Clinical Outcome of a Modified Coracoid Tunnel-Free Coracoclavicular Sling Technique With Remnant Preservation for the Treatment of High-Grade Acromioclavicular Joint Separation: A Report of 48 Cases With 2 to 5 Years of Follow-up

Abstract

Background: High-grade acromioclavicular (AC) joint separation injuries (Rockwood type IV or V) are surgically indicated because of complete disruption of the AC and coracoclavicular (CC) ligaments, leading to instability and pain. In surgical techniques that require a suspensory system, coracoid tunnel-related complications are not uncommon. Purpose: To report subjective and objective clinical outcomes and complication rates of a modified coracoid tunnel-free CC sling technique combined with CC ligament remnant preservation for a minimum 2-year follow-up. Study Design: Case series; Level of evidence, 4. Methods: Between January 2014 and January 2017, we prospectively enrolled patients who underwent a modified CC sling technique performed by 1 senior surgeon using the AC TightRope System in a coracoid tunnel-free fashion. The CC distance (CCD) and Rockwood AC joint classification were evaluated on radiographs preoperatively, immediately postoperatively, and at the final follow-up. The visual analog pain score, range of motion, American Shoulder and Elbow Surgeons score, Constant-Murley score, and University of California Los Angeles score were recorded preoperatively and at the final follow-up. Results: In total, 48 of 54 patients (88.9%) were included for the evaluation with a mean ± SD follow-up of 39.3 ± 8.9 months (range, 24.7-64.3 months). The CCD was significantly decreased from 22.7 ± 4.2 to 9.8 ± 2.3 mm ( P < .01) immediately after surgery and to 11.2 ± 1.8 mm ( P < .01) at final follow-up. At the final follow-up, the side-to-side difference of CCD was 3.5 ± 0.6 mm. Compared with the preoperative level, all subjective evaluations were significantly improved at the final follow-up. We observed that 4 of the 48 patients (8.3%) had a loss of reduction at the final follow-up, but no pain or instability was documented. Further, no coracoid-related complication or other complications were recorded. Conclusion: The coracoid tunnel-free CC sling technique using the AC TightRope System combined with CC ligament remnant preservation demonstrated significant improvement regarding both clinical and radiological outcomes, with a reduction loss rate of 8.3%. It is a safe method that could achieve satisfactory result without any coracoid drilling-related complications.

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

“…The clavicle cerclage and tensioning system described in this case series demonstrated satisfactory results in our cohort of patients. The technique used in this report showed similar if not slightly superior results compared to other techniques described in the literature such as Li et al, which reported a CC distance average of 11.2mm+/-1.8mm at the final follow-up [15]. The follow-up duration in the Li et al study was a mean +/-SD follow-up of 39.3 +/-8.9 months (range, 24.7-36.3 months) while our follow-up period was 3.29 months, highlighting a limitation in our study being its short follow-up duration.…”

Analysis of the curative effect of arthroscopic coracoid process drill-free U-shaped suspension fixation in the treatment of acute acromioclavicular joint dislocation

“…In a study of coracoclavicular ligament reconstruction in 17 patients conducted by Banffy et al [20], an arti cial material was used to form a ring in the coracoid process for suspension, and satisfactory results were obtained at the 2-year follow-up, with no coracoid fracturs. In a series of 48 cases of coracoclavicular ligament reconstruction conducted conducted by Li et al [21], used coracoid process drill-free suspension xation, only 8.3% of patients had partial (CCD) loss, and no pain, instability, or coracoid fracture-related complications were reported. These evidences suggest that coracoclavicular ligament reconstruction with drill-free suspension xation of the coracoid process can not only achieve good clinical effects but also avoid coracoid fractures, our results are basically consistent with those reported in the literature.…”