Treatments of Chronic Acromioclavicular joint dislocation are controversial. Many procedures have been described in the past for the management of them. Treatment modalities have changed with increasing understanding of the nature of the problem, patient expectations and the biomechanics of the joint. Aim. To assess the functional outcome of the chronic AC joint dislocations treated by modified Weaver-Dunn procedure combined with Acromioclavicular joint augmentation. Material and methods. We treated 54 patients with chronic AC joint dislocation by modified Weaver-Dunn procedure with additional AC joint augmentation. We used tight rope system in 20 patients, Mersilene tape in 22 patients and no 5 Ethibond in 12 patients. Results. This Study was done between Jan 2003 to Jan 2012. Mean follow up was 20 months, mean age of the patients was 35, and male to female distribution was 48:6. We assessed them clinically and radio logically during their follow up. All patients were back to their occupation. 80% are back to their pre injury sporting activity level. The mean Disabilities of the Arm, Shoulder, and Hand (DASH) score was 10.2 points. One patient had a failure of augmentation device. Conclusion. Our study shows that chronic symptomatic AC joint dislocations, (Rockwood types III to V) Managed with modified modified Weaver-Dunn procedure with augmentation are showing good short term results. Significant improvement in the patient satisfaction, early return to work and radiological appearance

Treatments of Chronic Acromioclavicular joint dislocation are controversial. Many procedures have been described in the past for the management of them. Treatment modalities have changed with increasing understanding of the nature of the problem, patient expectations and the biomechanics of the joint. To assess the functional outcome of the chronic AC joint dislocations treated by modified Weaver-Dunn procedure combined with Acromioclavicular joint augmentation. We treated 54 patients with chronic AC joint dislocation by modified Weaver-Dunn procedure with additional AC joint augmentation. We used tight rope system in 20 patients, Mersilene tape in 22 patients and no 5 Ethibond in 12 patients. This Study was done between Jan 2003 to Jan2012. Mean follow up was 20 months, mean age of the patients was 35, and male to female distribution was 48:6. We assessed them clinically and radio logically during their follow up. All patients were back to their occupation. 80% are back to their pre injury sporting activity level. The mean Disabilities of the Arm, Shoulder, and Hand (DASH) score was 10.2 points. One patient had a failure of augmentation device. Our study shows that chronic symptomatic AC joint dislocations, (Rockwood types III to V,) Managed with modified modified Weaver-Dunn procedure with augmentation are showing good short term results. Significant improvement in the patient satisfaction, early return to work and radiological appearance

The aim of our study was to assess, for the first time in a large study, whether there are radiological features of the acromioclavicular joint (ACJ) which vary with age or between genders and side. Clinical experience suggested that there was no clear correlation between the radiological features and symptoms arising from the ACJ. Therefore we also aimed to test the null hypothesis that there are no consistent radiological features which correspond with the need for surgical excision of the ACJ. We analysed 240 shoulder radiographs, divided into male and female, left and right shoulders, and decades from 20 to 80 years inclusive. At the ACJ the presence of sclerosis, osteophytes, cysts and lysis were recorded, and the width of the joint measured. These same parameters were assessed on the pre-operative radiographs for a group of 100 patients by a blinded observer. Fifty had undergone ASD (arthroscopic subacromial decompression), and 50 ASD with ACJ excision. These two groups were age matched. Statistical analyses were performed. There was no statistical difference between any of the parameters for gender or side however with increasing age there was a significantly increased incidence of joint space narrowing and increased features of osteoarthrosis. When comparing the matched ASD and the ACJ excision groups it was found that the presence of medial sclerosis (p = 0.016) and superior clavicular osteophytes (p = 0.016) were more common in the ACJ excision group. We concluded that there is a change in the radiological features of the ACJ with increasing age but not between sides or gender. The null hypothesis is upheld. Only 2 parameters, namely medial acromial sclerosis and superior clavicular osteophytes, are radiological features which correlate with a symptomatic acromioclavicular joint. These have poor sensitivity and specificity and therefore should not be used as a test

