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Background: A coracoclavicular (CC) fixation technique using an all-suture anchor with the assistance of fluoroscopy can prevent iatrogenic anterior deltoid detachment from the clavicle; however, soft anchor pullout has been reported as a complication. Purpose: To compare the biomechanical properties of conventional metallic and all-suture anchors for CC suture fixation. Study design: Controlled laboratory study. Methods: A total of 24 fresh-frozen cadaveric specimens were divided into 2 groups: metal anchor group (group M) and all-suture anchor group (group A). In group M, 5.0-mm metallic suture anchors were used for CC fixation, whereas 2.8-mm all-suture anchors were used in group A. The prepared specimens were mounted on a materials testing machine. After preconditioning at 0 to 20 N for 10 cycles, the specimens were subjected to cyclic loading from 20 to 70 N for 1000 cycles. Finally, all the specimens were loaded to failure. Cyclic elongation, linear stiffness, ultimate load, and failure modes were recorded, and the Mann-Whitney U test was used to compare nonparametric parameters between the 2 groups. Results: All of the specimens completed the cyclic loading test. The elongation after cyclic loading in group M (1.6 ± 0.6 mm) was significantly smaller compared with that in group A (2.5 ± 1.2 mm) (P = .02). No between-group differences were found in linear stiffness (42 ± 17 N/mm in group M and 41 ± 17 N/mm in group A). The ultimate failure load in group M (263 ± 66 N) was significantly greater than that in group A (177 ± 76 N) (P = .02). All specimens failed because of suture anchor pullout. Conclusion: The use of all-suture anchors in CC fixation resulted in significantly greater cyclic displacement and smaller ultimate failure load than that of metallic anchors. Clinical relevance: Understanding the most biomechanically sound suture anchor may assist in lowering the risk of clinical failure in CC fixation and repair. [ABSTRACT FROM AUTHOR]

ObjectiveTo compare the effects of allogeneic tendon coracoclavicular ligament reconstruction combined with Kirschner wire fixation and clavicular hook plate fixation on early postoperative pain, postoperative shoulder joint function score and shoulder joint mobility in patients with acromioclavicular joint dislocation.MethodsFrom January 2020 to January 2023, 43 patients with acromioclavicular joint dislocation admitted to Xi ‘an Honghui Hospital were included. Among them, 24 patients were treated with the clavicular hook plate technique (Hook Plate,HP) group, and 19 patients were treated with allogeneic tendon coracoclavicular ligament reconstruction combined with the Kirschner wire technique (Allogeneic Tendon, AT) group. The Constant-Murley score of shoulder joint function 6 months after operation, postoperative shoulder joint activity, preoperative and postoperative pain, operation time, intraoperative blood loss and complications were compared between the two groups.ResultsAll 43 patients were followed up for an average of 9.7 (9–12) months. The intraoperative blood loss in the allogeneic tendon group was less than in the hook plate group. The Constant-Murley shoulder function score was higher than that in the hook plate group 6 months after the operation. The abduction and lifting activity was greater than that in the hook plate group. The visual analogue scale scores at 3 days and 14 days after operation were lower than those in the hook plate group. The difference was statistically significant (p < 0.001). There was 1 case (5.3%) of exudation around the Kirschner needle track in the allogeneic tendon reconstruction group, and 5 cases (20.8%) of complications in the hook plate group, including 1 case of internal fixation stimulation, 2 cases of acromion impingement syndrome, 1 case of acromioclavicular joint osteoarthritis, and 1 case of shoulder joint stiffness. The complication rate of the allogeneic tendon group was lower than that of the hook plate group.ConclusionThe clinical efficacy of allogeneic tendon coracoclavicular ligament reconstruction combined with Kirschner wire fixation in treating acromioclavicular joint dislocation (Rockwood type III-V) is better than hook plate internal fixation. The patients have less early postoperative pain and better recovery of shoulder joint function and shoulder joint mobility.

Open reconstruction of the coracoclavicular (CC) and acromioclavicular (AC) ligaments results in excellent reduction of severely displaced AC dislocations, most commonly Grades III and V. Anatomic CC reconstruction through clavicular bone tunnels can prevent vertical instability, whereas the addition of an acromial limb of the graft can increase horizontal stability. Autograft tendon is preferred in the young athletic group of collision sports participants, although allograft has had acceptable results. Accessory fixation may be placed to protect the graft during healing, or for severe instability, especially for athletes involved in contact sports. [ABSTRACT FROM AUTHOR]

Classification and treatment of acromioclavicular joint (ACJ) dislocations according to the Rockwood classification is controversial. The "circles measurement" on Alexander views was proposed to enable a clear assessment of displacement in ACJ dislocations. However, the method and its ABC classification were introduced on a Sawbones model based on exemplary Rockwood scenarios without soft tissue. This is the first in vivo study to investigate the circles measurement. We aimed to compare this new measurement method with the Rockwood classification and the previously described semiquantitative degree of dynamic horizontal translation (DHT). A total of 100 consecutive patients (87 men and 13 women) with acute ACJ dislocations between 2017 and 2020 were included retrospectively. The mean age was 41 years (range, 18-71 years). ACJ dislocations on panoramic stress views were classified according to Rockwood type (type II, n = 8; type IIIA, n = 9; type IIIB, n = 24; type IV, n = 7; and type V, n = 52). On Alexander views, where the hand of the affected arm rested on the contralateral shoulder, the circles measurement and the semiquantitative degree of DHT (none, n = 6; partial, n = 15; or complete, n = 79) were assessed. Convergent and discriminant validity of the circles measurement (including its ABC classification according to displacement) with the coracoclavicular distance and Rockwood types, as well as the semiquantitative degree of DHT, was tested. The circles measurement showed a strong correlation with the coracoclavicular distance according to the Rockwood classification (r = 0.66, P <.001) and differentiated between Rockwood types according to the ABC classification, including types IIIA and IIIB. The circles measurement correlated with the semiquantitative method of assessing DHT (r = 0.61, P <.001). Measurement values were smaller in cases without DHT than in cases with partial DHT (P =.008). Cases with complete DHT had respectively larger measurement values (P <.001). In this first in vivo study, the circles measurement allowed differentiation between Rockwood types according to the ABC classification in acute ACJ dislocations with a single measurement and correlated with the semiquantitative degree of DHT. On the basis of these validations of the circles measurement, its use for evaluating ACJ dislocations is recommended. [ABSTRACT FROM AUTHOR]

Neer type IIB lateral clavicle fractures are inherently unstable fractures with associated disruption of the coracoclavicular (CC) ligaments. Because of the high rate of nonunion and malunion, surgical fixation is recommended; however, no consensus has been reached regarding the optimal fixation method. A new plating technique using a superior lateral locking plate with anteroposterior (AP) locking screws, resulting in orthogonal fixation in the lateral fragment, has been designed to enhance stability and reduce implant failure. The purpose of this study was to biomechanically compare 3 different clavicle plating constructs within a fresh frozen human cadaveric shoulder model. Twenty-four fresh frozen cadaveric shoulders were randomized into 3 groups (n = 8 specimens): group 1, lateral locking plate only (Medartis Aptus Superior Lateral Plate); group 2, lateral locking plate with CC stabilization (No. 2 FiberWire); and group 3, lateral locking plate with 2 AP locking screws stabilizing the lateral fragment. All specimens were subject to cyclic loading of 70 N for 500 cycles. Data were analyzed for gap formation after cyclic loading, construct stiffness, and ultimate load to failure, defined by a marked decrease in the load displacement curve. After 500 cycles, there was no statistically significant difference between the 3 groups in gap formation (P =.179). No specimen (0/24) failed during cyclic loading. Ultimate load to failure was significantly higher in group 3 compared to group 1 (286 N vs. 167 N; P =.022), but not to group 2 (286 N vs. 246 N; P =.604). There were no statistically significant differences in stiffness (group 1: 504 N/mm; group 2: 564 N/mm; group 3: 512 N/mm; P =.712). Peri-implant fracture was the primary mode of failure for all 3 groups, with group 3 demonstrating the lowest rate of peri-implant fractures (group 1: 6/8; group 2: 7/8; group 3: 4/8; P =.243). Biomechanical evaluation of the clavicle plating techniques showed effective fixation across all specimens at 500 cycles. The lateral locking plate with orthogonal AP locking screw fixation in the lateral fragment demonstrated the greatest ultimate failure load, followed by the lateral locking plate with CC stabilization. This new plating technique showed compatible stiffness and gap formation when compared to conventional lateral locking plates as well as plates with CC fixation. The use of orthogonal screw fixation in the distal fragment may negate against the need for CC stabilization in these types of fractures, thus minimizing surgical dissection around the coracoid and potential complications. [ABSTRACT FROM AUTHOR]

