Summary

Anatomical reconstruction of coracoclavicular ligaments using a double tunnel, single tendon graft Zip-Tight®- like synthetic suspensory loop device has proven to be biomechanically superior to other techniques in the surgical treatment of acromioclavicular dislocation

Abstract

INTRODUCTION. There exists a wide-ranging debate on the best surgical technique for acromioclavicular (AC) joint injury (ACJI) treatment: from primary ligament reparation in acute injuries to anatomical reconstruction using tendon grafts or synthetic materials and suspensory loop devices. The objective of anatomical reparation is to stabilise the joint in both the frontal and sagittal planes.
OBJECTIVES. The objective of our case-study was to evaluate clinical, functional, and subjective results of anatomical arthroscopic AC joint dislocation injury reparation using single bundle tendon allograft and a synthetic coracoclavicular suspensory loop device in patients at our hospital.

MATERIALS AND METHODS. We carried out an observational retrospective case-study of 45 patients who underwent surgery for ACJI using single bundle tendon graft and a Zip-Tight®- like synthetic coracoclavicular suspensory loop device between the years of 2011 and 2021. Postoperative clinical and functional assessment was carried out through patient surveys using the visual analogue pain scale (VAS) as well as DASH (Disabilities of the Arm, Shoulder and Hand) and Constant scores.

RESULTS. Average follow-up time was 54.6 months, with a minimum follow-up of 12 months. Mean age at time of surgery (ATOS) was 36 years. 43 (95.56%) of subjects were male. There were 24 cases of dominant arm ACJI (53.33%). 10 patients (22.22%) were diagnosed with type III Rockwood ACJI while 35 (77.78%) were Rockwood V injuries. We had 39 (86.67%) cases of acute ACJI versus 6 cases (13.33%) of chronic dislocation (over 6 months since injury). Overall, there was a statistically significant improvement in VAS and Constant scores after surgery. The mean preoperative Constant score was 56.61 compared a postoperative score of 87.65. Average VAS fell from 6.74 to 1.78. Full or almost-full articular shoulder balance was restored in all patients as compared to contralateral movement. We had one case of surgical wound infection, one case of Zip-Tight® failure which underwent successful revision surgery, and two cases of clavicular osteolysis which required graft extraction but did not compromise articular stability.

DISCUSSION. The anatomical reconstruction of the conoid and trapezoid ligaments using a double tunnel, single graft suspensory loop device has proven to be biomechanically superior to other techniques in the surgical treatment of acromioclavicular dislocation. Zip-Tight®- like synthetic suspensory loop devices better control superior and posterior translation forces on the distal portion of the clavicle while allowing for the tendon graft to assimilate. It is thus a useful technique in both acute and chronic ACJI. It is worth noting that, if the graft was of adequate length, an anteroposterior (AP) acromial tunnel was added to stabilise the joint in the AP plane as well. Additionally, even though it was outside the scope of our study, there were no cases of osteoarthritis at 5-year follow-up.