Summary

Anatomic considerations for the arthroscopic reconstruction of coraco-clavicular ligament

Abstract

Background

Arthroscopic reconstruction of the coraco-clavicular ligament has been described in some studies to patients with acromio-clavicular joint dislocation. Few published reports have considered the importance of anatomic reconstruction. The present study reports the importance of anatomic reconstruction and evaluates the position of the reconstructed ligaments and the clinical and radiographic results of arthroscopic reconstruction of coraco-clavicular ligament. Material and Methods: Arthroscopic reconstruction of the coraco-clavicular ligament using a Fiber tape and Dog Bone Button (Arthrex) was performed in 9 shoulders between June 2014 and May 2016. The mean age was 42.9 years (range, 28 to 64 years). The mean follow-up period was 8.5 months (range, 4 to 20 months). The injuries were as follows: Rockwood type 3 (n=7), Rockwood type 4 (n=1), and Rockwood type 5 (n=1). We evaluated the position of the bone tunnel on CT images, and the extent of the tunnel widening and loss of reduction using radiography. The subjective patient outcomes were evaluated. Results: The distance from the lateral side of the clavicle to the clavicular tunnel was 30.0 ± 6.1 mm. If we divided the sagittal view of clavicle into three columns (anterior, middle, posterior), 1 shoulder was anterior, 5 shoulders were middle, and 3 shoulders were posterior. The distance from the anterior aspect of the coracoid to the coracoid tunnel was 29.2 ± 4.98 mm. Intraoperative reduction was lost in 7 patients (78%). The clavicular tunnel width was 5.34 ± 1.1 mm. The coracoid tunnel width was 4.93 ± 1.05 mm. One patient reported experiencing slight pain. The mean Constant score 93 (range, 86 to 100). Discussion: Although our clinical results were mostly satisfactory, we experienced tunnel widening and a loss of reduction. We consider that the reason for this is that the position of the bone tunnel in these studies tended to differ from the anatomic attachment of the coraco-clavicular ligament; thus, we could not reconstruct the coraco-clavicular ligament in the anatomic position. Arthroscopic reconstruction of the coraco-clavicular ligament is recommended in patients with acromio-clavicular joint dislocation. However, in order to decrease the enlargement of the bone tunnel and the loss of reduction, it was suggested that we should reconstruct the bone tunnel in the anatomic position.