2025 ISAKOS Biennial Congress ePoster
The 3-Tunnel Technique of Superior Shoulder Suspensory Ligament Complex Reconstruction for Acute and Chronic ACJ Dislocations
Helen Ingoe, MBBS, FRCS (Tr+Orth), MD, MSc, PGCert, Dunedin NEW ZEALAND
Jashint Maharaj, MBBS, FRSPH, Brisbane, QLD AUSTRALIA
Nagmani Singh, M.S., Arthroscopy and Sports Medicine Fellow, Kathmandu, Bagmati NEPAL
Kathirazhagan Stalin, MS Orthopaedics, DNB, MRCS, FAOA, Chennai, Tamil Nadu INDIA
Kristine R. Italia, MD, FPOA, Quezon City, Metro Manila PHILIPPINES
Mohammad Jomaa LEBANON
Roberto Pareyon MEXICO
Kenneth Cutbush, MBBS, FRACS, FAOrthA, Spring Hill, QLD AUSTRALIA
Ashish Gupta, MBBS, MSc, FRACS, FAORTHOA, Brisbane, QLD AUSTRALIA
Queensland Unit for Advanced Shoulder Research (QUASR), Brisbane, QLD, AUSTRALIA
FDA Status Not Applicable
Summary
This study describes our 3-Tunnel Technique with LARS artificial ligament to reconstruct the superior shoulder suspensory complex (SSSC) in ACJ dislocations and equivalent lateral clavicle fractures.
ePosters will be available shortly before Congress
Abstract
Introduction
Acromioclavicular joint (ACJ) dislocations are common musculoskeletal shoulder injuries. This study describes our 3-Tunnel Technique with LARS artificial ligament to reconstruct the superior shoulder suspensory complex (SSSC) in ACJ dislocations and equivalent lateral clavicle fractures. Functional outcomes are reported using this technique for acute, chronic, and complex revision cases.
Methods
Prospective cohort series of patients undergoing the 3-Tunnel Technique using LARS artificial ligament were included in the study. This technique reconstructs the SSSC using two 4mm tunnels in the clavicle, one tunnel in the acromion, and is arthroscopically assisted to pass the artificial ligament under the coracoid. The ligament is secured to itself with braided composite sutures. No interference screw is used. Pre- and post-operative range of motion (ROM), lateral elevation strength, Specific Acromioclavicular Score (SACS), American Shoulder and Elbow Score (ASES), Constant, Simple Shoulder Test (SST), and Visual Analogue Score (VAS) were compared in patients with a minimum of 12 months follow up.
Results
A total of 26 patients were included in the study. Mean time from injury to operation was 14 weeks (2-650). Seven (27%) were operated within 4 weeks of injury, two (8%) were revision cases, and six (23%) were lateral clavicle fractures. On average, all functional outcome scores, ROM, and lateral elevation strength improved at 12 months compared to pre-operative scores and were similar to the normal contralateral shoulder. Mean postoperative scores with associated 95% CI were 87.38 (CI 75.38, 99.37), 94.60 (87.85, 101.35), 79.47 (71.87, 87.07), 85.44 (72.34, 98.54), and 0.50 (-0.15, 1.15) for SACS, ASES, Constant, SST, and VAS, respectively. There were two infections and one atraumatic loss of reduction, however there were no tunnel fractures.
Discussion
The 3-Tunnel Technique with LARS artificial ligament is a safe and efficient technique for both acute and chronic ACJ dislocations, lateral clavicle fractures with coracoclavicular ligament disruption, and complex revision cases. It leads to favorable outcomes at mid-term follow-up, with low complication rates.