Skip to main content
SpringerLink
Log in

Open capsular and ligament reconstruction with semitendinosus hamstring autograft successfully controls superior and posterior translation for type V acromioclavicular joint dislocation

  • Shoulder
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Appropriate surgical management for type V complete acromioclavicular (AC) joint dislocation remains controversial. The purpose of this paper is to retrospectively report the clinical and radiographic outcomes of an open surgical technique consisting for AC joint ligamentous and capsular reconstruction using autologous hamstring tendon grafts and semi-permanent sutures.

Methods

Between January 2005 and December 2011, 32 consecutive patients with symptomatic type V complete AC joint dislocation underwent surgical treatment using the same technique. The median time from injury to surgery was 45 days (range 24–90). The average median postoperative clinical and radiographic follow-up time was 30 months (range 24–33). Clinical outcomes measures included the ASES score, the visual analog score (VAS), and subjective patient satisfaction score. Minimum follow-up was 2 years.

Results

ASES score increased from a median of 38.2 ± 6.2 preoperative to 92.1 ± 4.7 postoperatively (p ≤ 0.05). The median VAS score improved from 62 mm (range 45–100 mm) preoperatively to 8 mm (range 0–20 mm) at final follow-up (p ≤ 0.05). No patient experienced pain or discomfort with either direct palpation of the AC joint or with cross-body adduction. Final radiographs demonstrated symmetric AC joint contour in 25/32 (78%) patients. Seven patients (22%) radiographically demonstrated superior translation of the distal clavicle relative to the superior margin of the acromion but less than 50% of the clavicular width. 30/32 patients (93%) were able to return to their pre-injury level of work and sports activities.

Conclusions

This novel surgical technique using a free graft and braided suture for simultaneous coracoclavicular ligament and AC joint capsular reconstruction successfully controls superior and posterior translations after type V AC joint dislocation and minimizes the incidence of persistent postoperative AC joint subluxation.

Level of evidence

Retrospective case series, Level IV.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

ACJ:

Acromioclavicular joint

AC:

Acromioclavicular

ASES:

American shoulder and elbow surgeons score

VAS:

Visual analog scale

References

  1. Beitzel K, Obopilwe E, Apostolakos J et al (2014) Rotational and traslational stability of different methods for direct acromionclavicular ligament repair in anatomic acromionclavicular joint reconstruction. Am J Sports Med 42(9):2141–2148

    Article  PubMed  Google Scholar 

  2. Beitzel K, Sablan N, Chowaniec DM et al (2012) Sequential resection of the distal clavicle and its effects on horizontal acromioclavicular joint translation. Am J Sports Med 40:681–685

    Article  PubMed  Google Scholar 

  3. Branch TP, Burdette HL, Shahriari AS et al (1996) The role of the acromioclavicular ligaments and the effect of distal clavicle resection. Am J Sports Med 24:293–297

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  5. 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

    Article  PubMed  Google Scholar 

  6. Debski RE, Fenwick JA, Vangura A Jr, Fu FH, Woo SL, Rodosky MW (2003) Effect of arthroscopic procedures on the acromioclavicular joint. Clin Orthop Relat Res 406:89–96

    Article  Google Scholar 

  7. Faraj AA, Ketzer B (2001) The use of a hook plate in the management of acromioclavicular injuries: report of ten cases. Acta Ortho Belgica 67:448–451

    CAS  Google Scholar 

  8. Jensen G, Katthagen JC, Alvarado LE, Lill H, Voigt C (2014) Has the arthroscopically assisted reduction of acute AC joint separations with the double tight-rope technique advantages over the clavicular hook plate fixation? Knee Surg Sports Traumatol Arthrosc 22(2):422–430

    Article  PubMed  Google Scholar 

  9. Lee SJ, Nicholas SJ, Akizuki KH, McHugh MP, Kremenic IJ, Ben-Avi S (2003) Reconstruction of the coracoclavicular ligaments with tendon grafts. Am J Sports Med 31:648–654

    PubMed  Google Scholar 

  10. Richards RR, An K-N, Bigliani LU, Friedman RJ, Gartsman GM, Gristina AG, Iannotti JP et al (1994) A standardized method for assessment of shoulder function. J Shoulder Elbow Surg 3:347–352

    Article  CAS  PubMed  Google Scholar 

  11. Rockwood CA Jr, Young DC (1998) Injuries to the acromioclavicular joint. In: Rockwood CA Jr, Bucholz RW, Heckmen JD (eds) Rockwood and Green’s fractures in adults. Lippincott Williams and Wilkins, Philadelphia, pp 1341–1413