The aim of our study was to assess, for the first time in a large study, whether there are radiological features of the acromioclavicular joint (ACJ) which vary with age or between genders and side. Clinical experience suggested that there was no clear correlation between the radiological features and symptoms arising from the ACJ. Therefore we also aimed to test the null hypothesis that there are no consistent radiological features which correspond with the need for surgical excision of the ACJ. We analysed 240 shoulder radiographs, divided into male and female, left and right shoulders, and decades from 20 to 80 years inclusive. At the ACJ the presence of sclerosis, osteophytes and cysts were recorded, and the width and angle of the joint measured. These same parameters were assessed on the preoperative radiographs for a group of 100 patients by a blinded observer. Fifty had undergone ASD (arthroscopic subacromial decompression), and 50 ASD with ACJ excision. These two groups were age matched. Statistical analyses were performed. There was no statistical difference between any of the parameters for gender or side however with increasing age there was a significantly increased incidence of acromial sclerosis and joint space narrowing. When comparing the matched ASD and the ACJ excision groups it was found that the presence of medial sclerosis of the acromium (p = 0.016) and superior clavicular osteophytes (p = 0.016) were more common in the ACJ excision group. We concluded that there is a change in the radiological features of the ACJ with increasing age but not between sides or gender. The null hypothesis has been rejected. The presence of either medial sclerosis of the acromium, and superior clavicular osteophytes, are radiological features which correlate with a symptomatic acromioclavicular joint

Acromioclavicular joint injuries are one of the most common injuries in the shoulder girdle complex. Surgical management is considered based on patient profile, level of activity, pain, and classification of injury. To date, a vast array of surgical techniques have been proposed and described in the literature, a possible reason being that the optimal solution is still uncertain. The aim of this study is to determine the efficacy of an alternative surgical technique. This study is a retrospective case series of 80 patients that have been operated by a single surgeon over a period of 6 years. A novel surgical technique, the ‘BiPOD method’, was applied where a synthetic artificial ligament (LARS®) is used to reconstruct and reduce the acromioclavicular joint. The technique is done in a reproducible manner, where a single continuous artificial ligament is used to reduce and reconstruct both, the coracoclavicular and acromioclavicular ligament complexes to achieve bidirectional stability. Patients were followed-up postoperatively, either clinically where possible or telephonically. The Acromioclavicular Joint Instability Score (ACJI) and radiographic measurements were used to determine the clinical and surgical outcome of the surgery. Radiographic parameters, measuring the reduction of the coracoclavicular- and acromioclavicular joint, were analysed and documented. The results showed marked improvement in both, the coracoclavicular distance and acromioclavicular distance. Clinically, using the ACJI scoring system, the patients reported substantial improvement in pain and function. Complications were recorded but were insignificant. The BiPOD surgical technique, making use of an artificial LARS® ligament, has proven acceptable outcomes in the surgical management of acromioclavicular joint dislocations

Introduction: Acromioclavicular (AC) joint injuries are common in both the sporting and working populations. Most injuries are grade I in severity and settle with an appropriate non-operative treatment program. Arthroscopic soft tissue debridement of the AC Joint without excising the distal clavicle, is a bone sparing procedure that, to our knowledge, has never been reported in the literature. This paper is a retrospective review of patients with chronic recalcitrant AC joint injuries, who underwent arthroscopic soft tissue debridement of the AC joint. Materials and Methods: Fourteen patients underwent arthroscopic AC joint soft tissue debridement. All patients had failed a non-operative treatment program including physiotherapy, anti-inflammatory tablets and corticosteroid injections. All patients had been symptomatic for a minimum of four months prior to surgery. The surgery involves a glenohumeral joint arthroscopy, subacromial bursoscopy and AC joint arthroscopy. Excision of the torn AC joint meniscus, AC joint synovectomy and soft tissue clearance were performed in all cases. Surgery was performed as a day-only procedure. Results: Ten out of fourteen patients obtained good pain relief and a corresponding increase in function. One patient was lost to follow-up. One patient subsequently underwent an open AC joint reconstruction for chronic instability. Five patients had previously undiagnosed SLAP tears. Conclusion. Arthroscopic soft tissue debridement for recalcitrant AC joint injuries gave good results in 77% of cases. Arthroscopy of the glenohumeral joint in patients with presumed isolated AC joint disease is important as there is a significant proportion of patients who have associated significant superior labral tears. Soft tissue arthroscopic AC joint debridement allows quick post-operative rehabilitation, an early return to sport and work and avoids having to excise bone from the distal clavicle. Arthroscopic AC joint debridement is contraindicated in patients who have grade II or grade III AC joint instability

