Coracoclavicular Reconstruction Research Articles

Proximally Based Conjoined Tendon Transfer for Coracoclavicular Reconstruction in the Treatment of Acromioclavicular Dislocation

We report an alternative to the modified Weaver-Dunn technique that can achieve stable coracoclavicular reconstruction while avoiding sacrifice of the coracoacromial arch. The purpose of this study was to retrospectively analyze the functional outcomes and radiographic features of patients treated with coracoclavicular ligament reconstruction with use of a proximally based conjoined tendon transfer. The cases of thirty-eight patients with type-IV, type-V, and selected type-III acromioclavicular dislocations according to the Rockwood classification system, who were followed for an average follow-up of 38.7 months, were evaluated retrospectively. Transfer of the lateral half of the conjoined tendon to the distal aspect of the clavicle in a proximally based fashion, with additional coracoclavicular fixation, was performed in all patients. At the latest follow-up evaluation, radiographic analysis and the scores on the American Shoulder and Elbow Surgeons, Constant and Murley, and Simple Shoulder Test questionnaires were used to provide a final evaluation of shoulder function. The ability to return to work and the ability to return to sports were also recorded. At the time of final follow-up, the mean American Shoulder and Elbow Surgeons score was 91.4, with a mean pain score on the visual analog scale of 1.8, mean forward flexion of 148.2 degrees , and mean external rotation of 38.0 degrees . The mean Constant and Murley score was 90.6. The new number of positive answers on the Simple Shoulder Test was 10.9. The overall rate of satisfaction (an excellent or good result) was 89% (thirty-four patients). Thirty-five (92%) of the thirty-eight patients returned to their previous work, and thirty-two (84%) returned to their preinjury level of sports. The proximally based conjoined tendon transfer is a reliable treatment for a high-grade acromioclavicular dislocation. The lateral half of the conjoined tendon is a safe graft source with ample length, and this technique avoids sacrifice of the coracoacromial ligament.

견봉 쇄골 탈구의 봉합 나사못과 오구 견봉 인대 이전술을 이용한 오구 쇄골 인대 재건술

Purpose: This study examined the outcomes of reconstruction of the coracoclavicular ligaments with using two suture anchors and performing coracoacromial ligament transfer in patients with acromioclavicular dislocation. Material and methods: Forty patients with complete acromioclavicular dislocation were included in this study. According to the preoperative radiographs, 5 patients with AC dislocations were diagnosed as type III, 4 patients as type IV and 31 patients as type V. Two 3.5mm suture anchors with four strands of nonabsorbable sutures were separately placed on the anterolateral and posteromedial portion of the base of the coracoid process to stabilize the distal clavicle. The coracoacromial ligament was then transferred to the undersurface of the distal end of the clavicle for augmentation. Results: At a mean follow-up of 28 months, the average Constant score improved to 97 points. All the patients returned to normal life at an average of 3.2 months postoperatively. At the last follow-up, 37 patients achieved anatomical reduction and three patients showed complete redislocation. However, the clinical results of the patients with redislocation were satisfactory. Conclusion: Anatomical coracoclavicular reconstruction using two suture anchors and coracoacromial ligament transfer for treating complete acromioclavicular dislocation is a safe, effective procedure for restoring a physiologically stable acromioclavicular joint.

Proximally Based Conjoined Tendon Transfer for Coracoclavicular Reconstruction in the Treatment of Acromioclavicular Dislocation

We report an alternative to the modified Weaver-Dunn technique that can achieve stable coracoclavicular reconstruction while avoiding sacrifice of the coracoacromial arch. The purpose of this study was to retrospectively analyze the functional outcomes and radiographic features of patients treated with coracoclavicular ligament reconstruction with use of a proximally based conjoined tendon transfer. The cases of thirty-eight patients with type-IV, type-V, and selected type-III acromioclavicular dislocations according to the Rockwood classification system, who were followed for an average follow-up of 38.7 months, were evaluated retrospectively. Transfer of the lateral half of the conjoined tendon to the distal aspect of the clavicle in a proximally based fashion, with additional coracoclavicular fixation, was performed in all patients. At the latest follow-up evaluation, radiographic analysis and the scores on the American Shoulder and Elbow Surgeons, Constant and Murley, and Simple Shoulder Test questionnaires were used to provide a final evaluation of shoulder function. The ability to return to work and the ability to return to sports were also recorded. At the time of final follow-up, the mean American Shoulder and Elbow Surgeons score was 91.4, with a mean pain score on the visual analog scale of 1.8, mean forward flexion of 148.2 degrees , and mean external rotation of 38.0 degrees . The mean Constant and Murley score was 90.6. The new number of positive answers on the Simple Shoulder Test was 10.9. The overall rate of satisfaction (an excellent or good result) was 89% (thirty-four patients). Thirty-five (92%) of the thirty-eight patients returned to their previous work, and thirty-two (84%) returned to their preinjury level of sports. The proximally based conjoined tendon transfer is a reliable treatment for a high-grade acromioclavicular dislocation. The lateral half of the conjoined tendon is a safe graft source with ample length, and this technique avoids sacrifice of the coracoacromial ligament.

