Minimum 10-Year Outcomes After Revision Anatomic Coracoclavicular Ligament Reconstruction for Acromioclavicular Joint Instability

Abstract

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.

Iatrogenic instability of the acromioclavicular joint leads to ongoing impairment of shoulder function even following secondary surgical stabilization

“…To this, current literature investigating revision ACJ surgery reported on smaller or similar patient cohorts. [ 4 , 17 , 29 ] Given the retrospective character of the study, there were no preoperative functional scores for comparison to the postoperative result. Also, the series may be underpowered to draw a definitive conclusion about which fixation method is preferable and if age, number of prior surgeries, manner of prior surgery and mm of excision of the lateral clavicle have an influence on the postoperative result.…”

Current concepts in acromioclavicular joint (AC) instability – a proposed treatment algorithm for acute and chronic AC-joint surgery

“…Muench et al reported on 43 patients undergoing ACCR for acute and chronic type III and V AC joint injuries with 81% of patients reaching the substantial clinical benefit (SCB) after surgical reconstruction [20]. Similar, good outcomes can be expected in revision cases using the ACCR technique [60].…”

Restablecimiento de la estabilidad horizontal en luxaciones acromioclaviculares III-V mediante la reconstrucción anatómica de los ligamentos coracoclaviculares y acromioclaviculares; técnica quirúrgica

“…3,14 La fijación con placa gancho presenta como complicación osteólisis y fractura acromial, osteoartrosis de la articulación AC, pinzamiento subacromial y desgarros del manguito rotador así como la necesidad de una segunda cirugía para la extracción del implante, siendo ésta otra desventaja que puede conducir a una fractura en el tercio distal de la clavícula. 2,3 Las técnicas artroscópicas obtienen mejores resultados funcionales, mejor estética y permiten un retorno más temprano a las actividades de la vida diaria. 6 Se enfocan en la reparación de los ligamentos o en su reconstrucción.…”

“…El uso de aloinjerto para replicar los ligamentos CC nativos demostró proporcionar mejor estabilidad vertical y horizontal en comparación con otras técnicas no anatómicas. 2 Otra ventaja es que nuestra técnica hace uso de aloinjerto para la reconstrucción de los ligamentos CC, pudiendo proporcionar mejor estabilidad biomecánicamente y una posible reconstrucción biológica permanente, con un rango de falla equivalente al de los ligamentos CC nativos. 1,2,4 El injerto además de servir para la reconstrucción de los ligamentos CC, su interposición en el espacio AC funciona como espaciador, reemplazando la función del disco articular de dicha articulación.…”

“…Representan ~12% y pueden llegar a 21% en algunos casos de todas las lesiones del hombro. 1,2,3 La articulación AC es una articulación diartroidea plana que sirve como principal conexión entre el esqueleto axial y la extremidad superior. 4 Su compleja estructura ligamentaria es fundamental para el funcionamiento normal de la cintura escapular.…”