Better Radiographic Reduction and Lower Complication Rates With Combined Coracoclavicular and Acromioclavicular Ligament Reconstruction Than With Isolated Coracoclavicular Reconstruction

Jordan D Walters; Anthony Ignozzi; Francis Bustos; Brian C Werner; Stephen F Brockmeier

doi:10.1016/j.asmr.2020.10.009

Better Radiographic Reduction and Lower Complication Rates With Combined Coracoclavicular and Acromioclavicular Ligament Reconstruction Than With Isolated Coracoclavicular Reconstruction

Arthrosc Sports Med Rehabil. 2021 Feb 24;3(2):e441-e448. doi: 10.1016/j.asmr.2020.10.009. eCollection 2021 Apr.

Authors

Jordan D Walters¹, Anthony Ignozzi², Francis Bustos¹, Brian C Werner¹, Stephen F Brockmeier¹

Affiliations

¹ Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A.
² University of Virginia School of Medicine, Charlottesville, Virginia, U.S.A.

Abstract

Purpose: To determine whether combined acromioclavicular (AC) ligament reconstruction and coracoclavicular (CC) ligament reconstruction without bone tunnels would improve radiographic reduction maintenance and complication rates for type III to V AC dislocations.

Methods: This single-institution retrospective study analyzed all patients who underwent a hybrid synthetic/graft wrap CC reconstruction without tunnels with additional AC reconstruction/repair from January 2013 to August 2019. This 26-patient cohort was compared with a 1:1 sex- and age-matched control group who underwent CC reconstruction without AC reconstruction. CC distances on postoperative radiographs were compared with normal contralateral shoulders.

Results: Of the 93 patients who underwent AC reconstructive surgery during this time period, 26 patients (96% male) met the inclusion criteria. The AC/CC cohort had 23.5% type III injuries, 23.1% type IV injuries, and 53.8% type V injuries, similar to the control group. Final radiographs of the operative shoulder's CC distance were (mean ± standard deviation) 0.9 ± 4.0 mm greater than that of the contralateral shoulder (9.6 ± 8.7 mm) in the AC/CC cohort. Final radiographs of the operative shoulder's coracoclavicular distance were 4.0 ± 4.7 mm greater than that of the contralateral shoulder (13.3 ± 9.3 mm) in the CC control group, a significant difference (P = .014). The AC/CC reconstruction group had fewer patients with a loss of reduction >5 mm (11.5% versus 38.5%, P = .025). The complication rate in the CC control group was higher than in the AC/CC cohort (30.7% versus 7.7%, P = .035). The reoperation rate was also greater in the CC control group (8 versus 1, P = .010).

Conclusion: This cohort study shows that the addition of AC reconstruction to CC reconstruction using synthetic tapes/grafts or allograft tissues without bone tunnels significantly improves durable radiographic outcomes, diminishes complication rates, and improves reoperation rates.

Level of evidence: III, retrospective comparative study.