    Google Scholar 

  12. Saccomanno MF, Fodale M, Capasso L, Cazzato G, Milano G (2014) Reconstruction of the coracoclavicular and acromionclavicular ligaments with semtetendionous tendon graft: a pilot study. Joint 2(1):6–14

    Google Scholar 

  13. Sage FP, Salvatore JE (1963) Injuries of the acromioclavicular joint: a study of results in 96 patients. South Med J 56:486–495

    Article  CAS  PubMed  Google Scholar 

  14. Salem KH, Schmelz A (2009) Treatment of Tossy III acromioclavicular joint injuries using hook plates and ligament suture. J Orthop Trauma 23:565–569

    Article  PubMed  Google Scholar 

  15. Salzmann GM, Walz L, Buchmann S, Glabgly P, Venjakob A, Imhoff AB (2010) Arthroscopically assisted 2-bundle anatomical reduction of acute acromioclavicular joint separations. Am J Sports Med 38:1179–1187

    Article  PubMed  Google Scholar 

  16. Schickendantz MS, Jones RB (2004) Acromioclavicular joint injuries. In: Krishnan SG, Hawkins RJ, Warren RF (eds) The shoulder and the overhead athlete. Lippincott Williams and Wilkins, Philadelphia, pp 209–221

    Google Scholar 

  17. Schliemann B, Roßlenbroich SB, Schneider KN, Petersen W, Raschke MJ, Weimann A (2015) Why does minimally invasive coracoclavicular ligament reconstruction using a flip button repair technique fail? An analysis of risk factors and complications. Knee Surg Sports Traumatol Arthrosc 23(5):1419–1425

    Article  PubMed  Google Scholar 

  18. Shin SJ, 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 Traumatol Arthrosc 22(9):2216–2222

    Article  PubMed  Google Scholar 

  19. Singh B, Mohanlal P, Bawale R (2016) Early failure of coracoclaviular ligament reconstruction using TightRope system. Acta Orthop Belg 82(1):119–123

    PubMed  Google Scholar 

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

    Article  Google Scholar 

  21. Tomlinson DP, Altchek DW, Davila J, Cordasco FA (2008) A modified technique of arthroscopically assisted AC joint reconstruction and preliminary results. Clin Orthop Relat Res 466(3):639–645

    Article  PubMed  PubMed Central  Google Scholar 

  22. Urist MR (1963) Complete Dislocation of the Acromioclavicular Joint. J Bone Joint Surg Am 45:1750–1753

    Article  CAS  PubMed  Google Scholar 

  23. Virtanen KJ, Remes VM, Tulikoura IT, Pajarinen JT, Savolainen VT, Björkenheim JM et al (2013) Surgical treatment of Rockwood grade V acromionclavicular joint dislocations. 50 patients followed for 15–22 years. Acta Orthop 84(2):191–195

    Article  PubMed  PubMed Central  Google Scholar 

  24. Weaver JK, Dunn HK (1972) Treatment of acromioclavicular injuries, especially complete acromioclavicular separation. J Bone Joint Surg Am 54(6):1187–1194

    Article  CAS  PubMed  Google Scholar 

  25. 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

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Shoulder Service F MIULLI Hospital, Km 4 strada per Santeramo, Acquaviva delle fonti, Bari, 70026, Italy

    Raffaele Garofalo

  2. Villa Stuart Sport Clinic, Rome, Italy

    Enrico Ceccarelli

  3. Shoulder and Elbow Unit IRCCS Humanitas Institute, Milan, Italy

    Alessandro Castagna & Marco Conti

  4. University of l’Aquila, L’aquila, Italy

    Vittorio Calvisi

  5. Orthopedic Associated of Dallas, Dallas, USA

    Brody Flanagin

  6. The Shoulder Center Baylor University Medical Center at Dallas, Dallas, USA

    Sumant G. Krishnan

Authors
  1. Raffaele Garofalo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Enrico Ceccarelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alessandro Castagna
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Vittorio Calvisi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Brody Flanagin
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Marco Conti
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Sumant G. Krishnan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Raffaele Garofalo.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Funding

No funding.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research commitee and with the 1964 helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the independent institutional review board of the Miulli hospital (n0014-12).

Informed consent

Although for this type of study formal consent is not required, all the patients given consent to be included in this study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Garofalo, R., Ceccarelli, E., Castagna, A. et al. Open capsular and ligament reconstruction with semitendinosus hamstring autograft successfully controls superior and posterior translation for type V acromioclavicular joint dislocation. Knee Surg Sports Traumatol Arthrosc 25, 1989–1994 (2017). https://doi.org/10.1007/s00167-017-4509-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-017-4509-7

Keywords

Search

Navigation