Open Acromioclavicular Repair With a Suture Cerclage Tensioning System: A Case Series

Abstract

Introduction Numerous surgical techniques to address a type III and type V acromioclavicular (AC) joint separation have been described in the literature, but a preferred standard approach is still in debate. Current approaches include anatomic reduction, coracoclavicular (CC) ligament reconstruction, and anatomic reconstruction of the joint. In this case series, subjects received a surgical approach that avoids metal anchors and utilizes a suture cerclage tensioning system to achieve adequate reduction. Surgical technique An AC joint repair was achieved with a suture cerclage tensioning system, which allows the surgeon to apply a specific amount of force on the clavicle to achieve adequate reduction. This technique repairs the AC and CC ligaments, restoring the anatomy of the AC joint while avoiding some of the common risks and disadvantages associated with metal anchors. Methods From June 2019 to August 2022, 16 patients underwent repair of the AC joint with a suture cerclage tension system. Inclusion criteria included the diagnosis of type III or type V AC joint separation with another concomitant injury, acute and chronic injury, and patients who attended all their postoperative visits. Exclusion criteria included patients who lost to follow-up or patients who missed any of their postoperative visits. Radiographic images were taken during each subject's preoperative and postoperative visits, and the CC distance was measured to determine the integrity of the all-suture cerclage repair. Results Of the 16 patients included in this case series, radiographic images taken during each subject's postoperative visit showed a stable construct with little changes in the CC distance. The average change in CC distance when comparing the two-week and one-month postoperative follow-up is 0.2mm. The average change in CC distance when comparing the two-week and two-month postoperative follow-up is 1.45mm. The average change in CC distance when comparing the two-week and four-month postoperative follow-up is 2.6mm. Conclusion Overall, an AC joint repair with the suture cerclage tension system can be a viable, cost-effective technique for restoring vertical and horizontal stability. Although follow-up, larger-scale studies are required to determine the biomechanical integrity of the construct with an all-suture approach, this case series presents 16 subjects whose postoperative radiographic images showed only a small change in CC distance at two to four months after surgery.

Keywords: ac joint; case-series; orthopedic sports medicine; orthopedic surgery; shoulder injuries.

Figure 1. Labeled depiction of open AC joint repair with suture cerclage tensioning system.

Image credit: Therese Dela Rueda

Figure 2. Average CC distance measured among all enrolled patients. The average CC distance measured at two weeks, one month, two months, and four months postoperatively is 8.2mm, 8.8mm, 9.7mm, and 11.02mm, respectively.

Image credit: Alvarho Guzman

Figure 3. Average CC distance change of all patients over the postoperative course in comparison to first postoperative visit (PO1) two weeks following surgery.

Image credit: Alvarho Guzman

Figure 4. AP radiographs of subject 3 with two weeks, one month, two months, and four months postoperative radiographs available. At the subject’s two weeks visit, the CC distance is 7.8mm. During the one-month visit, the CC distance is 8.0mm. At the two months visit, CC distance is 8.1mm. At the four months visit, the CC distance slightly increased to 10.3mm.

Image credit: Alvarho Guzman