Arthroscopic Coracoclavicular Ligament Reconstruction with Double-Bundle Soft Tissue Allograft for Chronic Type V Acromioclavicular Dislocations Shows Excellent Patient Outcomes and Return to Duty and Sport at Minimum 10-year Follow-Up.

Abstract

Purpose: To report long-term outcomes at over 10 years of follow-up after arthroscopic coracoclavicular (CC) ligament reconstruction using a double-bundle soft tissue allograft coracoid cerclage technique for chronic (>4 weeks), high-grade (Type V) acromioclavicular (AC) dislocations in an active-duty military population.

Methods: Patients undergoing arthroscopic CC ligament reconstruction for chronic Type V AC dislocations between March 2011 and December 2013 with minimum ten-year follow-up (range: 10-12.8 years) were eligible for inclusion in this retrospective case series. Outcomes measures included the pain visual analog scale (VAS), single assessment numeric evaluation (SANE), Constant score, American Shoulder and Elbow Surgeons Shoulder (ASES) Score, Simple Shoulder Test (SST); range of motion (ROM) including forward flexion (FF), external rotation (ER), and internal rotation (IR); and rates of return to active duty and sports participation.

Results: Overall, 19 patients (average age of 26.1±6.7 years, 100% male) met inclusion criteria. The mean follow-up was 134.2±10.4 months. All patients demonstrated a profound decrease in pain as measured by the pain VAS and a marked, sustained improvement in functional outcomes at final follow-up as determined by the SANE, Constant, SST, and ASES scores (p value <0.0001 for all). There were no statistically significant differences between preoperative and postoperative ROM (FF: p=.3382, ER: p=.2350, IR: p=.2590). Overall, 94.7% (n=18/19) of patients were able to remain on active duty and 89.5% (n=17/19) of patients returned to sport, 94.1% (n=16/17) of whom were able to return to sport at prior levels. One patient experienced superficial wound infection, one developed AC osteoarthritis, and one progressed to asymptomatic loss of reduction.

Conclusion: Outcomes after arthroscopic CC reconstruction for chronic Type V AC dislocations in an active-duty military patient population demonstrate sustained and statistically significant improvements in functional outcomes as well as high rates of return to sport and active-duty.

Level of evidence: IV (Retrospective Case Series).