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Arthroscopic coracoclavicular ligament reconstruction for ACJ dislocations

Authors: Lafosse

References: SECEC 2005

We present a total arthroscopic technique for coracoclavicular ligament reconstruction by ligamentoplasty after acute or chronic acromioclavicular joint dislocation.  A coracoacromial ligament transfer is done to reconstruct the torn coracoclavicular ligaments similar as in open surgery.  The coracoacromial ligament is dissected from the undersurface of the acromion and is reinserted on the inferior clavicle by transosseous suture fixation.  First series from May 2002 to May 2003 in which complementary temporary fixation in stage IV and V was done with k-wire gave satisfactory results but improvement of the technique had been done this complementary fixation is not with k-wires but performed by 4 additional suture between an anchorage with a screw in the coracoid and trans osseous clavicle tunnels.  This actual technique provides excellent results in terms of reduction and avoids complications but it is too soon to make reliable conclusion.

 

MATERIAL OF THE FIRST SERIES:

-                     14 cases

-                     May 2002 => May 2003

-                     8 males/6 females

-                     Age 18-52

-                     Stage III: 1, Stage IV: 3, Stage V:10

-                     Acute: 6 / Chronic: 8

-                     Meniscal resection: 14

-                     AC Joint Resection: 12

-                     Anchors: 6

-                     K wire: 7

 

RESULTS:

Complications:

-                     Infection: 1

-                     K wire: 4

-                     Follow up: 14 m (6-18)

-                     Satisfaction: 13/1

-                     Reduction:

o        Full:             3

o        Incomplete: 9

o        None:          1

-                     Cosmetic: 14

 

DISCUSSION:

This new arthroscopic technique provides good result without scar as for open surgery, but improvement of the reduction has been provided by additional fixation to the coracoid with strong sutures fixed passed through the clavicle tunnel and fixed to the coracoid by an anchor.

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