A Case Series of Arthroscopically Assisted Anatomical Coracoclavicular Ligaments and Acromioclavicular Joint Reconstruction in Chronic High-Grade Acromioclavicular Joint Separations
Introduction: Acromioclavicular (AC) joint separation is regarded as a common shoulder girdle injury that disrupts the anatomical and functional linkage between the upper extremity and the trunk. Various surgical techniques have been developed to treat high-grade AC joint disruption, with convincing clinical outcomes. There are numerous complications that need to be aware of and reduced to ensure consistent positive treatment results. Methods: This was a retrospective report of 6 cases (5 male; 1 female; mean age 25.7 years) of arthroscopically assisted AC joint and coracoclavicular (CC) ligaments anatomical reconstruction for chronic high-grade (Rockwood type IIIB - V) AC joint injury. Patient-reported clinical outcomes and complications encountered were acknowledged and highlighted. The average time from injury to surgery was 194.3 days. Results: The American shoulder and elbow surgeons (ASES) score for the 6 patients increased with a median of 36 at pre-operative to 77.5 at 6 months post-operative and 92.5 at final follow-up. The Visual Analogue Scale, VAS for pain showed improvements from the median of 5.5 at pre-operative to 3.0 at 6 months post-operative and 1.0 at final follow-up. Three patients had tolerable shoulder discomfort post-operatively. Two clavicle tunnels widening (cTW) were detected. One patient presented with loss of reduction (LOR). No infection was encountered post-operatively. All the patients regained full shoulder range of motion post-operatively. No concomitant intraarticular pathology was detected during surgeries. Conclusion: Arthroscopically assisted AC joint and CC ligament anatomical reconstruction with biological graft is a feasible and promising technique to treat chronic AC joint separations. This minimally invasive approach enables accurate implant and graft placement and reduces soft tissue disturbance to the minimum.
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