Anatomic reconstruction of acromioclavicular joint dislocations using allograft and synthetic ligament

Abstract

Background Acromioclavicular (AC) separations are commonly seen shoulder injuries. Numerous surgical reconstruction techniques have been described. In this study, we present a series of patients who underwent an anatomic reconstruction using a synthetic ligament and allograft construct. Methods We performed a retrospective review of patients with type IV or V AC separations who underwent primary or revision AC reconstruction with a luggage-tag synthetic ligament and a semitendinosus allograft placed through the anatomic insertion sites of the coracoclavicular ligaments. Patient-reported outcomes, as well as complication rates, were recorded at a minimum 2-year follow-up. Results Ten patients with a mean age of 44.2 ± 14.9 years were included in the study. The mean Disabilities of the Arm, Shoulder and Hand score was 15.5 ± 15.4; mean Single Assessment Numeric Evaluation score, 81.8 ± 12.1; mean Simple Shoulder Test score, 11.4 ± 1.1; mean American Shoulder and Elbow Surgeons score, 84.6 ± 15.7; mean Constant score, 82.5 ± 11.6; and mean visual analog scale score, 2 ± 2.6. Conclusion The technique using a luggage-tag synthetic ligament along with an anatomic allograft coracoclavicular ligament reconstruction is a safe, effective alternative to other techniques described in the literature.

Anatomical acromioclavicular joint stabilization with chemically sterilized tendon allografts: A retrospective study

“…1,2,13,17,29,30 The use of free tendon grafts (ST) together with nonbiological support is widely used for better healing and remodelling times. 7,12,20,22 An artificial band is used to avoid elongation in the first weeks after surgery, but cannot be used alone, because high re-rupture rates are reported with artificial grafts alone. 36,37 Additionally to the high re-rupture rate, there is poor biological integration of the artificial graft in bone tunnels and articular cavity.…”

“…The mean follow-up of patients was 33 months with a range of 12-68 months, similar to others (26-49 months). 10,11,15,17,18,22,40,43 Complications after AC-joint stabilization vary and may be unique to the implant and fixation method used during the index procedure. 3 Here, complications resolved without surgery and were as observed by others (8.5-40%).…”

“… 15 Reconstruction of the CC- and AC-ligaments with an allogenic tendon provides good stability of the AC-joint 7 , 10 – 12 , 16 – 20 and has gained popularity in the past few decades. 7 , 13 , 20 – 23 The clavicle is further strengthened by AC-ligament reconstruction allowing for horizontal stabilisation of the clavicle. 10 The tendon allograft plays an important role in AC reconstruction, particularly for patients who have a shortage of autograft tendons or for those who do not want to use their own functioning tendons.…”

“…Currently, there is no consensus regarding the optimal graft choices for AC-joint stabilization. Semitendinosus (ST) allografts 1 , 2 , 11 , 13 , 17 , 20 , 22 , 29 , 30 are mainly used for AC joint reconstruction with other allografts also being used. 2 , 7 , 10 , 11 , 20 , 27 Costic et al 31 concluded that with semitendinosus grafts, the course of the ligaments can be imitated, providing stability to the clavicle similar to that provided by the intact ligaments.…”

Bone tunnel placement influences shear stresses at the coracoid process after coracoclavicular ligament reconstruction: a finite element study and radiological analysis

“…Injuries of the acromioclavicular (AC) joint are common shoulder lesions in athletes [ 1 ]. The incidence is considered to be 3–4 cases among 100,000 persons per year, and their ideal treatment is still discussed controversially [ 2 ]. While low-grade lesions without alteration of the coracoclavicular (CC) distance show good results after conservative treatment, high-grade lesions demand surgical stabilization in order to maintain a satisfying level of function [ 3 – 5 ].…”