Anatomic coracoclavicular ligament reconstruction (ACCR) using free tendon allograft is effective for chronic acromioclavicular joint injuries at mid-term follow-up

Abstract

Purpose To evaluate the clinical and radiographic outcomes of patients undergoing anatomic coracoclavicular ligament reconstruction (ACCR) using free tendon allografts for the treatment of chronic acromioclavicular joint (ACJ) injuries with a minimum 1-year follow-up. Methods Patients who underwent ACCR for chronic ACJ injuries between 2003 and 2017 were analyzed. Clinical outcome measures included American Shoulder and Elbow Surgeons (ASES), Constant-Murley (CM), Simple Shoulder Test (SST), and Single Assessment Numerical Evaluation (SANE) scores. Radiographic loss of reduction during follow-up was evaluated by calculating the diference (mm) in the coracoclavicular distance (CCD) of the involved side immediately postoperatively and at terminal follow-up. Results Forty-two patients (mean age: 42.7 ± 12.8 years) were included in the study with an average follow-up of 3.8 ± 3.1 years (range: 1.1-11.5 years). Patients achieved signiicant improvement in ASES (50.2 ± 20.1 pre to 85.2 ± 16.3 post), CM (60.2 ± 18.5 pre to 88.2 ± 9.1 post), SST (6.1 ± 3.2 pre to 9.5 ± 3.7 post), and SANE (24.0 ± 25.7 pre to 89.0 ± 12.7 post) scores (P < 0.001, respectively). There were no signiicant diferences in functional improvement when comparing type III and V injuries (n.s.). Mean increase in CCD of the involved side from immediately postoperative to inal radiographic follow-up was 4.1 ± 3.9 mm, with no signiicant correlation to clinical outcomes scores. Complications occurred in 33.3% of cases, with postoperative heterotopic ossiication being most frequent (14.3%). Conclusion Patients undergoing ACCR using free tendon allografts for chronic ACJ injuries achieved signiicant improvement in shoulder function at a mean follow-up of 3.8 years. No correlation was observed between the amount of loss of reduction and clinical outcome scores. Free tendon allografts may be a reliable alternative to autografts in the treatment of chronic ACJ dislocations.

Biomechanical Efficacy of Tape Cerclage as an Augment or Stand-alone for Coracoclavicular Ligament Reconstruction

“…There is significant evidence to suggest that ACCR alone results in good clinical outcomes with low rates of loss of reduction clinically. 2,8,9 It is conceivable that taking an already efficacious ACCR and augmenting it with a single suture cerclage to make it biomechanically stronger, as evidenced in this study, may decrease the loss of reduction risk.…”

Is coracoclavicular ossification a complication or a good prognostic factor after surgical treatment of acromioclavicular joint injury?

“…Heterotopic ossification in the CC space is a common finding after surgical treatment of AC joint injuries, regardless of the treatment modality, and has been traditionally considered a complication according to previous knowledge. 6 , 9 , 22 , 28 However, it is unknown whether heterotopic ossification in the CC space is due to injured ligaments or opened bone tunnels. Assessment of heterotopic ossification in techniques without bone tunneling may be helpful for further understanding of this issue.…”

Low rate of substantial loss of reduction immediately after hardware removal following acromioclavicular joint stabilization using a suspensory fixation system

“…Acknowledging that a substantial loss of reduction was rare (< 5%), removal of the suspensory fixation system does not categorically jeopardize the postoperative result of AC joint stabilization. While previous outcome studies could not determine a correlation between a moderate loss of reduction of 3–4 mm and clinical outcomes [ 6 , 7 , 35 ], the clinical relevance of a significant CCD increase following hardware removal yet remains to be investigated in a prospective approach.…”