of horizontal instability, which was found to compromise clinical results. For an acute injury, we describe the use of a low-profile button system combined with an additional acromioclavicular cerclage. In the chronic setting with a bidirectional (vertical and horizontal) instability, a free tendon graft combined with a single TightRope augmentation is recommended.

Management of Acromioclavicular Injuries - Current Concepts.

Treatment of a patient with acromioclavicular joint (ACJ) injury remains challenging for orthopedic surgeons. To date, there is debate over the optimal management of ACJ injuries. This review provides an overview of assessment, treatment, and future perspectives for the treatment of and research into ACJ. A scoping literature review was performed. The search was built including the following terms: acromioclavicular joint injuries or dislocation, and pathophysiology, etiology, anatomy, treatment, and trauma mechanism. The papers with evidence levels 1-3 were included in the current narrative review. A total of 2242 potential relevant studies were identified in the searches. After removal of duplicates, 432 studies were screened on their titles and abstracts, resulting in 35 studies being included in the review, based on the eligibility criteria. The management of acute and chronic ACJ injuries is not clarified in the current literature. However, there is currently insufficient high-level evidence for the overall treatment options for ACJ injuries. If surgical intervention is decided upon in consultation with the patient, the complications may not outweigh the benefits. The multitude of existing techniques is indicative of the uncertainty surrounding this issue, and no gold standard has yet been established for treatment methods. An ideal classification would include not only vertical and horizontal instability, but also the severity of kinematic alterations of the shoulder complex. This indicates the need for a new and improved diagnostic tool for the classification of ACJ injuries.

Implant-dependent behavior of tunnel widening and clavicular button migration after arthroscopic-assisted treatment of acromioclavicular joint instabilities.

Despite ongoing discussions for the previous few decades, there is still no consensus regarding the optimal surgical technique for acromioclavicular joint instabilities. The purpose of this study was to determine the impact of various implant materials following arthroscopically assisted stabilization of acromioclavicular joint instabilities on tunnel widening and implant migration. We hypothesized an implant-dependent behavior for tunnel widening and implant migration with differences when comparing acute and chronic acromioclavicular joint instabilities. This study compared 105 patients with acromioclavicular joint instabilities that were managed operatively with coracoclavicular double button constructs. Two of the groups containing acute cases were treated with either a double button construct with a wire (TR) or a tape (D) as a central pillar. The two groups with chronic cases were either treated with a wire (T+) or tape D+ as a central pillar and additional hamstring tendon augmentation (+). One central transclavicular-transcoracoidal drill channel was made in the acute cases, while additional medial and lateral drill channels to augment the central pillar with the hamstring tendon were made. The central drill channel in all cases and the medial/lateral drill channels in chronic cases were subsequently radiologically analyzed immediately postoperatively and at follow-up. Following this, additional radiological analysis of the implant migration of the clavicular button took place. All groups showed significant tunnel widening of the central drill channel at follow-up (p ≤ 0.001). The TR+ technique demonstrated significant widening in both the medial (p ≤ 0.001) and lateral (p ≤ 0.001) drill channels. The D and D+ group displayed significant higher rates of clavicular button migration to a cortical and intraosseous level (p ≤ 0.002). Tunnel widening and implant migration following arthroscopically assisted management of acromioclavicular joint instabilities are dependent on the chosen implant. The stable tape showed a significantly increased degree of tunnel widening with respect to the central drill channel in comparison with the wire. In contrast, a higher degree of load capacity of the tape ultimately favors a protected intraosseous graft healing for chronic cases, which leads to less tunnel widening of the medial and lateral drill channel. Finally, the D/D+ implant groups showed higher rates of implant migration due to lower contact surface area of the implant at the upper clavicular cortex.

Coracoid process transfer and distal clavicle resection for chronic acromioclavicular separation.

