Primary versus revision arthroscopically-assisted acromio- and coracoclavicular stabilization of chronic AC-joint instability.

BACKGROUND: A gracilis tendon autograft with TightRope-augmentation can be used for arthroscopically-assisted acromioclavicular (AC)- and coracoclavicular (CC-)stabilization of chronic bidirectional AC-joint instability after failed primary treatment. The impact of failed initial treatment on postoperative outcome is unclear. Hence, the purpose of this study was to evaluate it.

METHODS: Twenty-seven of 38 patients suffering from chronic AC-joint instability after either failed conservative (group 1) or surgical treatment (group 2) treated in the above-mentioned technique were finally included in this study. The Subjective Shoulder Value, the Constant Score, the Taft Score and the Acromioclavicular Joint Instability Score were used for clinical evaluation. Bilateral anteroposterior stress radiographs and bilateral Alexander views were obtained for radiological evaluation.

RESULTS: 14 patients of group 1 [3f/11m; median age 47.6 (range 20.9-57.4) years] could be evaluated after a median follow-up of 24.3 (range 20-31.2) months and 13 patients of group 2 [6f/7m; median age 44.9 (range 24.9-61.0) years] were available after a median follow-up of 28.8 (range 20-33) months. Comparison of clinical score results revealed no significant differences between both groups. The median CC-difference showed no significant difference between the groups [group 1 0.8 (0-10.5) mm, group 2 0.9 (0-4.3) mm].

CONCLUSION: AC- and CC-stabilization of chronic bidirectional AC-joint instability using a gracilis tendon autograft with TightRope-augmentation can be recommended after failed conservative and surgical treatment.

STUDY DESIGN: Retrospective cohort study; Level of evidence III.