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Long-term stability of coracoclavicular suture fixation for acute acromioclavicular joint separation

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The optimal (SBJI) surgical treatment for acute acromioclavicular (AC) joint disruption remains controversial. What is being presented is the long-term functional outcomes of a double cross-looped coracoclavicular (CC) suture technique with the intention of restoring both anteroposterior and superior displacement of the clavicle.

Methods

Between 2007 and 2016, 81 patients underwent surgical reconstruction for acute acromioclavicular joint (AC) disruption in two orthopaedic centers. Two patients died for reasons unrelated to the treatment, and seven missed the final follow-up appointment, leaving 72 patients (67 males; 5 females; age 37 ± 12.4; range 15–64 years) for clinical and radiological assessments. All cases were classified according to the Rockwood classification as type III (n = 34), IV (n = 14) or V (n = 24). The dislocation was repaired with double cross-looped CC fixation using four Ethibond sutures passing underneath the coracoid and through a 4.5 mm drill hole in the clavicle in opposing directions to control both anteroposterior and vertical displacement. Radiological investigation preoperatively and at the last follow-up included anteroposterior and/or Zanca views, axillary or Alexander views, and comparative stress radiography of both AC joints. Patients were evaluated clinically with the Constant-Murley score (CMS) and Acromio Clavicular Joint Instability Score (ACJIS). Loss of reduction, subluxation, CC ligament ossification, post-traumatic arthritis, and peri-implant fractures were also recorded.

Results

Seventy-two patients were available for the last clinical and radiological evaluations. At a median follow-up period of 6.3 ± 2.1 years (range 3–12 years), the CMS and ACJIS were 92.1 ± 7.2 (range 60–100 points) and 90.4 ± 8.6 (range 45–100 points), respectively. Complications included 9 (12.5%) patients with slight loss of reduction, 2 (1.7%) with dislocation recurrence, 1 (1.3%) with superficial infection, 1 (1.3%) with a fracture of the lateral end of the clavicle, and 2 (1.7%) with persistent tenderness in the AC joint. The incidence of periarticular ossification was 22.4% and did not affect the final outcome.

Conclusions

This technique represents an effective and low-cost treatment for acute AC joint separations.

Level of evidence

IV.

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Authors and Affiliations

  1. Department of Shoulder and Elbow Surgery, Patras University Hospital, Papanikolaou 1, 26504, Patras, Greece

    A. Panagopoulos, Z. T. Kokkalis & P. Dimakopoulos

  2. Hand Surgery-Upper Limb and Microsurgery Department, General Hospital “KAT” Athens, Kifissia, Greece

    E. Fandridis

  3. Department of Biomedical Sciences, Humanitas University, Via Manzoni 56, Rozzano, Pieve Emanuele-Milan, 20089, Italy

    R. Ranieri & A. Castagna

  4. Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, Rozzano, Milan, 20089, Italy

    G. Delle Rose & A. Castagna

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  1. A. Panagopoulos
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Correspondence to A. Panagopoulos.

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No outside funding or financial support was received to undertake this study.

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Ethical review board approval (IRB number 3672/24.10.2016) was granted prior to commencement of the study.

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All patients gave their informed consent for participation in the study.

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Panagopoulos, A., Fandridis, E., Rose, G.D. et al. Long-term stability of coracoclavicular suture fixation for acute acromioclavicular joint separation. Knee Surg Sports Traumatol Arthrosc 29, 2103–2109 (2021). https://doi.org/10.1007/s00167-020-06158-3

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