Tratamiento de la inestabilidad acromioclavicular crónica mediante reconstrucción coracoclavicular anatómica con aloinjerto tendinoso: resultados preliminares en 10 casos

Abstract

Purpose

To assess the outcomes of the arthroscopy-assisted technique indicated for the treatment of chronic acromioclavicular instability (CAI), based on coracoclavicular (CC) non-rigid fixation plus CC anatomical reconstruction with a tendon allograft.

Methods

The study included patients with CAI managed surgically between 2008 and 2012. Clinical assessments were made using the SF36, a VAS, and DASH scale, at a visit prior to surgery (VPS) and at the last follow-up visit. The Constant score and the overall satisfaction (0-10) were assessed at the last follow-up visit. Development of secondary subluxations was also evaluated.

Results

A total of 10 patients were included, with a mean age of 41 years (range 33-55). In all patients surgical treatment was indicated after conservative measures failed. The time elapsed from shoulder injury to surgical intervention was more than three weeks in all cases, with a mean of 6.75 months (range 1.5-12). At a mean follow-up of 25.50 months (range 24-30), a significant improvement was registered as regards the preoperative values of the physical SF36 (from 29.6 ± 3.41 to 59.6 ± 1.98, P < .001); the mental SF36 (from 46.6 ± 3.80 to 56.6 ± 1.89, P < .001); VAS (from 5.2 ± 2.40 to 1.7 ± 2.07, P = .022), and DASH (from 63.3 ± 23.56 to 2.6 ± 1.79, P < .001). The Constant score and the overall satisfaction registered at the last follow-up visit were 95.6 ± 3.28 and 9.2 ± 0.67, respectively. No secondary subluxations were recorded.

Conclusion

Treatment of CAI by means of an anatomical reconstruction of the CC ligaments plus an arthroscopically placed CC suspension device, may offer a significant improvement to the quality of life of patients. It could also be used as a strategy that might minimise the possibilities of failure and development of secondary subluxations by adding a CC primary mechanical stabiliser.

Clinical relevance

The technique described represents a valid alternative for the management of patients with chronic and symptomatic acromioclavicular joint instability, providing good results at two years follow-up, without any complications recorded.

Level of evidence

Level IV Case series.