Background: Loss of initial reduction of the acromioclavicular joint after coracoclavicular (CC) ligament reconstruction remains a challenge for various repair techniques. Previous studies using polydioxanone suture cerclage augments for CC ligament reconstruction demonstrated poor clinical and biomechanical outcomes. Tape-style sutures have recently gained popularity because of their added stiffness and strength relative to traditional sutures. These tape cerclage systems have yet to be biomechanically studied in CC ligament reconstruction. Purpose: To determine the efficacy of a tape cerclage system as an augment to CC ligament reconstruction. Study Design: Controlled laboratory study. Methods: A total of 24 human cadaveric shoulders were utilized. These were divided into 4 repair groups: anatomic CC ligament reconstruction (ACCR), ACCR with a tape cerclage augment (ACCR + C), tendon graft sling with a cerclage augment (TGS + C), or tape cerclage sling alone (CS). The repairs underwent superior/inferior cyclic loading to evaluate for displacement. Specimens were visually inspected for cortical erosion by the tape cerclage after cyclic loading. Finally, the constructs underwent superior plane load-to-failure testing. Results: Less displacement after cyclic loading was observed in the ACCR + C (mean ± SD, 0.42 ± 0.32 mm), TGS + C (0.92 ± 0.42 mm), and CS (0.93 ± 0.39 mm) groups as compared with the ACCR group (4.42 ± 3.40 mm; P =.002). ACCR + C (813.3 ± 257.5 N), TGS + C (558.0 ± 120.7 N), and CS (759.5 ± 173.7 N) demonstrated significantly greater load at failure relative to ACCR (329.2 ± 118.2 N) (P <.001). ACCR + C (60.88 ± 17.3 N/mm), TGS + C (44.97 ± 9.15 N/mm), and CS (54.52 ± 14.24 N/mm) conferred greater stiffness than ACCR (27.43 ± 6.94 N/mm) (P =.001). No cortical erosion was demonstrated in any specimen after cyclic loading. Conclusion: In a cadaveric model at time zero, repairs utilizing a tape cerclage system confer significantly greater load to failure and stiffness, as well as decreased displacement with cyclic loading, when compared with traditional ACCR repair. Clinical Relevance: Tape cerclage augmentation may provide a useful augment for CC ligament reconstruction. [ABSTRACT FROM AUTHOR]

Objective: To describe MRI changes of the coracoclavicular bursa in patients presenting with shoulder pain and examine whether there is an association with coracoclavicular distance measurements. Methods: Retrospective analysis of 198 shoulder 3T MRI scans for patients with shoulder pain was performed. Two musculoskeletal trained radiologists read all MRI scans. Inter-reader and intra-reader agreements for the bursal changes were assessed using the Kappa coefficient. The coracoclavicular distance was stratified into three intervals: < 5 mm, 5–10 mm, and > 10 mm. Statistical analysis for the coracoclavicular bursal changes and coracoclavicular distance was conducted using Fisher's exact test. Results: Coracoclavicular bursal changes were detected in 9% (n = 18/198) of patients. There was a statistically significant association between coracoclavicular distance (< 5 mm) and the presence of coracoclavicular bursal changes (p-value = 0.011). All patients (100%, n = 18/18) with coracoclavicular bursal fluid presented with shoulder pain with 44.5% of the patients (n = 8/18) describing anterior shoulder pain. A statistically significant association was detected between coracoclavicular bursal changes and anterior shoulder pain (p-value = 0.0011). Kappa coefficient for the bursal changes inter-reader agreement was moderate (0.67) and the intra-reader agreement was almost perfect (0.91). Conclusion: Coracoclavicular bursal changes were detected in 9% of shoulder MRI scans and were associated with reduced coracoclavicular distance (< 5 mm) suggesting an underlying mechanical disorder such as a friction or an impingement process. Documenting coracoclavicular bursal changes in the MRI report could help address patients' concerns and guide further management particularly in the context of shoulder pain and coracoclavicular distance of less than 5 mm. [ABSTRACT FROM AUTHOR]

Hypothesis: Neer type II distal clavicle fractures are unstable and associated with high nonunion rates. The aim of this retrospective study was to compare the clinical and radiographic outcomes of anatomic locking plate fixation and arthroscopic coracoclavicular button fixation for unstable distal clavicle fractures. Methods: Forty-seven patients with Neer type II distal clavicle fractures were treated surgically using either anatomic locking plate fixation (group 1, n = 20) or all arthroscopic coracoclavicular button fixation (group 2, n = 27) between 2012 and 2019 in 2 centers. Clinical and radiographic outcomes after an average follow-up period of 49 months for group 1 and 32 months for group 2 were assessed using the American Shoulder and Elbow Surgeons Shoulder score, Constant-Murley score, visual analog scale score and X-rays. Results: At the final follow-up, the mean American Shoulder and Elbow Surgeons Shoulder score, Constant-Murley score, and visual analog scale score for group 1 and group 2 were 92.5 ± 3.9 (range 88.3-98.3), 93.6 ± 4.0 (range 90-100), and 0.6 ± 0.6 (range 0-2) and 95 ± 3.3 (range 86.6-100), 96.2 ± 3.0 (range 88-100), and 0.4 ± 0.5 (range 0-1), respectively (P = .32, P = .15, and P = .59, respectively). At the final follow-up, acceptable reduction and bone healing were achieved in all patients. All patients in both groups were able to resume work as well as sports activities. Postoperative complications included 1 case of acromioclavicular joint arthritis and 1 case of screw penetration in group 1 and 2 cases of coracoid process fracture that did not require additional surgery in group 2. Five patients underwent hardware removal owing to skin irritation and dissatisfaction with the cosmetic appearance in group 1. Conclusion: Both distal anatomic locking plate fixation and arthroscopic coracoclavicular button fixation provide satisfactory functional and radiological outcomes. Both procedures can be used to treat distal clavicle fractures because they have a minimal risk of complications and present similar, high union rates.

