Skip to main content

Anatomic reconstruction of the coracoclavicular and acromioclavicular ligaments with semitendinosus tendon graft for the treatment of chronic acromioclavicular joint dislocation provides good clinical and radiological results

Knee Surgery, Sports Traumatology, Arthroscopy volume 29, pages 2356–2363 (2021)Cite this article

Abstract

Purpose

To evaluate clinical and radiographic outcomes of anatomical reconstruction of the coracoclavicular and acromioclavicular ligaments with single-strand semitendinosus tendon graft for the treatment of chronic acromioclavicular joint dislocation.

Methods

Patients affected by chronic type III–V acromioclavicular joint dislocations were included. Exclusion criteria were: age under 18 years, concomitant rotator cuff tears, previous surgery to the same shoulder, degenerative changes of the glenohumeral joint, infections, neurologic diseases, patients with a previous history of ligament reconstruction procedures that had required harvesting of the semitendinosus tendon from the ipsilateral or contralateral knee. All patients underwent the same surgical technique and rehabilitation. Primary outcome was the normalized Constant score. Secondary outcomes were: DASH score, radiographic evaluation of loss of reduction and acromioclavicular joint osteoarthritis.

Results

Thirty patients with a mean age of 28.9 ± 8.3 years were included. Mean time to surgery was 12.8 ± 10 months. Mean follow-up was 28.1 ± 2.4 months (range: 24–32). Comparison between pre- and postoperative functional scores showed significant clinical improvement (p < 0.001). Time to surgery was independently associated with a poorer Constant score (p < 0.0001). On radiographs, 4 patients (13.3%) showed asymptomatic partial loss of reduction.

Conclusion

Anatomic reconstruction of coracoclavicular and acromioclavicular ligaments using a semitendinosus tendon graft for the treatment of chronic acromioclavicular joint dislocation provided good clinical and radiological results at minimum 2-year follow-up.

Level of evidence

Level III.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3

References

  1. Bagg SD, Forrest WJ (1988) A biomechanical analysis of scapular rotation during arm abduction in the scapular plane. Am J Phys Med Rehabil 67:238–245

    CAS  PubMed  Google Scholar 

  2. Barth J, Duparc F, Baverel L, Bahurel J, Toussaint B, Bertiaux S, Clavert P, Gastaud O, Brassart N, Beaudouin E, De Mourgues P, Berne D, Duport M, Najihi N, Boyer P, Faivre B, Meyer A, Nourissat G, Poulain S, Bruchou F, Ménard JF, d’Arthroscopie SF (2015) Prognostic factors to succeed in surgical treatment of chronic acromioclavicular dislocations. OrthopTraumatolSurg Res 101:S305–311

    CAS  Google Scholar 

  3. 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

    PubMed  Google Scholar 

  4. Carbone S, Postacchini R, Gumina S (2015) Scapular dyskinesis and SICK syndrome in patients with a chronic type III acromioclavicular dislocation. Results of rehabilitation. Knee Surg Sports TraumatolArthrosc 23:1473–1480

    Google Scholar 

  5. Carofino BC, Mazzocca AD (2010) The anatomic coracoclavicular ligament reconstruction: surgical technique and indications. J Shoulder Elbow Surg 19:37–46

    PubMed  Google Scholar 

  6. Charles ER, Kumar V, Blacknall J, Edwards K, Geoghegan JM, Manning PA, Wallace WA (2017) A validation of the Nottingham Clavicle Score: a clavicle, acromioclavicular joint and sternoclavicular joint-specific patient-reported outcome measure. J Shoulder Elbow Surg 26:1732–1739

    PubMed  Google Scholar 

  7. Clavert P, Meyer A, Boyer P, Gastaud O, Barth J, Duparc F (2015) Complication rates and types of failure after arthroscopic acute acromioclavicular dislocation fixation. Prospective multicenter study of 116 cases. OrthopTraumatolSurg Res 101:S313–316

  8. Cook JB, Krul KP (2018) Challenges in Treating Acromioclavicular Separations: Current Concepts. J Am AcadOrthopSurg 26:669–677

    Google Scholar 

  9. Cook JB, Shaha JS, Rowles DJ, Bottoni CR, Shaha SH, Tokish JM (2012) Early failures with single claviculartransosseouscoracoclavicular ligament reconstruction. J Shoulder Elbow Surg 21:1746–1752