Aim: The purpose of this study was to evaluate the results after arthroscopic treatment of traumatic AC joint dislocation using a Bosworth screw. Method: 18 Patients with acute AC Joint dislocation type Rockwood 3 were arthroscopically treated with temporary transfixation using a 7.0mm cannulated titanium screw of the clavicle to the coracoid process. The coracoid process is arthroscopically visualized and a drill guide for tibial anterior cruciate ligament positioning is used to exactly place the screw into the coracoid process. The screws were removed after 8 weeks. Patients were followed using a prospective study using the Constant Score after 3, 6, 12 and 24 months. Results: 17 Patients were completely evaluated. One screw slipped out of the coracoid process 3 days after surgery requiring revision surgery. No screw breakage was observed. There were no other operation conditioned complications. Constant score showed a mean of 94,7 at last follow up. At follow up, no patient hat a redislocation without weight bearing. With 10kg weight a mean clavicular elevation of 1,8mm was observed. All remaining patients were satisfied with the functional and cosmetic result. Discussion: There is some controversy about the surgical treatment of acute traumatic AC joint dislocation type Rockwood 3. Most open surgery techniques have the disadvantage of a poor cosmetic result or a difficult and dangerous hardware removal, because the scar of the AC joint capsule that is supposed to stabilize the clavicle has to be opened. The Bosworth screw technique does not touch the AC joint at all, but the open procedure has poor cosmetic outcome. It is also important to use a large screw to ensure proper hardware stability to avoid hardware failure. Our technique might be an alternative for the operative treatment of acute AC joint instability, because it is safe and all anatomical structures remain intact in case revision surgery with i.e. arthroscopic AC joint resection and ligamentoplasty is necessary

Because there is little in the literature about specific presentation and examination methods for acromioclavicular (AC) joint pathology, we aimed to define and identify the most reliable tests. We identified and examined 30 patients with probable AC joint pathology. We then excluded eight patients who experienced no pain relief after local Lignocaine infiltration, and examined 22 patients, two of whom had bilateral shoulder problems. There were 15 complaints of AC joint pain, 13 of anterior pain, five of posterior pain and five of lateral pain. Pain radiated anteriorly in 14 patients, posteriorly in two, laterally in three and to the cervical region in three. Pain increased with weight-bearing in 18 shoulders, on elevation in five, on activities of daily living in six, at night or on being lain on in 11, and on reaching across the body in three. Clinical examination revealed swelling in seven shoulders and AC joint prominence in seven. There was local tenderness in 21 shoulders and there were crepitations in four. The forced cross-body test produced pain in 22 shoulders. In 22 shoulders, elevation was less than 60°. Jobe’s test was positive in 20, the Speed’s test in 19, O’Brien’s test in 15, the compression test in 15, the distraction test in 13. A painful arc was present to 160° in 13 shoulders. There was neck tenderness in 13 patients. Associated conditions included two cases of shoulder arthritis, six of impingement, two rotator cuff tears, two cases of biceps tendinitis and two of cervical pathology. Radiological changes were evident in 19 AC joints, 13 shoulder joints and 11 cervical spines. On ultrasonography, pathology was resent in 10 of 15 cases. The most common symptoms were pain with weight-bearing, elevation and lying on shoulder. Anterior and posterior pain was the most common. The most common clinical findings were local tenderness, pain on elevation and the forced cross-body test, positive Jobe’s and Speed’s tests. Because no test is 100% accurate, the whole clinical presentation must be taken into account. Local infiltration of the AC joint is extremely helpful

