Purpose
We report the outcome of an arthroscopic technique for coracoclavicular ligament reconstruction
using an anatomic coracoid cerclage.
Methods
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.
Results
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.
Conclusions
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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Article info
Publication history
Published online: May 22, 2015
Accepted:
March 19,
2015
Received:
October 17,
2014
Footnotes
The authors report the following potential conflict of interest or source of funding: D.F. receives support from Arthrex and Allen Medical.
Identification
Copyright
Published by Elsevier Inc.
