Outcome After Arthroscopic Reconstruction of the Coracoclavicular Ligaments Using a Double-Bundle Coracoid Cerclage Technique

Abstract

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.