Surgical treatment of chronic acromioclavicular dislocation with biologic graft vs synthetic ligament: a prospective randomized comparative study

Abstract

BackgroundAcromioclavicular (AC) dislocation involves complete loss of articular contact; it is defined as chronic when it follows conservative management or unsuccessful surgical treatment.Materials and methodsThe study compared the clinical and radiographic outcomes of AC joint stabilization performed in 40 patients with chronic dislocation using a biological allograft (group A) or a synthetic ligament (group B). Demographic data included: M/F: 25/15; mean age: 35 ± 3.2 years; previous surgery in 11 patients, including Weaver–Dunn (3), coracoacromial ligament repair (4), stabilization with K-wires (4). Dislocation was type III in 14 (35 %) and type IV in 26 (65 %) patients. Clinical assessment was with the Constant–Murley score (pre- and postoperative) and with the modified UCLA score. Enrollment started in January 2004 and was completed in March 2008. Patients were evaluated at 1 and 4 years. Postoperative X-rays were examined to assess joint stability in the coronal and axial planes, coracoclavicular ossification, and signs of AC joint osteoarthritis and distal clavicular osteolysis.ResultsThe “biological” group achieved significantly better clinical scores than the “synthetic” group at both 1 and 4 years. Poor subjective satisfaction and lower clinical scores were found in the 3 patients (1 from group A and 2 from group B) who experienced complete postoperative dislocation. No significant correlations were found with other radiographic parameters.ConclusionsThe biological graft afforded better clinical and radiographic outcomes than the synthetic ligament in patients with chronic AC joint instability. Fixation to the clavicle constitutes the main weakness of both approaches and needs improving.

Two-Year Outcomes After Primary Anatomic Coracoclavicular Ligament Reconstruction

“…Several other authors have found similar results after ACCR with tendon grafts. [32][33][34][35][36][37][38][39][40] In our study the mean ASES score improved from 58.9 preoperatively to 93.8 postoperatively, with a high median patient satisfaction rating of 9 of 10.…”

Biological Solutions to Anatomical Acromioclavicular Joint Reconstruction

“…26,37,40 A prospective comparison of autograft CC reconstruction and the modified Weaver-Dunn procedure demonstrated improved clinical and radiological outcomes for the biological CC ligament reconstruction with allograft. 40 A small prospective randomized study compared allografts with synthetic anatomical CC ligament reconstructions, finding improved outcome scores at 1 and 4 years postoperatively for the allograft group.…”

“…40 A small prospective randomized study compared allografts with synthetic anatomical CC ligament reconstructions, finding improved outcome scores at 1 and 4 years postoperatively for the allograft group. 37 The complications of surgical anatomical CC ligament reconstruction include clavicle fractures, coracoid fractures, recurrent AC joint instability and pain, infection, and risk of axillary artery or brachial plexus injury. A study of 27 cases of anatomical CC ligament reconstruction found a 51% rate of …”

“…29,[32][33][34][35][36][37][38][39] Similar to autografts, these have been reported utilizing both anatomical and nonanatomical techniques, isolated graft reconstruction and graft combined with synthetic materials, and both open and arthroscopic procedures. Descriptions of allografts used for CC ligament reconstruction include hamstring allografts, peroneus brevis allografts, anterior tibial allografts, and Achilles tendon allografts.…”

Primary Acromioclavicular-Coracoclavicular Reconstruction Using 2 Allografts, TightRope, and Stabilization to the Acromion

“…Proper graft selection is also fundamental to the success of the present technique. We prefer biologic over synthetic grafts as biologic grafts have been reported in the literature to have superior clinical and radiographic outcomes 18 . Moreover, we believe that the use of Dog Bone Buttons to tension the superior clavicle until the clavicle is fully reduced reinforces the reconstruction, further minimizing the risk of loss of reduction and subsequent instability.…”