The optimal surgical procedure for acromioclavicular (AC) joint dislocations is still debated. Recently, the procedures which stabilized coracoclavicular (CC) ligament by suspension system become popular. However, persistent posterior instability of the AC joint has been observed after CC stabilization without AC stabilization. We developed the new technique putting artificial ligament to AC joint from anterior part of the acromion to posterior part of the distal clavicle (AC oblique brace) and confirmed to increase posterior stability of the AC joint by the cadaveric biomechanical study. We performed arthroscopic CC stabilization using suspension system with mini open AC oblique brace for acute severe AC joint dislocation (Rockwood type-3B or 5). The purpose of this study was to analyze the radiological and clinical outcomes of the new technique for acute severe AC dislocation.
Eight consecutive patients who treated with arthroscopic CC stabilization using suspension system (Dog bone button and FiberTape, Arthrex, Naples) with mini open AC oblique brace (Internal brace, Arthrex, Naples) for acute severe AC joint dislocation (Rockwood type-3B or 5) and observed for 12 months after operation were included in this study. We evaluated active ROMs (forward elevation, external rotation, and internal rotation), functional score for AC joint (Acromioclavicular Joint Instability Score: ACJI score) at preoperative and 6 and 12 months after operation. For radiological evaluation, we analyzed coracoclavicular distance (%CCD) as vertical stability of AC joint and dynamic posterior instability by Alexander view (no/partial/complete horizontal translation) as horizontal stability at preoperative and 6 and 12 months after operation
Active ROMs were significantly improved in forward elevation and internal rotation at 6 and 12 months and external rotation at 12 months after operation compared to preoperative them (p<0.05). ACJI score were significantly improved at 6 and 12 months after operation (82 and 86 points) compared to preoperative that (19 points. p<0.05). %CCD were significantly decreased at 6 and 12 months (124 and 126%) after operation compered to preoperative that (21%, p<0.05). Dynamic posterior instability was improved from 5 complete and 3 partial horizontal translation to 4 no and 4 partial horizontal translation. No complication was observed within 12 months, such as infection, neurovascular injury, fracture of clavicle, coracoid, and acromion.
Arthroscopic CC stabilization using suspension system with mini open AC oblique brace for acute severe AC joint dislocation showed good clinical and radiological outcomes at 6 and 12 months after operation without complication, suggesting that this technique is one of the good options for the treatment for acute severe AC dislocation.