Modified Weaver-Dunn Procedure Research Articles

Acromioclavicular joint Stabilization: Our experience with the lockdown technique

BackgroundAcromioclavicular joint (AC joint) disruption is a common injury with considerable variation with regards to surgical management. The Lockdown™ procedure (previously known as Surgilig™), Modified Weaver-Dunn procedure, Arthroscopic AC joint stabilization and Ligament Augmentation and Reconstruction system (LARS) procedure have all been described for treatment of this injury with varying outcomes. PurposeTo measure the functional and radiological outcomes following all cases of AC joint reconstruction using the Lockdown™ technique over the last 10 years at Medway Maritime Hospital. MethodsData on a total of 53 patients who underwent AC joint reconstruction between 2012 and 2021 were collected. Electronic records were used to extract data regarding patient characteristics, surgery details, and duration of follow-up. Telephonic interviews of patients were conducted to collect data on hand dominance, surgical complications, and responses to Oxford shoulder score (OSS) and QuickDASH score questionnaires. Hospital PACS data were reviewed to record preoperative injury severity and postoperative acromioclavicular joint reduction. ResultsResults for 42 patients were available and analysed as 10 could not be contacted and 1 patient sadly passed away. Of the patients reviewed, 92.9% were males with a mean age of 42.2 years (Range 16–67 years) and mean follow up of 68 months (12–119.1 months). The injury involved the dominant arm in 59.5%cases. Majority of the cases were Rockwood type V injuries (71.43%) while the rest were either type III(19.05%) or type IV(9.52%).The mean preoperative OSS was 21.3/48 which improved to 44.3/48 in the postoperative period. Similarly, the mean QuickDASH score was 50.6 preoperatively, that improved to 9.1 postoperatively.The most common patient reported complication was prominent metalwork seen in 5 cases (11.6%) followed by stiffness seen in 3 cases (7%) and superficial infection seen in 1 case (2.3%). The AC joint remained reduced radiologically in 81% of cases, while a resubluxation between 50 and 100% was seen in the rest of the cases. Patients with radiological resubluxation did not report this as a complication in 87.5% of the cases. Overall, 38 patients reported their outcome as excellent, 2 patients rated it good while 1 patient reported it as fair and 1 as poor. ConclusionThe Lockdown™ technique for stabilization of AC joint has excellent or good patient satisfaction in 95.2% of cases in long term follow up of more than 5.7 years. Prominent metalwork and stiffness are the commonest clinical complications. Radiological resubluxation can be seen in a fifth of the cases but does not directly lead to patient dissatisfaction. Level of evidenceLevel IV Retrospective case series.

Modified Weaver-Dunn procedure, a novel approach to type-3 acromioclavicular joint dislocation

Even though a generally accepted opinion is present about conservative management for type 1 and type 2 acromioclavicular dislocation and surgical management for type 4 to type 6 dislocations, different opinions come under play for conservative versus surgical management in cases with acute type 3 acromioclavicular joint dislocation. We came across 20 cases of type 3 AC joint dislocation with a varied age profile (range 18 to 50 years, mean 34.4±6.5 years). Patients usually complain of pain and swelling and difficulty in moving shoulder joint. The diagnosis can be confirmed by radiographs which shows widening of AC joint >2-4 mm and coracoclavicular distance >5 mm and superior displacement of distal clavicle. In our series, we have treated them with modified Weaver Dunn technique. Immobilized arm in arm pouch for 3 weeks and follow up was done to assess functional outcome. In this study we present the outcome and related complications with modified Weaver Dunn technique for type 3 acromioclavicular joint dislocation.

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 & 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)

Modified Weaver-Dunn Technique Using Transosseous Bone Tunnels and Coracoid Suture Augmentation.

