Although arthroscopic coracoclavicular ligament reconstruction has been generally successful, failure of the suture construct has led to the exploration of adding a biologic component to the construct, theoretically improving long term viability.
Twelve patients were selected as candidates for reconstruction utilizing both suture and biologic fixation. An arthroscopic approach is employed to expose the base of the coracoid. After performing an open distal clavicle excision, clavicular and coracoid tunnels are performed arthroscopically. The myotendinous end of a semitendinosis allograft is sutured to a Spider Plate (Kintekos, San Diego, CA) and the tendinous end of the graft is prepared with a running baseball stitch. A nitinol wire with a loop end (Arthrex, Naples, FL) is utilized to pass two free FiberTape sutures and the leading sutures from the tendinous end of the graft through the clavicular and coracoid tunnels, exiting out the anterior portal. One of the FiberTape sutures is retrieved with a grasper and passed over the anterior aspect of the distal clavicle. The second FiberTape suture and the allograft are passed over the distal end of the resected clavicle. While the acromioclavicular joint is held reduced, the FiberTape sutures are tied to the plate and the allograft is tensioned until the plate is embedded against the clavicle. The tendinous end of the graft is secured to the superior surface of the clavicle with a bio-tenodesis screw.
At one (n=3) to two years (n=9), eleven of the twelve patients were satisfied. There was one hardware complication, and one infection (secondary to patient non-compliance).
This arthroscopic approach allows the secure fixation of acromioclavicular joint dislocations with theoretically less morbidity of comparable open approaches. The addition of a semitendinosis graft to previously reported suture reconstruction concepts adds biologic fixation to the construct, thus providing long term stability to the reconstruction of the coracoclavicular ligamentous complex.
© 2007 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.