Abstract
Purpose
To evaluate the clinical and radiographic outcomes of patients undergoing anatomic coracoclavicular ligament reconstruction (ACCR) using free tendon allografts for the treatment of chronic acromioclavicular joint (ACJ) injuries with a minimum 1-year follow-up.
Methods
Patients who underwent ACCR for chronic ACJ injuries between 2003 and 2017 were analyzed. Clinical outcome measures included American Shoulder and Elbow Surgeons (ASES), Constant–Murley (CM), Simple Shoulder Test (SST), and
Single Assessment Numerical Evaluation (SANE) scores. Radiographic loss of reduction during follow-up was evaluated by calculating the difference (mm) in the coracoclavicular distance (CCD) of the involved side immediately postoperatively and at terminal follow-up.
Results
Forty-two patients (mean age: 42.7 ± 12.8 years) were included in the study with an average follow-up of 3.8 ± 3.1 years (range: 1.1–11.5 years). Patients achieved significant improvement in ASES (50.2 ± 20.1 pre to 85.2 ± 16.3 post), CM (60.2 ± 18.5 pre to 88.2 ± 9.1 post), SST (6.1 ± 3.2 pre to 9.5 ± 3.7 post), and SANE (24.0 ± 25.7 pre to 89.0 ± 12.7 post) scores (P < 0.001, respectively). There were no significant differences in functional improvement when comparing type III and V injuries (n.s.). Mean increase in CCD of the involved side from immediately postoperative to final radiographic follow-up was 4.1 ± 3.9 mm, with no significant correlation to clinical outcomes scores. Complications occurred in 33.3% of cases, with postoperative heterotopic ossification being most frequent (14.3%).
Conclusion
Patients undergoing ACCR using free tendon allografts for chronic ACJ injuries achieved significant improvement in shoulder function at a mean follow-up of 3.8 years. No correlation was observed between the amount of loss of reduction and clinical outcome scores. Free tendon allografts may be a reliable alternative to autografts in the treatment of chronic ACJ dislocations.
Level of evidence
IV
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References
Aliberti GM, Kraeutler MJ, Trojan JD, Mulcahey MK (2019) Horizontal instability of the acromioclavicular joint: a systematic review. Am J Sports Med. https://doi.org/10.1177/0363546519831013363546519831013
Baran S, Belisle JG, Granger EK, Tashjian RZ (2018) Functional and radiographic outcomes after allograft anatomic coracoclavicular ligament reconstruction. J Orthop Trauma 32:204–210
Beitzel K, Cote MP, Apostolakos J, Solovyova O, Judson CH, Ziegler CG et al (2013) Current concepts in the treatment of acromioclavicular joint dislocations. Arthroscopy 29:387–397
Beitzel K, Mazzocca AD, Bak K, Itoi E, Kibler WB, Mirzavan R et al (2014) ISAKOS upper extremity committee consensus statement on the need for diversification of the Rockwood classification for acromioclavicular joint injuries. Arthroscopy 30:271–278
Beitzel K, Obopilwe E, Apostolakos J, Cote MP, Russell RP, Charette R et al (2014) Rotational and translational stability of different methods for direct acromioclavicular ligament repair in anatomic acromioclavicular joint reconstruction. Am J Sports Med 42:2141–2148
Berthold DP, Muench LN, Dyrna F, Uyeki CL, Cote MP, Imhoff AB et al (2020) Radiographic alterations in clavicular bone tunnel width following anatomic coracoclavicular ligament reconstruction (ACCR) for chronic acromioclavicular joint injuries. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-020-05980-z
Boffano M, Mortera S, Wafa H, Piana R (2017) The surgical treatment of acromioclavicular joint injuries. EFORT Open Rev 2:432–437
Borbas P, Churchill J, Ek ET (2019) Surgical management of chronic high-grade acromioclavicular joint dislocations: a systematic review. J Shoulder Elbow Surg 28:2031–2038