    PubMed  Google Scholar 

  10. Cvetanovich GL, Gowd AK, Liu JN, Nwachukwu BU, Cabarcas BC, Cole BJ, Forsythe B, Romeo AA, Verma NN (2019) Establishing clinically significant outcome after arthroscopic rotator cuff repair. J Shoulder Elbow Surg 28:939–948

    PubMed  Google Scholar 

  11. Dabija DI, Jain NB (2019) Minimal clinically important difference of shoulder outcome measures and diagnoses: a systematic review. Am J Phys Med Rehabil 98:671–676

    PubMed  PubMed Central  Google Scholar 

  12. Deans CF, Gentile JM, Tao MA (2019) Acromioclavicular joint injuries in overhead athletes: a concise review of injury mechanisms, treatment options, and outcomes. Curr Rev Musculoskelet Med 12:80–86

    PubMed  PubMed Central  Google Scholar 

  13. Ernberg LA, Potter HG (2003) Radiographic evaluation of the acromioclavicular and sternoclavicular joints. Clin Sports Med 22:255–275

    PubMed  Google Scholar 

  14. Faul F, Erdfelder E, Lang A-G, Buchner A (2007) G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 39:175–191

    PubMed  Google Scholar 

  15. Frank RM, Cotter EJ, Leroux TS, Romeo AA (2019) Acromioclavicular joint injuries: evidence-based treatment. J Am AcadOrthopSurg 27:e775–e788

    Google Scholar 

  16. Grassbaugh JA, Cole C, Wohlrab K, Eichinger J (2013) Surgical technique affects outcomes in acromioclavicular reconstruction. J SurgOrthopAdv 22:71–76

    Google Scholar 

  17. Gumina S, Carbone S, Postacchini F (2009) Scapular dyskinesis and SICK scapula syndrome in patients with chronic type III acromioclavicular dislocation. Arthroscopy 25:40–45

    PubMed  Google Scholar 

  18. Hann C, Kraus N, Minkus M, Maziak N, Scheibel M (2018) Combined arthroscopically assisted coraco- and acromioclavicular stabilization of acute high-grade acromioclavicular joint separations. Knee Surg Sports TraumatolArthrosc 26:212–220

    Google Scholar 

  19. Hippensteel KJ, Brophy R, Smith M, Wright R (2018) Surgical volume and postoperative complications of acromioclavicular joint separations: analysis of the ABOS Part II examination. Am J Sports Med 46:3174–3181

    CAS  PubMed  Google Scholar 

  20. Inoue D, Furuhata R, Kaneda K, Ritsuno Y, Kono A, Kiyota Y, Morioka H, Arino H (2019) Clavicle fracture at the suture hole after acromioclavicular joint reconstruction using a suture-button: a case report. BMC MusculoskeletDisord 20:333

    Google Scholar 

  21. Kibler WB, Sciascia AD, Morris BJ, Dome DC (2017) Treatment of symptomatic acromioclavicular joint instability by a docking technique: clinical indications, surgical technique, and outcomes. Arthroscopy 33:696–708.e2

    PubMed  Google Scholar 

  22. Kraus N, Hann C, Minkus M, Maziak N, Scheibel M (2019) Primary versus revision arthroscopically-assisted acromio- and coracoclavicular stabilization of chronic AC-joint instability. Arch Orthop Trauma Surg 139:1101–1109

    PubMed  Google Scholar 

  23. Kukkonen J, Kauko T, Vahlberg T, Joukainen A, Aärimaa V (2013) Investigating minimal clinically important difference for Constant score in patients undergoing rotator cuff surgery. J Shoulder Elbow Surg 22:1650–1655

    PubMed  Google Scholar 

  24. Lee SK, Song DG, Choy WS (2015) Anatomical double-bundle coracoclavicular reconstruction in chronic acromioclavicular dislocation. Orthopedics 38:e655–662

    PubMed  Google Scholar 

  25. Longo UG, Ciuffreda M, Rizzello G, Mannering N, Maffulli N, Denaro V (2017) Surgical versus conservative management of Type III acromioclavicular dislocation: a systematic review. Br Med Bull 122:31–49

