Abstract
Objectives:
Acromioclavicular joint (ACJ) injuries can lead to severe pain and reduced shoulder function. Anatomic coracoclavicular reconstruction (ACCR) using a free tendon graft has demonstrated favorable biomechanical properties and good short- to mid-term outcomes, but data on long-term outcomes are scarce. The purpose of the present study was to evaluate the long-term clinical and functional outcomes after ACCR, with a focus on return to sport and revision surgery.
Methods:
Patients who underwent ACCR using a free tendon allograft for the treatment of ACJ injuries type III or V between November 2006 and April 2011 by a single surgeon with a minimum 10-year follow-up were eligible for inclusion. Patient-reported outcome measures, including the American Shoulder and Elbow Surgeons (ASES) Score, short version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire, Single Assessment Numeric Evaluation (SANE) and patient satisfaction (1-10 scale with “10” indicating maximum satisfaction), rates of return to sport and further surgery, specifically revision ACJ stabilization, were evaluated minimum 10 years follow-up. Survivorship was defined as not undergoing revision ACJ stabilization. Pain (via Visual Analog Scale [VAS]) was additionally assessed preoperatively and at final follow-up. Patients who underwent further surgery were excluded from analysis.
Results:
Fourteen patients were evaluated after 13.0 (interquartile range, 12.0-15.0) years. Four patients (28.6%) underwent further surgery (2x revision ACJ stabilization, 2x exostosis removal) and were excluded from further analysis (survivorship: 85.7%). In the remaining patients, shoulder function was excellent at follow-up (ASES Score: 100 [96.6-100], QuickDASH: 0 [0-5.1]), SANE: 99.0 [91.5-99.0]). Pain levels decreased significantly from preoperative measurements to follow-up (VAS for pain: 2.0 [1.0-3.0] to 0 [0-0.5], p = 0.016). Satisfaction at follow-up was high (10 [5.0-10]). The majority of patients returned to their sports equal to or above (44.4%, n = 4) or slightly below (22.2%, n = 2) their preoperative level. One patient reported hypersensitivity and anterior shoulder pain postoperatively, but reported low pain levels at follow-up. No other complications occurred.
Conclusions:
Anatomic coracoclavicular reconstruction using a free tendon graft for the treatment of ACJ injuries type III or V resulted in excellent shoulder function, low pain levels and high patient satisfaction at long-term follow-up. The rate of revision ACJ stabilization was 14.3%.