Carofino BC, Mazzocca AD (2010) The anatomic coracoclavicular ligament reconstruction: surgical technique and indications. J Shoulder Elbow Surg 19:37–46
Costic RS, Labriola JE, Rodosky MW, Debski RE (2004) Biomechanical rationale for development of anatomical reconstructions of coracoclavicular ligaments after complete acromioclavicular joint dislocations. Am J Sports Med 32:1929–1936
Debski RE, Parsons IM, Woo SL, Fu F (2001) Effect of capsular injury on acromioclavicular joint mechanics. J Bone Joint Surg Am 83:1344–1351
Dyrna F, Berthold DP, Feucht MJ, Muench LN, Martetschlager F, Imhoff AB et al (2019) The importance of biomechanical properties in revision acromioclavicular joint stabilization: a scoping review. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-019-05742-6
Dyrna F, Imhoff FB, Haller B, Braun S, Obopilwe E, Apostolakos JM et al (2018) Primary stability of an acromioclavicular joint repair is affected by the type of additional reconstruction of the acromioclavicular capsule. Am J Sports Med 46:3471–3479
Frank RM, Cotter EJ, Leroux TS, Romeo AA (2019) Acromioclavicular joint injuries: evidence-based treatment. J Am Acad Orthop Surg. https://doi.org/10.5435/JAAOS-D-17-00105
Gowd AK, Liu JN, Cabarcas BC, Cvetanovich GL, Garcia GH, Manderle BJ et al (2019) Current concepts in the operative management of acromioclavicular dislocations: a systematic review and meta-analysis of operative techniques. Am J Sports Med 47:2745–2758
Grutter PW, Petersen SA (2005) Anatomical acromioclavicular ligament reconstruction: a biomechanical comparison of reconstructive techniques of the acromioclavicular joint. Am J Sports Med 33:1723–1728
Hegazy G, Safwat H, Seddik M, Al-Shal EA, Al-Sebai I, Negm M (2016) Modified weaver-dunn procedure versus the use of semitendinosus autogenous tendon graft for acromioclavicular joint reconstruction. Open Orthop J 10:166–178
Jordan RW, Malik S, Bentick K, Saithna A (2019) Acromioclavicular joint augmentation at the time of coracoclavicular ligament reconstruction fails to improve functional outcomes despite significantly improved horizontal stability. Knee Surg Sports Traumatol Arthrosc 27:3747–3763
Klimciewicz JJ, Williams GR, Sher JS, Karduna A, Des Jardins J, Iannotti JP (1999) The acromioclavicular capsule as a restraint to posterior translation of the clavicle: a biomechanical analysis. J Shoulder Elbow Surg 8:119–124
Lee SJ, Nicholas SJ, Akizuki KH, McHugh MP, Kremenic IJ, Ben-Avi S (2003) Reconstruction of the coracoclavicular ligaments with tendon grafts: a comparative biomechanical study. Am J Sports Med 31:648–655
Mazzocca AD, Arciero RA, Bicos J (2007) Evaluation and treatment of acromioclavicular joint injuries. Am J Sports Med 35:316–329
Mazzocca AD, Conway JE, Johnson S, Rios CG, Dumonski ML, Santangelo SA et al (2004) The anatomic coracoclavicular ligament reconstruction. Oper Tech Sports Med 12:56–61
Mazzocca AD, Santangelo SA, Johnson ST, Rios CG, Dumonski ML, Arciero RA (2006) A biomechanical evaluation of an anatomical coracoclavicular ligament reconstruction. Am J Sports Med 34:236–246
Millett PJ, Horan MP, Warth RJ (2015) Two-year outcomes after primary anatomic coracoclavicular ligament reconstruction. Arthroscopy 31:1962–1973
Moatshe G, Kruckeberg BM, Chahla J, Godin JA, Cinque ME, Provencher MT et al (2018) Acromioclavicular and coracoclavicular ligament reconstruction for acromioclavicular joint instability: a systematic review of clinical and radiographic outcomes. Arthroscopy 34(1979–1995):e1978
