Acromioclavicular Joint Separation: Repair Through Suture Anchors for Coracoclavicular Ligament and Nonabsorbable Suture Fixation for Acromioclavicular Joint

Abstract

Objective: To evaluate the clinical and radiographic outcomes of patients undergoing coracoclavicular (CC) ligament repair by two suture anchors and acromioclavicular (AC) joint (ACJ) fixation using heavy nonabsorbable sutures for the treatment of types III-V ACJ injuries with a minimum of 1-year follow-up. Methods: The clinical and radiographic outcomes of 36 consecutive patients (26 men and 10 women) who underwent anatomic reduction for acute ACJ dislocation using two suture anchors for CC ligament reconstruction and two strands of non-absorbable stitches for ACJ fixation between December 2013 and December 2018 were reviewed. Two 3.5 mm suture anchors with double-loaded sutures were separately inserted into the anterolateral and posteromedial portions of the coracoid process. The suture strands were passed through the hole created in the clavicle using 2.0 mm drill and tied over the clavicle. Additional ACJ augmentation using two strands of non-absorbable heavy sutures was performed in all patients. At 3, 6, and 12 months and last follow-up visit, the scores on the visual analog scale (VAS), the American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score, and simple shoulder test (SST) questionnaires were used to provide a final evaluation of shoulder function. Comparison between baseline and treatment results was performed. Radiographic analysis included vertical displacement and horizontal shift. Results: A total of 29 patients (20 men and nine women) were included in the study. A total of seven, six, and 16 patients had Rockwood type III, type IV, and type V ACJ dislocations, respectively. The mean patient age was 42.8 AE 13.5 years, with a mean follow-up of 28 months (range, 12-56 months). At the 12-month follow-up, the mean ASES score was 92.1 AE 3.5, with a mean pain score of 0.5 AE 0.7 on the VAS and mean Constant-Murley score of 93.0 AE 2.4. The new number of positive answers on the SST was 11.5 AE 0.6. Compared with the baseline, the clinical results improved significantly (P < 0.05). No significant difference could be found between the 6-and 12-month follow-up evaluations (P > 0.05). Radiographs showed two partial loss of reduction, whereas no horizontal displacement was found in all patients. One patient developed a superficial wound infection 3 weeks postoperation. The wound healed after routine wound care. No neurovascular complications were recorded. Conclusions: CC ligament reconstruction using two suture anchors and ACJ augmentation using two strands of nonabsorbable heavy sutures on high-grade AC dislocation is a reliable technique for restoring stability to the ACJ and can obtain good to excellent clinical results.

Coracoclavicular and acromioclavicular ligament reconstruction with a cost-effective and reproducible method: A new surgical technique

“…Many studies emphasize coracoclavicular ligament reconstruction with different techniques with suture anchors, fixation device, hook plates, hamstring auto graft, allografts, non-absorbable suture materials show reliable technique for restoring stability and good to excellent clinical results. The parameters used were the American Shoulder and Elbow Surgeons (ASES) score, Constant Murley Score, Simple Shoulder Test (SST), Visual Analog Scale (VAS) [3] . Our study only demonstrates the newer surgical technique, further long-term prospective studies based on scores are to be carried out to demonstrate true efficacy at our setup.…”

Horizontal instability after acromioclavicular joint reduction using the two-hole technique is preferred over the loop technique: a single-blind randomized clinical trial

“…Regarding complications, because subcutaneous pins were used for both techniques in this study, mild infections with small secretions were observed in both groups and were controlled with antibiotics. In a study by Liu et al [13], a patient developed a superficial wound infection 3 weeks after surgery, which healed after routine care. Theopold et al [18] reported no intraoperative tion with various surgical techniques appears to have limited and acceptable complications.…”

“…By measuring the distance between the anterior edge of the acromion and the anterior edge of the lateral clavicle, the dislocation was categorized as stable ( ≤ 2 mm) or unstable ( > 2 mm) (Fig. 3) [13][14][15].…”

Does coracoclavicular augmentation additional to hook plate fixation provide benefits in acute unstable acromioclavicular dislocation? A meta-analysis

“…Various treatment options for acute unstable ACJ dislocation, such as CC fixation (using Bosworth screws, suture anchors, hook plates [HPs], or TightRope) [ 3 , 7 – 14 ], AC fixation (using tension band wires, Kirschner wires, or sutures) [ 8 , 15 ], AC or CC reconstruction, and ligament transfer (Weaver–Dunn procedures) [ 16 ], have been investigated [ 17 – 22 ]. However, the optimal treatment for ACJ dislocation is still debated [ 3 , 8 , 23 , 24 ]. The clavicle HP is used in one of the most common techniques to promote CC ligament scaring [ 25 – 27 ].…”