Dewar's procedure for transferring the coracoid process with the short head of biceps and coracobrachialis was reported in 1965 for treatment of both acute and chronic acromioclavicular (AC) joint separation, but little contemporary literature exists around the procedure. We report the clinical results of coracoid process transfer with excision of the lateral end of the clavicle for chronic AC joint separation. Fifty-one patients (39 men and 12 women, mean age 46±16 years) were included in the study. Clinical outcomes were evaluated using the American Shoulder and Elbow Surgeons and the Japanese Orthopaedic Association scores, as well as by measuring active range of motion in the shoulder, before-after (minimum follow-up time of 24 months [27±3 months]) surgery. Plain radiographs were used to examine stability of the AC joint and bone union of the graft. The mean American Shoulder and Elbow Surgeons and Japanese Orthopaedic Association scores increased (from 61±14 to 91±6, and from 54±9 to 89±8, respectively) at the time of final follow-up. There were no differences in active elevation and external rotation between before-after operation. Six patients whose grafts were fractured or displaced showed complete or partial loss of reduction of the AC joint. By transferring the coracoid process, the AC joint regained stability after chronic joint separation. Although potential complications related to the graft still need to be addressed, Dewar's procedure and lateral clavicle resection could be a reliable treatment of chronic AC joint separation.

Anatomic Acromioclavicular Joint Reconstruction Using Semitendinosus Graft with Internal Bracing in Chronic Acromioclavicular Joint Dislocation: Case Series

Introduction: Acromioclavicular joint dislocations represent a frequent condition, affecting a very specific and generally active population and accounting for around 9% of all shoulder injuries. Case Presentation: We present a series of patients who underwent AC Joint reconstruction using Semitendinosus graft with internal bracing. The beach chair position is used for acromioclavicular reconstruction surgery. In this technique, we restore the anatomy, reconstruct the coracoclavicular ligament, and reinforced the acromioclavicular ligament. And it is reliable for chronic acromioclavicular joint injury. At final follow up we found excellent results with average pain score of 1.6, and average ROM of 160° of forward flexion and abduction, 70° of external rotation, and internal rotation level at T11. Postoperative function also showed great improvements with average ASES of 85 points, an average Constant Score of 89 points. This technique also achieved acceptable radiographic results, with an average coracoclavicular distance increase of 1.4 mm Discussion &amp; Conclusion: The loss of AC joint congruence with the Weaver Dunn procedure suggested that possibly the problem wasn’t only biological. This technique seems to be especially advantageous as it allows for an anatomic, biological, and minimally invasive procedure while avoiding some of the inconveniences described in other reports. Although demanding, it can be reproducibly performed arthroscopically, and good clinical outcomes should be expected.

Current concepts in acromioclavicular joint (AC) instability – a proposed treatment algorithm for acute and chronic AC-joint surgery

There exists a vast number of surgical treatment options for acromioclavicular (AC) joint injuries, and the current literature has yet to determine an equivocally superior treatment. AC joint repair has a long history and dates back to the beginning of the twentieth century. Since then, over 150 different techniques have been described, covering open and closed techniques. Low grade injuries such as Type I-II according to the modified Rockwood classification should be treated conservatively, while high-grade injuries (types IV-VI) may be indicated for operative treatment. However, controversy exists if operative treatment is superior to nonoperative treatment, especially in grade III injuries, as functional impairment due to scapular dyskinesia or chronic pain remains concerning following non-operative treatment. Patients with a stable AC joint without overriding of the clavicle and without significant scapular dysfunction (Type IIIA) may benefit from non-interventional approaches, in contrast to patients with overriding of the clavicle and therapy-resistant scapular dysfunction (Type IIIB). If these patients are considered non-responders to a conservative approach, an anatomic AC joint reconstruction using a hybrid technique should be considered. In chronic AC joint injuries, surgery is indicated after failed nonoperative treatment of 3 to 6 months. Anatomic AC joint reconstruction techniques along with biologic augmentation (e.g. Hybrid techniques, suture fixation) should be considered for chronic high-grade instabilities, accounting for the lack of intrinsic healing and scar-forming potential of the ligamentous tissue in the chronic setting. However, complication and clinical failure rates remain high, which may be a result of technical failures or persistent horizontal and rotational instability. Future research should focus on addressing horizontal and rotational instability, to restore native physiological and biomechanical properties of the AC joint.

