Intraoperative and Postoperative Complications after Arthroscopic Coracoclavicular Stabilization

Abstract

Background Arthroscopic stabilization of torn coracoclavicular (CC) ligaments gained popularity recently. However, loss of reduction after the operation and complications unique to this technique involving tunnel placement through the distal clavicle and coracoid process are concerns. The purpose of this study was to report intraoperative and early postoperative complications associated with this procedure. Methods This study retrospectively evaluated 18 consecutive patients who had undergone arthroscopic stabilization for torn CC ligaments between 2014 and 2015. The indications for surgery were acute or chronic acromioclavicular dislocation and acute fracture of the distal clavicle, associated with CC ligament disruption. Clinical outcomes were evaluated with the American Shoulder and Elbow Surgeons (ASES) and the University of California, Los Angeles (UCLA) scores. Intra- and postoperative complications and reoperations were investigated. Results There were six female and 12 male patients with a mean age of 47 years (range, 22 to 86 years). At a mean follow-up of 17 ± 10 months (range, 10 to 28 months), the mean ASES score was 88.8 ± 19.9 and the mean UCLA score was 30.9 ± 5.2. Intraoperatively, seven complications developed: breach of lateral cortex of the coracoid process in five patients, medial cortex of the coracoid process in one, and anterior cortex of the clavicle in one. Postoperative complications developed in eight patients: four ossifications of the CC interspace, four tunnel widening of the clavicle, one bony erosion on the clavicle, and one superficial infection. A loss of reduction was found in six patients. Reoperation was performed in three patients for loss of reduction in two and superficial infection in the other. Conclusions Arthroscopic CC stabilization resulted in high rates of intraoperative and early postoperative complications. Most of them were related to the surgical technique involving bone tunnel placement in the coracoid process and the clavicle.

Acute high-grade acromioclavicular joint dislocation patients treated with titanium cable insertion under a homemade guider

“…The median CCD was 18 (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26) mm at the time of diagnosis, and it was 7.5 (6)(7)(8)(9)(10)(11)(12)(13)(14) mm after the operation 1 year later, representing a significant difference (t = −20.7 P< 0.001). The average VAS score preoperatively was 4.9 (3-7), and it improved to 0.55 (0-2), including the patient with subluxation, the difference was statistically significant (Wilcoxon test, median = −6, P < 0.001).…”

“…Cai L et al [4] found that compared with the single TightRope technique, arthroscopically assisted double TightRope fixation combined with percutaneous acromioclavicular joint cerclage significantly reduced the incidence of horizontal displacement. However, Tae Kang Lim [21] reported that the frequency of operative complications was very high in 61% (11/18) of CC ligament reconstructions with TightRope following arthroscopy. Martetschlager [22] et al reported that there were 16 cases of complications among 59 cases of CC ligament reconstruction with TightRope under arthroscopy, including three cases of coracoid process and clavicle fracture.…”

Treatment of distal clavicle fracture of Neer type II with locking plate in combination with titanium cable under the guide

“…In recent years, many authors have used arthroscopic reconstruction of the coracoclavicular ligament to treat distal clavicular fractures, which has the advantage of less damage, but there are still complications such as loss of reduction and coracoid process or clavicular fractures 18 , 19 . Tae KangLim 13 et al used arthroscopic reconstruction of the coracoclavicular ligament to treat 18 cases of acromioclavicular joint dislocation and distal clavicular fracture. Damage to the coracoid process tunnel during the operation was found in 7 patients who had to undergo open surgery.…”

“…The hook plate is often associated with shoulder pain, non-union, and subacromial impingement or the need for hook plate removal 10 – 12 . Anchor suture fixation and arthroscopic reconstruction of the conoid ligament are associated with bone tunnel enlargement, clavicle or coronoid fractures, and reduction loss 8 , 13 . Ideal fixation of Neer type II distal clavicular fractures should provide enough stability to improve the union of fractures and the substantial deforming force on the fracture while avoiding implant irritation and the need for implant removal.…”

Getting the Starting Point Right: Prevention of Skiving and Fibular Cortical Breach During Suture Button Placement for Syndesmotic Ankle Injuries

“…However, intraoperative cortical breach is a documented complication for other SB applications, such as coracoclavicular joint stabilization. 22 In addition to the inherent expense of the SB, this technical error can be costly because the SB technique must typically be abandoned following the complication of fibular cortical breach.…”