scholarly journals Arthroscopic Coracoclavicular Ligament Reconstruction of Chronic Acromioclavicular Dislocations Using Autogenous Semitendinosus Graft: A Two-Year Follow-up Study of 58 Patients

2020 ◽  
Vol 2 (1) ◽  
pp. e7-e15
Author(s):  
Juha O. Ranne ◽  
Terho U. Kainonen ◽  
Janne T. Lehtinen ◽  
Kari J. Kanto ◽  
Heidi A. Vastamäki ◽  
...  
Keyword(s):  
Ligament Reconstruction ◽  
Coracoclavicular Ligament ◽  
Follow Up Study ◽  
Coracoclavicular Ligament Reconstruction ◽  
Semitendinosus Graft

scholarly journals Functional and Radiographic Outcomes After Anatomic Coracoclavicular Ligament Reconstruction for Type III/V Acromioclavicular Joint Injuries

2019 ◽  
Vol 7 (11) ◽  
pp. 232596711988453 ◽  
Author(s):  
Lukas N. Muench ◽  
Cameron Kia ◽  
Aulon Jerliu ◽  
Matthew Murphy ◽  
Daniel P. Berthold ◽  
...  
Keyword(s):  
Ligament Reconstruction ◽  
Coracoclavicular Ligament ◽  
Ac Joint ◽  
Type Iii ◽  
Radiographic Outcomes ◽  
Joint Injuries ◽  
Coracoclavicular Ligament Reconstruction ◽  
Significant Difference ◽  
Ac Joint Injuries

Background: Acromioclavicular (AC) joint separation is a common injury. The anatomic coracoclavicular ligament reconstruction (ACCR) technique is a viable treatment option, designed to restore the native joint anatomy. Purpose: To evaluate the clinical and radiographic outcomes of patients undergoing ACCR for the treatment of type III and V AC joint injuries with a minimum 2-year follow-up. Study Design: Case series; Level of evidence, 4. Methods: A retrospective chart review was performed on prospectively collected data. Patients who underwent ACCR for type III or V AC joint injuries between January 2003 and December 2015 were analyzed. Clinical outcome measures included the American Shoulder and Elbow Surgeons (ASES) score, Rowe score, Simple Shoulder Test (SST), and Constant-Murley (CM) score. To determine the clinical relevance of the ASES score, the minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) were used. The pre- and postoperative coracoclavicular distance (CCD) and side-to-side difference in the CCD were measured for radiographic analysis. Results: A total of 43 patients (22 acute, 21 chronic) were included in the study. The mean patient age was 43.4 ± 11.4 years, with a mean follow-up of 3.4 years (range, 2.0-7.5 years). With regard to the ASES score, 92% of patients achieved the MCID, 81% achieved the SCB, and 49% reached or exceeded the PASS. There was no significant difference when stratifying by type (III vs V) or chronicity (acute vs chronic) of injury (both P > .05). The Rowe score improved from 66.6 ± 15.9 preoperatively to 88.6 ± 12.3 postoperatively, the CM score from 61.6 ± 18.8 to 87.4 ± 15.1, and the SST score from 6.2 ± 3.6 to 9.4 ± 3.7 (all P < .001). The postoperative side-to-side difference in the CCD was 3.1 ± 2.7 mm, with type III injuries (2.4 ± 1.9 mm) showing significantly lower measurements compared with type V (4.2 ± 3.4 mm) ( P = .02). No significant trend was found between joint reduction and the improvement in clinical outcomes ( P > .05). Conclusion: Patients undergoing ACCR for acute and chronic type III and V AC joint injuries maintained significant improvement in clinical and radiographic outcomes at a minimum 2-year follow-up. Additionally, 81% of patients reached the SCB after surgical reconstruction.

scholarly journals Minimum 10-Year Outcomes After Revision Anatomic Coracoclavicular Ligament Reconstruction for Acromioclavicular Joint Instability

2020 ◽  
Vol 8 (9) ◽  
pp. 232596712094703
Author(s):  
Daniel P. Berthold ◽  
Lukas N. Muench ◽  
Knut Beitzel ◽  
Simon Archambault ◽  
Aulon Jerliu ◽  
...  
Keyword(s):  
Operative Treatment ◽  
Revision Surgery ◽  
Ligament Reconstruction ◽  
Coracoclavicular Ligament ◽  
Ac Joint ◽  
Type Iii ◽  
Joint Injuries ◽  
Coracoclavicular Ligament Reconstruction ◽  
Ac Joint Injuries

