Systematic review of the treatment of acromioclavicular joint disruption comparing number of tunnels and graft type

“…10,14,19 Distal clavicle or coracoid process fractures represent rare complications after CC ligament procedures. A recent systematic review by Pill et al 20 identified 17 postoperative fractures within a population of 460 patients (3.7% fracture rate). Additionally, those authors noted that clavicle fractures represented the most common reason for revision surgery within their study population.…”

Section: Discussionmentioning

confidence: 99%

Coracoid or Clavicle Fractures Associated With Coracoclavicular Ligament Reconstruction

et al. 2021

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Background: Coracoclavicular (CC) ligament reconstruction is a commonly performed procedure for high-grade acromioclavicular (AC) joint separations. Although distal clavicle and coracoid process fractures represent potential complications, they have been described in only case reports and small case series. Purpose: To identify the incidence and characteristics of clavicle and coracoid fractures after CC ligament reconstruction. Study Design: Case series; Level of evidence, 4. Methods: The US Military Health System Data Repository was queried for patients with a Current Procedural Terminology code for CC ligament repair or reconstruction between October 2013 and March 2020. The electronic health records, including patient characteristics, radiographs, operative reports, and clinical notes, were evaluated for intraoperative or postoperative clavicle or coracoid fractures. Initial operative technique, fracture management, and subsequent clinical outcomes were reviewed for these patients. Results: A total of 896 primary CC ligament repairs or reconstructions were performed during the study period. There were 21 postoperative fractures and 1 intraoperative fracture in 20 patients. Of these fractures, 12 involved the coracoid and 10 involved the clavicle. The overall incidence of fracture was 3.81 fractures per 1000 person-years. In 5 patients who sustained a fracture, bone tunnels were not drilled in the fractured bone during the index procedure. A total of 17 fractures were ultimately treated operatively, whereas 5 fractures had nonoperative management. Of the 16 active-duty servicemembers who sustained intraoperative or postoperative fractures, 11 were unable to return to full military duty after their fracture care. Conclusion: Fracture of the distal clavicle or coracoid process after CC ligament repair or reconstruction is a rare but serious complication that can occur independent of bone tunnels created during the index procedure. Fractures associated with CC ligament procedures occurred at a rate of 2.46 per 100 cases. Most patients were ultimately treated surgically with open reduction and internal fixation or revision CC ligament reconstruction. Although the majority of patients with intraoperative or postoperative fractures regained full range of motion, complications such as anterior shoulder pain, AC joint asymmetry, and activity-related weakness were common sequelae resulting in physical limitations and separation from military service.

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“…Their study found that significantly more patients in the two-bundle group experienced good to excellent outcomes based on modified UCLA rating score than their single bundle group (70% vs 18%, P > .99). However, Pill et al 14 performed a systematic review of treatments for AC joint disruption comparing the number of tunnels and found that patients in the double tunnel group experienced significantly more adverse events, which included clavicle and coracoid fractures. This is likely due to the increased number of drill holes and stress risers leading to an increased failure rate of the clavicle and coracoid fixation.…”

Section: Discussionmentioning

confidence: 99%

“…However, Pill et al. 14 performed a systematic review of treatments for AC joint disruption comparing the number of tunnels and found that patients in the double tunnel group experienced significantly more adverse events, which included clavicle and coracoid fractures. This is likely due to the increased number of drill holes and stress risers leading to an increased failure rate of the clavicle and coracoid fixation.…”

Section: Discussionmentioning

confidence: 99%

Acromioclavicular Joint Reconstruction with Recessed Clavicular Implant Technique Guide

Buckley

Jildeh

Abbas

et al. 2021

Arthroscopy Techniques

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Acromioclavicular (AC) joint injuries are common and often require operative intervention. Although there are many described surgical techniques, there remains a lack of consensus on the optimal technique. The purpose of this Technical Note is to provide our preferred method of AC reconstruction with a recessed clavicular implant and semitendinosus allograft, which mitigates hardware pain associated with arthroscopic techniques.

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Systematic review of the treatment of acromioclavicular joint disruption comparing number of tunnels and graft type

Cited by 21 publications

References 31 publications

Treatment of Acromioclavicular Joint Instability With a Tunnel-Free Reconstruction Technique

Treatment of Acromioclavicular Joint Instability With a Tunnel-Free Reconstruction Technique

Coracoid or Clavicle Fractures Associated With Coracoclavicular Ligament Reconstruction

Acromioclavicular Joint Reconstruction with Recessed Clavicular Implant Technique Guide

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