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

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-two-year follow-up.Level of evidence: level III.

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

“…The need for a tendon graft for achieving a sustainable CC reconstruction is obvious. 25 , 26 It is equally important that the AC joint capsule is assessed. 27 The reconstruction of the superior acromioclavicular ligament with the graft limb and capsule plication seemed to have improved the stability of the entire reconstruction.…”

Comparison of the Clinical Outcomes of Tight-Rope technique and Clavicular Hook Plate in Treating Acute Acromioclavicular Joint Dislocation

“…Inclusion criteria: (1) patients with unilateral acute AC joint dislocation (< 3 weeks) diagnosed radiologically; (2) patients with high-grade ACJ dislocations classi ed as Rockwood type III and higher, (3) patients treated with either Tight-Rope technique or clavicular hook plate, (4) patients who received routine at least one-year follow-up after surgery, (5) age between 18 years old and 70 years old, (6) no other accompanying injury in the same upper extremity, (7) normal function of the shoulder before the injury.…”

“…Patients with acute ACJ dislocation typically manifested pain, swelling, deformity and signi cant limited range of motion (ROM) of the shoulder [3] [4]. As non-operative treatment might result in moderate rate of persistent pain, instability, and limited mobility [5][6], surgical procedure is recommended especially for high-grade ACJ dislocations classi ed as Rockwood type III and higher, indicating the completely torn acromioclavicular (AC) and coracoclavicular (CC) ligaments [7]. As numerous surgical techniques have been reported, clavicular hook plate (CHP) and tight-rope (TR) technique were two most preferred options for treating acute ACJ dislocation, with promising clinical outcomes and had gainer reasonable support by extensive literature [8] [9].…”

Minimalinvasive Techniken zur Therapie der Schultereckgelenksprengung

“…Bei den biologischen Verfahren zeigte sich die klinisch-radiologische Überlegenheit eines freien Sehnengrafts (Semitendinosussehne) gegenüber dem CA-Bandtransfer [42]. Dabei konnten sowohl bei autologen als auch bei allogenen Sehnengrafts vergleichbar gute bis sehr gute Ergebnisse nachgewiesen werden [33,43,44,45,46,47,48,49]. Durch einen transakromialen Einzug des Sehnengrafts wird biomechanisch eine höhere Stabilität erreicht [44].…”