A modified Weaver-Dunn procedure for the management of acromioclavicular joint injuries that uses transosseous bone tunnels and coracoid suture augmentation is described with associated clinical results. A retrospective review of 39 consecutive patients who underwent a primary mWD procedure by a single surgeon from January 2013 to July 2019 was conducted. Patient charts and radiographs were reviewed for clinical course, complications and management, and radiographic evaluation. Satisfaction, American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation, and Simple Shoulder Test scores were obtained. A total of 28 patients (72%) with a mean follow-up of 37.5 (12 to 84 months) and a mean age of 44.3 ± 15.1 years were included. Postoperative ASES, Simple Shoulder Test, Single Assessment Numeric Evaluation, and satisfaction scores were 90.6 ± 14.2, 11.1 ± 1.5, 87.3 ± 10.2, and 4.4 ± 1.2 (out of 5), respectively, with a significant improvement in ASES of 42.2 ± 21.8 points (P < 0.001). All patients had significant decrease in coracoclavicular distance (P < 0.001). Three patients (10.7%) had complications, with two (7.1%) requiring additional surgery. Excellent functional and radiographic outcomes can be achieved with this modified Weaver-Dunn technique. Complication and revision rates are comparable with those that are found in the literature. Level IV, Retrospective cohort study.

Combination of Surgical Techniques Restores Multidirectional Biomechanical Stability of Acromioclavicular Joint

To measure the multiaxial stability of the acromioclavicular joint before and after transection of the acromioclavicular capsule and coracoclavicular ligaments and after sequential repair of acromioclavicular and coracoclavicular ligaments. Biomechanical testing was performed on fresh-frozen human cadaveric shoulders (N= 6). Translational and rotational stability in the vertical and horizontal planes was measured in intact specimens, after transecting the acromioclavicular and coracoclavicular ligaments, and after sequentially performing the following procedures: single-bundle coracoclavicular repair (CCR), modified Weaver-Dunn procedure (WD), and acromioclavicular stabilization (ACS). Resecting the acromioclavicular and coracoclavicular significantly reduced translational stiffness in the inferior and anteroposterior directions, as well as rotational stiffness about the vertical and anteroposterior axes. All 3 surgical procedures increased inferior translational stiffness relative to the intact condition (Intact: 38 ± 9 N/mm, CCR: 54 ± 23 N/mm (P = .03), CCR+WD 52 ± 20 N/mm (P= .07), CCR ± WD+ACS 50 ± 21 N/mm (P= .17)). However, the combination of CCR, modified WD, and ACS resulted in the greatest increase in stiffness in internal rotation (Intact: 12.5 ± 7.4 cNm/deg, CCR: 1.2 ± 1.1 cNm/deg, CCR+WD 7.2 ± 3.0 N∗m/deg [P= .023], CCR+WD+ACS 11.6 ± 4.9 cNm/deg [P= .055]). The cumulative stability of CCR, WD reconstruction, and ACS appears to be additive. Our findings provide a biomechanical justification for combining all three techniques. Biomechanical studies assessing the performance of various acromioclavicular repairs and reconstructions should therefore incorporate multiaxial testing in their protocols. Multiple points of fixation that provide multidirectional stability have the potential to improve clinical outcomes and reduce failure rates of acromioclavicular joint repair or stabilization.

Arthroscopically Assisted Stabilization of Chronic Acromioclavicular Joint Instability.

