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All-Arthroscopic Modified Weaver Dunn Reconstruction of Chronic Acromioclavicular Joint Dislocations

Authors: M Snow & L Funk

References: Tech Shoulder & Elbow Surg, 2006

Abstract
Introduction: The commonest treatment of chronic symptomatic Allman and Tossy type III acromioclavicular joint injuries is the open modified Weaver-Dunn procedure. Recent reports of acute arthroscopic stabilisation have been encouraging, but there is little literature on arthroscopic reconstruction of chronic dislocations. We present an all arthroscopic technique for modified Weaver Dunn reconstruction of symptomatic chronic type III acromioclavicular joint injuries.

Method: Over a one year period we performed 12 all arthroscopic modified Weaver-Dunn procedures. All patients had failed non-operative management for at least 6 months, with symptoms of pain and difficulty with overhead activities.

The technique involved excision of the lateral end of clavicle, stabilisation with a suture cerclage technique from 2 anchors placed in the base of the coracoid and coracoacromial ligament transfer from the acromion to lateral end of clavicle. The technique is identical to our open technique and those published previously by Imhoff et al.

Post-operatively the patients were immobilised for six weeks, followed by an active rehabilitation programme and return to work and sports at 3 months.

Results: We have currently performed this technique in 12 patients, all male. The average age at operation was 25.8yrs at a mean interval of 11 months post injury. The mean Constant score preoperatively was 49 (44-54). The mean 3 month postoperative Constant score was 88.6 (84-96). There have been no complications, and the 2 professional sportsmen within our cohort returned to full contact at 3 months. Due to an irreducible clavicle, one patient required an open excision of lateral clavicle, with the rest of the procedure performed arthroscopically.

Discussion: Arthroscopic Weaver-Dunn has a number of advantages over the corresponding open procedure. It avoids the detachment of deltoid needed to gain exposure and also the morbidity from the wound. From our experience is that it enables patients to regain their function more rapidly with an earlier return to sporting activities.

Conclusion: The early results from our initial experience have been excellent, with no complications. With this technique an anatomic reconstruction can be achieved with excellent cosmesis, low morbidity and potentially accelerated rehabilitation.

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