Minimum 10-year outcomes after arthroscopically assisted anatomic coracoclavicular ligament reconstruction for the treatment of type III and V acromioclavicular joint injuries

Background

Acromioclavicular joint (ACJ) injuries can lead to severe pain and reduced shoulder function. Anatomic coracoclavicular ligament reconstruction (ACCR) using a free tendon graft has demonstrated favorable biomechanical properties and good short- to mid-term outcomes, but data on long-term outcomes are scarce. The purpose of the present study was to evaluate the long-term clinical and functional outcomes after ACCR with a focus on return to sport and revision surgery.

Methods

Patients who underwent ACCR using a free tendon allograft for the treatment of ACJ injuries type III or V between November 2006 and April 2011 by a single surgeon, with a minimum 10-year follow-up, were eligible for inclusion. Patient-reported outcome measures, including the American Shoulder and Elbow Surgeons score, short version of the Disabilities of the Arm, Shoulder and Hand questionnaire, Single Assessment Numeric Evaluation, patient satisfaction (1-10 scale with “10” indicating maximum satisfaction), rates of return to sport and revision surgery were evaluated minimum 10 years postoperatively. Pain (via visual analog scale) was assessed preoperatively and at final follow-up. Patients who underwent further surgery were excluded from analysis. Survivorship was reported as two scenarios: not undergoing revision ACJ stabilization and not undergoing any further surgery.

Results

Fourteen patients were evaluated after 13.0 (interquartile range, 12.0-15.0) years. Four patients (28.6%) underwent further surgery (revision ACJ stabilization [n = 2], exostosis removal [n = 2]) and were excluded from further analysis. Shoulder function was excellent at follow-up (American Shoulder and Elbow Surgeons score: 100 [96.6-100], Quick Disabilities of the Arm, Shoulder and Hand: 0 [0-5.1]), Single Assessment Numeric Evaluation: 99.0 [91.5-99.0]). Pain levels decreased significantly from preoperatively to follow-up (visual analog scale for pain: 2.0 [1.0-3.0] to 0 [0-0.5], P = .016). Satisfaction at follow-up was high (10 [5.0-10]). Nine patients reported their postoperative sporting level, of which eight returned to sport (88.9%). Four patients (44.4%) returned equal to or above the preoperative level and 4 patients (44.4%) returned below their preoperative level. One patient reported hypersensitivity and anterior shoulder pain postoperatively but reported low pain levels at follow-up. Survivorship was 85.7% for not undergoing revision ACJ stabilization and 71.4% for not undergoing any further surgery.

Conclusion

ACCR using a free tendon graft for the treatment of ACJ injuries type III or V resulted in good to excellent shoulder function, low pain levels, and high patient satisfaction at long-term follow-up. The rate of revision ACJ stabilization was 14.3%.