Coraco Clavicular Ligament Reconstruction

What is Coraco Clabicular Ligament?

  • Acromioclavicular (AC) joint dislocation accounts for approximately 9% of shoulder girdle injuries. These injuries are classified into type I–VI injuries on the basis of the radiographic findings using the Rockwood criteria. The Rockwood classification takes into account not only the AC joint, but also the coracoclavicular (CC) ligament (which consists of fasciculi, the trapezoid and conoid ligaments), the deltoid and trapezius muscles, and the direction of dislocation of the clavicle with respect to the acromion. Most type I and type II injuries can be successfully treated nonoperatively in the majority of patients. Although Type IV through type VI injuries are treated operatively because of their severe instability, treatment for type III injury is still controversial.
  • Most surgical procedures involving the AC joint primarily involve fixation of the joint and reconstruction of the CC ligament. AC joint fixation methods involve the use of wires, screws, and hook plates, although these techniques have significant limitations including unsatisfactory maintenance of AC joint reduction, osteolysis, and fracture as well as hardware-related complications. In addition, many of these procedures necessitate a second procedure for hardware removal.
  • Several procedures for reconstruction of CC ligament have been described. The modified Weaver-Dunn procedure is the most widely used CC reconstruction method. After resecting the distal clavicle, it involves transfer of the coracoacromial (CA) ligament (which was detached from the under surface of the acromion) together with a small piece of boneto, the distal clavicle using cerclage wires. However, postsurgical complications include persistent pain, weakness, and clavicular osteolysis.
  • Anatomic and biomechanical studies have addressed the contributions of both CC and AC ligaments to AC joint stability. Consequently, different stabilizing procedures have been developed, which focus on reconstruction of the CC ligament, including single-bundle, double-bundle, as well as a sling-fashion reconstructions using autograft, allograft, or synthetic materials. Reconstruction of the trapezoid and conoid ligaments in independent procedures was found to be biomechanically superior. Clinical articles also report promising outcomes from such reconstruction techniques.
  • Recently, the triple endo button technique has been used in reconstruction of complete AC joint dislocations. This technique allows restoration of the CC ligament to be in a position as anatomical as possible with the strength of the fixation superior to its original strength. We present our experience with reconstruction of CC ligaments using the triple endobutton technique (Acufex; Smith & Nephew, Andover, MA), including its biomechanical performance in comparison with the modified Weaver-Dunn technique using a cadaveric model. We hypothesized that the triple endobutton reconstruction would prove superior to the modified Weaver-Dunn technique in restoration of AC joint stability and strength.