Orthogonal soft tissue reconstruction for acute acromioclavicular joint dislocations: ‘A novel technique ensures predictable outcome’

Background

Acromioclavicular joint (ACJ) injuries are common in young active populations. Various surgical procedures have been described but each has had limited success. We have described a novel technique of open reduction of AC joint, and coracoclavicular fixation using synthetic tape followed by reconstruction of coracoclavicular and AC joint ligaments using hamstring graft to ensure healing and predictable outcome.

Methods

Twenty-five adults with severe ACJ dislocation were taken up for the open reduction of ACJ & coracoclavicular fixation with fibretape tied and cinched over dog bone buttons through tunnels in the clavicle and base of the coracoid. This was followed by an autologous semitendinosus graft looped around the coracoid and clavicle in a figure-of-eight fashion. Patients were followed up over two years to look for maintained ACJ reduction and recovery of shoulder function using subjective and objective outcome assessment scores.

Results

Twenty-five patients with ACJ dislocation with a mean age of 30 years were operated using our technique. 84 % of them were active adult male patients. At a mean follow-up of 28 months (range 24–36), the mean Constant Score was 94.12 ± 6.2 (range 80–100) and was close to pre-injury level. The quick DASH score improved to 6.8 ± 7.18 from the baseline of 66.84 ± 14.18. The average European quality of life 5 Dimensions index improved from a baseline of 0.52 ± 0.05 to 0.92 ± 0.03. Only in two cases (8 %) there was loss of reduction with subluxation of AC joint.

Conclusion

Primary open reduction and fixation of ACJ after severe ACJ dislocation, when augmented with the biological reconstruction of coracoclavicular and acromioclavicular ligaments, promises predictable outcomes allowing return to preinjury level of activity in young adults.