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Background: Revision surgery in cases of previously failed primary acromioclavicular (AC) joint stabilization remains challenging mainly because of anatomic alterations or technical difficulties. However, anatomic coracoclavicular ligament reconstruction (ACCR) has been shown to achieve encouraging biomechanical, clinical, and radiographic short-term to midterm results. Purpose: To evaluate the clinical and radiographic long-term outcomes of patients undergoing revision ACCR after failed operative treatment for type III through V AC joint injuries with a minimum 10-year follow-up. Study Design: Case series; Level of evidence, 4. Methods: A retrospective chart review was performed on prospectively collected data within an institutional shoulder registry. Patients who underwent revision ACCR for type III through V AC joint injuries between January 2003 and December 2009 were analyzed. Clinical outcome measures included the American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test (SST), and Single Assessment Numeric Evaluation (SANE). The coracoclavicular distance (CCD) was measured for radiographic analysis immediately postoperatively and at last postoperative follow-up. Results: A total of 8 patients with a mean age at the time of surgery of 44.6 ± 10.6 years and a mean follow-up of 135.0 ± 17.4 months (range, 120-167 months) were eligible for inclusion in the study. The time from initial AC joint stabilization until revision surgery was 10.2 ± 12.4 months (range, 0.5-36 months); 62.5% of the patients had undergone more than 2 previous AC joint surgical procedures. The ASES score improved from 43.9 ± 22.4 preoperatively to 80.6 ± 28.8 postoperatively ( P = .012), the SST score improved from 4.4 ± 3.6 preoperatively to 11.0 ± 2.2 postoperatively ( P = .017), and the SANE score improved from 31.4 ± 27.3 preoperatively to 86.9 ± 24.1 postoperatively ( P = .018) at final follow-up. There was no significant difference in the CCD ( P = .08) between the first (7.6 ± 3.0 mm) and final (10.6 ± 2.8 mm) radiographic follow-up (mean, 50.5 ± 32.7 months [range, 18-98 months]). Conclusion: Patients undergoing revision ACCR after failed operative treatment for type III through V AC joint injuries maintained significant improvement in clinical outcomes at a minimum 10-year follow-up.

Introduction: Traditionally, spontaneous cervical artery dissections have been associated with violent, sudden neck movements. These events are a significant cause of stroke related morbidity, particularly in young people. Only a handful of cases of golf-induced vertebral artery dissection (VAD) have been described, and the discussion has primarily focused on middle-aged men. Despite the discussion focused on this demographic, women are participating in golf at higher rates than ever before, and have a higher risk for developing VAD. Case Report: A 41-year-old woman presented to our hospital with sharp neck pain, dizziness, and ptosis after swinging a driver during a morning round of golf. Imaging demonstrated a right V3/V4 VAD and subsequent ischemic infarction. After administration of tissue plasminogen activator she had abrupt change in mental status with seizure-like activity. She underwent angiogram and mechanical thrombectomy, and was started in heparin 24 hours post-tissue plasminogen activator. This was subsequently changed to low-dose aspirin following thalamic petechial hemorrhage. She was discharged from the hospital after a few days with only minor deficits. We will discuss mechanism, treatment, and outcomes of VAD in context of this case. Conclusion: This patient is the first woman in the literature to suffer from VAD as a result of playing golf. The twisting motion of the head and neck in a golf swing may be a risk factor for dissection and subsequent development of stroke. As a result of increased female participation in golf, we expect to see increased incidence of women presenting with “golfer’s stroke” in coming years.

Background: Elliptical humeral head implants have been proposed to result in more anatomic kinematics following total shoulder arthroplasty (aTSA). The purpose of this study was to compare glenohumeral contact mechanics during axial rotation using spherical and elliptical humeral head implants in the setting of aTSA. Methods: Seven fresh-frozen cadaveric shoulders were utilized for biomechanical testing in neutral (NR), internal (IR), and external (ER) rotation at various levels of abduction (0°, 15°, 30°, 45°, 60°) with lines of pull along each of the rotator cuff muscles. Each specimen underwent the following three conditions: (1) native, and TSA using (2) an elliptical and (3) spherical humeral head implant. Glenohumeral contact mechanics, including contact pressure (CP; kPa), peak contact pressure (PCP; kPa), and contact area (CA; mm2), were measured in neutral rotation as well as external and internal rotation using a pressure mapping sensor. Results: Elliptical head implants showed a significantly lower PCP in ER compared to spherical implants at 0° (Δ−712.0 kPa; p = 0.034), 15° (Δ−894.9 kPa; p = 0.004), 30° (Δ−897.7 kPa; p = 0.004), and 45° (Δ−796.9 kPa; p = 0.010) of abduction, while no significant difference was observed in ER at 60° of abduction or at all angles in NR and IR. Both implant designs had similar CA in NR, ER, and IR at all tested angles of abduction (p > 0.05, respectively). Conclusions: In the setting of aTSA, elliptical heads showed significantly lower PCP during ER at 0° to 45° of abduction, when compared to spherical head implants. However, in NR and IR, PCP was similar between implant designs. Both designs showed similar CA during NR, ER, and IR at all abduction angles. Level of Evidence: basic science; controlled laboratory study.

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