Clinical results of coracoacromial ligament transfer in acromioclavicular dislocations: A review of published literature

Abstract

Acromioclavicular joint dislocations are common injuries, which typically occur with trauma in young men. Treatment recommendations for these injuries are highly variable and controversial. There are greater than 100 surgical techniques described for operative treatment of this injury. One of the most widely recommended methods of surgical reconstruction for acromioclavicular joint dislocations is to utilize the coracoacromial ligament for stabilization of the distal clavicle. Several modifications of this procedure have been described which have involved adjunct coracoclavicular fixation or fixation across acromioclavicular joint. Although the literature is replete with descriptive papers, there is paucity of studies evaluating the surgical outcome of this procedure. We systematically reviewed the English language published literature in peer reviewed journals (Medline, EMBASE, SCOPUS) and assigned a level of evidence for available studies. We critically reviewed each paper for the flaws and biases and then evaluated the comparable clinical outcomes for various procedures and their modifications. The published literature consists entirely of case series (Level IV evidence) with variability in surgical technique and outcome measures. On review there is low level evidence to support the use of coracoacromial ligament for acromioclavicular dislocation but it has been associated with high rate of deformity recurrence. Adjunct fixation does not improve clinical results when compared to isolated coracoacromial ligament transfer. This is in part because of the high incidence of fixation related complications. Similar results are reported with coracoacromial ligament reconstruction for acute and chronic cases. The development of secondary acromioclavicular joint symptoms with distal clavicle retention is poorly reported with the incidence rate varying from 12% to 32%. Despite this, the retention or excision of distal clavicle did not affect overall clinical results except in the patients with pre existing acromioclavicular joint osteoarthritis who have inferior results with retention of distal end of clavicle. Further well designed clinical trials with validated outcome measures are required to fully evaluate the clinical results of this procedure.

Anatomic reconstruction of acromioclavicular joint dislocations using allograft and synthetic ligament

“…The technique combining synthetic ligament reconstruction and anatomic allograft reconstruction of the CC ligaments attempts to address the potential drawbacks of previously described methods. 31 The results of this study suggest that combining the LockDown device with anatomic CC ligament reconstruction using allograft is a viable surgical treatment option for AC dislocations. There was an 8% rate of recurrent dislocation, which is lower than the 15%-29% reported in the literature.…”

“… 12 , 36 This has not proved clinically significant, however, as the recurrent instability rates between CA ligament transfer techniques with and without supplemental fixation are similar (15%-29%). 31 …”

The Infinity-Lock System for Chronic Grade III AC Joint Dislocation: A Novel Technique, Rehabilitation Protocol and Short Term Results

“…All surgical treatments evaluated in the literature reported improved subjective patient-reported outcomes and low unplanned reoperation rates [ 5 , 6 , 7 , 8 , 15 , 20 , 36 ].…”

“…Conversely, there is a paucity of randomized controlled trials and prospective comparative studies regarding the treatment of grade III AC joint dislocation and decision making is often based on the individual’s occupation and sporting activity. However, approximately 17% to 28% of patients receiving nonoperative treatment have reported disability with pain, weakness, fatigue, impingement, and AC instability [ 8 ].…”

Acromioclavicular Joint Dislocation: Repair Through Open Ligament Transfer and Nonabsorbable Suture Fixation

“…Sood et al. 23 performed a systematic review on differences in outcomes between isolated CAL transfer and CAL transfer associated with a concomitant fixation procedure and found satisfactory results with similar recurrence rates. Despite similar outcomes, the group with an associated fixation procedure aside from CAL transfer experienced more complications especially when involving metal hardware.…”