For this procedure, the patient is placed in the beach chair position. After establishing standard posterior, anteroinferior, and anterolateral (transtendinous) portals, the arthroscopic preparation of the coracoid base is performed. Next, transcoracoidal-transclavicular drilling is performed, and a nitinol suture passing wire is utilized to aid the placement of the TightRope later in the procedure. The graft passage around the clavicle and the coracoid is then set up by placing 2 additional nitinol suture passing wires. Following this, coracoclavicular stabilization is performed with use of the low-profile TightRope device, after which the graft is shuttled around the clavicle and the coracoid with the help of the passing wires. After the acromial drilling, the graft is shuttled laterally transacromially and subcutaneously back to the clavicle, completing the AC cerclage. Finally, the graft ends are sewn together under tension. The deltotrapezial fascia is closed above the graft, incorporating the tendon ends into the suture. Finally, the skin can be closed. In case of chronic AC joint injuries, many surgical stabilization techniques have been described. On the one hand there are rigid stabilization techniques like the hook-plate or temporary Kirschner wire fixation. On the other hand, there are dynamic stabilization techniques like the modified Weaver-Dunn procedure or solitary synthetic coracoclavicular reconstruction with use of pulley-like devices, with or without additional AC stabilization3. As for nonsurgical alternatives, physiotherapy with periscapular stabilization and muscle strengthening may be an option4. For the treatment of chronic AC joint instability, many techniques5-9 have been described that utilized horizontal and vertical stabilization with a tendon graft combined with a synthetic pulley-like device. Usually, multiple transclavicular and transcoracoidal drill holes are utilized for the graft passage, which could weaken the bone and may result in postoperative fractures of the coracoid and clavicle10. Considering this, we present a modified technique that focuses on the optimization of the graft passage. In contrast to other aforementioned techniques, this procedure requires only 1 transcoracoidal-transclavicular tunnel for the TightRope and another transacromial tunnel for the passage of the AC cerclage. By forming a loop of the graft around the coracoid and the clavicle, the graft passage is managed without any additional coracoidal or clavicular drilling. A dedicated study investigating the specific clinical and radiographic results of our technique will be part of future research. Because the biomechanical principle of reconstruction of our technique is very similar to the technique described by Kraus et al., we refer to their clinical and radiographic results regarding the expected outcome. As shown in the chart in the video, Kraus et al. demonstrated good clinical and radiographic results with their biologic and synthetic AC-stabilization technique at a median follow-up of 24 months. The outcomes measured in that study were the Constant score, Subjective Shoulder Value, AC Joint Instability Score, and Taft score. Patients were divided into 2 groups. Group 1 included patients with failed prior conservative treatment, and group 2 included those with failed prior surgical treatment. Overall, the authors report complete dynamic posterior translation in 1 patient and partial dynamic posterior translation in 5 patients. Although there was no notable enlargement of the TightRope drill hole, the authors of that study found a significant enlargement of the clavicular graft tunnels. However, the enlargement had no clinical relevance10. Utilize a low-profile TightRope device to minimize the risk of suture irritation from knot stacks.The tendon graft should be ≥24 cm in length. If the graft is too short, perform an end-to-end anastomosis of 2 grafts.Utilize an image intensifier to ensure correct drill hole placement and avoid damage to neurovascular structures.The graft passage around the clavicle and the coracoid can be dilated by hand with the use of differently sized drill bits.Incorporate the graft into fascial closure at the end of the procedure.

A study on functional outcome of modified weaver-dunn procedure for acromioclavicular joint dislocation in rural setup

Background: The ideal surgical management for Acromioclavicular joint dislocation (ACJ) is debatable and is unsolved as newer and more sophisticated techniques are being continuously evolved. The present study evaluates the functional outcome of ACJ reconstruction using the modified Weaver-Dunn procedure in rural setup where availability of latest implant is difficult. Materials and Methods: 30 patients (20 males, 10 females) with ACJ dislocation, between the age group of 18 years to 48 years (mean age 30 years), were operated using modified Weaver-Dunn procedure at our institute from JUNE 2017 to DECEMBER 2019. The dominant side was involved in 25 patients (17 right side, 8 left side). The mean period from the time of injury to the surgery was 8 days (range 3 to 16 days). All the patients were assessed with Oxford Shoulder Score (OSS) and time required to complete functional return to their work was assessed. Results: At the mean follow up of 6 months, the mean Oxford Shoulder Score improved from 23.36 (± 5.56) to 44.0 (± 4.1), 25 out of 30 patients had satisfactory results, while 5 out of 30 patients had mild shoulder dysfunction using Oxford Shoulder scoring system. Of these 5 patients who had mild shoulder dysfunction, 2 developed ossification around the coracoclavicular ligament and 1 patient had intermittent mild pain without any functional disability, 1 patient had a moderate stiffness at shoulder joint movements, and 1 patient had postoperative superficial infection. Conclusion: ACJ reconstruction using the modified Weaver-Dunn procedure in ACJ dislocation in rural setup is a good method and provides a good functional outcome without the use of latest sophisticated implants and instruments.