Proximally Based Conjoined Tendon Transfer for Coracoclavicular Reconstruction in the Treatment of Acromioclavicular Dislocation

Proximally Based Conjoined Tendon Transfer for Coracoclavicular Reconstruction in the Treatment of Acromioclavicular Dislocation

Acromioclavicular reconstruction using autogenous semitendinosus tendon graft: Results of revision surgery in chronic cases

Revision surgery of acromioclavicular dislocation is challenging owing to the altered anatomic relationships and the lack of stabilizing structures. In this study, an autogenous semitendinosus tendon graft was used for revision acromioclavicular stabilization, aiming at anatomic coracoclavicular reconstruction, as these patients had previously undergone a Weaver-Dunn procedure, which failed. Twelve patients were followed up clinically and radiographically for a mean of 49.5 months. The primary diagnosis was acromioclavicular joint dislocation Rockwood type III in 6, type IV in 4, and type V in 2 cases. At follow-up, the mean Constant score averaged 76.4 points. Pain relief was statistically significant (P < .01). Radiologic coracoclavicular distance and posterior displacement of the lateral clavicle in the Rockwood type IV cases decreased significantly (P < .01). We conclude that with this new technique of autogenous semitendinosus tendon graft replicating the anatomic ligamentous properties, good to excellent results can be achieved in revision cases of acromioclavicular reconstruction.

Primary and Revision Acromioclavicular Joint Reconstruction

Injury of the acromioclavicular (AC) joint can occur as the result of direct or indirect trauma. The treatment of these injuries has remained controversial. The first reported surgical procedure for internal fixation of AC dislocation was performed by Cooper in 1861 using silver wire to secure the AC joint. Since then, a wide variety of techniques have been used. In 1972, Weaver and Dunn described an open technique involving resection of the distal clavicle and reconstruction of the coracoclavicular (CC) ligament by transferring the acromial end of the coracoacromial ligament to the intramedullary shaft of the distal clavicle. More recent surgical modifications of these techniques have incorporated augmentation of the coracoclavicular reconstruction with heavy suture fixation, as well as tissue augmentation with tendon auto or allograft. This article describes our technique for acromioclavicular reconstruction using tendon allograft combined with suture augmentation.

A Biomechanical Evaluation of an Anatomical Coracoclavicular Ligament Reconstruction

Background Despite numerous surgical techniques described, there have been few studies evaluating the biomechanical performance of acromioclavicular joint reconstructions. Purpose To compare a newly developed anatomical coracoclavicular ligament reconstruction with a modified Weaver-Dunn procedure and a recently described arthroscopic method using ultrastrong nonabsorbable suture material. Study Design Controlled laboratory study. Methods Forty-two fresh-frozen cadaveric shoulders (72.8 ± 13.4 years) were randomly assigned to 3 groups: arthroscopic reconstruction, anatomical coracoclavicular reconstruction, and a modified Weaver-Dunn procedure. Bone mineral density was obtained on all specimens. Specimens were tested to 70 N in 3 directions, anterior, posterior, and superior, comparing the intact to the reconstructed states. Superior cyclic loading at 70 N for 3000 cycles was then performed at a rate of 1 Hz, followed by a load to failure test (120 mm/min) to simulate physiologic states at the acromioclavicular joint. Results In comparison to the intact state, the modified Weaver-Dunn procedure had significantly (P <. 05) greater laxity than the anatomical coracoclavicular reconstruction or the arthroscopic reconstruction. There were no significant differences in bone mineral density (g/cm2), load to failure, superior migration over 3000 cycles, or superior displacement. The anatomical coracoclavicular reconstruction had significantly less (P <. 05) anterior and posterior translation than the modified Weaver-Dunn procedure. The arthroscopic reconstruction yielded significantly less anterior displacement (P <. 05) than the modified Weaver-Dunn procedure. Conclusion The anatomical coracoclavicular reconstruction has less anterior and posterior translation and more closely approximates the intact state, restoring function of the acromioclavicular and coracoclavicular ligaments. Clinical Relevance A more anatomical reconstruction using a free tendon graft of both the trapezoid and conoid ligaments may provide a stronger, permanent biologic solution for dislocation of the acromioclavicular joint. This reconstruction may minimize recurrent subluxation and residual pain and permit earlier rehabilitation.

Technique and results of arthroscopic coracoclavicular reconstruction (SS-61)

technique and results of arthroscopic coracoclavicular reconstruction (SS-61)

Surgical treatment of complete acromioclavicular separations.

A retrospective study of fifty-two patients (48 cases followed up), with Allman-Tossy grade III acromioclavicular separations, who were treated with coracoclavicular reconstruction by Mersilene prosthetic substitute (Mersilene tape with polyester suture, 5 mm wide, 30 cm, Ethicon), was carried out. The average follow up was 38 months, with the longest being 10 years, and the shortest being 8 months. The average age of the patients was 32 years, with a range from 20 to 62 years. Two groups were divided by age. Although the younger age group showed better results than the elder one in pain, range of motion and return to previous occupation or sports, the overall outcome was satisfactory in 41 of 48 (86%) followed patients. For the grade III acromioclavicular separation patients, surgical reconstruction with Mersilene looping provides a reliable result including use of the arm for sports or repetitive work.

Stress fracture of the clavicle leading to nonunion secondary to coracoclavicular reconstruction with Dacron

We have reported the case of a nonunion of a clavicle fracture in which the Dacron had eroded the bone and acted as a stress riser contributing to the fracture. The Dacron then became interposed in the fracture site preventing union.

Bone Block Transfer of Coracoacromial Ligament in Acromioclavicular Injury

A bone block transfer of coracoacromial ligament into the medullary canal of the clavicle for Grade III acromioclavicular injury was developed in an attempt to prevent occasional pullout of the ligament in the procedure described by Weaver and Dunn. Fifteen consecutive cases (12 acute, three chronic) with Grade III acromioclavicular injury were treated by this method. All but one patient regained painless full range of shoulder motion. All patients returned to previous activity. Failure of coracoclavicular reconstruction occurred in one case. Asymptomatic focal myositis ossificans developed in four cases with no functional deficit.