Anatomic and non-anatomic reconstruction improves post-operative outcomes in chronic acromio-clavicular instability: a systematic review

Abstract

Purpose To systematize the surgical outcomes of anatomic and non-anatomic reconstruction in patients with chronic acromio-clavicular joint (ACJ) instability and determine which technique is superior. Methods This review was conducted according to the PRISMA guidelines. PubMed and Cochrane Library databases were searched up to April 30th, 2018 for original articles that assessed the outcomes of one or more surgical techniques of anatomic and non-anatomic reconstruction in patients with chronic ACJ instability. The Methodological Index for Non-randomized Studies (MINORS) was used to assess study quality. Pre-to-post meta-analysis was performed for both anatomic and nonanatomic reconstructions. Results Twenty-eight studies were included comprising 799 patients (mean age of 36.6 years old and 84% males) with a mean follow-up of 34.6 months (range 13 to 74). Surgical techniques included anatomic (tendinous or synthetic grafts/constructs) and non-anatomic reconstruction (Weaver-Dunn or Modiied Weaver-Dunn, conjoined tendon transfer, or temporary hook plate). There were signiicant pre-to-post improvements on the constant score with an average improvement ranging from 11.1 to 50.7 (p < 0.01). Average failure rate was 7.6% (7.5% for anatomic and 8.5% for non-anatomic reconstruction). Noncomparative studies had a mean MINORS score of 9 points (out of 16) and comparative studies 17 (out of 24) with excellent interrater agreement (k = 0.910). Conclusion Both anatomic and non-anatomic ACJ reconstructions provide signiicant post-operative improvements, but deinitive conclusions on optimal technique remain elusive. Notwithstanding, comparative studies support the use of anatomic ACJ reconstruction which should be preferably used. However, until superiority is demonstrated by robust studies, surgeons should supplement their decision-making with experience and patient preference. Level of evidence IV.

Arthroscopic Coracoclavicular Reconstruction Combined with Open Acromioclavicular Reconstruction Using Knot Hiding Clavicular Implants Is a Stable Solution

“…In the previous techniques, wound irritation, infection, and palpable knots on the clavicle were among the problems encountered in open and arthroscopic CC reconstructions. 11 The Clavicular Clip was designed to be used with a tendon graft and hide protruding suture knots, and therefore, avoid any wound irritations. No wound complications occurred in this series nor could the patients feel any postoperative subcutaneous prominence.…”

“… 6 , 7 The complication rates in surgical treatment can be quite high and appear to be related to reconstruction failure, clavicular or coracoid fracture, and/or infections. 8 , 9 , 10 , 11 The foreign material may also induce wound irritations and persistent palpable resistances underneath the skin on the clavicle. 12 …”

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

“…Similarly, Xarà-Leite et al [49] included twenty-eight studies. Surgical techniques were categorized in anatomic and non-anatomic reconstructions.…”

Review of Weaver and Dunn on treatment of acromioclavicular injuries, especially complete acromioclavicular separation

“…Over 100 techniques have been described. 2 The transfer of the coracoacromial ligament from its acromial to the distal clavicle for ACJ dislocation was first described in 1917. 3 In 1972, Weaver and Dunn were the first to publish a case series with coracoacromial ligament transfer.…”