T A Wood1, P A E Rosell, J C Clasper. 1. Ministry of Defence Hospital Unit, Frimley Park Hospital, Portsmouth Road, Frimley, Surrey GU16 7UJ. tomwood@doctors.org.uk
Abstract
BACKGROUND: Chronic instability of the acromiocavicular joint is relatively common and normally occurs following a fall onto the point of the shoulder. Reconstruction of the joint [Weaver-Dunn procedure] using the coracoacromial ligament is often required in service personnel, and a number of methods to augment this repair have been used. Many of these operative methods require a second operation to remove the metalwork, and in addition can be associated with a failure rate of up to 30%. The 'Surgilig' was originally designed for use in the revision of failed Weaver-Dunn procedures. However this study evaluates its use in the primary operation, reinforcing the autologous graft, in an attempt to reduce the failurerate. DATA COLLECTION AND ANALYSIS: We prospectively followed up the Modified Weaver Dunn procedures using Surgilig. The post-operative x-rays were reviewed at six weeks, three months and then six months to assess the radiological success of the procedure. Our patients were discharged at six months. RESULTS: We have performed this procedure in 11 patients. One of the 11 patients was excluded from the study as the Surgilig graft was used in addition to a hook plate. The remaining ten patients have all reached the six-month post-operative time with no incidence of radiological failure of the graft. After six months they were discharged from clinic follow-up asthe coracoacromial graft had sufficient strength to no longer rely on the augment for mechanical stability of the joint. All 10 patients had a good clinical and radiological result. One patient even had inadvertent stress/ weight-bearing x-rays taken at six weeks, with no discernable detrimental effect to outcome. CONCLUSION: Although a small study, these initial results for primary fixation of acromioclavicular joint disruption with Surgilig are extremely encouraging. The results suggest that Surgilig should continue to be used in its current role. As patient numbers increase, a follow-up study to evaluate these preliminary findings should be conducted.
BACKGROUND: Chronic instability of the acromiocavicular joint is relatively common and normally occurs following a fall onto the point of the shoulder. Reconstruction of the joint [Weaver-Dunn procedure] using the coracoacromial ligament is often required in service personnel, and a number of methods to augment this repair have been used. Many of these operative methods require a second operation to remove the metalwork, and in addition can be associated with a failure rate of up to 30%. The 'Surgilig' was originally designed for use in the revision of failed Weaver-Dunn procedures. However this study evaluates its use in the primary operation, reinforcing the autologous graft, in an attempt to reduce the failurerate. DATA COLLECTION AND ANALYSIS: We prospectively followed up the Modified Weaver Dunn procedures using Surgilig. The post-operative x-rays were reviewed at six weeks, three months and then six months to assess the radiological success of the procedure. Our patients were discharged at six months. RESULTS: We have performed this procedure in 11 patients. One of the 11 patients was excluded from the study as the Surgilig graft was used in addition to a hook plate. The remaining ten patients have all reached the six-month post-operative time with no incidence of radiological failure of the graft. After six months they were discharged from clinic follow-up asthe coracoacromial graft had sufficient strength to no longer rely on the augment for mechanical stability of the joint. All 10 patients had a good clinical and radiological result. One patient even had inadvertent stress/ weight-bearing x-rays taken at six weeks, with no discernable detrimental effect to outcome. CONCLUSION: Although a small study, these initial results for primary fixation of acromioclavicular joint disruption with Surgilig are extremely encouraging. The results suggest that Surgilig should continue to be used in its current role. As patient numbers increase, a follow-up study to evaluate these preliminary findings should be conducted.
Authors: Sven A F Tulner; Andy Fowler; Kimberley L Edwards; Vinod Kumar; Paul Manning; John M Geoghegan; William A Wallace Journal: J Clin Orthop Trauma Date: 2019-01-15