Acromioclavicular joint is an integral component of Shoulder Complex and common site of injury particularly for athletes involved in sports such as Football, Cricket, Rugby and Shotput. Acromioclavicular Injuries are often neglected and goes untreated especially in low demand patients. Classic surgical techniques are associated with high complication rates. This is a prospective study from 2015–2017 wherein 32 patients with Acute grade 3, 4, 5, 6 Acromioclavicular joint dislocations, were operated with Minimally Invasive Double Tunnel Anatomical Coraco-clavicular Ligament Reconstruction (DT-ACCLR) with Tightrope Suspensory fixation. Clinical Outcomes were evaluated with Visual Analog Scale, Constant functional scale, Start of Movement, Return to Work, Satisfaction index and Coraco-clavicular distance over 12 months. Mean follow-up was 14 ± 3.8 months. Visual analog scale and Constant scores revealed significant advancements 0 ± 0.5 (range, 0–2) and 95 ± 3 (range, 92–98) scores at 12 months respectively. The coraco-clavicular distance significantly reduced from 23 ± 2.4 mm to 8 ± 0.5 mm. Mean return to work by 7 days. 98.6% patients were satisfied with surgical results. We conclude that DT-ACCLR is simple and creative surgical technique which provides stable, reliable and painless AC joint. The patients can move the shoulder same day and return to Work by 5–7days and Sports 3–4 weeks

Acromioclavicular joint (ACJ) dislocations is a common disorder amongst our population for which numerous techniques have been described. It is thought that by using this novel technique combining a CC and AC repair with a reconstruction will result in high maintenance of anatomical reduction and functional results. 12 consecutive patients ACJ dislocations were included. An open superior clavicular approach is used. Firstly, the CC ligaments are repaired after which a CC reconstruction is performed using a tendon allograft. Secondly, the AC ligaments are repaired using an internal brace construct combined with a tendon allograft reconstruction (Figure 1). The acute:chronic ratio was 6:6. Only IIIB, IV and V AC-joint dislocations were included. The Constant-Murley Score improved from 27.6 (8.0 – 56.5) up to 61.5 (42.0 – 92.0) at 12 months of follow up. Besides one frozen shoulder from which the patient recovered spontaneously no complications were observed with this technique. The CCD was reduced from 18.7 mm (13.0 – 24.0) to 10.0 mm (6.0 – 16.0) and 10.5 mm (8.0 – 14.0) respectively 12 weeks and 12 months postoperatively. There is some evidence, suggesting to address as well as the vertical (coracoclavicular (CC) ligaments) as the horizontal (acromioclavicular (AC) ligaments) direction of instability. This study supports addressing both entities however comparative studies discriminating chronic as acute cases should be conducted to further clarify this ongoing debate on treating ACJ instability. This study describes a novel technique to treat acute and chronic Rockwood stage IIIB – IV ACJ dislocations with promising short-term clinical and radiological results. This suggests that the combined repair and reconstruction of the AC and CC ligaments is a safe procedure with low complication risk in experienced hands. Addressing the vertical as well as horizontal stability in ACJ dislocation is considered key to accomplish optimal long-term results

Aims: Most of the orthopaedic literature on os acromiale (OA) is focused on corresponding clinical implication, such as impingement syndrome and rotator cuff tear; whilst, although it is present in 8% of subjects, scarce information is reported on the causes that may predispose to it. Our aim is to investigate whether the origin of OA is related to position of AC joint. Methods: The acromions of 211 volunteers (control group) and 33 subjects, respectively, without or with OA have been radiographically (axillary view) classiþed in accordance to the Edelson and Taitzñ method. The latter distinguishes the acromion in three types on the basis of the distance between the anterior aspect of the acromion and AC joint. Out of 33 subjects with os acromiale, 11 were shoulder painless. We have compared among them the frequencies of the types of acromion observed in the two investigated cohorts. Results: Half (52.1%) of the acromions of the control group had the articular facet for the AC joint on the acromion tip whilst in 45.4% facet was tip distally located. On the other hand, out of 33 subjects with OA, 18.1% and 81.1% had, respectively, AC joint lying on or distally to the acromion tip. Conclusions: Our data suggest that the longer is the distance of AC joint from the anterior edge of the acromion, the higher is the possibility that an OA origin

