Outcome of exact anatomic repair and coracoclavicular cortical lag screw in acute acromioclavicular dislocations.

BACKGROUND: The optimal surgical approach for acute acromioclavicular (AC) dislocations is still controversial. The purpose of this study is to analyze the outcome of anatomic repair or approximation of intra-articular and extra-articular damage.

METHODS: Fifty-six patients with Rockwood type-III, IV, and V acute AC dislocations followed up for an average of 76.6 months were evaluated. Direct repair of clavicular muscle attachments, AC joint, and repair or approximation of coracoclavicular (CC) ligaments was done. A CC of 4.5-mm cortical lag screw was used to protect the repair for 60 days. At the final follow-up, clinical assessment, radiographic analysis, function according to American Shoulder and Elbow Surgeons score, University of California-Los Angeles (UCLA) Shoulder Scale, Disabilities of Arm, Shoulder and Hand score, and the ability to return to previous work were used for evaluation.

RESULTS: At the time of final follow-up, the mean values of American Shoulder and Elbow Surgeons score, University of California-Los Angeles, and Disabilities of Arm, Shoulder and Hand scores were 91.3 ± 6.1, 31.5 ± 2.3, and 2.8 ± 2.1, respectively. Reduction was maintained in all but two patients, and CC distance was not statistically different from that on the healthy side. Five patients had occasional pain during daily activities and one developed AC osteoarthritis. All patients maintained their previous jobs.

CONCLUSIONS: The anatomic repair of damage in AC dislocations is a reliable treatment although it is not always feasible. Approximating torn ligaments can still produce good results under the rigid CC screw protection.