High grade acromioclavicular injury: Comparison of arthroscopic assisted acromioclavicular joint fixation and anatomic acromioclavicular joint reconstruction

Abstract

Background: Injuries to the acromioclavicular (AC) joint disrupting the AC and Coracoclavicular (CC) ligaments could lead to loss of clavicular strut function. A High-grade AC joint injury remain challenging because of highly variety of treatment and limited evidence exists comparing clinical outcomes and complications after surgery.

Purpose: The purpose of this study was to compare the clinical and radiological outcome after arthroscopic assisted acromioclavicular Joint fixation and anatomic acromioclavicular joint reconstruction.

Study design: Retrospective Clinical Cohort Study.

Methods: Twenty-nine patients with a high grade (Rockwood Type III-V) Acromioclavicular Joint Injury, operatively treated with arthroscopic assisted acromioclavicular joint fixation and anatomic acromioclavicular joint reconstruction from 2012 to 2018. The clinical assessment consists of Specific AC Score (SACS) and Nottingham Score. The radiographic evaluations were performed to evaluate the stability of reduction and the complications are assessed.

Results: There were a significant different between groups with AC joint reconstruction and fixation group (20 vs. 8, p < 0.005) and (19 vs. 10, p < 0.005) in SAC score and Nottingham score, respectively. There were no significant different in CC dstance between two groups. At the last follow up 6 patient develop loss of reduction with CC percentage >50% in AC joint fixation. Complication developed in 5 patients (17%) including 2 mild osteolysis, 1 superficial infection, 1 implant failure, and 1 clavicle fracture.

Conclusion: Anatomic AC joint reconstruction was associated with functional and radiologic benefits and better restored the stability.

Keywords: AC joint Fixation; AC joint Reconstruction; Acromioclavicular joint injury.

Fig. 1

Kim's portal is used for visualization, an anterior portal is made just inferolateral to the tip of the coracoid.

Fig. 2

Arthroscopic view from Kim's portal. Exposed and roughened the coracoid.

Fig. 3

After AC joint is exposed, the arthroscope is inserted again and fibersuture is placed under the coracoid.

Fig. 4

AC joint is placed in over reduced position, and temporary fixation using Kirschner wire.

Fig. 5

The four free ends of the suture were passed through the endobutton hole. and the suture was tightened over the titanium plate or endobutton.

Fig. 6

Arthroscopic view from Kim's portal demonstrate semitendinosus-gracilis autograft under the coracoid process.

Fig. 7

Two tunnels in the clavicle and two in the acromion process are then drilled at a diameter that matches the graft diameter. For clavicle tunnels, both limbs of the graft are held vertically parallel to each other, and two points are marked on the clavicle, which will be approximately at the same distance as the width of the coracoid process base. Two tunnel in the acromion are placed on the anterior and posterior side of the acromion.

Fig. 8

The graft is crossed, and the medial end is pulled through the lateral tunnel and the lateral end is pulled through the medial tunnel.

Fig. 9

AC joint is placed in over reduced position, and temporary fixation using Kirschner wire.

Fig. 10

Showing the final reconstruction of AC joint. An Ultrabraid #5 suture and Endobutton are used to provide fixation augmentation and to avoid tissue cut-through.

Fig. 11

The interposed graft also serves as an interposition spacer, replacing the function of the AC joint disc.

Fig. 12

AC joint is reduced in over-reduction position.

Fig. 13

Complication including (a) loss of reduction, (b) clavicle fracture, (c) osteolysis, and (d) superficial infection.