Stephan G Pill1, Lane Rush2, John Arvesen3, Ellen Shanley4, Charles A Thigpen4, John L Glomset5, Robert Longstaffe6, Michael J Kissenberth3. 1. Steadman Hawkins Clinic of the Carolinas, Prisma Health-Upstate, Greenville, SC, USA. Electronic address: allysonsandago@gmail.com. 2. Rush Health Systems, Meridian, MI, USA. 3. Steadman Hawkins Clinic of the Carolinas, Prisma Health-Upstate, Greenville, SC, USA. 4. ATI Physical Therapy, Greenville, SC, USA. 5. Oklahoma Sports and Orthopedic Institute, SSM Health Medical Group, Oklahoma City, OK, USA. 6. Pan Am Clinic, Winnipeg, MB, Canada.
Abstract
BACKGROUND: The management of high-grade acromioclavicular separations remains unclear. The surgical interventions have shifted to more anatomic, less invasive techniques. The purpose of this study was to systematically review the outcomes and complications of anatomic coracoclavicular ligament reconstruction using a tendon graft. METHODS: Twenty-one studies (n = 460 patients) met the criteria for inclusion. A double clavicle tunnel tendon graft construct was used in 348 patients (75.7%), whereas a single clavicle tunnel technique was used in 112 patients (24.3%). No significant difference in loss of reduction was found between the 2 techniques. Of 460 patients, 96 (20.9%) demonstrated some form of radiographic displacement at the final follow-up. The overall complication rate was 21.3% (98 of 460), and a higher complication rate was found in the double clavicle tunnel technique (P < .001). The overall reoperation rate was 7.6% (37 of 460). The most common reason for reoperation was clavicle fracture (8 of 37). There was a statistically significant increase in reoperation when allograft was used (P = .003). CONCLUSION: The results of this study suggest that despite newer techniques, approximately 20% of patients develop loss of reduction and/or experience a surgical complication. Attempts to minimize trauma to the clavicle and use autograft tendon may reduce the risk of reoperation.
BACKGROUND: The management of high-grade acromioclavicular separations remains unclear. The surgical interventions have shifted to more anatomic, less invasive techniques. The purpose of this study was to systematically review the outcomes and complications of anatomic coracoclavicular ligament reconstruction using a tendon graft. METHODS: Twenty-one studies (n = 460 patients) met the criteria for inclusion. A double clavicle tunnel tendon graft construct was used in 348 patients (75.7%), whereas a single clavicle tunnel technique was used in 112 patients (24.3%). No significant difference in loss of reduction was found between the 2 techniques. Of 460 patients, 96 (20.9%) demonstrated some form of radiographic displacement at the final follow-up. The overall complication rate was 21.3% (98 of 460), and a higher complication rate was found in the double clavicle tunnel technique (P < .001). The overall reoperation rate was 7.6% (37 of 460). The most common reason for reoperation was clavicle fracture (8 of 37). There was a statistically significant increase in reoperation when allograft was used (P = .003). CONCLUSION: The results of this study suggest that despite newer techniques, approximately 20% of patients develop loss of reduction and/or experience a surgical complication. Attempts to minimize trauma to the clavicle and use autograft tendon may reduce the risk of reoperation.
Authors: Theodorakys Marín Fermín; Jean Michel Hovsepian; Víctor Miguel Rodrigues Fernandes; Ioannis Terzidis; Emmanouil Papakostas; Jason Koh Journal: Arthrosc Sports Med Rehabil Date: 2021-02-24