Study of outcome of management of chronic acromioclavicular joint dislocation with palmaris longus autograft and tension band wiring

Abstract

Introduction: The management of chronic Rockwood type III, IV, V nad VI Acromioclavicular joint (ACJ) dislocation remains controversial. Good-to-excellent results can be obtained with nonsurgical management, however, surgical management of ACJ dislocation restores joint anatomy, thus avoiding obvious deformity and gives overall better outcome. Methods: In this prospective study ten patients (7 men, 3 women), with Rockwood type III (ACJ) dislocation, underwent coracoclavicular (CC) ligament reconstructive surgery using a palmaris longus tendon graft and tension band wiring across AC joint. All patients were evaluated clinically preoperative and at subsequent follow-ups using Visual Analogue Scale and Constant Murley Shoulder Score, and radiologically comparing Coracoclavicular distance(CCD) of injured to the normal side on preoperative radiograph, on the second day postoperative and at final follow-up. The mean follow-up was 12 months (range: 10-18 months). Results: At the final follow-up, the Visual Analogue Scale (mean 0.8) revealed a good to excellent clinical outcome. The mean Constant-Murley score was 93.4 (range 74-96). The difference in the CCD of injured side compared to the contralateral side was <5mm for 9 patients and between 5-10 mm for 1 patients at final follow up. Conclusion:This study concludes that Acromioclavicular joint reduction with tension band wiring and reconstruction of the coracoclavicular ligament using palmaris longus tendon autograft provides good functional outcome with satisfactory clinical and radiological results for Chronic AC joint injuries. However larger group case series is required to further evaluate this procedures outcome.