Clinical outcomes of coracoclavicular ligament reconstructions using tendon grafts

Stephen J Nicholas, Steven J Lee, Michael J Mullaney, Timothy F Tyler, Malachy P McHugh
American Journal of Sports Medicine 2007, 35 (11): 1912-7

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.

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