Combined Repair and Reconstruction of Coracoclavicular and Acromioclavicular Ligaments for Acute and Chronic AC Joint Dislocations: A Technical Note and Prospective Case Series

Abstract

Background/Objectives: Dislocation of the acromioclavicular joint (ACJ) is a common injury for which numerous operative fixation and reconstructive techniques have been described. This technique combines a coracoclavicular ligament (CC) repair with an acromioclavicular ligament (AC) and CC reconstruction with an additional ACJ internal brace to address both horizontal and vertical instability. Methods: The surgery is performed through a superior approach in the following sequence: (1) CC ligaments are repaired using a TightRope construct, (2) CC reconstruction is performed using a peroneus longus tendon allograft, (3) AC ligaments are repaired using an internal brace, and (4) AC reconstruction is performed with a second peroneus longus tendon allograft. The results of consecutive patients with grade IIIB, IV, and V AC joint dislocations were included. Results: Six patients with acute and six patients with chronic injuries were eligible for inclusion. The Constant-Murley Score improved significantly from 27.6 (8.0-56.5) to 61.5 (42.0-92.0) (p = 0.006 paired t-test) at 12 months of follow-up. There was one complication (frozen shoulder) from which the patient recovered spontaneously; no other complications were observed with this technique. The coracoclavicular distance (CCD) was reduced from 18.7 mm (13.0-24.0) to 10.0 mm (6.0-16.0, p < 0.001) and 10.5 mm (8.0-14.0, p = 0.002) at 12 weeks and 12 months, respectively. Conclusions: This study describes a new technique to treat acute and chronic Rockwood stage IIIB-V ACJ dislocations with promising short-term clinical and radiological results. The results suggest that the combined repair and reconstruction of the AC and CC ligaments is a safe procedure with low complication risk in experienced hands. Addressing the vertical and horizontal stability in ACJ dislocation is key to achieving optimal long-term results. Further, follow-up is required to investigate the long-term outcomes.

Keywords: AC and CC ligament complex; AC joint reconstruction; AC joint repair; acute and chronic AC joint dislocation; technical note.

Figure 1

(A): superior clavicular approach with lateral extension; (B): AC reduction with temporary fixation and CC Dog Bone repair; (C): CC reconstruction with single-sided looped peroneal longus allograft; (D): AC repair using an internal brace; (E): AC reconstruction using a peroneal longus allograft and removal of K-wire to provide temporary reduction. If the tendon allograft used to reinforce the coracoclavicular ligament reconstruction is long enough, it may be passed twice around the coracoid and clavicle before securing it.