We report the outcome of an arthroscopic technique for coracoclavicular ligament reconstruction using an anatomic coracoid cerclage.
Between March 2011 and September 2012, 12 consecutive patients with symptomatic chronic (>4 weeks from injury) type V acromioclavicular separation for which nonoperative treatment failed were treated with arthroscopic double-bundle reconstruction of the coracoclavicular ligaments using tendon allograft by the first author. The clinical records, operative reports, and preoperative and follow-up radiographs were reviewed. The visual analog scale score, Subjective Shoulder Value, Simple Shoulder Test score, and Constant-Murley score were evaluated preoperatively and at each follow-up appointment.
The study included 12 shoulders in 12 young active-duty soldiers with symptomatic high-grade acromioclavicular separation who were treated with a technique for arthroscopic reconstruction of the coracoclavicular ligaments. The mean age was 25 years (range, 20 to 35 years). The injury occurred during sports activity in 11 patients. One patient was injured in a motorcycle accident. The mean time from injury to surgery was 17.8 months (range, 1.5 to 72 months). The minimum length of follow-up was 24 months (mean, 30.4 months; range, 24 to 42 months). The mean preoperative and postoperative outcome scores were significantly different (P < .0001) for all subjective outcome measures. The mean Constant-Murley score improved from 58.4 (range, 51 to 76) to 96 (range, 88 to 100). The mean visual analog scale score improved from 8.1 (range, 7 to 10) to 0.58 (range, 0 to 2). The mean Subjective Shoulder Value improved from 32.9% (range, 10% to 70%) to 95% (range, 80% to 100%). The mean Simple Shoulder Test score improved from 6 (range, 5 to 8) to 11.83 (range, 11 to 12). All patients returned to their normal preinjury level of activity by 6 months. Radiographs at last follow-up showed no loss of reduction with maintenance of the coracoclavicular interval. There was 1 complication (8.5%), a postoperative superficial wound infection, that was treated accordingly.
We present an arthroscopic technique for double-bundle tendon graft reconstruction of the coracoclavicular ligaments using the coracoid cerclage technique. This method showed good outcomes and maintenance of radiographic reduction with high patient satisfaction and a low complication rate.
Level of Evidence
Level IV, therapeutic case series.
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- Evaluation and treatment of acromioclavicular joint injuries.Am J Sports Med. 2007; 35: 316-329
Rockwood CJ, Williams G, Young D. Disorders of the acromioclavicular joint. In: Rockwood CJ, Matsen FA III, ed. The Shoulder. Ed 2. Philadelphia: WB Saunders, 1998:483-553
- Arthroscopic stabilization of acromioclavicular joint dislocation using the AC graftrope system.J Shoulder Elbow Surg. 2010; 19: 47-52
- The anatomic coracoclavicular ligament reconstruction: Surgical technique and indications.J Shoulder Elbow Surg. 2010; 19: 37-46
- Acromioclavicular joint reconstruction: A comparative biomechanical study of three techniques.J Shoulder Elbow Surg. 2013; 22: 171-178
- A biomechanical evaluation of an anatomical coracoclavicular ligament reconstruction.Am J Sports Med. 2006; 34: 236-246
- Biomechanical comparison of coracoclavicular reconstructive techniques.Am J Sports Med. 2011; 39: 804-810
- Arthroscopic reconstruction of the acromioclavicular joint using semitendinosus allograft: Technique and preliminary results.Tech Shoulder Elbow Surg. 2008; 9: 109-113
- Long-term results of the surgical treatment of type III acromioclavicular dislocations: An update of a previous report.J Bone Joint Surg Br. 2011; 93: 1088-1092
- The management of acute acromioclavicular dislocation. A randomised prospective controlled trial.J Bone Joint Surg Br. 1989; 71: 848-850
- Decision making: Operative versus nonoperative treatment of acromioclavicular joint injuries.Clin Sports Med. 2003; 22: 277-290
- Current concepts in the treatment of acromioclavicular joint dislocations.Arthroscopy. 2013; 29: 387-397
- Double-loop suture repair for acute acromioclavicular joint disruption.Am J Sports Med. 2006; 34: 1112-1119
- Surgical treatment of chronic acromioclavicular dislocation: Comparison between two surgical procedures for anatomic reconstruction.Injury. 2010; 41: 1103-1106
- Semitendinosus tendon graft versus a modified Weaver-Dunn procedure for acromioclavicular joint reconstruction in chronic cases: A prospective comparative study.Am J Sports Med. 2009; 37: 181-190
- Acromioclavicular joint injuries: Diagnosis and management.J Am Acad Orthop Surg. 2009; 17: 207-219
- Complications related to anatomic reconstruction of the coracoclavicular ligaments.Am J Sports Med. 2012; 40: 1628-1634
- Anatomic considerations of transclavicular-transcoracoid drilling for coracoclavicular ligament reconstruction.J Shoulder Elbow Surg. 2013; 22: 137-144
- Early failures with single clavicular transosseous coracoclavicular ligament reconstruction.J Shoulder Elbow Surg. 2012; 21: 1746-1752
- Surgery about the coracoid: Neurovascular structures at risk.Arthroscopy. 2004; 20: 591-595
- Graft fixation is highest with anatomic tunnel positioning in acromioclavicular reconstruction.Arthroscopy. 2013; 29: 434-439
Published online: May 22, 2015
Accepted: March 19, 2015
Received: October 17, 2014
The authors report the following potential conflict of interest or source of funding: D.F. receives support from Arthrex and Allen Medical.
Published by Elsevier Inc.