Modified Weaver-Dunn Procedure for Type 3 Acromioclavicular Joint Dislocation: Functional and Radiological Outcomes.

BackgroundControversy surrounds the indication for treatment of type 3 acromioclavicular joint dislocation, and the optimal reconstructive technique has not yet been defined. Since the first description of the Weaver-Dunn procedure, several studies have described the clinical and radiological results that can be expected postoperatively; however, few studies have evaluated the outcomes of this technique for chronic type 3 acromioclavicular joint dislocation.Purpose/HypothesisThe purpose of this study was to evaluate the functional and radiographic mid- to long-term outcomes of a modified Weaver-Dunn procedure for chronic Rockwood type 3 acromioclavicular joint dislocation. We hypothesized that (1) functional outcomes comparable with sex- and age-matched healthy individuals could be achieved with the modified Weaver-Dunn procedure and (2) joint stability could be restored after surgery.Study DesignCase series; Level of evidence, 4.MethodsOut of 30 patients who sustained a chronic type 3 acromioclavicular joint dislocation, 27 had a minimum 12-month follow-up and were included in the study. All patients underwent a modified Weaver-Dunn procedure. The Constant-Murley score was used to assess patient postoperative function. Subjective evaluation of patient satisfaction with surgery was also recorded. Radiological assessment was performed postoperatively to evaluate superoinferior and anteroposterior joint stability.ResultsAfter a mean follow-up period of 51.6 months, the mean Constant-Murley score was 90.1, which was 97.2% that of a group of sex- and age-matched healthy individuals. In the multivariate analysis, higher Constant-Murley score was associated with male sex (β = 0.385; P = .043) and higher subjective satisfaction scale (β = 0.528; P = .003). All patients returned to their previous work and sport activity levels having high satisfaction with surgery. Successful vertical acromioclavicular joint reduction was obtained in all but 1 patient; however, horizontal joint stability was not completely restored with the modified Weaver-Dunn procedure. No intraoperative complications occurred, and the postoperative complication rate was 7.4%.ConclusionIn patients with chronic type 3 acromioclavicular joint dislocation, the modified Weaver-Dunn procedure is an effective technique to restore vertical but not horizontal joint stability 4 years after surgery. High levels of satisfaction with surgery and functional outcomes comparable with sex- and age-matched healthy individuals can be achieved.

All-Arthroscopic Reconstruction of Severe Chronic Acromioclavicular Joint Dislocations

To report the outcomes of all-arthroscopic coracoclavicular (CC) ligament reconstruction and simultaneous diagnosis and treatment of glenohumeral pathologies in patients with symptomatic, chronic (>6weeks), complete (Rockwood type III-V) acromioclavicular joint (ACJ) separations. We prospectively followed up 57 consecutive patients treated arthroscopically for chronic Rockwood type III (n= 11), type IV (n= 19), and type V (n= 27) ACJ dislocations. Previous ACJ surgery failed in 11 (19%). The mean delay between injury and surgery was 39months (range, 6months to 17years). The mean age at surgery was 42years (range, 19-71years). After glenohumeral exploration, an arthroscopic modified Weaver-Dunn procedure with CC suture button fixation (Twinbridge) was performed. The CC reduction and tunnel position were analyzed with radiographs and computed tomography. The mean follow-up period was 36months (range, 12-72months). Intra-articular pathology was treated arthroscopically in 27 patients (48%): 17 labral tears, 8 rotator cuff tears (3 partial and 5 complete), and 15 biceps lesions (4 SLAP lesions and 11 subluxations). At last follow-up, 7 patients (12%) experienced recurrent ACJ instability: 2 frank dislocations (1 trauma and 1 infection) and 5 ACJ subluxations. There was no significant correlation between subluxation and clinical outcome. The rate of recurrent ACJ instability was significantly higher in patients with higher-grade ACJ dislocations (P < .01) and/or previous failed surgery (P < .001). Recurrent subluxation was observed in 3 cases of lateral migration of the coracoid button with lateral tunnel placement, as well as 2 cases of anterior migration of the clavicular button with anterior tunnel placement. The Constant score increased from 67 (range, 28-89) to 85.5 (range, 66-100), and the mean Subjective Shoulder Value increased from 54% to 85% (P < .001). At last follow-up, 95% of patients (54 of 57) were satisfied. All-arthroscopic treatment allows successful CC ligament reconstruction and simultaneous diagnosis and treatment of frequently associated (48%) glenohumeral lesions. Higher-grade ACJ dislocations, previous ACJ surgery, and misplacement of bone tunnels are risk factors for recurrent instability. Level IV, case series.