Philip C Nolte,1,2 Lucca Lacheta,1,3 Travis J Dekker,1,4 Bryant P Elrick,1 Peter J Millett1,5 1Steadman Philippon Research Institute, Vail, CO, USA; 2Department of Trauma and Orthopedic Surgery, BG Trauma Center Ludwigshafen, Ludwigshafen, Germany; 3Center for Musculoskeletal Surgery, Charité Universitaetsmedizin Berlin, Berlin, Germany; 4Eglin Air Force Base, 96th Medical Group, United States Air Force, Eglin, FL, USA; 5The Steadman Clinic, Vail, CO, USACorrespondence: Peter J MillettSteadman Philippon Research Institute, 181 W Meadow Dr, Ste 400, Vail, CO 81657, USATel +1 970 479-5871Email drmillett@thesteadmanclinic.comAbstract: Injuries to the acromioclavicular (AC) joint are common and mostly involve younger, male individuals. Whereas the majority of AC joint dislocations can be treated nonoperatively with a trial of immobilization, pain medication, cryotherapy, and physiotherapy, there are patients that do not respond well to conservative management and may require surgical treatment. Identifying and treating these patients according to the type and chronicity of AC joint dislocation is paramount. To date, a myriad of surgical techniques have been proposed to address unstable AC joint dislocations and are indicative of the uncertainty that exists in optimal management of these injuries. Historically research has focused on the restoration of the coracoclavicular ligament complex. However, recently the importance of the acromioclavicular capsule and ligaments has been emphasized. This review aims to provide the reader with an overview of current treatment strategies and research, as well as future perspectives.Keywords: AC capsule, AC joint, coracoclavicular, reconstruction, stabilization, shoulder surgery

Introduction: Various surgical procedures for coracoclavicular (CC) ligament repair have been described for symptomatic acromioclavicular joint dislocations, with none emerging as a clear gold standard. There has been increased interest in arthroscopic approaches. This systematic review evaluates clinical outcomes after arthroscopic surgeries used to treat chronic and acute AC joint dislocations., Methods: We searched three databases (PubMed, EMBASE, and OVID [MEDLINE]) from database inception to December 20, 2022. Studies were included if they met the following criteria: studies evaluating humans, English language studies, level of evidence I to IV, and studies investigating clinical outcomes in patients following arthroscopic surgery for coracoclavicular ligament reconstruction. Studies on open reconstruction techniques only were excluded. Primary outcomes included function/pain scores, coracoclavicular distances, complications, and revision rates., Results: Fifty-two studies were included. In 33 studies, postoperative Constant-Murley scores ranged from 82.8 to 99 points. Postoperative VAS scores ranged from 0.3 to 4.1 in 16 studies. In 46 studies, revision rates ranged from 0 % to 44.4 %. We did not observe a difference in revision rates between chronic and acute cases (P = 0.268). Complications were more common in chronic than acute cases (25.5 % vs. 16.4 %; P < 0.001)., Conclusions: Arthroscopic surgery for chronic and acute CC ligament injuries exceeds the MCID and PASS for several outcomes, with low failure rates. Arthroscopic CC reconstruction is a safe and effective alternative for chronic AC joint dislocations., Level of Evidence: IV (Systematic Review of Level I-IV Studies)., (© 2024 Professor P K Surendran Memorial Education Foundation. Published by Elsevier B.V. All rights are reserved, including those for text and data mining, AI training, and similar technologies.)

Purpose: The purposes of this study were to assess clinical and radiographic outcomes of arthroscopically-assisted, anatomic coracoclavicular ligament reconstruction using tendon allograft (AA-ACCR) for the treatment of Rockwood type III-V injuries at minimum 2-year follow-up and to perform subgroup analyses of clinical and radiographic outcomes for acute versus chronic and type III versus type IV-V injuries.Methods: In this retrospective study of prospectively collected data, patients who underwent primary AA-ACCR for the treatment of type III-V dislocations and had minimum 2-year follow-up were included. Preoperative and postoperative patient-reported outcome scores (PROs) were collected, including American Shoulder and Elbow Surgeons score, Single Numeric Assessment Evaluation score, Short Form-12 Physical Component Summary, Quick Disabilities of the Arm Shoulder and Hand score, and patient satisfaction. Preoperative and postoperative coracoclavicular distance (CCD) was obtained. PROs and CCD were reported for the total cohort and for the subgroups. Complication and revision rates were demonstrated.Results: In total, 102 patients (10 women, 92 men) with a mean age of 45.0 years (range, 18-73 years) were included. There were 13 complications (12.7%) resulting in revision surgery. After exclusion of revised patients, PROs were available for 69 (77.5%). At mean follow-up of 4.7 years (range, 2.0-12.8 years), all PROs improved significantly (P < .001). Median patient satisfaction was 9.0 (interquartile range, 8.0-10.0). Median preoperative to postoperative CCD decreased significantly (P < .001). Subgroup analyses revealed significant improvements in all PROs and CCD from preoperative to postoperative for both acute and chronic, and type III and type IV-V dislocations (P < .05) with no significant differences in postoperative PROs and satisfaction between (P > .05).Conclusion: AA-ACCR for high-grade acromioclavicular joint injuries resulted in high postoperative PROs and patient satisfaction with significant improvements from before to after surgery in those who did not undergo revision surgery. Furthermore, subgroup analyses revealed that acute and chronic, and type III and type IV-V injuries benefitted similarly from AA-ACCR.Level Of Evidence: Level IV; therapeutic case series. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this review was to compare clinical and radiological outcome of acromio-clavicular joint reconstruction with allografts versus autografts. Methods: The PubMed, MEDLINE, The Cochrane Library and WEB OF SCIENCE databases were searched in accordance with the PRISMA guidelines until February 2020 using the terms: 'coracoclavicular' OR 'coraco-clavicular' OR 'acromioclavicular' OR 'acromio-clavicular joint', AND 'reconstruction'. All studies reporting on clinical and radiological outcome as well as complications after ACJ reconstruction using allo- and/or autografts were included. Results: A total of 29 articles, including 2 prospective and 27 retrospective studies, involving 622 patients, reconstructed with either allo- (n = 360) or auto-grafts (n = 262), for acromio-clavicular joint instability were identified and included in this review. The majority of studies had low sample sizes (66.7% below n = 20), were retrospective (93.3%), with short-term follow-ups (average 26.2 ± 12.6 months; range 6–186). The study with the largest sample size (n = 128) did not report clinical outcome. A comparison between allo- and auto-graft showed no significant differences regarding age, gender, and follow-up times. Clinical outcome was comparable in both groups, loss of reduction (LOR) and complication rates were higher in the allograft group. Overall a reduction of LOR was shown if additional horizontal stabilization was performed. Also a higher LOR and revision rate was documented in allografts without suture or suture-tape augmentation. The use of more clavicular drill-holes correlated with a higher frequency of fracture. Conclusions: A systematic review of the available peer-reviewed literature addressing allograft and autograft reconstruction of unstable coracoclavicular ligaments shows that the published studies are generally of low quality with low levels of evidence. The published literature shows no significant difference in clinical outcomes between the use of autografts or allografts in ACJ reconstruction surgery. Surgical techniques utilizing additional horizontal stabilization may contribute to lower rates of LOR. In cases where allograft tissue is used for ACJ reconstruction the use of suture/tape augmentation may reduce LOR rates as well as revision rates. Level of evidence: III. [ABSTRACT FROM AUTHOR]

Purpose: Neer type II distal clavicle fractures are associated with a high rate of non-union or malunion due to impaired coracoclavicular ligament stability. The purpose of this study was to assess the clinical and radiological outcomes of arthroscopically assisted indirect osteosynthesis for type II distal clavicle fractures using a cortical suture button device.Methods: Seventeen patients Neer type II fractures of the distal clavicle were treated surgically using cortical suture button fixation between 2012 and 2017. The clinical and radiological results were assessed using the American Shoulder and Elbow Surgeons Shoulder Score (ASES), Constant-Murley score and visual analogue scale (VAS) score.Results: Anatomic reduction and bone healing were achieved in all patients at the final follow-up. The median age of the patients was 31 years (range 19-57). The mean follow-up was 25.9 months (range 14-64). The average delay before surgery was 2 days (range 1-4). At the final follow-up, the mean ASES, Constant-Murley score and VAS score were 92.6 ± 3.2 (range 84.9-96.6), 96.2 ± 2.4 (range 92-100) and 0.47 ± 0.51 (range 0-1), respectively. All patients were able to resume work as well as sport activities. The postoperative complications included two coracoid process fractures, and none of the patients required additional surgery related to the index procedure.Conclusion: All arthroscopic coracoclavicular button fixation of Neer type II distal clavicle fractures would provide sufficient stability and union with satisfactory radiological and clinical outcomes. This arthroscopic fixation technique would be more efficient than other osteosynthesis methods because it is a minimally invasive surgery with a low complication rate.Level Of Evidence: III. [ABSTRACT FROM AUTHOR]