Management of highly displaced acromioclavicular joint (ACJ) injuries remain contentious. It is unclear if delayed versus acute reconstruction has an increased risk of fixation failure and complications. The primary aim of this was to compare complications of early versus delayed reconstruction. The secondary aim was to determine modes of failure of ACJ reconstruction requiring revision surgery. A retrospective study was performed of all patients who underwent operative reconstruction of ACJ injuries over a 10-year period (Rockwood III-V). Reconstruction was classed as early (<12 weeks from injury) or delayed (≥12 weeks). Patient demographics, fixation method and post-operative complications were noted, with one-year follow-up a minimum requirement for inclusion. Fixation failure was defined as loss of reduction requiring revision surgery. 104 patients were analysed (n=60 early and n=44 delayed). Mean age was 42.0 (SD 11.2, 17–70 years), 84.6% male and 16/104 were smokers. No difference was observed between fixation failure (p=0.39) or deep infection (p=0.13) with regards to acute versus delayed reconstruction. No patient demographic or timing of surgery was predictive of fixation failure on regression modelling. Overall, eleven patients underwent revision surgery for loss of reduction and implant failure (n=5 suture fatigue, n=2 endo-button escape, n=2 coracoid stress fracture and n=2 deep infection). This study suggests that delayed ACJ reconstruction does not have a higher incidence of fixation failure or major complications compared to acute reconstruction. For those patients with ongoing pain and instability following a trial of non-operative treatment, delayed reconstruction would appear to be a safe treatment approach

This prospective, randomized, controlled trial compares patient outcome after non-operative care versus open reduction and tunneled suspension device fixation (ORTSD) for grade III or IV acromioclavicular joint disruptions. Sixty patients aged between sixteen and thirty-five years with an acute grade III or IV AC joint disruption were randomized to receive ORTSD fixation or non-operative treatment. Functional assessment was conducted at six weeks, three months, six months, and one year using the Disabilities of the Arm, Shoulder and Hands (DASH), Oxford Shoulder Scores (OSS) and Short Form (SF-12). Reduction was evaluated using radiographs. Complications were recorded, and an economic evaluation performed. There was no significant difference in DASH or OSS at one year between non-operative and ORTSD groups (DASH score, 4.67 versus 5.63; OSS, 45.72 versus 45.63). Patients undergoing surgery had inferior DASH scores at 6 weeks (p<0.01). Five patients who failed non-operative management subsequently received surgery. Overall cost of treatment was significantly greater after ORTSD fixation (£796.22 vs £3359.73 (p<0.01)). ORTSD fixation confers no functional benefit over non-operative treatment at one year. While patients managed non-operatively generally recover faster, a significant group remain dissatisfied following non-operative treatment requiring delayed surgical reconstruction

Chronic instability of the acromioclavicular joint is relatively common and normally occurs following a fall onto the point of the shoulder. Reconstruction of the joint (Weaver-Dunn procedure) is often required in service personnel, and numerous methods of fixation have been used, including vicryl tape, PDS loops and the use of a hook plate. Many of these operative methods require a second operation to remove the plates and/or screws, and are associated with a failure rate of up to 30%. The ‘Surgilig’ was designed as a method of revision for failed Weaver-Dunn procedures. However this study evaluates its use in the primary operation. We prospectively followed up the Modified Weaver Dunn procedures using surgilig. The post-operative x-rays were reviewed at six weeks, 3 months and then 6 months when the patients were discharged to assess the radiological success of the procedure. We have performed this procedure in 11 patients. Of the eight patients that have reached the six month postoperative time so far, at which they would be discharged from clinic follow-up, none have had radiological failure of the fixation. One patient even had weight-bearing x-rays taken at 6 weeks, with no detrimental effect. Even though a small study, the initial results for primary fixation of acromioclavicular joint disruption with surgilig are extremely encouraging. The study suggests that surgilig should continue to be used in its current role. As patient numbers increase, a follow-up study should be conducted to evaluate these preliminary findings

