Reconstruction of the coracoclavicular and acromioclavicular ligaments with semitendinosus tendon graft: a pilot study

Abstract

Purpose: this study was conducted to assess the safety and efficacy of a new surgical technique for anatomical reconstruction of the coracoclavicular (CC) and acromioclavicular (AC) ligaments using one singlestrand semitendinosus tendon graft. Methods: eighteen patients affected by chronic type III-V AC joint dislocations were included in the present study between January 2010 and March 2012. All underwent the same surgical operation and rehabilitation protocol. The semitendinosus tendon was harvested from the ipsilateral knee. The CC and AC ligaments were reconstructed using the graft passed beneath the coracoid and through bone tunnels in the clavicle and in the acromion. The graft was secured with non-absorbable sutures. Radiographic recurrence of AC joint dislocation was the primary outcome. Clinical outcome was assessed using the DASH score and normalized Constant score. Wilcoxon's signedrank test was used for comparison between pre-and postoperative results. Significance was set at p≤0.05. Results: the mean follow-up duration was 26.4+2.3 months (range: 24-30 months). On X-ray evaluation, only two patients (11%) showed asymptomatic recurrence of AC joint instability. Comparison between pre-and postoperative DASH and Constant scores showed significant clinical improvement (p<0.001). Conclusion: anatomical reconstruction of CC and AC ligaments using an autologous semitendinosus tendon graft for the treatment of AC joint dislocation provided good and reliable clinical and radiological results with a low failure rate at short-term follow-up. Level of evidence: level IV, therapeutic case series.

The surgical treatment of acromioclavicular joint injuries

“…The management of AC lesions is based on minimal intervention, either surgical or non-surgical, 9 aiming to restore both vertical and horizontal stability 10 and a stable joint. 11 …”

“…Vertical and horizontal post-operative AC joint stability 10 are the main factors affecting final outcome; in fact, the best results are recorded in patients with completely stable joints. 11 Although the synthetic graft is effective from a biomechanical standpoint, graft shredding, wear and bone remodelling around the screws can compromise mechanical strength over time, particularly in elderly patients and in those with poor clavicle bone thickness or osteoporosis.…”

Treatment of AC dislocation by reconstructing CC and AC ligaments with allogenic tendons compared with hook plates

“…Subcoracoid suture placement is not completely anatomical, and poor visualization risks injury to nearby neurovascular structures; therefore, the separation and drilling should be performed with extreme care to maintain coracoid integrity and avoid potential fractures. The method we used was similar to that of Saccomanno [ 35 ] and was used at nearly the same time. The difference is that we used allogenic tendons and omitted the process of harvesting tendons.…”

Acromioclavicular Joint Dislocation: Repair Through Open Ligament Transfer and Nonabsorbable Suture Fixation

“…Anatomical reconstruction of the AC joint that involves CAL reconstruction through the use of a graft has been shown to result in positive outcomes. 25 Regarding the comparison in outcomes between AC joint reconstruction through the use of a semitendinosus autograft and the modified Weaver-Dunn procedure, Hegazy et al. 26 found better outcomes in AC joint reconstruction based on 20 patients with a mean follow-up time of 27.8 months.…”