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. 2021 Feb 24;3(2):e441-e448.
doi: 10.1016/j.asmr.2020.10.009. eCollection 2021 Apr.

Better Radiographic Reduction and Lower Complication Rates With Combined Coracoclavicular and Acromioclavicular Ligament Reconstruction Than With Isolated Coracoclavicular Reconstruction

Jordan D Walters  1 , Anthony Ignozzi  2 , Francis Bustos  1 , Brian C Werner  1 , Stephen F Brockmeier  1
Affiliations

Better Radiographic Reduction and Lower Complication Rates With Combined Coracoclavicular and Acromioclavicular Ligament Reconstruction Than With Isolated Coracoclavicular Reconstruction

Jordan D Walters et al. Arthrosc Sports Med Rehabil. .

Abstract

Purpose: To determine whether combined acromioclavicular (AC) ligament reconstruction and coracoclavicular (CC) ligament reconstruction without bone tunnels would improve radiographic reduction maintenance and complication rates for type III to V AC dislocations.

Methods: This single-institution retrospective study analyzed all patients who underwent a hybrid synthetic/graft wrap CC reconstruction without tunnels with additional AC reconstruction/repair from January 2013 to August 2019. This 26-patient cohort was compared with a 1:1 sex- and age-matched control group who underwent CC reconstruction without AC reconstruction. CC distances on postoperative radiographs were compared with normal contralateral shoulders.

Results: Of the 93 patients who underwent AC reconstructive surgery during this time period, 26 patients (96% male) met the inclusion criteria. The AC/CC cohort had 23.5% type III injuries, 23.1% type IV injuries, and 53.8% type V injuries, similar to the control group. Final radiographs of the operative shoulder's CC distance were (mean ± standard deviation) 0.9 ± 4.0 mm greater than that of the contralateral shoulder (9.6 ± 8.7 mm) in the AC/CC cohort. Final radiographs of the operative shoulder's coracoclavicular distance were 4.0 ± 4.7 mm greater than that of the contralateral shoulder (13.3 ± 9.3 mm) in the CC control group, a significant difference (P = .014). The AC/CC reconstruction group had fewer patients with a loss of reduction >5 mm (11.5% versus 38.5%, P = .025). The complication rate in the CC control group was higher than in the AC/CC cohort (30.7% versus 7.7%, P = .035). The reoperation rate was also greater in the CC control group (8 versus 1, P = .010).

Conclusion: This cohort study shows that the addition of AC reconstruction to CC reconstruction using synthetic tapes/grafts or allograft tissues without bone tunnels significantly improves durable radiographic outcomes, diminishes complication rates, and improves reoperation rates.

Level of evidence: III, retrospective comparative study.

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Figures

Fig 1
Fig 1
(A) Preoperative upright bilateral standing anteroposterior (AP) acromioclavicular (AC) joint radiograph showing a left type V AC dislocation. (B) Postoperative upright bilateral standing AP AC joint radiograph showing appropriate reduction of left AC joint after combined hybrid coracoclavicular (CC) reconstruction using a Lockdown device with AC reconstruction with both left and right CC distances of 8.3 mm.
Fig 2
Fig 2
(A) Preoperative upright bilateral standing anteroposterior (AP) acromioclavicular (AC) joint radiograph showing a right type V AC dislocation. (B) Postoperative upright bilateral standing AP AC joint radiograph showing appropriate reduction of right AC joint after combined hybrid coracoclavicular (CC) reconstruction using double Fibertape plus Dogbone fixation with AC reconstruction with both left and right CC distances of 5.9 mm.
Fig 3
Fig 3
Dissection of acromioclavicular (AC) ligaments in preparation for AC reconstruction with suture anchor incorporating graft limbs.
See this image and copyright information in PMC

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