Anatomic-Biological Reconstruction
of Acromio-clavicular Joint Injuries
Dr Utsav AgrawalDr Vikram Sapre
Dr Samir Dwidmuthe
Department of OrthopaedicsLata Mangeshkar Hospital
Nagpur
INTRODUCTION Analysis of shoulder function in 11 patients with chronic
(>6weeks) acromio-clavicular joint injuries managed by
ANATOMIC-BIOLOGIC
ACROMIO-CLAVICULAR JOINT RECONSTRUCTION
• > Grade III injuries
• A Retrospective case series
• Study period of 2 years with a minimum follow-up of
6 months
• All patients were evaluated by questionnare based on Constant score and ASES score (Association of shoulder and elbow surgeons) for shoulder function.
Cause
Direct injury
Fall on lateral aspect of shoulder
on an adducted arm
• Lead to chronic shoulder pain
and instability
• Should thus be managed
actively, especially in arm
dominant individuals
Management Options
Conservative
Intra-articular fixation
Extra-articular fixation
Acromio-clavicular joint reconstruction
Bosworth Screw Weaver-Dunn Procedure
Sood A, Wallwork N, Bain GI.
Int J Shoulder Surg. 2008 Jan;2(1):13-21.
The traditional surgeries for acromioclavicular joint disruptions like Bosworth’s Screw , Modified Weaver-Dunn procedure, has been
associated with high rate of recurrence of deformity and complications
Thomas K, Litsky A, Jones G, Bishop JY. Am J Sports Med. 2011 Apr;39(4):804-10
Compared five different techniques for reconstruction of AC joint and concluded :
Anatomic AC joint techniques gives biomechanically more stringer construct when compared to traditional
techniques.
Lee SJ, Keefer EP, McHugh HP, et al. Am J Sports Med. 2008;36:1990.Cadaver study
All of the un-augmented Weaver-Dunn reconstructions failed with low loading. None of the augmented (with ethibond #5) Weaver Dunn reconstructions failed at low load while all failed under high load.
The semitendinosus graft reconstructions did not fail under the low- or high-load conditions.
27 cases of anatomic ACJ reconstruction - 10 cases with coracoid tunnel and 17 cases of coracoid sling. They found high incidence of complication with coracoid tunnel(80%) as compared to sling technique(35%).They concluded that newer techniques have high complication rates more in
coracoid tunnel technique. They emphasized the real danger of clavicle fracture while drilling two tunnels in clavicle.
Milewski MD, et alAm J Sports Med. 2012 Jul;40(7):1628-34.
Anatomic-Biologic Acromio-clavicular Joint reconstruction
Open reconstruction of coracoclavicular ligament (both conoid and trapezoid part) and acromioclavicular ligament with semi-tendinosus graft
2 tunnels in clavicle and looping semi-tendinosus from under coracoid
• 40 years, Male patient
• Pain in right shoulder
• History of Road traffic accident
Deformity at right shoulder
Tunnels created for graft placementMazzocca et al. The anatomic coracoclavicular ligament reconstruction.
Op Tech in Sports Med, Vol12, No1 (Jan), 2004: 56-61
10 RG4 42 Male Aug’13 No loss of reduction 96.66 14 19 38 22 93 Excellent
11 NOC 2 44 Male Jan ’14 Satisfactory reduction 91.22 13 20 36 21 90 Excellent
Sr.
No
Patien
t Age Sex
D.O.S
x Post op xrays
ASES
score pain /15 ADL/20 ROM/40
Power
/25
Total
Scor
e Result
1 LMH 1 45 male Oct-11
Reduction
maintained,no osteolysis 96.66 15 20 40 22 97 Excellent
2
LMH
2 55 male
Mar-
12
Reduction Maintained,
Superficial Infection 89.99 10 18 40 24 92 Excellent
3 NOC 25 male Apr-12 reduced 89.97 15 14 40 20 89 Excellent
4 NOC 1 34 male
Nov-
12
min loss of reduction
<5mm 89.99 15 16 40 18 89 Good
5 MT 1 46 male Jan-13 Reduction maintained 88.32 10 18 40 22 90 Good
6 MT2 54 male Jan-13 Reduction maintained 96.66 15 18 40 24 97 Excellent
7 RG 1 49 male Feb-13 Reduction maintained 93.32 15 16 40 22 93 Excellent
8 RG 2 52 male
May-
13 Reduction maintained 86.66 10 16 40 20 86 Excellent
9 RG3 47 male Jun-13 Reduction maintained 69.99 10 12 40 13 75 Satisfactory
RESULTS
Complications Minimal loss of reduction in one patient (<5mm)
Wound edge necrosis in 1 patient
No clavicle fracture/osteolysis
Conclusion The anatomic coracoclavicular joint reconstruction
technique is designed to place tendon grafts in the exact anatomic location
Also attempts to reproduce AC ligament
Use of internal splint with ethibond helps to keep joint reduced till ligamentization occurs
Endobutton helps preventing cut through of tunnels
Looping of graft from under coracoid avoids chances of fracture
Use of minimal and cheaper implants
Drawbacks of study and technique Less no. patients studied
More biomechanical studies are required to validate the procedure
Need long term evaluation to know specific complications of the procedure
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