Clinical results of single-tunnel coracoclavicular ligament reconstruction using autogenous semitendinosus tendon.

BACKGROUND: Over 60 repair/reconstruction techniques have been described for the treatment of coracoclavicular (CC) ligament injuries.

PURPOSE: To report the functional and radiological outcomes of single-tunnel CC ligament reconstruction using autogenous semitendinosus tendon.

STUDY DESIGN: Case series; Level of evidence, 4.

METHODS: Between August 2005 and January 2008, a total of 21 patients, 16 patients (14 men, 2 women) with a Rockwood type IV, type V, or a chronic type III acromioclavicular (AC) dislocation and 5 patients (4 men, 1 woman) with a painful nonunited distal clavicle fracture with CC separation, underwent CC reconstructive surgery using a semitendinosus autograft. All 21 patients were followed up clinically and radiographically. The mean follow-up was 33 months (range, 18-47), and the mean patient age was 39.8 years (range, 18-70). Chronic type III AC dislocations and nonunited distal clavicle fractures with CC separation were scored using preoperative AC scoring (AC Joint Separation Questionnaire). Constant, University of California-Los Angeles (UCLA), and AC scores were evaluated for all patients at final follow-up.

RESULTS: At the final follow-up, 10 patients achieved an "excellent" result and 11 a "good" result according to the AC scoring scheme. Mean final Constant and UCLA scores were 84.7 (range, 67-94) and 30.0 (range, 23-35), respectively. In the antero-posterior (AP) plane, 17 (81%) of the 21 patients maintained complete reduction, and 1 of the remaining 4, a manual laborer, had complete reduction loss. Of the 17 patients with an axillary view at final follow-up, 1 patient (5.9%) showed partial subluxation, although no subluxation was observed in the AP radiograph. The other 16 patients (94.1%) had a complete reduction state in axillary view.

CONCLUSION: Single-tunnel CC reconstruction with an autogenous hamstring tendon graft after a mean follow-up of 33 months (range, 18-47) appears to be a satisfactory means of treating acute Rockwood type IV, V, chronic type III, and painful nonunited distal clavicle fractures with CC separation.