Background: The acromioclavicular (AC) capsule and ligament have been found to play a major role in maintaining horizontal stability. To reconstruct the AC capsule and ligament, precise knowledge of their anatomy is essential. Purpose/Hypothesis: The purposes of this study were (1) to determine the angle of the posterosuperior ligament in regard to the axis of the clavicle, (2) to determine the width of the attachment (footprint) of the AC capsule and ligament on the acromion and clavicle, (3) to determine the distance to the AC capsule from the cartilage border of the acromion and clavicle, and (4) to develop a clockface model of the insertion of the posterosuperior ligament on the acromion and clavicle. It was hypothesized that consistent angles, attachment areas, distances, and insertion sites would be identified. Study Design: Descriptive laboratory study. Methods: A total of 12 fresh-frozen shoulders were used (mean age, 55 years [range, 41-64 years]). All soft tissue was removed, leaving only the AC capsule and ligament intact. After a qualitative inspection, a quantitative assessment was performed. The AC joint was fixed in an anatomic position, and the attachment angle of the posterosuperior ligament was measured using a digital protractor. The capsule and ligament were removed, and a coordinate measuring device was utilized to assess the width of the AC capsule footprint and the distance from the footprint to the cartilage border of the acromion and clavicle. The AC joint was then disarticulated, and the previously marked posterosuperior ligament insertion was transferred into a clockface model. The mean values across the 12 specimens were demonstrated with 95% CIs. Results: The mean attachment angle of the posterosuperior ligament was 51.4° (95% CI, 45.2°-57.6°) in relation to the long axis of the entire clavicle and 41.5° (95% CI, 33.8°-49.1°) in relation to the long axis of the distal third of the clavicle. The mean clavicular footprint width of the AC capsule was 6.4 mm (95% CI, 5.8-6.9 mm) at the superior clavicle and 4.4 mm (95% CI, 3.9-4.8 mm) at the inferior clavicle. The mean acromial footprint width of the AC capsule was 4.6 mm (95% CI, 4.2-4.9 mm) at the superior side and 4.0 mm (95% CI, 3.6-4.4 mm) at the inferior side. The mean distance from the lateral clavicular attachment of the AC capsule to the clavicular cartilage border was 4.3 mm (95% CI, 4.0-4.6 mm), and the mean distance from the medial acromial attachment of the AC capsule to the acromial cartilage border was 3.1 mm (95% CI, 2.9-3.4 mm). On the clockface model of the right shoulder, the clavicular attachment of the posterosuperior ligament ranged from the 9:05 (range, 8:00-9:30) to 11:20 (range, 10:00-12:30) position, and the acromial attachment ranged from the 12:20 (range, 11:00-1:30) to 2:10 (range, 13:30-14:40) position. Conclusion: The finding that the posterosuperior ligament did not course perpendicular to the AC joint but rather was oriented obliquely to the long axis of the clavicle, in combination with the newly developed clockface model, may help surgeons to optimally reconstruct this ligament. Clinical Relevance: Our results of a narrow inferior footprint and a short distance from the inferior AC capsule to cartilage suggest that proposed reconstruction of the AC joint capsule should focus primarily on its superior portion. [ABSTRACT FROM AUTHOR]

Many surgical techniques have been used to address unstable distal third clavicle fractures. Complications and the need for hardware removal are still a concern. We propose a surgical technical using highstrength sutures to restore vertical and horizontal stability in Neer type II and Neer type V distal-third clavicle fractures. It has been used in three cases; two type V and one type II. In all cases, bone healing was achieved uneventfully and all patients resumed their pre-injury activities including sports at six-months postoperatively. The coraco-clavicular loop and tension band suture technique is a simple procedure that allows vertical and horizontal stabilization of the fracture. It achieves good clinical results and it may be a cost-effective alternative to other techniques although a longer series and long-term follow-up is required to adequately assess the results. [ABSTRACT FROM AUTHOR]

The aim: type 2B clavicle fractures with conoid ligament rupture are considered unstable. Although surgical treatment is recommended as the standard treatment modality for type 2B fractures, there is no consensus about the type of operative treatment. We aimed to evaluate results of surgical treatment with an anatomical distal clavicle plate using CC ligament augmentation. Materials and methods: 15 patients that diagnosed with distal clavicle fractures, who underwent surgery for unstable type 2 fractures. The average patient age was 38 years (range 24-52 years). All patients were male; the right clavicle was injured in 10 patients whereas the left clavicle was injured in 5 cases. Surgical treatment was done with a distal clavicle anatomic locked plate augmentation (ZipTight™) at all cases. The mean follow-up period was 24 months (range, 12-40 months). Results: bony union was achieved at a mean follow-up of 8 weeks (range 6-10 weeks). The mean Constant score was 97 (range, 92-100). There were no complications or no need to second operation. All patients achieved satisfactory full range of shoulder motion. Hardware removal was performed for prominence in one case after the union was completed. Conclusion: the augmented technique reported here, provides early motion, increased stability and anatomic healing compared to other conventional options. We recommend augmentative CC ligament repair techniques over the distal locking anatomic plate for type 2 fractures. [ABSTRACT FROM AUTHOR]

Background. The treatment of Neer's type II distal clavicle fractures is challenging because of the high risk of non-union with non-operative management on one hand and complications associated with the operation on other. Methods. Autologous semitendinosus tendon mediated anatomical coracoclavicular (CC) ligament reconstruction was done in 9 Neer's type II acute distal clavicle fractures. The functional and radiological outcomes were assessed after 12 months of operation. Results. There were 8 men and 1 woman in the patients assessed at 12 months of operation. At final evaluation of 12 months 7 Neer's type IIA, and 2 IIB fractures were assessed. The mean age of the patients included in the study was 39 years. The mean operating time was 87 minutes. All except one patient achieved radiological union. All patients had excellent functional outcome scores. The mean Constant and Murley (CMS) score at 12 months of follow up was 90.55 ± 57.80. The CMS score for the case with non-union was 85 at 12 months. The mean CC distance before and after the operation was 19.56 ± 2.80 mm and 11.56 ± 6.7 mm. The difference in the mean CC distance between normal and operated side was less than 5 mm after 12 months of operation in all the cases. Conclusions. The application of autograft mediated anatomical acromioclavicular joint reconstruction technique to CC stabilization in Neer's II distal clavicle fracture achieves union and excellent functional outcomes. [ABSTRACT FROM AUTHOR]

