Summary

We have performed anatomical reconstruction of the coracoclavicular ligaments using the arthroscopic techniques for acromioclavicular joint dislocations. However, there were some patients with residual superior instability. Therefore, we added open repair of the acromioclavicular ligament and deltoid muscle to the conventional arthroscopic techniques. We evaluated the usefulness of this method.

Abstract

Background

The surgical treatment for acromioclavicular joint (ACJ) separations is recommended for type 5 injuries. We have performed anatomic reconstruction of the trapezoid and conoid ligament separately using arthroscopic techniques. However, some cases have a residual subluxation of ACJ. From 2012, we added re-attachment of deltoid muscle and repair of the acromioclavicular ligament using open techniques to this arthroscopic procedure. Here, we reviewed patients that had been followed up for at least 2 years postoperatively, and evaluated the usefulness and significance of the Hybrid Arthroscopic method. Furthermore, we investigated whether the arthroscopic CCLs reconstruction performed in previous studies truly achieved anatomical CCLs reconstruction based on the anatomical characteristics of CCLs, and compared it with our arthroscopic technique.

Materials And Methods

The subjects were 26 patients. The mean age at the time of surgery was 39.7 years old. The mean follow-up period was 31 months. As the substitute ligaments, we used palmaris longus for the conoid ligament and artificial ligament for the trapezoid ligament, respectively. Both ligaments were reconstructed arthroscopically. In 12 out of 26 patients, we added re-attachment of deltoid muscle and repair of acromioclavicular ligament using open techniques to this arthroscopic procedure.

Results

The reduction of ACJ was complete in 20 of 26 patients. Meanwhile, there were subluxation in 4, and dislocation of greater than 10 mm in 2 patients. Also, on reassessing these incidence without or with open techniques, the reduction was complete in 9 of 14 or 11 of 12 patients. However, there was no significant correlation between two groups.

Discussion

Arthroscopic reconstruction of the CCLs has been recently reported as a treatment for ACJ dislocation. The studies by Scheibel et al. and Balog et al. have demonstrated surgical techniques and clinical results. However, based on the detail of their surgical techniques, the bone tunnels for the trapezoid and conoid ligament reconstruction were both in the mid-portion of longitudinal dimension on the clavicle side and in the body on the coracoid process side. Arthroscopic CCLs reconstruction with these bone tunnels was not always consistent with the anatomical characteristics of both ligaments. Therefore, the arthroscopic CCLs reconstruction would have only resulted in reconstruction with the lateral and medial fiber of the trapezoid ligament for the anatomical CCLs structures. Scheibel et al. reported that in vertical stabilization alone, posterior instability in the ACJ could remain, as in anatomical CCLs reconstruction, and that simultaneous reconstruction of the acromioclavicular ligament is important for stabilizing posterior instability. However, considering their surgical techniques based on the locations of the bone tunnels, their techniques did not achieve anatomical CCLs reconstruction, which might have been the true reason for the residual posterior instability.

Conclusion

It is possible to treat ACJ dislocations by minimally invasive arthroscopic techniques. We believe that anatomic restoration could best restore the function of ACJ. In order to improve the results, we performed arthroscopic reconstruction with re-attachment of deltoid muscle and repair of acromioclavicular ligament. As the results, the vertical stability of ACJ was improved without relatively significance.