A Modified Weaver-Dunn Procedure with or without Chip Bone Graft for the Treatment of Acromioclavicular Joint Separation.

Background:In spite of frequent injuries to the acromioclavicular (AC) joint, there is no consensus regarding optimal technique to be used. This cohort study evaluated the clinical results of a modified Weaver-Dunn procedure with or without chip bone graft for the treatment of AC joint separation retrospectively.Materials and Methods:60 consecutive patients with AC joint separation, between the age of 19-76 years (mean age 43 years), were enrolled between January 2005 and September 2011. Forty patients (35 men, 5 women) were treated with a modified Weaver-Dunn procedure, and did not receive bone graft during the procedure (Group 1), whereas twenty patients (19 men, 1 woman) received autogenous chip bone graft (Group 2). Stability of the AC joint was evaluated clinically and radiographically, and the clinical results were assessed by the Imatani evaluation system.Results:The mean duration of followup was 2 years and 2 months. The results were excellent in all patients except one. At final followup, roentgenographic measurement revealed that the mean coracoclavicular interval was 8.2 mm on the affected side, and 8.9 mm on the unaffected side in Group 1, and 9.5 mm on the affected side and 10.1 mm on the unaffected side in Group 2. For Group 1, there were significant differences between augmentation of the grafted coracoacromial (CA) ligament antero-posteriorly and laterally (Option B) and repair of the torn AC ligament with augmentation of the grafted CA ligament antero-inferiorly (option A; P = 0.0351).Conclusions:The modified Weaver-Dunn procedure (Group 1 and 2) provides a stable and strong reconstruction for the treatment of AC joint separation. In addition, this modified Weaver-Dunn procedure with chip bone graft (Group 2) may lead to same or more secure healing of the grafted CA ligament-bone than the same procedure without chip bone graft (P = 0.9737).

Functional Outcome of Modified Weaver Dunn Technique for Acromioclavicular Joint Dislocation.

Background:The debate about the ideal surgical procedure for acromioclavicular joint (ACJ) dislocation is still unresolved and newer techniques are being evolved continuously. The present study evaluates functional outcome of ACJ reconstruction using the modified Weaver Dunn procedure.Materials and Methods:35 patients (26 males, 9 females) with ACJ dislocation, between the age group of 18–48 years (mean age 31 years), were operated using modified Weaver Dunn procedure at our center from May 2005 to June 2010. The dominant side was involved in 25 patients (22 right, 13 left). The mean period from the time of injury to the surgery was 14 days (range 4–26 days). All the patients were assessed with Oxford shoulder score and the time required to return to preinjury level was recorded.Results:At the mean followup of 95 months (range 72–120 months), the mean Oxford Shoulder Score improved from 25 ± 7.2 to 43 ± 6.9. 85% (30 out of 35) patients had satisfactory results, while 15% (5 out of 35) had mild shoulder dysfunction using this scoring system. Five patients had radiological evidence of Grade 2 ACJ subluxation. Out of these five patients, two developed ossification around the coracoclavicular ligament. Three patients had intermittent mild pain without any functional disability, and one had a moderate restriction of shoulder movements.Conclusion:ACJ reconstruction, using the modified Weaver Dunn procedure in ACJ dislocation, is a reproducible procedure and provides a good functional outcome.

Acromio-Clavicular Joint Dislocation Types IV to VI: Does the Outcome with the modified Weaver-Dunn Procedure Justify the Treatment?

