Purpose
The purpose of this study was to report the clinical and structural outcomes after
anatomic coracoclavicular ligament reconstruction (ACCR) with free tendon allografts
in patients with grade III and grade V acromioclavicular (AC) joint dislocations.
Methods
Thirty-one shoulders underwent primary ACCR with tendon allografts for Rockwood grade
III and grade V AC joint dislocations. Preoperative data included patient demographic
characteristics, injury characteristics, and surgical history, along with American
Shoulder and Elbow Surgeons (ASES) scores, Short Form 12 Physical Component Summary
(SF-12 PCS) scores, and various pain scales. Outcome measures were also collected
a minimum of 2 years postoperatively with the addition of Quick Disabilities of the
Arm, Shoulder and Hand (QuickDASH) scores; Single Assessment Numeric Evaluation (SANE)
scores; and patient satisfaction. In addition, preoperative and postoperative coracoclavicular
distances were analyzed using standard anteroposterior radiographs.
Results
ACCR was performed in 31 patients (31 shoulders) with a mean age of 43.9 years (range,
21 to 71 years). In 7 patients (22.6%) a complication occurred that required a subsequent
surgical procedure including graft rupture/attenuation (2), clavicle fractures (2),
distal clavicle hypertrophy (2), and adhesive capsulitis (1). Of the remaining 24
patients, 20 (83.3%) had subjective outcome data available after a minimum 2-year
follow-up period (mean, 3.5 years; range, 2.0 to 6.2 years). The mean postoperative
ASES and SF-12 PCS scores significantly improved when compared with the preoperative
baseline values (58.9 v 93.8 for ASES scores [P < .001] and 45.3 v 54.4 for SF-12 PCS scores [P = .007]). At final follow-up, the SANE and QuickDASH scores were 89.1 and 5.6, respectively,
with a median patient satisfaction rating of 9 of 10.
Conclusions
Patients who did not require revision surgery showed excellent postoperative outcome
scores: The mean ASES score was 93.8, the mean SANE score was 89.1, and the mean QuickDASH
score was 5.6, with a median patient satisfaction rating of 9 of 10. Further study
regarding ACCR techniques should focus on decreasing the risks of complications and
maintaining reduction of the AC joint.
Level of Evidence
Level IV, therapeutic case series.
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Article info
Publication history
Published online: May 18, 2015
Accepted:
March 19,
2015
Received:
August 11,
2014
Footnotes
The authors report the following potential conflicts of interest or source of funding: P.J.M. receives support from Arthrex, GameReady, and VuMedi. The Steadman Philippon Research Institute receives support from Ossur, Smith & Nephew Endoscopy, Siemens Medical Solutions, and Arthrex.
Identification
Copyright
© 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
