Summary

This study evaluates a novel technique of reconstruction of chronic Acromio-clavicular joint dislocations without the use of implants, which gives a cheaper yet efficient option for the management of these injuries

Abstract

Acromio-clavicular joint (ACJ) dislocations have a plethora of techniques for reconstruction; however, the optimal operative method remains controversial. Numerous implants have also been developed and used, but pose additional expenses to the patient, particularly in a nation where majority of the hospital expenditures are out of pocket rather than health insurance based. We propose a simple, safe, cheap yet effective technique of ACJ reconstruction using the semitendinosus autograft. 15 consecutive patients with chronic ACJ dislocations (Rockwood type 4 and type 5) were operated using this technique and were prospectively followed up for an average duration of 3.8 years. Mean duration from the date of injury to date of surgery was 61.33days. The technique involved looping semitendinosus autograft around the coracoid and tying it over the clavicle after reducing the joint. Excess tendon was then stitched over the acromioclavicular joint as well. On Final follow up mean Oxford shoulder scores increased from 19.28[SD 8.51] pre op to 51.67[SD 3.48]. All patients had excellent range of movement at the final follow up and no visible deformity. Radiologically final follow up x rays showed no evidence of subluxation even on stress radiographs when compared to the normal side. With respect to complications only one patient had neuropraxia at the donor site which resolved in 3months. This procedure saved each patient a minimum of INR 18,900 (minimum cost of implant). No implants not only meant lower cost but also reduced complications related to drilling of coracoid, osteolysis and need for implant removal. Despite the small sample size, the outcomes and reduced costs prove that this technique may be a cost effective and efficient alternative in the treatment of chronic ACJ dislocations.