Objective: To compare the effects of allogeneic tendon coracoclavicular ligament reconstruction combined with Kirschner wire fixation and clavicular hook plate fixation on early postoperative pain, postoperative shoulder joint function score and shoulder joint mobility in patients with acromioclavicular joint dislocation., Methods: From January 2020 to January 2023, 43 patients with acromioclavicular joint dislocation admitted to Xi 'an Honghui Hospital were included. Among them, 24 patients were treated with the clavicular hook plate technique (Hook Plate,HP) group, and 19 patients were treated with allogeneic tendon coracoclavicular ligament reconstruction combined with the Kirschner wire technique (Allogeneic Tendon, AT) group. The Constant-Murley score of shoulder joint function 6 months after operation, postoperative shoulder joint activity, preoperative and postoperative pain, operation time, intraoperative blood loss and complications were compared between the two groups., Results: All 43 patients were followed up for an average of 9.7 (9-12) months. The intraoperative blood loss in the allogeneic tendon group was less than in the hook plate group. The Constant-Murley shoulder function score was higher than that in the hook plate group 6 months after the operation. The abduction and lifting activity was greater than that in the hook plate group. The visual analogue scale scores at 3 days and 14 days after operation were lower than those in the hook plate group. The difference was statistically significant ( p < 0.001). There was 1 case (5.3%) of exudation around the Kirschner needle track in the allogeneic tendon reconstruction group, and 5 cases (20.8%) of complications in the hook plate group, including 1 case of internal fixation stimulation, 2 cases of acromion impingement syndrome, 1 case of acromioclavicular joint osteoarthritis, and 1 case of shoulder joint stiffness. The complication rate of the allogeneic tendon group was lower than that of the hook plate group., Conclusion: The clinical efficacy of allogeneic tendon coracoclavicular ligament reconstruction combined with Kirschner wire fixation in treating acromioclavicular joint dislocation (Rockwood type III-V) is better than hook plate internal fixation. The patients have less early postoperative pain and better recovery of shoulder joint function and shoulder joint mobility., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Du, Xu, Li, Ji, Ren, Li, Zhang and Ma.)

Purpose: Despite the high failure rates of techniques used to maintain the reduction of single-tunnel coracoclavicular (CC) fixation, analyses of the etiology of loss of reduction related to surgical techniques are limited. Therefore, it was hypothesized that the initial coracoclavicular tunnel angle was related to loss of reduction in the single-tunnel technique for AC joint dislocation. This study aimed to evaluate the clinical and radiological outcomes of arthroscopic single-tunnel CC suture button fixation according to the initial coracoclavicular tunnel angle.Methods: Thirty-two consecutive patients who underwent arthroscopic single-tunnel CC suture button fixation for AC joint dislocation from 2014 to 2018 were enrolled. The tunneling-first technique was used in the first 11 patients, while the reduction-first technique was used in the remaining 22 consecutive patients. For clinical assessments, the American Shoulder and Elbow Surgeons (ASES) score and Korean Shoulder Score (KSS) were recorded. For radiological evaluation, coracoclavicular distance ratio, coracoclavicular tunnel angle, coracoid, and clavicular tunnel widths were measured.Results: The ASES score did not differ significantly between the two groups (n.s.). However, the KSS was significantly better in the reduction-first group (p = 0.031). No significant intergroup differences were observed in the pre- and postoperative coracoclavicular distance ratio. However, at the last follow-up, loss of coracoclavicular distance ratio was significantly smaller in the reduction-first group (p < 0.001). At the final follow-up, loss of the coracoclavicular distance ratio was positively correlated with the postoperative coracoclavicular tunnel angle (p < 0.001, Spearman's rho correlation coefficient = 0.602). The final follow-up clavicular tunnel width was also significantly smaller in the reduction-first group (p = 0.002). Finally, the last follow-up clavicular tunnel width was positively correlated with the postoperative coracoclavicular tunnel angle (p = 0.008, Spearman's rho correlation coefficient = 0.459).Conclusion: The reduction-first technique showed better clinical and radiological outcomes than the tunneling-first technique in single-tunnel CC fixation for AC joint dislocation. A large postoperative coracoclavicular tunnel angle was associated with loss of reduction and clavicular tunnel widening. Therefore, obtaining a straight coracoclavicular tunnel angle is crucial for achieving better outcomes and minimizing loss of reduction.Level Of Evidence: III. [ABSTRACT FROM AUTHOR]

Background: A coracoclavicular (CC) fixation technique using an all-suture anchor with the assistance of fluoroscopy can prevent iatrogenic anterior deltoid detachment from the clavicle; however, soft anchor pullout has been reported as a complication., Purpose: To compare the biomechanical properties of conventional metallic and all-suture anchors for CC suture fixation., Study Design: Controlled laboratory study., Methods: A total of 24 fresh-frozen cadaveric specimens were divided into 2 groups: metal anchor group (group M) and all-suture anchor group (group A). In group M, 5.0-mm metallic suture anchors were used for CC fixation, whereas 2.8-mm all-suture anchors were used in group A. The prepared specimens were mounted on a materials testing machine. After preconditioning at 0 to 20 N for 10 cycles, the specimens were subjected to cyclic loading from 20 to 70 N for 1000 cycles. Finally, all the specimens were loaded to failure. Cyclic elongation, linear stiffness, ultimate load, and failure modes were recorded, and the Mann-Whitney U test was used to compare nonparametric parameters between the 2 groups., Results: All of the specimens completed the cyclic loading test. The elongation after cyclic loading in group M (1.6 ± 0.6 mm) was significantly smaller compared with that in group A (2.5 ± 1.2 mm) ( P = .02). No between-group differences were found in linear stiffness (42 ± 17 N/mm in group M and 41 ± 17 N/mm in group A). The ultimate failure load in group M (263 ± 66 N) was significantly greater than that in group A (177 ± 76 N) ( P = .02). All specimens failed because of suture anchor pullout., Conclusion: The use of all-suture anchors in CC fixation resulted in significantly greater cyclic displacement and smaller ultimate failure load than that of metallic anchors., Clinical Relevance: Understanding the most biomechanically sound suture anchor may assist in lowering the risk of clinical failure in CC fixation and repair., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: Research support was received from Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital (NCKUH-11204010). AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto. Ethical approval was not sought for the present study., (© The Author(s) 2024.)

To date, no gold-standard technique exists for the treatment of chronic acromioclavicular joint (ACJ) instability. We systematically reviewed the clinical results of 3 main categories of ACJ reconstruction for high-grade chronic instability. A literature search was performed according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The inclusion criteria were clinical studies involving patients with ACJ instability (Rockwood grades III-VI) for at least 6 weeks, managed with ACJ stabilization, with a minimum 1-year follow-up. Depending on the surgical technique, patients were divided into 1 of 3 groups: nonbiological fixation between the coracoid and clavicle, for example, suture loops and synthetic ligaments (group 1); biological reconstruction of the coracoclavicular ligaments, for example, allograft or autograft ligament reconstruction (group 2); and ligament and/or tendon transfer, for example, the Weaver-Dunn procedure (group 3). Patient demographic characteristics, functional scores, radiographic outcomes, and complications were compared. Two independent investigators reviewed 960 articles. A total of 27 studies met the inclusion criteria, comprising 590 patients divided into 1 of 3 groups. The complication rates were similar among the 3 groups: 15% for nonbiological fixation, 15% for biological reconstruction, and 17% for ligament and/or tendon transfer, with failure rates of 8%, 7%, and 5%, respectively. In terms of functional results, the mean Constant score was 87.2 points for nonbiological fixation (n = 89), 92.4 points for biological reconstruction (n = 86), and 87.4 points for ligament and/or tendon transfer (n = 49). On comparison of the results of 3 different ACJ reconstruction methods, all techniques showed similar complication rates. Among the level II studies, ACJ reconstruction with a tendon graft showed superior results. [ABSTRACT FROM AUTHOR]

Voluntary glenohumeral dislocations have been reported in academic literature; however, voluntary dislocations of the acromioclavicular joint are rare, with four cases previously reported in published literature. We present a case of an adolescent female with bilateral, atraumatic acromioclavicular joint dislocation who ultimately was treated with arthroscopic reconstruction of the coracoclavicular ligament. The case is discussed in addition to a review of previously reported cases of voluntary acromioclavicular joint dislocations. Treatment methods in each of the four previously reported cases are discussed with recommendation for surgeons that may encounter this rare shoulder problem in future patients. [ABSTRACT FROM AUTHOR]