    PubMed  Google Scholar 

  26. Lopiz Y, Checa P, García-Fernández C, Valle J, Vega ML, Marco F (2019) Complications with the clavicle hook plate after fixation of Neer type II clavicle fractures. IntOrthop 43:1701–1708

    Google Scholar 

  27. Mazzocca AD, Arciero RA, Bicos J (2007) Evaluation and treatment of acromioclavicular joint injuries. Am J Sports Med 35:316–329

    PubMed  Google Scholar 

  28. Menge TJ, Boykin RE, Bushnell BD, Byram IR (2014) Acromioclavicular osteoarthritis: a common cause of shoulder pain. South Med J 107:324–329

    PubMed  Google Scholar 

  29. Morikawa D, Dyrna F, Cote MP, Johnson JD, Obopilwe E, Imhoff FB, Beitzel K, Mazzocca AD, Scheiderer B (2019) Repair of the entire superior acromioclavicular ligament complex best restores posterior translation and rotational stability. Knee Surg Sports TraumatolArthrosc 27:3764–3770

    Google Scholar 

  30. Muench LN, Kia C, Jerliu A, Murphy M, Berthold DP, Cote MP, Arciero RA, Mazzocca AD (2019) Functional and radiographic outcomes after anatomic coracoclavicular ligament reconstruction for type III/V acromioclavicular joint injuries. Orthop J Sports Med 7:2325967119884539

    PubMed  PubMed Central  Google Scholar 

  31. Nakazawa M, Nimura A, Mochizuki T, Koizumi M, Sato T, Akita K (2016) The orientation and variation of the acromioclavicular ligament: an anatomic study. Am J Sports Med 44:2690–2695

    PubMed  Google Scholar 

  32. Nolte PC, Lacheta L, Dekker TJ, Elrick BP, Millett PJ (2020) Optimal management of acromioclavicular dislocation: current perspectives. Orthop Res Rev 12:27–44

    PubMed  PubMed Central  Google Scholar 

  33. Padua R, Padua L, Ceccarelli E, Bondi R, Alviti F, Castagna A (2010) Italian version of ASES questionnaire for shoulder assessment: cross-cultural adaptation and validation. MusculoskeletSurg 94(Suppl 1):S85–90

    Google Scholar 

  34. Padua R, Padua L, Ceccarelli E, Romanini E, Zanoli G, Amadio P, Campi A (2003) Italian version of the disability of the arm, shoulder and hand (dash) questionnaire. cross-cultural adaptation and validation. J Hand Surg Br 28:179–186

    CAS  PubMed  Google Scholar 

  35. Palauro FR, Stirma GA, Secundino AR, Riffel GB, Baracho F, Dau L (2019) Kirschner wire migration after the treatment of acromioclavicular luxation for the contralateral shoulder - case report. Rev Bras Ortop (Sao Paulo) 54:202–205

    Google Scholar 

  36. Pallis M, Cameron KL, Svoboda SJ, Owens BD (2012) Epidemiology of acromioclavicular joint injury in young athletes. Am J Sports Med 40:2072–2077

    PubMed  Google Scholar 

  37. Rockwood CJ, Williams G, Young D (1998) Disorders of the acromioclavicular joint. In: Rockwood CJ, Matsen FA (eds) The Shoulder, 2nd edn. WB Saunders, Philadelphia, pp 483–553

    Google Scholar 

  38. Saccomanno MF, Fodale M, Capasso L, Cazzato G, Milano G (2014) Reconstruction of the coracoclavicular and acromioclavicular ligaments with semitendinosus tendon graft: a pilot study. Joints 2:6–14

    PubMed  PubMed Central  Google Scholar 

  39. Scheibel M, Dröschel S, Gerhardt C, Kraus N (2011) Arthroscopically assisted stabilization of acute high-grade acromioclavicular joint separations. Am J Sports Med 39:1507–1516

    PubMed  Google Scholar 

  40. Shaffer BS (1999) Painful conditions of the acromioclavicular joint. J Am AcadOrthopSurg 7:176–188

    CAS  Google Scholar 

  41. Shin S-J, Campbell S, Scott J, McGarry MH, Lee TQ (2014) Simultaneous anatomic reconstruction of the acromioclavicular and coracoclavicular ligaments using a single tendon graft. Knee Surg Sports TraumatolArthrosc 22:2216–2222

