Arthroscopic-Assisted Coracoclavicular Ligament Reconstruction for Acute Acromioclavicular Dislocation Using 2 Clavicular and 1 Coracoid Cortical Fixation Buttons With Suture Tapes

Abstract

Purpose To introduce an arthroscopically assisted coracoclavicular (CC) fixation technique using a cortical fixation button device and to evaluate the clinical and radiologic outcomes in patients with acute acromioclavicular (AC) dislocation who were treated with the technique. Methods Twenty-one consecutive patients with grade III and V acute AC dislocation who underwent arthroscopically assisted CC ligament reconstruction using a cortical fixation button device were prospectively enrolled. Our fixation technique involved using a cortical fixation button device consisting of 1 coracoid button and 2 clavicular buttons connected with 2 suture tapes to reconstruct the conoid and trapezoid ligaments, respectively. Clinical outcomes were evaluated and CC distance and horizontal displacement of the AC joint were measured. Results The mean follow-up period was 27.2 months (range, 24-32 months). The average CC distance of the injured shoulder was 17.2 ± 5.2 mm preoperatively, which represented an increase of 103% ± 42% compared with the uninjured shoulder. The CC distance was significantly reduced to 8.5 ± 1.5 mm after surgery (P <.001). At the final follow-up, the CC distance was maintained in 20 patients (95%) without loss of reduction. No significant radiologic difference was found in horizontal displacement of the AC joint immediately after the operation and at the final follow-up (P =.422). The average American Shoulder and Elbow Surgeons and Constant scores were 95.7 ± 3.6 and 95.4 ± 3.4, respectively. There were 3 complications, including 1 reduction loss, 1 coracoid process fracture, and 1 CC interval ossification. Conclusions Satisfactory clinical and radiologic outcomes were obtained simultaneously by arthroscopically assisted CC reconstruction using cortical fixation buttons. This reconstruction technique provided sufficient stability of the AC joint by using 2 clavicular holes to reconstruct the conoid and trapezoid ligaments separately. Therefore, arthroscopically assisted CC ligament reconstruction using a cortical fixation button device for management of acute AC dislocation is considered a viable treatment option for restoring stability to the AC joint. Level of Evidence Level IV, therapeutic case series. © 2017 Arthroscopy Association of North America