Acromioclavicular Dislocations. A Novel Surgical Technique for biological reconstruction of coracco-claviculer ligaments Study designe: Clinical case series study

Abstract Background: Acromioclavicular joint represents the link between the clavicle and the scapula, which is responsible for the synchronized dynamics of shoulder girdle. Several surgical tactics for acromioclavicular joint dislocation has been described which aim to restore joint congruity and mechanical stability. The range of possibilities includes anatomical and non-anatomical techniques, open and arthroscopy-assisted procedures, and biological and synthetic grafts Purpose: of this study was to asses functional, radiological outcomes and complications of coracoclavicular (CC) ligaments reconstruction utilizing a novel technique sacrificing the lateral half of conjoint and passé it through holes in the clavicle. Patients &Methods: Between July 2017 to December 2020, a prospective case series study was conducted in Al-zahraa University hospitals, El-marg one day surgery hospital and Sharm international hospital including 25 patients with types III ,IV and V AC injuries. All patients underwent CC ligament reconstruction by using lateral half of conjoint tendon. The conjoint tendon is exposed and its lateral half splitted. The clavicle was prepared through debridement of it’s under surface. Two clavicular holes were drilled by 1.7 mm drill bit. An Ethibond suture (NO.5) tagged in the conjoint tendon, gentle mobilization was done while the elbow and shoulder flexed till the tendon could reach the under surface of the clavicle. Ethibond sutures in conjoint tendon were passed through clavicular holes followed by suturing the tendon to itself after reducing ACJ. In 10 patients the AC joint temporary fixed with 2 k-wires that removed after 3-4 weeks. The patients were evaluated for pain, range of motion (ROM), radiologic findings (CC distance difference between both sides was measured), American Shoulder and Elbow Surgeons (ASES), and Constant scores. Postoperative complications were recorded and assessment of time of returning to the work was done. The evaluation was done preoperatively and each time of follow up with a minimum period of one year. Results:After a mean follow up period of 18±2.3 months. Patients showed significant improvement between mean preoperative and postoperative pain, ROM, Constant, ASES scores and CC distance difference. The mean post-operative pain and ROM scores ( as a part of constant score) was 11.48 (±3.2) and 31.53 (±2.9) respectively The mean post-operative Constant and ASES scores was 88.93 (±7.33) and 91.84 (±7.5) respectively. Radiographic CC distance difference (mm) between both shoulders at one year postoperatively was 1.89. The mean time to return to work (3.7 months). Some complications evolved in our series included: recurrent sublaxation in one case, loss of reduction occurred in two patients, superficial wound infection occurred in one case and fracture clavicle occurred in one case. Conclusion: The described technique is simple, reproducible and anticipated to reduce the cost of the operative procedure significantly. Although the study includes a relatively small number of cases, it gives excellent results that are promising to consider the technique as a valid option of management in acute acromioclavicular dislocations.