[Open anatomic reconstruction of chronic acromioclavicular instability]

Abstract

Objective: The aim of open anatomic reconstruction of the acromioclavicular (AC) joint is combined reconstruction of the AC and coracoclavicular ligaments using a tendon graft.

Indications: Symptomatic instabilities of the AC joint > type III.

Contraindications: Asymptomatic instabilities < type III and general contraindication against elective surgery.

Surgical technique: Through the open surgical approach, the exact anatomical insertion sites of the ligamentous structures can be reproduced. In addition, this approach enables accurate repositioning of the AC joint under direct vision (including possible debridement of the intraarticular discus) and an additional fixation of deltotrapezoidal fascia.

Postoperative management: Postoperatively, the arm is positioned in an abduction brace for 6-8 weeks. Passive exercises in flexion up to 90° and in external rotation up to 30° are permitted during this period. After 6-8 weeks, free and active motion is allowed.

Results: Between January 2003 and December 2010, 46 patients (9 women and 37 men, mean age 42 ± 13 years) underwent AC combined reconstruction. Complete outcome data were available for 25 patients. Mean length of follow-up was 31 ± 26 months. The mean preoperative coracoclavicular distance was 20.1 ± 5.6 mm; postoperatively the mean distance was 7.1 ± 3.0 mm (p < 0.001) The mean clinical scores also statistically improved (p < 0.001): American Shoulder and Elbow Score improved from 53.4 ± 18.7 points preoperatively to 80.6 ± 25.7 points postoperatively and the Constant Murley Score improved from 60.0 ± 16.7 points preoperatively to 85.2 ± 22.8 points postoperatively.