Does Weaver–Dunn procedure have a role in chronic acromioclavicular dislocations? A meta-analysis

Abstract

Background In treatment of chronic acromioclavicular (AC) joint dislocations, both the Weaver–Dunn procedure (WD) and CC ligament reconstruction (CCR) are recommended options due to the low possibility of healing of the coracoclavicular (CC) ligaments. The aim of this review was to determine whether CCR will yield favorable clinical and radiographic outcomes in the treatment of chronic AC dislocations. Method The Cochrane Library, EMBASE, and PubMed databases were searched for literature on chronic AC dislocations from data inception to June 30, 2021. Patient data were pooled using standard meta-analytic approaches. The Cochrane-Mantel–Haenszel method and variance-weighted means were used to analyze the outcomes. The Review Manager version 5.3 software (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark) was used to calculate the heterogenicity, mean difference, and relative risk (RR) for all outcomes in the meta-analysis. Results The current analysis included four trials on this topic, and all AC joint dislocations were classified as Rockwood types III to VI. The pooled data showed that the CCR group had significantly better post-operative American Shoulder and Elbow Surgeons Shoulder (ASES) scores, Oxford Shoulder Scores (OSSs), and Nottingham Clavicle Scores (NCSs) than the WD group, with a significant difference (p < 0.001, p = 0.020, and p < 0.001, respectively). In terms of the post-operative Constant-Murley Scores (CMSs), there were no significant differences between the CCR group and the WD group (p = 0.100). The CCR group had significantly better post-operative abduction and flexion of the index shoulder than the WD group (p < 0.001 and p < 0.001, respectively). In terms of radiological outcomes, the post-operative coracoclavicular distance (CCD) with a 10 kg load was smaller in the CCR group compared to that in the WD group (p < 0.001). The overall surgical wound infection rate was 11.6% in the WD group and 12.9% in the CCR, respectively (p = 0.82). Conclusion The CCR group had better clinical outcome scores in the ASES, OOS, NCS, abduction, flexion, and external rotation than the WD group. In terms of radiological outcomes, the CCR group showed less displacement in weight-loaded post-CCD than the WD group, which indicated that the CCR provided more stability and resistance to deformation forces.

Arthroscopic Treatment of Chronic Acromioclavicular Dislocation With Semitendinosus Autograft and Coracoclavicular Suspension Fixation

“… 26 conclude that CC reconstruction provided more stability and resistance to deformation forces than the Weaver-Dunn procedure in the treatment of chronic ACC dislocations. 26 We achieved an anatomical reduction. The biological contribution of the autograft allows these results to be maintained over time by healing the autograft and avoiding stress failure of the implant over time.…”

“…The mechanical contribution of the button suspension system allows the clavicle to be reduced and stabilized 25 , 26 to the coracoid during the autograft-healing process. In a meta-analysis in 2022, Chang et al.…”

“…In a meta-analysis in 2022, Chang et al. 26 conclude that CC reconstruction provided more stability and resistance to deformation forces than the Weaver-Dunn procedure in the treatment of chronic ACC dislocations. 26 We achieved an anatomical reduction.…”

Comparison of Effectiveness and Safety in Treating Acute Acromioclavicular Joint Dislocation with Five Different Surgical Procedures: A Systematic Review and Network Meta‐Analysis

“…However, the literature on AC reconstruction is scarce and valid data are not available. And Weaver–Dunn procedures were used to treat chronic ACJ dislocation 60 . Therefore, our study only includes TR, HP, EB, SA, and TG of CC reconstruction.…”

“…And Weaver–Dunn procedures were used to treat chronic ACJ dislocation. 60 Therefore, our study only includes TR, HP, EB, SA, and TG of CC reconstruction.…”