Suspension Suture Augmentation for Repair of Coracoclavicular Ligament Disruptions

Abstract

Surgical reconstruction of the coracoclavicular ligament is a fundamental part of management of highgrade acromioclavicular dislocations and Type II lateral third clavicular fractures. However, no single surgical procedure is fully satisfactory because of failure or complications. We present an alternative coracoclavicular stabilization technique, which avoids the use of hardware or tendon graft, that was used in 10 consecutive patients with complete coracoclavicular ligament disruptions. These patients were followed for a minimum of 14 months (average, 34.8 months; range, 14-55 months). At the final followup, functional outcome measurement instruments (University of California-Los Angeles shoulder rating system and Western Ontario Shoulder Instability Index) and radiographic analysis were adopted as the main outcome measures of shoulder function. The mean University of California-Los Angeles shoulder rating score and the mean Western Ontario Shoulder Instability Index aggregation score at 12 months after surgery were 33.8 (95% confidence interval, 32.8-34.8) and 93.4 (95% confidence interval, 88.2-98.6), respectively. The radiographic analysis revealed all patients had maintained reduction on radiographs at the final followup. These preliminary results suggest that this simple technique can achieve stable coracoclavicular reconstruction and facilitate healing of the repaired ligaments or fractures.

Acromioclavicular joint injuries: indications for treatment and treatment options

“…15,56 A recent retrospective study reviewed 10 patients with a complete CC ligament disruption who were each treated with two #5 Ethibond sutures (Ethicon, Somerville, NJ) placed through drill holes in the clavicle and looped around the coracoid process. 40 This technique afforded good functional outcomes and no loss of reduction at a minimum follow up of 14 months (average, 34.8 months). 40 At 12 months after surgery, the mean University of CaliforniaeLos Angeles shoulder rating score was 33.8 points, and the mean Western Ontario Shoulder Instability Index aggregation score was 93.4 points.…”

“…40 This technique afforded good functional outcomes and no loss of reduction at a minimum follow up of 14 months (average, 34.8 months). 40 At 12 months after surgery, the mean University of CaliforniaeLos Angeles shoulder rating score was 33.8 points, and the mean Western Ontario Shoulder Instability Index aggregation score was 93.4 points. The study excluded 2 patients treated surgically (including 1 who had sustained a coracoid fracture) because of loss to follow-up.…”

“…25,36,49 CC interval fixation CC interval fixation has been described with screw fixation, suture loop fixation, endobutton fixation (flip buttons), and suture anchors. 8,40 These techniques transfer the combined forces normally exposed to the AC joint complex and CC ligaments to fixation points on the clavicle and coracoid process. The concern with these techniques is that the fixation is rigid and the concentrated forces placed on the fixation points may lead to hardware failure, osteolysis of the clavicle or coracoid by the devices, or fracture of the clavicle or coracoid process.…”

Intra- and Interobserver Agreement in the Classification and Treatment of Distal Third Clavicle Fractures

“…Dating back to the work of Neer and other earlier reports, 22% to 33% of Neer type II distal clavicle fractures fail to heal with nonoperative treatment, and an additional 45% to 67% require more than the traditional 3 months for the fracture to heal. 4,10,[15][16][17][19][20][21][22]26,28 However, in older patients with more osteoporotic bone, there is a concern that surgical intervention can lead to operative complications. Several authors have reported acceptable results with nonoperative treatment in this age group.…”

“…11,14,23 Although the current literature describes many procedures for the treatment of these unstable fractures, there has been no consensus or gold standard determined, and many of the treatment options have high complication rates. 13,15,16 Currently, the most widely used options for surgical fixation of these fractures are (1) a soft tissue reconstruction/repair with heavy suture, 10,17,26,31 (2) internal fixation with a plate and screw construct, 1,9 or (3) a Hook plate construct. 2,[5][6][7]12 However, these treatment options are still fraught with complications, and again the decision for treatment choice is very subjective.…”