Background: An anatomic double-tunnel (DT) reconstruction technique has been widely adopted to reconstruct the ruptured coracoclavicular (CC) ligaments seen with high-grade acromioclavicular (AC) joint injuries. However, the anatomic DT reconstruction has been associated with the risk of clavicle fractures, which may be problematic, particularly for contact athletes. Purpose/Hypothesis: The purpose was to compare a single-tunnel (ST) CC ligament reconstruction for AC joint injuries with the native state as well as with the more established anatomic DT CC ligament reconstruction. The hypothesis was that ST CC ligament reconstruction would demonstrate biomechanical properties similar to those of the native state and the DT CC ligament reconstruction. Study Design: Controlled laboratory study. Methods: Eighteen fresh-frozen human cadaveric shoulders (9 matched pairs) with mean ± SD age of 55.5 ± 8.5 years underwent biomechanical testing. One specimen of each matched pair underwent a ST CC ligament reconstruction and the second, a DT CC ligament reconstruction. The ST and DT CC ligament reconstruction techniques involved a 5-mm distal clavicle excision, avoided coracoid drilling, and utilized a 3.0-mm suture anchor to fix the excess lateral limb to reconstruct the superior AC joint capsule. The ST CC ligament reconstruction technique additionally included a 1.3-mm suture tape to help avoid a sawing effect, as well as a dog-bone button over the clavicular tunnel to increase stability of the construct. All specimens were tested to 70 N in 3 directions (superior, anterior, and posterior) in the intact and reconstructed states. The ultimate load, yield load, stiffness, and mode of failure of the reconstructed specimens were tested. Results: There were no significant differences in translation at 70 N in the superior (P = .31), anterior (P = .56), and posterior (P = .35) directions between the ST CC ligament reconstruction and the intact state. The ultimate load to failure, yield load, and stiffness in the ST and DT groups were also not significantly different. There were no distal clavicle fractures in load-to-failure testing in the ST or DT group. Conclusion: In this biomechanical study, ST CC ligament reconstruction demonstrates biomechanical properties comparable to the intact state. Additionally, use of the ST CC ligament reconstruction shows biomechanical properties similar to the DT CC ligament reconstruction technique while theoretically posing less risk of clavicle fracture. Clinical Relevance: This study suggests that the ST CC ligament reconstruction has biomechanical properties equivalent to the DT CC ligament reconstruction with less theoretical risk of clavicle fracture. [ABSTRACT FROM AUTHOR]

Purpose: Recently, many acromioclavicular-coracoclavicular (AC-CC) ligament reconstruction techniques address only the CC ligament. However, many of these techniques are costly, time-consuming, and require the use of allogenic grafts, making them prone to creep and failure or novel devices making them challenging for orthopaedic surgeons. The purpose of this study was to compare the biomechanical characteristics of a double endobutton technique using a standard endobutton CL with those of a coracoid cerclage sling (CS) for reconstruction of the CC ligaments.Methods: Anterior-posterior (AP) translation and superior-inferior (SI) translation were quantified for eight matched pairs of intact AC joints. One shoulder from each pair underwent a double endobutton repair, using an endobutton CL modified with an additional endobutton (Smith & Nephew, Memphis, Tenn) and placed through holes in the coracoid and clavicle. The contra-lateral shoulder received a coracoid sling reconstruction using an anterior tibialis tendon. Translation testing was repeated after reconstruction, followed by load-to-failure testing. Paired t tests were used for statistical analysis.Results: The CS technique demonstrated a greater SI and AP translation than the double endobutton technique (p < 0.05). Additionally, the double endobutton technique had a greater stiffness (40.2 ± 11.0 vs. 20.3 ± 6.4 N/mm, p = 0.005), yield load (168.5 ± 11.0 vs. 86.8 ± 22.9 N, p = 0.002), and ultimate load (504.4 ± 199.7 vs. 213.2 ± 103.4 N, p = 0.026) when compared to the CS technique.Conclusion: The double endobutton technique yielded less translation about the AC joint and displayed stronger load-to-failure characteristics than the CS reconstruction. As such, this technique may be better suited to restore native AC-CC biomechanics, reduce post-operative pain, and prevent recurrent subluxation and dislocation than an allogenic graft construct. The double endobutton technique may be a suitable option for addressing AC-CC injuries. [ABSTRACT FROM AUTHOR]

Background: Accuracy evaluation of navigated image free placement of double cortical fixation buttons for coracoclavicular tunnel position in comparison to conventional drill guide based placement. Methods: Twenty-six patients with acute acromioclavicular joint instability were included in this non-randomized cohort study. All patients were treated with a Double- TightRope technique. In 13 cases the conventional drill guide based placement was used (group 1). In 13 patients surgery was performed as a navigated procedure with a fluoro-free optoelectronic system (group 2). The number of coracoclavicular drillings per patient (First pass accuracy; FPA (%)) was documented, the subcoracoidal position of the fixation buttons has been evaluated and graded as "intended position achieved (IPA)" or "intended position not achieved (IPnA)". Results: In group 1 drilling had to be repeated in four patients (30.8 %) to achieve proper placement of the subcoracoidal fixation buttons. 100 % first pass accuracy was observed in group 2 (p = 0.03). In group 1, the intended position of the subcoracoid buttons was not achieved (IPnA) in six patients (46.2 %). In group 2 all intended positions were achieved (p = 0.005). Conclusion: Arthroscopic controlled fluoro-free navigated coracoclavicular drilling for the repair of acromioclavicular joint dislocation has higher first pass accuracy in comparison to conventional drill guide based placement. Therefore the navigation enables a precise position of the drill holes, may reduce the risk of an iatrogenic coracoid fracture and migration of fixation devices. [ABSTRACT FROM AUTHOR]

Background: Reconstruction of the coracoclavicular ligament functions to restore anatomic alignment of the clavicle and may improve biomechanical function and clinical outcomes. Improper placement of the coracoclavicular tunnel may inherently weaken the coracoid. The purpose of this study was to evaluate the feasibility and accuracy of navigated image-free placement of K-wires for coracoclavicular tunnel position in comparison to conventional drill guide-based placement. Materials and methods: Eight human shoulder specimens were assigned for conventional technique with a coracoclavicular guide device (group CP) and the paired contralateral side for the navigated procedure (group NP) with an optoelectronic system with a fluoro-free software module. First-pass accuracy (%) and the K-wire trajectory (lateral-center orientation (LC), center-center (CC) orientation and medial-center orientation (MC) were measured. Results: In all navigated K-wires a 100 % first-pass accuracy was observed. In three of the eight (37.5 %) specimens of the drill guide-based group, drilling had to be repeated. One of them had to be repeated twice, resulting in eight versus twelve drillings for the navigated versus conventional group, respectively ( p = 0.021). K-wire trajectory showed an MC orientation in most of the specimen ( n = 9, group NP 4, group CP 5). Conclusions: Image-free navigated coracoclavicular drilling for the repair of acromioclavicular joint dislocation has higher first-pass accuracy in comparison to conventional drill guide-based placement and, therefore, may enable a precise anatomic position of the drill holes and reduce the risk of an iatrogenic coracoid fracture. [ABSTRACT FROM AUTHOR]

Purpose: A novel radiation-free electromagnetic navigation system (ENS)-based method was developed, and its feasibility and accuracy for transclavicular-transcoracoid drilling procedures were evaluated in an experimental setting. Methods: Sixteen arthroscopically assisted electromagnetic navigated transcoracoid-transclavicular drilling procedures with subsequent TightRope device implantation were performed on eight human cadavers. Post-operative fluoroscopy and CT-scan analysis were acquired to determine tunnel placement accuracy. Optimal tunnel placement was defined as both the coracoid entry and exit point of the tunnel localized in the centre position of the coracoid base without cortical breach or fracture. Results: Successful tunnel placement was accomplished in all 16 cases. The mean overall operation time was 30.3 ± 5.0 min. Regarding the coracoid exit point, 15 of 16 tunnels (93.8 %) were localized in the desired base-centre position. During the navigated drilling procedure, no misguidance of the drill requiring directional readjustments or restarts occurred. No cortical breach, no fractures and no complications occurred. Conclusions: The electromagnetically navigated transcoracoid-transclavicular drilling procedure used in this study demonstrated high targeting accuracy, required no intraoperative radiographs, was associated with no complications and provided user-friendliness. [ABSTRACT FROM AUTHOR]

The article presents a study that analyzes the complications associated with anatomic coraclavicular ligament procedures using either cortical fixation buttons or tendon grafts. The study evaluates the effect that these complications have on patient outcomes. Patients who did not have a complication are found having good to excellent outcomes.