Morikawa D, Dyrna F, Cote MP, Johnson JD, Obopilwe E, Imhoff FB et al (2018) Repair of the entire superior acromioclavicular ligament complex best restores posterior translation and rotational stability. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-018-5205-y
Pallis M, Cameron KL, Svoboda SJ, Owens BD (2012) Epidemiology of acromioclavicular joint injury in young athletes. Am J Sports Med 40:2072–2077
Parnes N, Friedman D, Phillips C, Carey P (2015) Outcome after arthroscopic reconstruction of the coracoclavicular ligaments using a double-bundle coracoid cerclage technique. Arthroscopy 31:1933–1940
Phadke A, Bakti N, Bawale R, Singh B (2019) Current concepts in management of ACJ injuries. J Clin Orthop Trauma 10:480–485
Tornetta P, Ricci WM, Ostrum RF (2019) Injuries to the acromioclavicular joint: Subluxations and dislocations about the shoulder. Rockwood and Green’s fractures in adults. Lippincott Williams and Wilkins (LWW), 9th edn. ISBN: 978-1-49-6386651-9
Rolf O, von Weyhern AH, Ewers A, Boehm TD, Gohlke F (2008) Acromioclavicular dislocation Rockwood III–V: results of early versus delayed surgical treatment. Arch Orthop Trauma Surg 128:1153–1157
Sirin E, Aydin N, Mert Topkar O (2018) Acromioclavicular joint injuries: diagnosis, classification and ligamentoplasty procedures. EFORT Open Rev 3:426–433
Tauber M, Gordon K, Koller H, Fox M, Resch H (2009) Semitendinosus tendon graft versus a modified Weaver-Dunn procedure for acromioclavicular joint reconstruction in chronic cases: a prospective comparative study. Am J Sports Med 37:181–190
Tauber M, Valler D, Lichtenberg S, Magosch P, Moroder P, Habermeyer P (2016) Arthroscopic stabilization of chronic acromioclavicular joint dislocations: triple- versus single-bundle reconstruction. Am J Sports Med 44:482–489
Tienen TG, Oyen JF, Eggen PJ (2003) A modified technique of reconstruction for complete acromioclavicular dislocation: a prospective study. Am J Sports Med 31:655–659
Xará-Leite F, Andrade R, Moreira PS, Coutinho L, Ayeni OR, Sevivas N et al (2019) Anatomic and non-anatomic reconstruction improves post-operative outcomes in chronic acromio-clavicular instability: a systematic review. Knee Surg Sports Traumatol Arthrosc 27:3779–3796
Yoo JC, Ahn JH, Yoon JR, Yang JH (2010) Clinical results of single-tunnel coracoclavicular ligament reconstruction using autogenous semitendinosus tendon. Am J Sports Med 38:950–957
Zanca P (1971) Shoulder pain: involvement of the acromioclavicular joint. (Analysis of 1000 cases). Am J Roentgenol Radium Ther Nucl Med 112:493–506
Zhu Y, Hsueh P, Zeng B, Chai Y, Zhang C, Chen Y et al (2018) A prospective study of coracoclavicular ligament reconstruction with autogenous peroneus longus tendon for acromioclavicular joint dislocations. J Shoulder Elbow Surg 27:e178–e188
Zumstein MA, Schiessl P, Ambuehl B, Bolliger L, Weihs J, Maurer MH et al (2018) New quantitative radiographic parameters for vertical and horizontal instability in acromioclavicular joint dislocations. Knee Surg Sports Traumatol Arthrosc 26:125–135
Funding
ADM receives research support and consulting fees from Arthrex Inc. (Naples, FL). KB is a consultant for Arthrex Inc. (Naples, FL). MPC receives personal fees from the Arthroscopy Association of North America (AANA) for the Arthroscopy Journal. The authors DPB, CU, CK, ABI and LNM have nothing to disclose.
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Cerciello, S., Berthold, D.P., Uyeki, C. et al. Anatomic coracoclavicular ligament reconstruction (ACCR) using free tendon allograft is effective for chronic acromioclavicular joint injuries at mid-term follow-up. Knee Surg Sports Traumatol Arthrosc 29, 2096–2102 (2021). https://doi.org/10.1007/s00167-020-06123-0
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DOI: https://doi.org/10.1007/s00167-020-06123-0