Arthroscopic Reconstruction of the Acromioclavicular Joint Using Semitendinosus Allograft

Abstract

The purpose of this report is to describe an arthroscopic technique using a semitendinosus allograft to reconstruct chronic grade III, IV, or V acromioclavicular joint separations. Indications for arthroscopic surgery include pain, functional limitation, severe cosmetic deformity, and failure of nonoperative treatment. Twelve patients were managed by this technique during a 2-year period. All 12 were reevaluated 2 to 4 years postoperatively. Of the 12 patients, 10 had satisfactory to excellent results. Two patients lost reduction: 1 was subsequently repaired with an excellent result and 1 loss of approximately 5 mm of reduction with no consent for follow-up procedure at this time. There was a 25% complication rate. The arthroscopic technique for reconstruction of the dislocated acromioclavicular joint is still evolving but shows much promise for the future management of these problematic injuries.

Addition of Allograft and Acromioclavicular Cerclage Improves Outcomes of Arthroscopic-Assisted Reconstruction of Acromioclavicular Separation With a Single Coracoclavicular Tunnel

“…In contrast, Tomlinson et al reported an 80% rate of maintenance of reduction 5 months postoperatively in acute and chronic separations managed with a loop technique [15]. VanSice and Savoie reported that 11 of 12 patients (92%) treated with a loop technique maintained reduction [16]. The current study provides further support that a loop technique with a graft is safe and efficacious.…”

Outcome After Arthroscopic Reconstruction of the Coracoclavicular Ligaments Using a Double-Bundle Coracoid Cerclage Technique

“…8,18 However, the findings may not be applicable to the broader population because of differences in general health condition and bone quality, as well as other anatomic considerations. In addition, although the follow-up period is sufficient to assess the outcome after the described procedure, a longer-term study including more patients may identify additional potential complications.…”

“…3 However, to our knowledge, all but one of the published arthroscopic reconstruction techniques use a single clavicular tunnel and require drilling of the coracoid base for graft fixation. 8 This creates the risk of coracoid fracture because the high load to failure of the graft or fixation device may exceed the load to failure of the 18 found in their study that transclaviculartranscoracoid reconstructive techniques cannot restore the footprint of the conoid and trapezoid ligaments without significant risk of cortical breach and fracture. Cook et al 19 reported an 80% early failure rate in 10 active-duty patients who underwent CC ligament reconstruction with the GraftRope technique.…”

“…3 However, to our knowledge, all but one of the described arthroscopic techniques require the use of bony tunnels in the coracoid, increasing the risk of coracoid fracture and graft fixation failure while reconstructing only 1 of the 2 CC ligaments. 8 We report the outcome of an arthroscopic technique for CC ligament reconstruction using an anatomic coracoid cerclage. This technique is an arthroscopic modification of the open anatomic reconstruction previously described by Carofino and Mazzocca.…”

Comparison of Short-term Complications Between 2 Methods of Coracoclavicular Ligament Reconstruction

“…2,7,9 More recently, reports have detailed successful application of arthroscopic techniques to perform or augment coracoclavicular reconstruction with favorable clinical results at early follow-up. 21,22,[27][28][29] However, even these newer techniques are not without risk of complication, and several studies with midterm results demonstrate a high risk for loss of reduction (LOR). 5,12,15 The purpose of this study was to compare early clinical outcomes and complication rates of patients treated with 2 different methods of CC ligament reconstruction.…”