Modified Weaver-Dunn Procedure versus the Use of a Synthetic Ligament for Acromioclavicular Joint Reconstruction

Abstract

PURPOSE. To compare the subjective outcome of acromioclavicular joint (ACJ) reconstruction using the modified Weaver-Dunn procedure versus the Surgilig synthetic ligament. METHODS. 55 patients aged 19 to 72 (mean, 42) years underwent ACJ reconstruction of Rockwood grade 3 (n=38), grade 4 (n=8), and grade 5 (n=9) using the modified Weaver-Dunn procedure (n=31) or the Surgilig synthetic ligament (n=24), based on the surgeon's preference. The mean period from injury to surgical treatment was 39 months. Subjective outcomes were assessed before and after surgery using the Oxford Shoulder score and Nottingham Clavicle score. The time required to return to work and sports was also recorded. RESULTS. After a mean follow-up period of 40 months, the mean Oxford Shoulder scores improved from 28 to 42 in the Weaver-Dunn group (p=0.009), and from 26 to 45 in the Surgilig group (p=0.007), whereas the respective mean Nottingham Clavicle scores improved from 53 to 81 (p=0.047) and from 51 to 93 (p=0.023). The Surgilig group achieved significantly better postoperative Oxford Shoulder score (p=0.008) and Nottingham Clavicle score (p=0.007), and could also return to work (14 vs. 6 weeks, p<0.001) and sports (25 vs. 12 weeks, p<0.001) sooner than the Weaver-Dunn group. Three patients in the Weaver- Dunn group and one patient in the Surgilig group had persistent pain and/or functional deficit with evidence of ACJ dislocation. CONCLUSION. Chronic ACJ reconstruction using the Surgilig synthetic ligament achieved better Oxford Shoulder score and Nottingham Clavicle score and earlier return to work and sports, compared with the modified Weaver-Dunn procedure.

Surgical treatment of acute Rockwood III acromioclavicular dislocations—Comparative study between two flip-button techniques

“…Debski et al 12 proved the conoid ligament restrains the movement against anterosuperior force of clavicle and the trapezoid ligament against the posterior force of clavicle. The Weaver-Dunn and Bosworth techniques, with their various modifications, are currently the most popular procedures in use 13,14 , alongside various fixation methods, like screws, pins, hook plates. Recently, hook plate is widely used.…”

Modified Weaver-Dunn Procedure Versus The Use of Semitendinosus Autogenous Tendon Graft for Acromioclavicular Joint Reconstruction

“…Therefore, many have recommended augmentation procedures to protect the transferred CA ligament. Modifications of the WD procedure have achieved good outcome for acute and chronic AC joint dislocations [ 28 - 31 ]. A biomechanical studies concluded that the CA ligament has only 30% of the strength and 10% of the stiffness of the intact ligaments, and failures occur mainly at the suture that attaches the transferred CA ligament [ 35 , 36 ].…”

“…The Modified WD method involved excision of the distal end of the clavicle and transferring of the CA ligament to the distal end of the clavicle, using the ligament as a substitute for the ruptured CC ligament with augmentation of the transposed CA ligament by either cerclage wires, [ 24 ] screw fixation, [ 12 ] autogenous fascia lata graft, [ 25 ] or synthetics such as GORE-TEX, [ 26 ] Dacron, [ 27 ] carbon fibers, [ 28 ] and braided polyester [ 29 ]. Recently the modified WD procedure was compared with synthetic ligament and Graft Ropet (Arthrex, Naples, FL) reconstruction in both clinical and biomechanical studies revealing inferior results [ 30 , 31 ]. It seems that while most nonanatomic techniques were able to restore vertical stability at the AC joint they still were significantly lacking in anteroposterior anatomic reconstruction of the CC ligaments [ 8 ].…”

<p>Optimal Management of Acromioclavicular Dislocation: Current Perspectives</p>

“…60 When comparing the modified Weaver-Dunn procedure to synthetic ligaments for the treatment of chronic dislocations, the synthetic ligament resulted in better outcome scores as well as earlier return to work and sport. 71 In a systematic review by Borbas et al tendon or ligament transfers, such as the Weaver-Dunn procedure, showed inferior clinical and radiological outcomes when compared to non-biological (e.g. synthetic ligaments and suture loops) and biological (e.g.…”