The treatment of Grade III acromioclavicular joint (ACJ) dislocations has been a subject of much controversy, even as early as Hippocrates. We hypothesized that this surgical technique would improve patient functional outcome. Methods and Results. We present a case series of 17 patients all of whom have had grade III dislocations of the ACJ. The patient population was young active adults. Surgery was performed within four weeks in all cases. One Surgeon in the Queen Elizabeth hospital, University of Birmingham, performed the same procedure on all 17 patients. A standard technique was used for tight rope fixation. The fixation device is comprised of no. 5 fibrewire suture and 2 metal buttons, joined by a continuous loop. This is a low-profile double-metallic button technique. Postoperatively all patients remained in a polysling for three weeks and postoperative rehabilitation was commenced after that point including physiotherapy supervised pendular exercises and gentle passive movements. They were all seen six weeks and three months post operatively. Clinical and radiographic assessment was performed to assess the fixation. Of our cohort of patients, one required revision open stabilization after sustaining a mechanical fall on the affected operated side. There was a failure of fixation in a patient who was non-compliant with postoperative instructions. At three months postoperatively all patients were satisfied with the functional outcome and were able to return to pre injury level of activity. Bar the two failures the average OSS was 45.2 (range 40–48). 14 patients returned to their pre injury occupation and sports fitness. Conclusion. This technique provides a simple, reproducible, minimally invasive technique for acute ACJ dislocation, which expedites a functional recovery of this acute injury. It is a non-rigid fixation of the AC joint that maintains reduction yet allowing for normal movement at the joint

Little has been written about the results of isolated acromioclavicular joint (ACJ) resection using the superior approach. We report the results of our large series. Between June 1994 and October 2003, a single surgeon performed 155 isolated ACJ resections, using the direct superior approach. Exclusion criteria were previous ipsilateral shoulder surgery, simultaneous arthroscopic procedures and OA. We asked 90 of the patients (94 shoulders) to complete the Simple Shoulder Test questionnaire by telephone. The median age of the 72 males and 18 females was 38 years (16 to 62). The dominant shoulder was involved in 54 patients. There was a history of trauma in 44 patients, with 11 rugby injuries. The median follow-up period was 29 months (6 to 118). One portal infection resolved with debridement and antibiotics. Five revision procedures were done, four open revision Mumfords and one subacromial decompression. The mean postoperative Simple Shoulder score was 11.5 (6 to 12). Patients rated outcome as excellent in 63 shoulders, good in 22, moderate in five and poor in four. The technique provides consistently good or excellent results (90%) and allows rapid return to normal function. There was complete resolution of pain in 73 of the 94 shoulders. All rugby players returned to the same level of play

Aim: A prospective study designed to assess and evaluate the results of arthroscopic acromioclavicular joint (ACJ) minimal excision arthroplasty. Patients and Methods: Twenty-two patients with ACJ arthropathy underwent an arthroscopic limited excision of the ACJ preserving the superior ligamentous complex. The patients were assessed pre and post operatively using the Constant score. The average time from surgery to review was five months (three to nineteen months). A self assessment questionnaire was also used, evaluating outcome measures such as activities of daily living, shoulder function and patients satisfaction. Results: The mean preoperative Constant score was 28 and postoperative score was 71 with an improvement in pain from 15% to 80% and the range of motion from 37% to 84%. The preoperative self assessment score was 25.9 and postoperative score was 83 with an improvement in activities of daily living from 28% to 79%, and shoulder function from 34% to 87%.Twenty patients were very satisfied, one was moderately satisfied and one patient was dissatisfied although his shoulder function increased from 20 to 60%. Discussion: This study suggests that this technique is well accepted by the patients and results in a good improvement in shoulder function. The results are comparable with those reported in the literature concerning the standard ACJ arthroplasty. We therefore believe that a limited excision of the ACJ is adequate and a reliable alternative to conventional techniques