Introduction: The optimal surgical treatment for acromioclavicular joint (ACJ) injuries remains controversial. The modified Weaver-Dunn (WD) procedure is one of the frequently used techniques. Recently when it was compared with anatomical autogenous tendon graft reconstruction procedures, the results were inferior. However, these anatomical procedures are technically more demanding with small margin of error and they have tendency for postoperative pain because of extra donor site incision.Materials and Methods: Forty patients with type IV to VI ACJ dislocations were treated by modified WD procedure using non-absorbable synthetic suture passed through the base of coracoid process for augmentation of transferred coraco-acromial (CA) ligament. Functional outcome was assessed using the Oxford Shoulder Score, Nottingham Clavicular Score and Visual Analog Score (VAS) at the final follow-up after surgery.Results: The mean pre-operative Oxford Shoulder Score improved from 25.22±2.64 (range 20 to 30) to 44.75±1.99 (range 40 to 48) and mean pre-operative Nottingham Shoulder Score improved from 49.25±4.91 (range 39 to 58) to 87.27±4.39 (range 79 to 96) at last follow-up after surgery with p-value <0.001. Thirty-five (87.5%) patients had excellent outcomes, four (10%) patients had good outcomes and one (2.5%) patient had fair outcome. Thirty-eight (95%) patients had no pain while two (5%) had moderate pain based on VAS score.Conclusion: Modified Weaver-Dunn is a simple well established technique for grade IV to VI ACJ dislocation. We cannot consider this procedure as old and outdated on the argument that the long term functional outcomes are not suboptimal.

Case report of non union of lateral end of clavicle fracture treated with modified weaver Dunn procedure and coracoclavicular screw fixationDr. Nitin Bhimrao Patil

A case of lateral end of clavicle non union in young patient, which was treated conservatively following trauma, treated with modified Weaver Dunn procedure, combined with fixation of coraco-clavicular interface with malleolar screw. Patient showed good range of movements at 6 months follow up.

Palmaris longus tendon graft versus modified Weaver-Dunn procedure via dynamic button system for acromioclavicular joint reconstruction in chronic cases

The hypothesis of this clinical study was that coracoclavicular (CC) reconstruction using autogenic palmaris longus graft through the GraftRope (PLG) system (Arthrex, Inc., Naples, FL, USA) would provide superior clinical and radiologic results compared with modified Weaver-Dunn procedure with the dynamic TightRope (Arthrex, Inc.) system (WDT). Between 2008 and 2013, 32 patients (average age, 39.7 years; range, 22-60 years) underwent surgical reconstruction of chronic acromioclavicular (AC) joint dislocation. A modified WDT procedure was performed in 16 patients and autogenous PLG was performed in the other 16 patients. Patient data were collected retrospectively, with a final follow-up of 44.9 months (range, 29-60 months). The degree of AC joint displacement was evaluated by measuring the CC distance on the anteroposterior and axillary view. Clinical and functional outcomes were compared by American Shoulder and Elbow Surgeons and the Constant scores at final follow-up. Comparison between the WDT and PLG groups showed a significantly better outcome in the American Shoulder and Elbow Surgeons and the Constant scores (P < .01), in favor of the PLG group. Both groups showed an increased CC distance compared with the uninjured side, with a mean difference of 1.1 mm for the PLG and 3.3 mm for the WDT groups. A tolerable loss of reduction within the follow-up time was observed. Reduction loss was higher with the WDT group (P < .05). CC palmaris longus tendon graft reconstruction with GraftRope system was associated with functional and radiologic benefits. The palmaris longus graft with GraftRope system could be used in chronic cases.