Abstract: Distal clavicle fracture accompanied by coracoid process one is a rare injury. Surgical and/or conservative treatments are proposed. We report the case of a 49-year-old woman presenting a distal clavicle fracture associated with a coracoid process one due to a fall on the left shoulder. Both injuries are treated surgically. Per operatively, and through an anterior “strap” approach, the coracoclavicular ligament was seen intact. The distal clavicle fracture was fixed with K-wires and cerclage and the coracoid process was secured by a screw. Active-assisted rehabilitation of the shoulder was initiated 3 weeks after surgery. At the last follow-up of twelve months, the patient had painless full shoulder functions and X-rays show bony union. Early recovery to normal life is possible with surgical treatment in patients with distal clavicle fracture combined with coracoid fracture. [Copyright &y& Elsevier]

Background: Reconstruction of only the coracoclavicular (CC) ligaments may restore superior-inferior (S-I) but not anterior-posterior (A-P) stability of the acromioclavicular (AC) joint. Concomitant reconstruction of both the AC and CC ligaments may more reliably restore intact biomechanical characteristics of the AC joint. Methods: Ten matched pairs of shoulders were utilized. Five specimens underwent CC ligament reconstruction while an equal number underwent combined AC and CC ligament reconstruction utilizing an intramedullary tendon graft. Each of the reconstructions was compared with the intact contralateral control. Translational and load to failure characteristics were compared between groups. Results: No difference was found in S-I translation between intact specimens and CC-only reconstructions (P = .20) nor between intact specimens and AC/CC reconstructions (P = .33) at 10 Newton (N) loads. Significant differences were noted in A-P translation between intact specimens and CC-only reconstructions (P < .001) but no difference in A-P translation between intact specimens and AC/CC reconstructions (P = .34). Conclusion: The A-P and S-I translational biomechanical characteristics of the AC joint were restored using the new technique described. Reconstruction of the CC ligaments only (versus AC/CC combined) led to significantly increased translational motion in the A-P plane as compared to intact control specimens. [Copyright &y& Elsevier]

Purpose: Optimal surgical treatment of high-grade acromioclavicular joint dislocations is still controversially discussed. The purpose of the present controlled laboratory study was to evaluate whether a polydioxansulfate (PDS) cord augmentation with separate reconstruction of the coracoclavicular (CC) ligaments and the acromioclavicular (AC) complex provides sufficient vertical stability in a biomechanical cadaver model. Methods: Twenty-four shoulders of fresh-frozen cadaveric specimen were tested. Cyclic loading and load to failure protocol was performed in vertical direction on 12 native AC joints and repeated after reconstruction. The reconstruction of the coracoclavicular ligament was performed using two CC PDS cerclages and an additional AC PDS cerclage. Results: In static load testing for vertical force, the native AC joint complex measured 590.1 N (±95.8 N), elongation 13.4 mm (±2.1 mm) and stiffness 48.7 N/mm (±12.0 N/mm). The mean maximum load to failure in the reconstructed joints was 569.9 N (±97.9 N), elongation 18.8 mm (±4.7 mm) and stiffness 37.9 N/mm (±8.0 N/mm). During dynamic testing of the reconstructed AC joints, all specimens reached the critical elongation of 12.0 mm, defined as clinical failure between 200 and 300 N. The mean amount of repetitions at clinical failure was 305. A plastic deformation of the reconstructed specimens throughout cyclic loading could not be detected. Conclusion: The AC joint reconstruction with acromioclavicular and coracoclavicular PDS cord cerclages did not provide the aspired vertical stability in a cadaver model. Level of evidence: Basic Science Study. [ABSTRACT FROM AUTHOR]

The article evaluates the effects of clavicular tunnel position in coracoclavicular (CC) ligament reconstruction. A study conducted a retrospective review of consecutive series of CC ligament reconstructions performed with two clavicular bone tunnels and a free tendon graft. Comparison of bone tunnel position showed that medialized bone tunnels were a significant predictor for early loss of reduction for the conoid and trapezoid bone tunnels.

Introduction: Coracoclavicular (CC) ligament reconstruction remains a challenging procedure. The ideal reconstruction is biomechanically strong, allows direct visualization of passage around the coracoid, and is minimally invasive. Few published reports have evaluated arthroscopic techniques with a single clavicular tunnel and transcoracoid reconstruction. One such report noted early excellent results, but without specific outcome measures. This study reports the clinical and radiographic results of a minimally invasive, arthroscopically assisted technique of CC ligament reconstruction using a transcoracoid and single clavicular tunnel technique. Materials and methods: A retrospective review was performed of 10 consecutive repairs in 9 active duty patients who underwent CC ligament reconstruction with the GraftRope (Arthrex, Naples FL, USA). All reconstructions were performed according to the manufacturer’s technique by a single, fellowship-trained surgeon. Medical records and radiographs were evaluated for demographics, operative details, loss of reduction, and return to duty. Results: In 8 of 10 repairs (80%) intraoperative reduction was lost at an average of 7.0 weeks (range, 3-12 weeks). Four patients (40%) required revision. Subjective patient outcomes included 5 excellent/good results, 1 fair result, and 4 poor results. Tunnel widening was universally noted, and the failure mode in most patients appeared to be at the holding suture. Conclusion: This transcoracoid, single clavicular tunnel technique was not a reliable approach to CC ligament reconstruction. We noted a high percentage of radiographic redisplacement and clinical failure. This technique, in its current form, cannot be recommended to treat AC joint injuries in our population. [ABSTRACT FROM AUTHOR]

Background: The management of grade III acute acromioclavicular dislocations is controversial. We hypothesized that direct repair of acromiocalvicular and coracoclavicular injured structures should yield better functional results than percutaneous stabilization of the clavicle to the coracoid without any capsulo-ligamento-muscular repair. Methods: Twenty-six patients in two matched groups with Rockwood type III acute acromioclavicular dislocations followed for a mean of 99.3 months were evaluated. Group-1 was treated by closed reduction, and group-2 was treated by direct repair of clavicular muscle attachments, coracoclavicular and acromioclavicular ligaments. A coracoclavicular 4.5-mm cortical screw inserted in a lag fashion was used in both groups for 45 days. Radiographic analysis, function according to American Shoulder and Elbow Surgeons Score (ASES), and the ability to return to previous work were used for evaluation. Results: At the final follow-up, ASES in group-1 was 91.2 (SD 4.5) points (83-98), while it was 92.7 (SD 4.2) points (87-100) in group-2, and this was statistically significant ( P = 0.010). Reduction was maintained with no statistically significant difference of coracoclavicular distance on the injured and the healthy sides in both groups. All patients returned to their previous work. Conclusion: Although the anatomic intra-articular and extra-articular repair yields better functional results than percutaneous screw fixation in grade III acromioclavicular dislocations, percutaneous screw fixation with its shorter operative time, minimally invasive nature, shorter rehabilitation and earlier return to work sounds like the better choice. [ABSTRACT FROM AUTHOR]

