Clinical outcomes of coracoclavicular ligament reconstructions using tendon grafts
by
Nicholas SJ, Lee SJ, Mullaney MJ, Tyler TF, McHugh MP.
—
last modified
2009-10-09 15:17
Am J Sports Med. 2007 Nov;35(11):1912-7. Epub 2007 Aug 8. Comment in: Am J Sports Med. 2008 Feb;36(2):398-9; author reply 399.
BACKGROUND: Numerous techniques for reconstruction of the coracoclavicular
ligaments have been developed to treat acromioclavicular joint separations. A
new, stronger method to reconstruct the coracoclavicular ligaments using
semitendinosus tendon allografts has been previously described. No outcome
studies have been published on this new procedure. HYPOTHESIS: Reconstruction of
the coracoclavicular ligaments using tendon grafts produces excellent functional
results. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Nine patients
underwent coracoclavicular ligament reconstruction using augmented cadaveric
semitendinosus tendon allografts after a grade V acromioclavicular separation.
All patients were evaluated for range of motion, strength, closed kinetic chain
testing, the American Shoulder and Elbow Surgeons Rating Scale, Pennsylvania
Shoulder Score, the Simple Shoulder Test, and the Acromioclavicular Joint
Separation Questionnaire. Preoperative and postoperative radiographs were
compared. RESULTS: Range of motion measurements were normal in all motions except
a loss of 5 degrees +/- 4 degrees (P < .05) in extension. No significant strength
deficits were found. Functional closed kinetic chain tests scored comparatively
to standardized norms. American Shoulder and Elbow Surgeons Rating scores were 96
+/- 5 out of 100; the Pennsylvania Shoulder Scale scores were 97 +/- 3 out of
100; the Simple Shoulder Test scores were 11.6 +/- 0 out of 12; and
Acromioclavicular Joint Separation Questionnaire scores were 28 +/- 3 out of 31.
Subjects reported an overall subjective satisfaction of 89% +/- 7%. Postoperative
radiographs showed no loss of reduction of the acromioclavicular joint in any
patient. CONCLUSION: Outcome for coracoclavicular ligament reconstructions using
augmented semitendinosus tendon grafts was excellent with full recovery of
strength, minimal range of motion loss, and no clinical or radiographic loss of
reduction of the acromioclavicular joint. CLINICAL RELEVANCE: This procedure
provides an excellent treatment for grade V acromioclavicular separations.