Introduction
Optimal treatment of chronic unstable acromioclavicular (AC) joint dislocations (stage 3-5 according the Rockwood classification) is still debated. Anatomic coracoclavicular (CC) reconstruction is a reliable option in terms of two-dimensional radiographic reduction, clinical outcomes, and return to sports, but there remain concerns regarding anterior-posterior stability of the AC joint with CC ligament reconstruction alone.The aim of the present study was to describe the mid-term results of a new hybrid technique with CC and AC ligament reconstruction for chronic AC joint dislocations.
Methods
Twenty-two patients with chronic AC joint dislocations (grade 3 and 5) were enrolled in the present prospective study. All patients were assessed before surgery and at final follow-up with the Constant-Murley score (CMS) and the American Shoulder and Elbow Surgeons (ASES) score. The CC vertical distance (CCD) and the CCD ratio (affected side compared to unaffected side) were measured on Zanca radiographs preoperatively, at 6 months postop and at final follow-up.
Results
Twenty-two shoulders in 22 patients (19 male and 3 female) were evaluated with a mean age of 34.4±9 years at the time of surgery. The mean interval between the injury and surgery was 53.4±36.7 days. The mean duration of postoperative follow-up was 49.9±11.8 months. According to the Rockwood classi?cation, there were 5 (22.6%) type-III and 17 (77.2%) type-V dislocations. Mean preoperative ASES and CMS were 54.4±7.6 and 64.6±7.2 respectively. They improved to 91.8±2.3 (p=0.0001) and 95.2±3.1 (p=0.0001) respectively at final FU. The mean preoperative CCD was 22.4±3.2 mm while the mean CCD ratio was 2.1±0.1. At final FU the mean CCD was 11.9±1.4 mm (p=0.002) and the mean CCD ratio was 1.1±0.1 (p=0.009). No recurrence of instability was observed. One patient developed a local infection and 4 patients referred some shoulder discomfort. Heterotopic ossifications were observed in 3 patients.
Conclusions
The optimal treatment of chronic high-grade AC joint dislocations requires superior-inferior and anterior-posterior stability to ensure good clinical outcomes and return to overhead activities or sports. The present hybrid technique of AC and CC ligaments reconstruction showed good clinical and radiographic results and is a reliable an alternative to other reported techniques.