Outcome of weaver Dunn acromio clavicular joint stabilisation

Introduction: Acromio clavicular joint injuries represent nearly half of all athletic shoulder injuries and Weaver Dunn procedure remains the most common operation at our institute Robert Jones and Agnus Hunt Hospital, for this injury so we assessed the outcome by of this procedure by measuring oxford shoulder scores, perceived deformity, complications and overall patient satisfaction. Aim and objectives: To access outcome of ACJ Weaver Dunn reconstruction by measuring shoulder Oxford scores, perceived deformity, complications and overall patient satisfaction. Methodology: A retrospective study of 21 patients performed at our institution from 2008-2013. Data was collected from electronic records and a telephonic interview of all the patients. Results: We had total 21 patients operated for Reconstruction of Acromioclavicular Joint Injuries Grad III and above using Modified Weaver Dunn Technique between 2008 to 2013 by four Orthopaedic consultants.We lost one patients in follow up as he could not be contacted and one patient refused to give feedback. Average Oxford score for 19 patients is 21(Max 54 and minimum 12). Average satisfaction was 80. There were 14(82%) patients who were able to return to their sports but three (18%) patients could not resume pre injury level. In addition 13 (76%) patients recovered normally with none to only mild residual deformity. However, 6 (24%) patients had major residual deformity. Overall only three (14%) patients underwent revision procedure. Conclusion: Modified Weaver-Dunn procedure gives a satisfactory long-term functional outcome in Type 3 ACJ dislocation. Firstly, it shows positive functional outcome and hence better patient’ satisfaction due to fast recovery. Secondly there is no need for a planned secondary procedure which in turn again improves patient’s satisfaction. As a result of above considerations it reduces financial burden for the hospital and patient alike.

Coracoid bypass procedure: surgical technique for coracoclavicular reconstruction with coracoid insufficiency

Failed acromioclavicular (AC) joint reconstruction secondary to a coracoid fracture or insufficiency of the coracoid is an uncommon but challenging clinical situation. We describe a surgical technique of revision coracoclavicular (CC) reconstruction, the coracoid bypass procedure, and report short-term results with this technique in 3 patients. In the coracoid bypass procedure, reconstruction of the CC ligaments is performed by passing a tendon graft through a surgically created bone tunnel in the scapular body (inferior to the base of the coracoid) and then fixing the graft around the clavicle or through bone tunnels in the clavicle. Three patients treated with this technique were retrospectively reviewed. AC joint reconstruction performed for a traumatic AC joint separation failed in the 3 patients reported in this series. The previous procedures were an anatomic CC reconstruction in 2 patients and a modified Weaver-Dunn procedure in 1 patient. The coracoid fractures were detected postoperatively, and the mean interval from the index surgery to the coracoid bypass procedure was 8 months. The patients were a mean age of 44 years, and average follow-up was 21 months. At the last follow-up, all 3 patients were pain free, with full range of shoulder motion, preserved CC distance, and a stable AC joint. The coracoid bypass procedure is a treatment option for CC joint reconstruction during revision AC joint surgery in the setting of a coracoid fracture or coracoid insufficiency.

Modified Weaver-Dunn Procedure Versus The Use of Semitendinosus Autogenous Tendon Graft for Acromioclavicular Joint Reconstruction.

Background:The optimal operative method for acromioclavicular joint reconstruction remains controversial. The modified Weaver-Dunn method is one of the most popular methods. Anatomic reconstruction of coracoclavicular ligaments with autogenous tendon grafts, widely used in treating chronic acromioclavicular joint instability, reportedly diminishes pain, eliminates sequelae, and improves function as well as strength. Objective:To compare clinical and radiologic outcomes between a modified Weaver-Dunn procedure and an anatomic coracoclavicular ligaments reconstruction technique using autogenous semitendinosus tendon graft.Methods:Twenty patients (mean age, 39 years) with painful, chronic Rockwood type III acromioclavicular joint dislocations were subjected to surgical reconstruction. In ten patients, a modified Weaver-Dunn procedure was performed, in the other ten patients; autogenous semitendinosus tendon graft was used. The mean time between injury and the index procedure was 18 month (range from 9 – 28). Clinical evaluation was performed using the Oxford Shoulder Score and Nottingham Clavicle Score after a mean follow-up time of 27.8 months. Preoperative and postoperative radiographs were compared.Results:In the Weaver-Dunn group the Oxford Shoulder Score improved from 25±4 to 40±2 points. While the Nottingham Clavicle Score increased from 48±7 to 84±11. In semitendinosus tendon graft group, the Oxford Shoulder Score improved from 25±3 points to 50±2 points and the Nottingham Clavicle Score from 48±8 points to 95±8, respectively.Conclusion:Acromioclavicular joint reconstruction using the semitendinosus tendon graft achieved better Oxford Shoulder Score and Nottingham Clavicle Score compared to the modified Weaver-Dunn procedure.

