Combined coracoclavicular ligament and transacromial capsule reconstruction for chronic acromioclavicular joint instability: clinical and radiological outcomes

Abstract

Objective: Acromioclavicular (AC) joint instability remains a challenging clinical problem, particularly in chronic cases where both vertical and horizontal stability must be restored. Traditional techniques have limitations in addressing multidirectional instability and minimizing implant-related complications. The aim of this study was to evaluate the clinical and radiological outcomes of a combined coracoclavicular (CC) ligament and transacromial capsule reconstruction technique in patients with chronic AC joint instability. Methods: A retrospective study was performed on 40 patients who underwent AC joint reconstruction at a single center from 2019 to 2023. Radiological outcomes (clavicle-coracoid distance) were evaluated preoperatively, immediately postoperatively, and at the last follow-up (6 months). Functional results were assessed using the Constant, American Shoulder and Elbow Surgeons score (ASES), and Disabilities of the Arm, Shoulder, and Hand (DASH) score. Data were analyzed using SPSS v28.0. T-tests and repeated measures of Analysis of Variance (ANOVA) were employed to compare outcomes, with significance set at P < .05. Results: The preoperative mean CC distance was 20.3 ± 3.4 mm. Early postoperative measurements showed a significant reduction in CC distance, with a mean of 9.5 ± 1.5 mm in the capsule reconstruction group compared to 10.5 ± 1.6 mm in the non-reconstruction group (P=.053). At the 6-month follow-up, the late postoperative CC distance was maintained at 10.1 ± 1.6 mm in the reconstruction group, while it increased to 14.4 ± 2.0 mm in the non-reconstruction group (P < .001). The mean ASES score was 87.1 ± 8.1. The mean Constant score was 86.2 ± 7.6. Pain levels, evaluated using the Visual Analog Scale (VAS), decreased from a mean of 5.8 ± 1.2 preoperatively to 2.1 ± 1.0 postoperatively, indicating significant pain relief and improved functionality. No hardware failure or infection was noted. About 12.5% of patients experienced short-term anterior knee pain. Conclusion: The results of this study demonstrate that combined CC ligament and transacromial capsule reconstruction improves radiographic outcomes by maintaining the clavicle-coracoid distance and enhances functional scores (ASES and Constant) in patients with chronic AC joint instability. Addressing both vertical and horizontal instability appears to contribute to better short-term clinical recovery. Further studies with larger sample sizes and longer follow-up are needed to confirm these findings. Level of evidence: Level III (Retrospective Comparative Study).

Figure 1.

Preoperative shoulder AP x-ray.

Figure 2.

The image shows the semitendinosus tendon graft passed through meticulously drilled bone tunnels in the coracoid process and distal clavicle, forming an “8” loop configuration. This setup mimics the native coracoclavicular ligament architecture, ensuring robust stabilization of the acromioclavicular joint.

Figure 3.

The image illustrates the residual graft segment being secured through a laterally directed acromial tunnel. The graft is sutured to the capsule and anchored to the clavicle using durable, non-absorbable sutures, enhancing AC joint horizontal stability and structural integrity.

Figure 4.

Schematic illustration depicting the surgical technique for acromioclavicular (AC) joint reconstruction. The image demonstrates the semitendinosus tendon graft looped in an “8” configuration through bone tunnels in the coracoid process and distal clavicle, effectively mimicking the natural coracoclavicular ligament structure to restore vertical and horizontal joint stability.

Figure 5.

Postoperative shoulder AP x-ray. Following surgical reconstruction, this x-ray demonstrates the acromioclavicular joint in a fully reduced position. The imaging was performed during the routine 3-week follow-up to assess the stability and alignment of the joint. The anatomical reduction of the acromioclavicular joint is well-maintained, with no evidence of displacement or subluxation, confirming the surgical intervention’s success and the graft’s integrity.