Anotomic-Biological Reconstruction of Acromio-Clavicular Joint Injuries-Dr. Utsav Agrawal
1. Anatomic-Biological
Reconstruction
of
Acromio-clavicular Joint Injuries
Dr Utsav Agrawal
Dr Vikram Sapre
Dr Samir Dwidmuthe
Department of Orthopaedics
Lata Mangeshkar Hospital
Nagpur
2. INTRODUCTION
Analysis of shoulder function in 11 patients with chronic
(>6weeks) acromio-clavicular joint injuries managed by
ANATOMIC-BIOLOGIC
ACROMIO-CLAVICULAR JOINT RECONSTRUCTION
• > Grade III injuries
• A Retrospective case series
• Study period of 2 years with a minimum follow-up of
6 months
• All patients were evaluated by questionnare based on
Constant score and ASES score (Association of shoulder
and elbow surgeons) for shoulder function.
3. Cause
Direct injury
Fall on lateral aspect of shoulder
on an adducted arm
• Lead to chronic shoulder pain
and instability
• Should thus be managed
actively, especially in arm
dominant individuals
4. Stabilizers of AC joint
AC Ligament
Trapezoid and
Conoid
part of CC ligment
7. Sood A, Wallwork N, Bain GI.
Int J Shoulder Surg. 2008 Jan;2(1):13-21.
The traditional surgeries for acromioclavicular joint disruptions like
Bosworth’s Screw , Modified Weaver-Dunn procedure, has been
associated with high rate of recurrence of deformity and
complications
Thomas K, Litsky A, Jones G, Bishop JY.
Am J Sports Med. 2011 Apr;39(4):804-10
Compared five different techniques for reconstruction of AC
joint and concluded :
Anatomic AC joint techniques gives biomechanically more
stringer construct when compared to traditional
techniques.
8. Lee SJ, Keefer EP, McHugh HP, et al.
Am J Sports Med. 2008;36:1990.
Cadaver study
All of the un-augmented Weaver-Dunn reconstructions failed
with low loading. None of the augmented (with ethibond #5)
Weaver Dunn reconstructions failed at low load while all failed
under high load.
The semitendinosus graft reconstructions did not fail under the
low- or high-load conditions.
Milewski MD, et al
Am J Sports Med. 2012 Jul;40(7):1628-34.
27 cases of anatomic ACJ reconstruction - 10 cases with coracoid tunnel and 17 cases
of coracoid sling.
They found high incidence of complication with coracoid tunnel(80%) as
compared to sling technique(35%).
They concluded that newer techniques have high complication rates more in
coracoid tunnel technique. They emphasized the real danger of clavicle
fracture while drilling two tunnels in clavicle.
9.
10. Anatomic-Biologic
Acromio-clavicular Joint
reconstruction
Open reconstruction of coracoclavicular ligament
(both conoid and trapezoid part) and
acromioclavicular ligament with semi-tendinosus graft
2 tunnels in clavicle and looping semi-tendinosus from
under coracoid
11. • 40 years, Male patient
• Pain in right shoulder
• History of Road traffic accident
Deformity at right shoulder
17. Tunnels created for graft placement
Mazzocca et al. The anatomic coracoclavicular ligament reconstruction.
Op Tech in Sports Med, Vol12, No1 (Jan), 2004: 56-61
18. 2 Tunnels created in clavicle for conoid
and trapezoid part of CC ligament
30. Sr.
No
Patien
t Age Sex
RESULTS
D.O.S
x Post op xrays
ASES
score pain /15 ADL/20 ROM/40
Power
/25
Total
Scor
e Result
1 LMH 1 45 male Oct-11
Reduction
maintained,no osteolysis 96.66 15 20 40 22 97 Excellent
2
LMH
2 55 male
Mar-
12
Reduction Maintained,
Superficial Infection 89.99 10 18 40 24 92 Excellent
3 NOC 25 maleApr-12 reduced 89.97 15 14 40 20 89 Excellent
4 NOC 1 34 male
Nov-
12
min loss of reduction
<5mm 89.99 15 16 40 18 89 Good
5 MT 1 46 male Jan-13 Reduction maintained 88.32 10 18 40 22 90 Good
6 MT2 54 male Jan-13 Reduction maintained 96.66 15 18 40 24 97 Excellent
7 RG 1 49 male Feb-13 Reduction maintained 93.32 15 16 40 22 93 Excellent
8 RG 2 52 male
May-
13 Reduction maintained 86.66 10 16 40 20 86 Excellent
9 RG3 47 male Jun-13 Reduction maintained 69.99 10 12 40 13 75 Satisfactory
10 RG4 42 Male Aug’13 No loss of reduction 96.66 14 19 38 22 93 Excellent
11 NOC 2 44 Male Jan ’14 Satisfactory reduction 91.22 13 20 36 21 90 Excellent
31. Out of 11 patients
8 had excellent outcome
2 good outcome
and
1 satisfactory outcome
32. Complications
Minimal loss of reduction in one patient (<5mm)
Wound edge necrosis in 1 patient
No clavicle fracture/osteolysis
33. Conclusion
The anatomic coracoclavicular joint reconstruction
technique is designed to place tendon grafts in the
exact anatomic location
Also attempts to reproduce AC ligament
Use of internal splint with ethibond helps to keep joint
reduced till ligamentization occurs
Endobutton helps preventing cut through of tunnels
Looping of graft from under coracoid avoids chances of
fracture
Use of minimal and cheaper implants
34. Drawbacks of study and technique
Less no. patients studied
More biomechanical studies are required to validate
the procedure
Need long term evaluation to know specific
complications of the procedure
35. Dr Utsav Agrawal
N.K.P. Salve Institute of Medical sciences
Nagpur