    Google Scholar 

  42. Stine IA, Vangsness CT (2009) Analysis of the capsule and ligament insertions about the acromioclavicular joint: a cadaveric study. Arthroscopy 25:968–974

    PubMed  Google Scholar 

  43. Taft TN, Wilson FC, Oglesby JW (1987) Dislocation of the acromioclavicular joint. An end-result study. J Bone Joint Surg Am 69:1045–1051

    CAS  PubMed  Google Scholar 

  44. 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

    PubMed  Google Scholar 

  45. Tavakkolizadeh A, Ghassemi A, Colegate-Stone T, Latif A, Sinha J (2009) Gender-specific constant score correction for age. Knee Surg Sports TraumatolArthrosc 17:529–533

    CAS  Google Scholar 

  46. Thangaraju S, Tauber M, Habermeyer P, Martetschläger F (2019) Clavicle and coracoid process periprosthetic fractures as late post-operative complications in arthroscopically assisted acromioclavicular joint stabilization. Knee Surg Sports TraumatolArthrosc 27:3797–3802

    Google Scholar 

  47. Virtanen KJ, Savolainen V, Tulikoura I, Remes V, Haapamäki V, Pajarinen J, Björkenheim J-M, Paavola M (2014) Surgical treatment of chronic acromioclavicular joint dislocation with autogenous tendon grafts. Springerplus 3:420

    PubMed  PubMed Central  Google Scholar 

  48. Wang Y, Zhang J (2014) Acromioclavicular joint reconstruction by coracoid process transfer augmented with hook plate. Injury 45:949–954

    CAS  PubMed  Google Scholar 

  49. Weinstein DM, McCann PD, McIlveen SJ, Flatow EL, Bigliani LU (1995) Surgical treatment of complete acromioclavicular dislocations. Am J Sports Med 23:324–331

    CAS  PubMed  Google Scholar 

  50. Xará-Leite F, Andrade R, Moreira PS, Coutinho L, Ayeni OR, Sevivas N, Espregueira-Mendes J (2019) Anatomic and non-anatomic reconstruction improves post-operative outcomes in chronic acromio-clavicular instability: a systematic review. Knee Surg Sports TraumatolArthrosc 27:3779–3796

    Google Scholar 

  51. Yeak RD, Daud H, Nizlan NM (2019) Osteomyelitis post acromioclavicular joint reconstruction. Chin J Traumatol 22:182–185

    PubMed  PubMed Central  Google Scholar 

Download references

Author information

Affiliations

  1. Orthopaedics Institute, Fondazione Policilinico A. Gemelli IRCCS, Rome, Italy

    Maristella F. Saccomanno, Fabrizio Mocini, Valeria Vismara & Vincenzo Campana

  2. University of Brescia, Brescia, Italy

    Andrea G. Salvi, Alessandra Scaini & Giuseppe Milano

  3. Department of Bone and Joint Surgery, Spedali Civili, Brescia, Italy

    Giacomo Marchi & Giuseppe Milano

Authors
  1. Maristella F. Saccomanno
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Giacomo Marchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Fabrizio Mocini
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Valeria Vismara
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Vincenzo Campana
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Andrea G. Salvi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Alessandra Scaini
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Giuseppe Milano
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Maristella F. Saccomanno.

Ethics declarations

Conflict of interest

The authors declared they have no competing interest.

Funding

No external funding was used.

Ethical approval

All procedures were in accordance with the ethical standards of the institutional research committee.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Saccomanno, M.F., Marchi, G., Mocini, F. et al. Anatomic reconstruction of the coracoclavicular and acromioclavicular ligaments with semitendinosus tendon graft for the treatment of chronic acromioclavicular joint dislocation provides good clinical and radiological results. Knee Surg Sports Traumatol Arthrosc 29, 2356–2363 (2021). https://doi.org/10.1007/s00167-020-06285-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-020-06285-x

Keywords

  • Acromioclavicular
  • Instability
  • Dislocation
  • Coracoclavicular ligament
  • Acromioclavicular ligament
  • Autograft
  • Semitendinosus
  • Reconstruction