Functional and Radiographic Outcomes of Intraoperatively Decreasing the Coracoclavicular Distance to 50% of the Unaffected Side in Stabilization of Acute Acromioclavicular Joint Injury: A Retrospective Evaluation

Abstract

Background: The postoperative failure rate of acromioclavicular (AC) joint fixation using the coracoclavicular (CC) stabilization technique is high. Studies have reported that compared with normal intraoperative anatomic reduction, intraoperative overreduction of the AC joint is more successful in achieving a satisfactory anatomic radiographic outcome at 1- to 2-year follow-up. Purpose: To evaluate the functional and radiographic outcomes and complications in patients with acute AC joint injury who underwent combined CC stabilization and AC capsular repair in which the CC distance was intraoperatively decreased to 50% of the unaffected side. Study Design: Case series; Level of evidence, 4. Methods: In this retrospective study, we collected and analyzed the data of patients with an acute AC joint injury (Rockwood type 5) who underwent combined CC stabilization and AC capsular repair during which the CC distance was decreased 50% compared with the unaffected side. At 2-year follow-up, we evaluated functional outcomes (American Shoulder and Elbow Surgeons [ASES] score), radiographic outcomes (alignment of the AC joint in the vertical and horizontal planes, tunnel widening), and complications (infection, clavicular fracture). Results: The study included 20 patients with a mean ± SD age of 42.20 ± 10.10 years. The mean follow-up period was 33.75 ± 11.50 months. At the 2-year follow-up, the mean ASES score was 95.13 ± 5.61. The overreduction alignment, anatomic alignment, and loss reduction alignment rates were 0% (0/20 patients), 95% (19/20 patients), and 5% (1/ 20 patients), respectively. No statistically significant difference was found in the mean CC distance between the affected and unaffected sides on radiographic evaluation. The mean medial clavicular tunnel width and lateral clavicular tunnel width were 5.03 ± 0.68 mm and 4.47 ± 0.67 mm, respectively. None of the patients experienced fractures or infections. Conclusion: Excellent functional and radiographic outcomes and no complications were seen at 2-year follow-up in patients with acute AC joint injury who underwent combined CC stabilization and AC capsular repair with the CC distance intraoperatively decreased to 50% of the unaffected side.

Comparing the Anatomical Landmarks Versus the Coracoid-Based Landmarks Techniques for Coracoclavicular Stabilization After High-Grade Acromioclavicular Injury: A Biomechanical Study

“…In CC stabilization and AC capsule repair, a number of studies have reported high incidences of superior displacement or loss of reduction after surgery of 5% to 50%. 4 , 5 , 12 , 18 , 23 The direction of the sutures is one of the important factors that affects postoperative reduction alignment. Seo et al 21 studied the outcomes of single-tunnel CC fixation and reported that an oblique suture direction was related to loss of reduction after surgery.…”

Comparing the Efficacy of Anatomical Locked Plate Fixation with Coracoclavicular Ligament Augmentation to Hook Plate Fixation in Treating Distal Clavicle Fractures

“…In addition, an anteroposterior (AP) view of the clavicle was performed preoperatively and postoperatively to identify the distal clavicle fracture or the reduction (Figure 2). The coracoclavicular (CC) distance was defined as the shortest distance between the superior cortex of the coracoid process and the clavicle's undersurface on the clavicle's AP view 23 . The fragment size was defined by the distance between the medial border of the fracture line and the distal border of the clavicle 24 …”

“…The coracoclavicular (CC) distance was defined as the shortest distance between the superior cortex of the coracoid process and the clavicle's undersurface on the clavicle's AP view. 23 The fragment size was defined by the distance between the medial border of the fracture line and the distal border of the clavicle. 24 …”

Using a Modified Kirschner Wire to Pass the First Suture Under the Coracoid Base in Coracoclavicular Stabilization

“…In this type of case, we prefer to do an overreduction. 6 The AC capsule is repaired using two 2.8-mm metal suture anchors (Arthrex) ( Fig 7 ). The deltotrapezial fascia and deltoid fascia are repaired using VICRYL 3-0.…”