Open Weaver-Dunn (Modified)
The Weaver-Dunn procedure and modifications thereof have the best results for stabilisation of the AC Joint. The true Weaver-Dunn, described in 1972 [1], comprises excision of the lateral end of clavicle and tranfer of the coraco-acromial ligament (CAL). Modifications include the addition of a coraco-clavicular stabiliser, usually a screw or suture around the coracoid & clavicle.
The modified technique below, is that described by Copeland in 1995 [2].
1. A Longitudinal incision (strap) is made over the AC joint extending down over the coracoid. The lateral end of clavicle will be found to have ruptured the delto-trapezial fascia and possibly button-holed through trapezius.
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2. The lateral end of clavicle is excised, obliquely.
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3. The CAL is mobilised with a small amount of bone from the acromion.
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4. Drill holes are made in the clavicle.
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5. A thick PDS cord is passed around the coracoid using a rotator cuff passer (Linvatec).
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6. The cord can be passed through a drill hole in the clavicle, to avoid excessive anterior translation of the clavicle.
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7. The PDS cord is tied, whilst the clavicle is held down and the scapula pushed up - reducing the dislocation. The CAL is then transferred to the lateral end of clavicle with two interposing sutures.
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8. When reducing the joint it is essential to ensure translation is anterior, as well as inferior.
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References:
- JK Weaver and HK Dunn. Treatment of acromioclavicular injuries, especially complete acromioclavicular separations. JBJS Vol 54-A. p 1187. 1972.
- S Copeland. Operative shoulder surgery. New York: Churchill Livingstone; 1995.
