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Surgical Technique for Arthroscopy-Assisted Anatomical Reconstruction of Acromioclavicular and Coracoclavicular Ligaments Using Autologous Hamstring Graft in Chronic Acromioclavicular Joint Dislocations.

ABSTRACT: Injuries to the acromioclavicular (AC) joint are becoming common with contact sports and bike accidents. It is well known that in AC dislocations, the first structure to fail is the AC capsule followed by the trapezoid and conoid ligaments. The function of these ligaments must be restored to restore the anatomy and physiology of the AC joint to get the best results. Until now, no technique has emerged as the gold standard for restoration of the AC joint anatomy and function. In our technique, the stress is on recreating the anatomy to make it more individualized based on individual variations. This Technical Note describes a procedure to reconstruct the coracoclavicular ligaments and AC joint by an arthroscopy-assisted technique. Arthroscopy helps to diagnose additional intra-articular pathologies that can be treated simultaneously, and better preparation of the undersurface of the coracoid helps in bone-to-graft healing. Our approach is more individualized as clavicle tunneling is done according to the size of the coracoid base instead of a fixed distance. Vertical stability is provided by coracoclavicular ligament reconstruction, horizontal stability is provided by AC ligament reconstruction, and the articular disc is recreated by soft-tissue graft interposition, thus restoring the complete anatomy.

SUBMITTER: Chernchujit B

PROVIDER: S-EPMC5495563 | biostudies-literature | 2017 Jun

REPOSITORIES: biostudies-literature

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Surgical Technique for Arthroscopy-Assisted Anatomical Reconstruction of Acromioclavicular and Coracoclavicular Ligaments Using Autologous Hamstring Graft in Chronic Acromioclavicular Joint Dislocations.

Chernchujit Bancha B Parate Prashant P

Arthroscopy techniques 20170529 3

Injuries to the acromioclavicular (AC) joint are becoming common with contact sports and bike accidents. It is well known that in AC dislocations, the first structure to fail is the AC capsule followed by the trapezoid and conoid ligaments. The function of these ligaments must be restored to restore the anatomy and physiology of the AC joint to get the best results. Until now, no technique has emerged as the gold standard for restoration of the AC joint anatomy and function. In our technique, th ...[more]

PMID: 28706811

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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

Surgical Technique for Arthroscopy-Assisted Anatomical Reconstruction of Acromioclavicular and Coracoclavicular Ligaments Using Autologous Hamstring Graft in Chronic Acromioclavicular Joint Dislocations.

Publications

Surgical Technique for Arthroscopy-Assisted Anatomical Reconstruction of Acromioclavicular and Coracoclavicular Ligaments Using Autologous Hamstring Graft in Chronic Acromioclavicular Joint Dislocations.

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