Results of Surgical Treatment of Patients with Chronic Acromioclavicular Joint Dislocations

Relevance. Treatment of chronic acromioclavicular joint dislocations remains a controversial issue and ranges from conservative treatment to extensive reconstruction.&#x0D; Objective: to compare clinical and radiographic results of surgical treatment of patients with chronic acromioclavicular joint dislocation.&#x0D; Materials and Methods. A retrospective analysis of 41 patients with chronic acromioclavicular joint dislocation was performed (time from the injury was more than 3 weeks). The patients were divided into two groups: group I (19 patients, 46.3%), which underwent arthroscopically assisted dynamic type of acromioclavicular joint dislocation stabilization with acromioclavicular and coracoclavicular ligaments augmentation, and group II (22 patients, 53.7%), which underwent fixation of acromioclavicular joint dislocation with Hook-plate and acromioclavicular and coracoclavicular ligaments augmentation. The mean age at surgery was 34.1±11.2 years (range 18-70 years). Most of the patients were males – 36 patients (87.8%). Clinical outcomes were assessed using the Oxford Shoulder Score, Constant – Murley Score, and Acromioclavicular Joint Instability Scoring System.&#x0D; Results. The mean Oxford Shoulder score before surgical treatment was 31.5±7.7 points and 33.3±4.2 points (p=0.347), and at the final follow-up 46±2.6 points and 46.1±1.6 points – in group I and group II, respectively. The mean Constant – Murley score before surgical treatment was 68.9±12.4 points and 69.7±14.5 points (p=0.863), and at the final follow-up 94.2±7.7 points and 96.5±3.9 points (p=0.291). The mean Acromioclavicular Joint Instability Scoring System score before surgical treatment was 31.3±9.5 points and 25.1±8.2 points (p=0.087), and at the final follow-up 79.9±16.7 points and 75.7±9.1 points (p=0.422), respectively. Concomitant intra-articular injuries of the shoulder joint were diagnosed in 68.4% of patients; the most common injuries were SLAP injury and long head of biceps tendonitis. Complications of treatment were noted in both groups, but there were no complications that would require additional reconstructive.&#x0D; Conclusions. Arthroscopic assisted dynamic fixation techniques or open fixation techniques with a specialized plate in combination with the reconstruction of acromioclavicular ligaments and coracoclavicular ligaments by tendon autografts provides good long-term functional results.

Operational Result After Modified Weaver Dunn (W.D) Procedure In Chronic Acromio-Clavicular (A.C) Joint Disruption

Background: In orthopedic trauma acromioclavicular joint disruptions are among the most commonly faced injuries that could be due to sports or road traffic accidents. These are injuries in which treatment is always controversial especially in type III of Rockwood type. These injuries accounts for 12% of the total shoulder injuries with young male patients have predominance. Aim: To assess the operational result after acromioclavicular joint fixation with Modified Weaver Dunn procedure using tight roping technique with two endobuttons. Place and duration of study: Department of Orthopedic Surgery, Govt. Shahdrah Teaching Hospital Lahore and Lahore General Hospital Lahore for one year from 01st July 2019 to 30th June 2020. Methodology: This is a descriptive case series study of 10 patients in the combined settings of Department of Orthopedic Surgery Govt. Shahdrah Teaching Hospital Lahore and Lahore General Hospital Lahore. All the cases were operated by a single surgeon using Modified WD procedure with endo-buttons and tight roping technique and operational result was assessed by using Oxford shoulder scoring system (OSS), this system was used in pre-operative and post-operative settings and results were compared. SPSS version 23 &amp; paired t test was used for the analysis of results of all the patients in both pre and post-operative settings. Results: The patient’s average age was 34±2. Road traffic accidents and sports injuries to the shoulders were mechanism of injuries. In 70% of cases dominant side was involved. The significant p value is found in the pre and post-operative oxford shoulder score. Conclusion: There is a consequential improvement in OSS in all the patients. However small number of follow ups and lesser patients were the reasons of our limited study that need to be looked upon in near future. Keywords: Weaver Dunn (WD), Acromioclavicular (AC), Coraco-Clavicular ligaments (CC), Oxford shoulder score (OSS)

Arthroscopic-Assisted Acromioclavicular Joint Reconstruction.

