We described a novel all-arthroscopic technique of coracoclavicular ligament reconstruction
and reported the early clinical and radiologic results of this procedure.
We performed all-arthroscopic coracoclavicular ligament reconstruction in 10 consecutive
patients (8 men and 2 women; mean age, 41 years) with a symptomatic chronic and complete
acromioclavicular (AC) joint dislocation (Rockwood type III or IV). Four patients
had undergone surgery previously: two had initial pinning of the acute AC joint separation,
and two had a subsequent Mumford procedure. The surgical technique, performed entirely
by arthroscopy, consisted of (1) rerouting the coracoacromial ligament with a bone
block harvested from the tip of the acromion in a socket created in the distal clavicle
(Chuinard's modification of the Weaver-Dunn procedure) and (2) augmenting the reconstruction
with 2 titanium buttons connected by a heavy suture in a 4-strand configuration (Double-Button
fixation; Smith & Nephew Endoscopy, Andover, MA). Patients were prospectively followed
up for a mean of 12.8 months (range, 6 to 20 months).
One patient had a superficial infection of the superior (clavicular) portal, which
resolved with oral antibiotics. At the most recent review, all patients were satisfied
or very satisfied with the cosmesis, and 9 of 10 returned to previous sports, including
contact and overhead sports. All symptoms resolved (pain, shoulder weakness, paresthesia).
The mean postoperative University of California, Los Angeles modified AC rating score
was 16.5 points (range, 13 to 18 points) out of 20 points. The mean Subjective Shoulder
Value improved from 36% (range, 0% to 70%) preoperatively to 82.5% (range, 70% to
100%) postoperatively (P = .005). The bone block was totally healed in the medullary
canal in 8 cases and partially healed in 2. No loss of reduction was observed in any
of the patients.
Our study shows that severe chronic symptomatic AC joint separations, defined as Rockwood
types III through V, can be repaired entirely by arthroscopy safely and effectively
by transferring the coracoacromial ligament with a bone block in the distal clavicle.
The bone block transfer (Weaver-Dunn-Chuinard procedure) has the advantage of making
the repair easier and stronger, and it provides bone-to-bone healing by use of free,
autologous vascularized tissue. Double-Button fixation has the advantage of maintaining
the reduction during the biological healing process. Although the durability of the
reconstruction remains unproven, in our short-term follow-up we observed no loss of
reduction and the functional and cosmetic results were uniformly good.
Level IV, therapeutic case series.
(c) 2010 Arthroscopy Association of North America. Published by Elsevier Inc. All
rights reserved.