Open Anatomic Coracoclavicular Ligament Reconstruction by Modified Conjoint Tendon Transfer for Treatment of Acute High-Grade Acromioclavicular Dislocation

Abstract

There is no ideal surgical technique for the treatment of acromioclavicular (AC) dislocations. Reconstruction of the coracoclavicular ligaments (CCLs) for the treatment of AC dislocations is evolving. Many techniques for CCL reconstruction have been described. They differ mainly in the method of fixation, number of tunnels, and graft used. The surgeon should select among hamstring autograft reconstruction, coracoacromial ligament transfer, and conjoint tendon transfer for CCL reconstruction. Early on, conjoint tendon transfer to the lateral clavicle was described for the treatment of high-grade AC dislocation. Dynamic instability occurred with poor long-term outcomes. The procedure was abandoned. Recently, proximally based conjoint tendon transfer for CCL reconstruction was described, but the technique is nonanatomic and leads to anterior displacement of the clavicle and malreduction. This article describes modified conjoint tendon transfer. The technique may yield stable, anatomic, biological reconstruction of the CCL for the treatment of acute high-grade AC dislocation. It consists of the following steps: (1) creation of clavicular holes, (2) coracoid osteotomy, (3) conjoint tendon mobilization, (4) conjoint tendon transfer and fixation to the CCL footprint on the undersurface of the clavicle, and (5) AC reduction and conjoint tendon tenodesis to the bed of the retained coracoid process.

Coracoid process transfer and distal clavicle resection for chronic acromioclavicular separation

“… 4 Some author added tenodesis at the coracoid bed after this Dewar’s procedure to reconstruct the CC ligaments. 16 Further experimental study could determine whether just the muscle transfer would work to reconstitute a static stabilizer.…”

Effect of Biological Environment on Polyester Surgical Suture's Physical Properties: An Experimental Study in Rats

“…While there are various surgical techniques treating acromioclavicular (AC) joint dislocation, suture-button method or surgery with autograft tendon using nonabsorbable polyester suture remains widely performed and analyzed [1][2][3]. Another suture-loop technique uses polyester sutures as well [4][5].…”