Background: Revision surgery in cases of previously failed primary acromioclavicular (AC) joint stabilization remains challenging mainly because of anatomic alterations or technical difficulties. However, anatomic coracoclavicular ligament reconstruction (ACCR) has been shown to achieve encouraging biomechanical, clinical, and radiographic short-term to midterm results. Purpose: To evaluate the clinical and radiographic long-term outcomes of patients undergoing revision ACCR after failed operative treatment for type III through V AC joint injuries with a minimum 10-year follow-up. Study Design: Case series; Level of evidence, 4. Methods: A retrospective chart review was performed on prospectively collected data within an institutional shoulder registry. Patients who underwent revision ACCR for type III through V AC joint injuries between January 2003 and December 2009 were analyzed. Clinical outcome measures included the American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test (SST), and Single Assessment Numeric Evaluation (SANE). The coracoclavicular distance (CCD) was measured for radiographic analysis immediately postoperatively and at last postoperative follow-up. Results: A total of 8 patients with a mean age at the time of surgery of 44.6 ± 10.6 years and a mean follow-up of 135.0 ± 17.4 months (range, 120-167 months) were eligible for inclusion in the study. The time from initial AC joint stabilization until revision surgery was 10.2 ± 12.4 months (range, 0.5-36 months); 62.5% of the patients had undergone more than 2 previous AC joint surgical procedures. The ASES score improved from 43.9 ± 22.4 preoperatively to 80.6 ± 28.8 postoperatively ( P = .012), the SST score improved from 4.4 ± 3.6 preoperatively to 11.0 ± 2.2 postoperatively ( P = .017), and the SANE score improved from 31.4 ± 27.3 preoperatively to 86.9 ± 24.1 postoperatively ( P = .018) at final follow-up. There was no significant difference in the CCD ( P = .08) between the first (7.6 ± 3.0 mm) and final (10.6 ± 2.8 mm) radiographic follow-up (mean, 50.5 ± 32.7 months [range, 18-98 months]). Conclusion: Patients undergoing revision ACCR after failed operative treatment for type III through V AC joint injuries maintained significant improvement in clinical outcomes at a minimum 10-year follow-up.

Cyclical Loading of Coracoclavicular Ligament Reconstructions

2008 ◽  
Vol 36 (10) ◽  
pp. 1990-1997 ◽  
Author(s):  
Steven J. Lee ◽  
Eric P. Keefer ◽  
Malachy P. McHugh ◽  
Ian J. Kremenic ◽  
Karl F. Orishimo ◽  
...  
Keyword(s):  
Ligament Reconstruction ◽  
Acromioclavicular Joint ◽  
Semitendinosus Tendon ◽  
Coracoclavicular Ligament ◽  
Coracoclavicular Ligaments ◽  
Coracoacromial Ligament ◽  
Loading Cycle ◽  
Coracoclavicular Ligament Reconstruction ◽  
N Loading ◽  
Semitendinosus Graft

Background Reconstruction for injuries to the acromioclavicular joint remains controversial. Hypothesis A coracoclavicular ligament reconstruction with a semitendinosus tendon would have superior performance to the classic coracoacromial ligament transfer with or without augmentation. Study Design Controlled laboratory study. Methods Five cadaveric shoulders were used to reconstruct the coracoclavicular ligaments with 3 methods: coracoacromial ligament transfer without augmentation, coracoacromial ligament transfer augmented with No. 5 Ethibond suture, and a semitendinosus tendon. Each reconstruction was cyclically loaded at 40 N to 80 N for 2500 cycles, then from 40 N to 210 N for 2500 cycles, followed by loading to failure. The number of cycles to 50% and 100% loss of acromioclavicular joint reduction were recorded. Results During the 40 N to 80 N-loading cycle, the coracoacromial transfer without augmentation failed (15 ± 16 cycles). The augmented coracoacromial ligament transfer and the semitendinosus reconstruction did not fail ( P = .008). During the 40 N to 210 N-loading cycle, the augmented coracoacromial ligament transfer failed (207 ± 399 cycles). The semitendinosus reconstruction survived through both loading cycles ( P < .01). Conclusion Coracoclavicular ligament reconstruction with a semitendinosus graft is a biomechanically superior construct in a cyclically loaded setting to a coracoacromial ligament transfer augmented with a No. 5 Ethibond suture. Clinical Relevance The semitendinosus graft is a strong, biologic option for reconstruction of the coracoclavicular ligaments.

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