Background
The operative treatment of acute high-grade acromioclavicular (AC) joint (ACJ) injuries has evolved during last decades offering arthroscopically assisted or all endoscopic techniques that display certain advantages. The goal of these techniques is to achieve anatomic reduction of the ACJ and allow for primary healing of AC and coracoclavicular (CC) ligaments, while minimizing associated complications. One of the implant-free techniques that have been described for the acute ACJ disruption is the open repair with double-loop sutures, as described by Dimakopoulos et al at 2006. This technique represents an effective and low-cost treatment for acute AC joint separations with proved long-term outcomes and stability. Recently the arthroscopically assisted surgical technique was described.
Objective
The objective of this study was to evaluate the clinical and radiological outcomes of double-loop suture repair for acute ACJ using the arthroscopically assisted technique.
Methods
Between January 2019 and December 2020, four male patients, with median age 23 years (range 18-27) underwent operative treatment for acute ACJ disruption by a single surgeon with arthroscopically-assisted double-loop suture repair CC fixation. All patients were operated during the first 15 days after the initial ACL injury. Two patients had injury type IIIb and two type V (Rockwood, modified by ISAKOS). Glenohumeral and subacromial space was arthroscopically inspected for any concomitant lesions. The dislocation was repaired with double-looped CC fixation using four Ethibond sutures passing underneath the coracoid and through a 4.5 mm drill hole in the clavicle in opposing directions to control both anteroposterior and vertical clavicle displacement.
Clinical outcome measures consisted of Constant-Murley score (CMS), VAS for pain, and Acromio Clavicular Joint Instability Score (ACJIS). Radiological assessment preoperatively and at the last follow-up included comparative anteroposterior of both ACJ, and axillary or Alexander views.
Loss of reduction, subluxation, and intraoperative or postoperative complications were recorded.
Results
With a median follow-up of 23 months (range 19-28), all patients demonstrated a significant improvement in post-operative functional outcome scores and VAS pain compared to their pre-operative state. Mean Constant score improved from 67 (range, 30-89) to 86 (range, 66-100) and the ACJIS from 55 (40-65) to 80 (75-95).
No intraoperative or postoperative complications were noted. Slight loss of reduction in the superior direction was noted in one patient without clinical deterioration. The median operative time for the procedure was 75 min (range, 65-100).
Conclusions
At the short-term follow-up arthroscopically assisted double-loop suture repair for acute ACJ disruption leads to successful functional outcome. Although this is a small case series, it is the first to report the results of the arthroscopically assisted double-loop suture repair technique.