Complications After Anatomic Fixation and Reconstruction of the Coracoclavicular Ligaments

Background: Reconstruction of the disrupted acromioclavicular (AC) joint has historically resulted in high complication rates. As a result, there has been a move toward anatomic coracoclavicular (CC) ligament fixation and reconstruction, owing to its numerous biomechanical advantages and perceived c...

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Bibliographic Details
Published in:The American journal of sports medicine 2013-12, Vol.41 (12), p.2896-2903
Main Authors: Martetschläger, Frank, Horan, Marilee P., Warth, Ryan J., Millett, Peter J.
Format: Article
Language:English
Subjects:
Acromioclavicular Joint - surgery
Adolescent
Adult
Aged
Clavicle - surgery
Female
Fractures, Bone - surgery
Humans
Ligaments
Ligaments, Articular - surgery
Male
Medical procedures
Middle Aged
Orthopedic Procedures - methods
Patient Satisfaction
Postoperative Complications
Reconstructive Surgical Procedures - methods
Retrospective Studies
Scapula - surgery
Shoulder - surgery
Shoulder Injuries
Skin & tissue grafts
Sports medicine
Studies
Tendons - transplantation
Treatment Outcome
Young Adult
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Summary:Background: Reconstruction of the disrupted acromioclavicular (AC) joint has historically resulted in high complication rates. As a result, there has been a move toward anatomic coracoclavicular (CC) ligament fixation and reconstruction, owing to its numerous biomechanical advantages and perceived clinical advantages. Purpose: To report and analyze the unique complications associated with these anatomic CC ligament procedures using either cortical fixation buttons (CFBs) or tendon grafts (TGs) and to evaluate the effect that these complications have on patient outcomes. Study Design: Case series; Level of evidence, 4. Methods: From January 2006 until May 2011, a total of 59 primary anatomic CC ligament procedures were performed using either CFBs or TGs. Demographic, surgical, subjective (including the American Shoulder and Elbow Surgeons [ASES], quick Disabilities of the Arm, Shoulder and Hand [QuickDASH], Short Form–12 [SF-12], and Single Assessment Numeric Evaluation [SANE] scores), and radiographic data along with surgical complications were prospectively collected and retrospectively analyzed. Construct survivorship, defined as the maintenance of reduction of the AC joint, was calculated using the Kaplan-Meier method at 12- and 24-month intervals. Results: Surgical treatment for AC joint dislocations was performed in 3 women (4 shoulders) and 52 men (55 shoulders) with a mean age of 43.6 years (range, 18-71 years); 13 shoulders (22.0%) underwent fixation using the CFB technique, and 46 shoulders (78.0%) underwent reconstruction using the TG technique. The overall complication rate was 27.1% (16/59) in this study. There were 3 complications (23.1%) in the CFB group, including 1 coracoid fracture and 2 cases of hardware failure resulting in a loss of reduction. There were 13 complications (28.2%) in the TG group, including 4 graft ruptures, 2 clavicle fractures, 1 case of hardware failure, 1 hypertrophic distal clavicle, 2 cases of hardware pain, 1 suture granuloma, 1 case of adhesive capsulitis, and 1 case of axillary neuropathy. Twelve- and 24-month construct survivorship was calculated to be 86.2% and 83.2%, respectively. Of the 43 shoulders that did not have a complication, mean ASES scores significantly improved from 57.5 (range, 0-97) to 91 (range, 63-100) (P < .001), and mean SF-12 physical component summary scores significantly improved from 45 (range, 25-58) to 56 (range, 43-65.8) (P < .001) after a mean 2.4-year follow-up (range, 1.0-5.7 years)
ISSN:0363-5465
1552-3365
DOI:10.1177/0363546513502459