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All-Arthroscopic Coracoclavicular Ligament Reconstruction Surgical Technique Using a Semitendinosus Allograft and Tenodesis Screws.

ABSTRACT: Acromioclavicular joint injuries account for 9% of shoulder girdle injuries and are most often associated with direct blows to the shoulder or axially directed forces onto the ipsilateral extremity. Type IV, V, and VI injuries are generally managed surgically, whereas type I and II injuries are treated with sling immobilization, early shoulder range of motion, and physical therapy. Type III injuries are more controversial but are generally managed surgically in the active and high-demand patient. When surgical treatment is indicated, the primary goal of a coracoclavicular (CC) ligament reconstruction is to restore anatomic reduction of the acromioclavicular joint and reconstruct the biomechanical forces of the CC ligaments. Many open surgical techniques are currently used to achieve these goals but can increase patient morbidity. We describe a technique for an all-arthroscopic CC ligament reconstruction using a semitendinosus allograft and BioComposite tenodesis screws (Arthrex) without disruption of the deltoid attachment onto the distal clavicle.

SUBMITTER: Li X

PROVIDER: S-EPMC5443243 | biostudies-literature | 2017 Apr

REPOSITORIES: biostudies-literature

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All-Arthroscopic Coracoclavicular Ligament Reconstruction Surgical Technique Using a Semitendinosus Allograft and Tenodesis Screws.

Li Xinning X Padmanabha Anand A Koh Justin J Cusano Antonio A

Arthroscopy techniques 20170403 2

Acromioclavicular joint injuries account for 9% of shoulder girdle injuries and are most often associated with direct blows to the shoulder or axially directed forces onto the ipsilateral extremity. Type IV, V, and VI injuries are generally managed surgically, whereas type I and II injuries are treated with sling immobilization, early shoulder range of motion, and physical therapy. Type III injuries are more controversial but are generally managed surgically in the active and high-demand patient ...[more]

PMID: 28580261

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Project description:Purpose:To determine the results of operatively treated chronic acromioclavicular (AC) joint dislocations after 2-year follow-up. Methods:Fifty-eight patients with chronic acromioclavicular separations underwent arthroscopic coracoclavicular ligament reconstructions using semitendinosus autografts. Constant and Simple Shoulder Test scores were determined before and 2 years after surgery as a part of standard clinical practice. General patient satisfaction with the outcome (poor, fair, or excellent) also was assessed. In addition, for purposes of routine clinical follow-up, the coracoclavicular distance was measured from the inferior cortex of the clavicle to the superior cortex of the coracoid using anteroposterior radiographs taken 2 years after surgery. The results were compared with postoperative radiographs and changes in the distance were recorded. The clavicular drill hole was similarly measured 2 years after surgery to detect possible tunnel widening. Results:The mean preoperative Constant score increased from a preoperative mean of 52.6 ± 16.5 to 94.7 ± 7.9 at 2 years postoperatively (P = .000). The Simple Shoulder Test score increased from a preoperative mean of 7.7 ± 1.64 to 11.8 ± 0.7 (P = .000). The mean coracoclavicular distance increased from 10.5 ± 3.4 to 12.4 ± 3.9 mm (P = .009). The diameter of the clavicular drill hole increased from 6.0 mm to a mean of 8.4 mm. Two coracoid fractures were observed, but no clavicular fractures. One patient experienced a deep infection, leading to total reconstruction failure, and 2 patients had superficial postoperative infections. Forty-five patients (85%) reported excellent subjective outcomes, and 8 (15%) reported a fair outcome. Conclusions:The outcomes of this series of coracoclavicular ligament reconstruction were favorable and the number of serious complications was small. However, clavicular wound issues were a significant problem. Coracoclavicular ligament reconstruction is a challenging procedure, but satisfactory results can be achieved with careful patient selection and good technique. Level of Evidence:Level IV, therapeutic case series.

Dataset Information

All-Arthroscopic Coracoclavicular Ligament Reconstruction Surgical Technique Using a Semitendinosus Allograft and Tenodesis Screws.

Publications

All-Arthroscopic Coracoclavicular Ligament Reconstruction Surgical Technique Using a Semitendinosus Allograft and Tenodesis Screws.

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