Radiographic failure and rates of re-operation after acromioclavicular joint reconstruction: a comparison of surgical techniques.
2016
Aims To compare radiographic failure and re-operation rates of anatomical
coracoclavicular (CC) ligament reconstructional techniques with
non-anatomical techniques after chronic high grade acromioclavicular
(AC) joint injuries. Patients and Methods We reviewed chronic AC joint reconstructions within a region-wide
healthcare system to identify surgical technique, complications,
radiographic failure and re-operations. Procedures fell into four
categories: ( 1) modified Weaver-Dunn, (2) allograft
fixed through coracoid and clavicular tunnels, (3) allograft loop
coracoclavicular fixation, and (4) combined allograft loop and synthetic
cortical button fixation. Among 167 patients (mean age 38.1 years,
(standard deviation (sd) 14.7) treated at least a four
week interval after injury, 154 had post-operative radiographs available
for analysis. Results Radiographic failure occurred in 33/154 cases (21.4%), with the
lowest rate in Technique 4
(2/42 4.8%, p = 0.001). Half the failures occurred by six weeks,
and the Kaplan-Meier survivorship at 24 months was 94.4% (95% confidence
interval (CI) 79.6 to 98.6) for Technique 4 and 69.9% (95% CI 59.4
to 78.3) for the other techniques when combined. In multivariable
survival analysis, Technique 4 had better survival than other techniques (Hazard
Ratio 0.162, 95% CI 0.039 to 0.068, p = 0.013). Among 155 patients
with a minimum of six months post-operative insurance coverage,
re-operation occurred in 9.7% (15 patients). However, in multivariable
logistic regression, Technique 4 did not reach a statistically significant
lower risk for re-operation (odds ratio 0.254, 95% CI 0.05 to 1.3,
p = 0.11). Conclusion In this retrospective series, anatomical CC ligament reconstruction
using combined synthetic cortical button and allograft loop fixation
had the lowest rate of radiographic failure. Take home message: Anatomical coracoclavicular ligament reconstruction
using combined synthetic cortical button and allograft loop fixation
had the lowest rate of radiographic failure. Cite this article: Bone Joint J 2016;98-B:512–18.
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