Coracoclavicular ligament reconstruction: a systematic review and a biomechanical study of a triple endobutton technique.

Operative intervention is recommended for complete acromioclavicular (AC) joint dislocation to restore AC stability, but the best operative technique is still controversial.Twelve fresh-frozen male cadaveric shoulders (average age, 62.8 ± 7.8 years) were equally divided into endobutton versus the modified Weaver-Dunn groups. Each potted scapula and clavicle was fixed in a custom made jig to allow translation and load to failure testing using a Zwick BZ2.5/TS1S material testing machine (Zwick/Roell Co, Germany). A systematic review of 21 studies evaluating reconstructive methods for coracoclavicular or AC joints using a cadaveric model was also performed.From our biomechanical study, after ligament reconstruction, the triple endobutton technique demonstrated superior, anterior, and posterior displacements similar to that of the intact state (P > 0.05). In the modified Weaver-Dunn reconstruction group, however, there was significantly greater anterior (P < 0.001) and posterior (P = 0.003) translation after ligament reconstruction. In addition, there was no significant difference after reconstruction between failure load of the triple endobutton group and that of the intact state (686.88 vs 684.9 N, P > 0.05), whereas the failure load after the modified Weaver-Dunn reconstruction was decreased compared with the intact state (171.64 vs 640.86 N, P < 0.001).From our systematic review of 21 studies, which involved comparison of the modified Weaver-Dunn technique with other methods, the majority showed that the modified Weaver-Dunn procedure had significantly (P < .05) greater laxity than other methods including the endobutton technique.The triple endobutton reconstruction proved superior to the modified Weaver-Dunn technique in restoration of AC joint stability and strength. Triple endobutton reconstruction of the coracoclavicular ligament is superior to the modified Weaver-Dunn reconstruction in controlling both superior and anteroposterior displacements with a failure load that approximates the intact ligament.

FINITE ELEMENT ANALYSIS FOR AC JOINT COMPLEX OF HUMAN SHOULDER AND ITS CLINICAL APPLICATIONS

The stress distributions of acromio-clavicular joint (AC joint) complex for human shoulder in intact condition, injured condition and two reconstruction procedures were presented in this paper. Two-dimensional finite element (FE) analysis was used to investigate various situations of AC joint from engineering viewpoint. The models are validated through comparison with the experimental results of Debski et al.17The results showed that the stress shifted to trapezoid ligament and conoid ligament once the AC joint was injured. The modified Weaver–Dunn procedure is better than the Neviaser procedure since the graft alleviates more stresses from trapezoid and conoid ligaments. The coraco-acromion ligament (CAL) plays an important role in the AC joint complex. AC joint complex model can provide alternative evidence to elucidate the detailed anatomy and functional role of each AC joint structures and numerical evidence for the advantage of specific procedures of AC joint and may serve as a potential tool to screen out improper material implementations and surgical procedures in the future.

Distal Clavicle Osteolysis after Modified Weaver-Dunn’s Procedure for Chronic Acromioclavicular Dislocation: A Case Report and Review of Complications

Distal clavicle osteolysis after acromioclavicular joint stabilization has only been described after the use of hardware for clavicle stabilization or synthetic graft causing a foreign body reaction. This paper reports a very rare case of distal clavicle osteolysis after modified Weaver-Dunn procedure for the treatment of chronic acromioclavicular joint dislocation. The paper also provides a comprehensive review of complications of this surgical technique and discusses a potential vascular etiology and preventive strategies aimed at avoiding clavicle osteolysis.