There are many documented techniques for the surgical treatment of a chronic acromioclavicular (AC) joint reconstruction, but unfortunately, there is no gold standard. Treatment options include hook plates, allograft reconstruction, and suture fixation, among many others.This technique is an innovative method for looping the allograft around the coracoid and clavicle and using the hook plate for fixation. This avoids any drilling within the clavicle or coracoid, therefore decreasing the risk of fracture and ensuring the reduction of the AC joint.

Treatment of Acromioclavicular Joint Instability With a Tunnel-Free Reconstruction Technique

Acromioclavicular joint injuries are a common shoulder injury encountered by orthopaedic surgeons. Many different surgical techniques have been described for the operative treatment of these injuries with no single, clear gold standard technique on which surgeons agree. Among the most common complications after surgical management of acromioclavicular injuries are loss of reduction, infection, fracture of clavicle or coracoid, and need for reoperation. We propose an arthroscopic-assisted, tunnel-free surgical technique using a tibialis anterior allograft combined with a FiberTape Cerclage (Arthrex, Naples, FL) to manage both acute and chronic acromioclavicular joint injuries. No bony tunnels are drilled and no hardware is implanted, which should obviate the risk for subsequent bony failure through a fracture, nor require subsequent hardware removal. In addition, the combination of suspensory and allograft fixation should impart sufficient stability to maintain an adequate reduction even in the face of failure of one of the fixation methods.

Occult clavicle osteomyelitis caused by Cutibacterium acnes (C. acnes) after coracoclavicular ligament reconstruction: A case report and review of the literature.

IntroductionClavicle osteomyelitis is a rare, but serious complication following operative repair of acromioclavicular (AC) joint separations. Cutibacterium Acnes (C. acnes) is rarely a causative pathogen in clavicle osteomyelitis and diagnosis can be challenging due to the indolent nature of this organism.Case presentationA 45–50 year old female with a chronic AC joint separation underwent an open coracoclavicular reconstruction using semitendinosus allograft and FiberTape (Arthrex, Naples, FL). At the six month follow up, the patient complained of mild persistent pain. Imaging demonstrated widening of the medial suture tunnel with distal clavicle osteolysis, which was concerning for osteomyelitis. This was successfully treated with implant removal revision surgery and additional intravenous antibiotics. Cultures of the graft material were positive for C. acnes. The patient continued to have osteolysis of the distal left clavicle for a period of time despite resolution of osteomyelitis.DiscussionC. acnes osteomyelitis of the clavicle is difficult to diagnose because of its vague associated symptoms when implicated in infections. There are no known obvious predisposing factors for C. acnes clavicle osteomyelitis. Literature suggests management should include aggressive irrigation and debridement, removal of any hardware, and extended intravenous antibiotic administration.ConclusionC. acnes clavicular osteomyelitis is uncommon, thus established treatment guidelines have not yet been formed. Revision surgery to remove graft material, irrigate, and debride in addition to antibiotic treatment was successful for our patient. Additional pathologic manifestations of C. acnes infections could include continued clavicular erosion post-clearance of infection, although further investigation is necessary.

Arthroscopically-Assisted Technique for Anatomic Reconstruction of Chronic Acromio-Clavicular Joint Dislocations Using an Autologous Graft with AC Joint Augmentation Using Acromial Tunnels - Short Term Results

AC joint dislocation is a common lesion after a direct impact to the lateral shoulder or a fall over an outstretched arm. There are countless techniques available for the treatment of this type of lesion and if left untreated, this type of lesion can lead to persistent pain, loss of strength, and even shoulder dyskinesia in some cases. When treating this lesion in the chronic stage, a number of additional problems must be considered, such as the need for additional biological support.