Background: For treatment of acute acromioclavicular separations, we have been using a reproducible radiographic view of the coracoid—the cortical ring sign—that we believe allows for placement of percutaneous coracoclavicular fixation safely and reliably in the center of the coracoid base, while avoiding the coracoid tip. This study evaluates the coracoid anatomy that the cortical ring sign represents, its utility for guiding fixation trajectory, and the proximity of neurovascular structures to this proposed trajectory. Materials and methods: Kirschner wires were used to measure the orientation of the fluoroscopic beam in relation to the scapula and the proposed fixation trajectory using this radiographic view. Results: The cortical ring sign is achieved by first directing the x-ray beam perpendicular to the medial border of the scapula in the parasagittal plane and 49° off the axis of the scapular spine in the axial plane, then fine-tuning until the coracoid cortical ring becomes evident. The nearest neurovascular structures to the fixation trajectory are the suprascapular artery and nerve (< 2 cm). Conclusion: The cortical ring sign view targets the coracoid base and, as such, allows reliable, safe, percutaneous fixation in the center of the coracoid base. Level of Evidence: Basic Science. [Copyright &y& Elsevier]

The ideal treatment for acute acromioclavicular joint dislocation is still controversial, both in terms of indications and surgical technique. The clinical and radiographic outcomes of 16 patients affected by acute AC joint dislocation (type III–V) and arthroscopically treated with a coracoclavicular double flip button are presented. Despite the excellent clinical results both in terms of Constant score (mean 97 points) and patient satisfaction, at a mean follow-up of 31 months the radiographs showed partial loss of reduction due to distal migration of the flip button within the upper third of the clavicle in one-fourth of the cases. The technique presented here proved to be safe and minimally invasive while delivering good aesthetic results and allowing for the treatment of associated lesions. Furthermore, the technique could benefit from more advanced retention devices, which ought to reduce or avoid migration of the flip buttons. [ABSTRACT FROM AUTHOR]

Background: Recently acromioclavicular joint reconstruction techniques have focused on anatomic restoration of the coraco-clavicular (CC) ligaments. Such techniques involve creating bone tunnels in the distal clavicle and coracoid. Purpose: To define the anatomy of the human clavicle and coracoidprocess of the scapula, in order to guide surgeons in reconstructing the CC ligaments. Study Design: Descriptive laboratory study. Methods: One hundred twenty (60 paired) cadaveric clavicles and corresponding scapulae (mean age ± and standard deviation, 48.3 ± 16.6 years) devoid of soft tissue were analyzed (dry osteology). Differences related to race and sex were recorded. Nineteen fresh-frozen cadaveric clavicles with intact CC ligaments were measured as well (fresh anatomic). Results: The mean clavicle length was 149 ± 9.1 mm. In the dry osteology group, the distance from the lateral edge of the clavicle to the medial edge of the conoid tuberosity in male and female specimens was 47.2 ± 4.6 mm and 42.8 ± 5.6 mm, respectively (P = .006). The distance to the center of the trapezoid tuberosity was 25.4 ± 3.7 mm in males and 22.9 ± 3.7 mm in females (P = .04). The ratio of the distance to the medial edge of the conoid tuberosity divided by clavicle length was 0.31 in males and females. This ratio for the trapezoid was 0.17 in both sexes. The mean coracoid length was 45.2 ± 4.1 mm. The mean width and height of the coracoid process were 24.9 ± 2.5 mm and 11.9 ± 1.8 mm, respectively. No interracial differences in measurements were observed. In the fresh anatomic samples, the ratio of the distance to the conoid center to clavicle length was 0.24. This ratio for the trapezoid was 0.17. Conclusions: While absolute differences in the origin of the CC ligaments exist between men and women, the ratio of these origins to total clavicle length is constant. Clinical Relevance: Clavicle length can be obtained intraoperatively. These findings allow the surgeon to predict the origin of the conoid and trapezoid ligaments accurately and to correctly create bone tunnels to reconstruct the anatomy of the CC complex. [ABSTRACT FROM AUTHOR]

Introduction: Acute acromioclavicular joint separation is a common injury to the shoulder. Various surgical reconstruction methods exist when operative management is required, but the optimal procedure is not known. The aim of this systematic review and meta-analysis is to review the literature to assess the clinical effectiveness of various surgical reconstruction modalities used for acute ACJ separation., Methods: The study protocol was designed and registered prospectively on PROSPERO (International prospective register for systematic reviews). Literature search will include MEDLINE, EMBASE, PsycINFO, and The Cochrane Library electronic databases. Randomised controlled trials (RCTs) evaluating surgical procedures for acute acromioclavicular joint (ACJ) separation will be included. Our primary outcome is any functional patient-reported outcome measure related to the shoulder. Secondary outcomes may include radiological measurements, objective measurements of strength testing, range of motion, other patient-reported outcome measures not specific to the shoulder such as the Visual-Analog Scale (VAS) for pain, timelines for return to sport or work, and rate of complications. Risk of bias will be assessed within each study using The Cochrane Risk of Bias Tool 2.0 and the Jadad score. Inconsistency and bias across included studies will be assessed statistically. Comparable outcome data will be pooled and analysed quantitatively or qualitatively as appropriate., Ethics and Dissemination: This study did not require ethical clearance. We plan to publish this systematic review and meta-analysis in a peer-reviewed journal and present the results at various national and international conferences., Highlights: There is currently variation in surgical synthetic ligament reconstruction techniques for acute acromioclavicular separation, with no clear consensus established.This systematic review evaluates the clinical effectiveness of various surgical reconstruction modalities used for acute ACJ separation.Our primary outcome is any functional patient-reported outcome measure related to the shoulder., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2022 The Author(s).)

Background: The purpose of this study was to compare clavicular tunnel complications after coracoclavicular (CC) reconstruction between a coracoid loop fixation group and a coracoid tunnel fixation group. We hypothesized that clavicular tunnel complications would be more common in the coracoid loop group., Methods: This retrospective study evaluated 24 patients who underwent CC reconstruction using coracoid tunnel fixation (n = 14) and coracoid loop fixation (n = 10). Radiographic measurements included the CC distance and clavicular tunnel diameter. Clavicular tunnel complications such as tunnel widening and clavicular tunnel fractures were investigated. Clinical outcomes were assessed using the American Shoulder and Elbow Surgeons Shoulder score and the University of California at Los Angeles Shoulder score., Results: The mean follow-up period was 17.5 months (range, 11-38 months). The final clavicular tunnel diameter and the increase in the clavicular tunnel diameter in millimeter and percentage were significantly greater in the coracoid loop group than in the coracoid tunnel group (all p < 0.05). Clavicular tunnel widening more than 100% was found in 5 patients, all belonging to the coracoid loop group. Clavicular tunnel fractures occurred in 3 patients (all in the coracoid loop group). Fracture was associated with severe tunnel widening (more than 100% increase). The mean value of the final clavicular tunnel diameter in patients with fractures was significantly larger than that in patients without (12.7 ± 3.3 mm vs. 8.4 ± 1.5 mm, p = 0.016)., Conclusions: Clavicular tunnel complications such as significant tunnel widening and fractures after CC reconstructions in acromioclavicular dislocations were common with the coracoid loop fixation technique. A greater clavicular tunnel widening and resultantly enlarged tunnel diameter might increase the risk of fracture through the clavicular tunnel., Competing Interests: CONFLICT OF INTEREST: No potential conflict of interest relevant to this article was reported., (Copyright © 2022 by The Korean Orthopaedic Association.)