Introduction. We present an all arthroscopic technique for modified Weaver Dunn reconstruction of symptomatic chronic type III acromioclavicular joint injuries. Method. Over a 1 year period we performed 12 all arthroscopic modified Weaver-Dunn procedures. All patients had failed non-operative management for at least 6 months, with symptoms of pain and difficulty with overhead activities. The technique involved excision of the lateral end of clavicle, stabilisation with a suture cerclage technique from 2 anchors placed in the base of the coracoid and coracoacromial ligament transfer from the acromion to lateral end of clavicle. The technique is identical to our open technique and those published previously by Imhoff. Post-operatively the patients were immobilised for six weeks, followed by an active rehabilitation programme and return to work and sports at 3 months. Results. We have currently performed this technique in 12 patients, all male. The average age at operation was 25.8yrs at a mean interval of 11 months post-injury. The mean Constant score pre-operatively was 49 (44-54). The mean 3 month post-operative Constant score was 88.6 (84-96). There have been no complications, and the 2 professional sportsmen within our cohort returned to full contact at 3 months. Due to an irreducible clavicle, one patient required an open excision of lateral clavicle, with the rest of the procedure performed arthroscopically. Discussion. Arthroscopic Weaver-Dunn has a number of advantages over the corresponding open procedure. It avoids the detachment of deltoid needed to gain exposure and also the morbidity from the wound. From our experience it enables patients to regain their function more rapidly with an earlier return to sporting activities. Conclusion. The early results from our initial experience have been excellent, with no complications. With this technique an anatomic reconstruction can be achieved with excellent cosmesis, low morbidity and potentially accelerated rehabilitation

Aims: To evaluate the functional outcome and patient satisfaction following the modified Weaver -Dunn procedure for the treatment of chronic acromioclavicular joint (ACJ) disruption. Methods: A cohort of 16 patients treated surgically for chronic, symptomatic ACJ disruption (Rockwood type 3 to 5) between 1992 and 2001 is reviewed. The constant – Murley functional shoulder scoring system and patients satisfaction was assessed at the latest follow-up evaluation. Results: All patients undergone modified Weaver – Dunn procedure which consists of excision of lateral end of clavicle, bone block transfer of corocoacromial ligament stabilized with 2 mm K-wires and Nylon tape or Ethibond suture to maintain acromioclavicular alignment. There were 13 males and 2 females with a mean age of 36 years (range: 17 to 58). 30% patients had sporting related injury. Mean delay from onset of symptoms to surgery was 30 months. 4 patients had failed primary operation to the ACJ. 2 patients had concomitant fibrous non-union of lateral 1/3 of clavicle. All the patients were re-examined at 2–11 years after surgery (mean 5.8 years). The mean Constant Murley scores were 86 (range: 70 to 100). Results were good to excellent in 75 % of cases. Complications consisted of 1 K-wire migration, 2 superficial wound infections, 1 deep infection and 3 failure of reconstruction. The latter were related to salvage procedure in previous failed primary operations. Conclusions Acromioclavicular realignment can be achieved using Nylon tape or Ethibond sutures and 2 stout K-wires. The latter appears to enhance the pull- out strength of bone block transfers and allows bone – to bone union. We recommend this modification of technique to ensure acromioclavicular alignment. This technique is not intended for salvage procedure, as failure rate is high

This study aimed to describe the morphology of the coracoid process and determine the frequency of commonly observed patterns. The second purpose was to determine the location of inferior tunnel exit with superior based tunnel drilling and the superior tunnel exit with inferior based tunnel drilling.

A sample of 100 dry scapulae for the morphology aspect and 52 cadaveric embalmed shoulders for tunnel drilling were used. The coracoid process was described qualitatively and categorized into 6 different shapes. A transcoracoid tunnel was drilled at the centre of the base. Twenty-six shoulders were used for the superior-inferior tunnel drilling approach and 26 for the inferior-superior tunnel drilling approach. The distances to the margins of the coracoid process, from both the entry and exit points of the tunnel, were measured.

Eight coracoid processes were of convex shape, 31 of hooked shape, 18 of irregular shape, 18 of narrow shape, 25 of straight shape, and 13 of wide shape. The mean difference for the distances between superior entry and inferior exit from the apex was Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation 3.65+3.51mm (p=0.002); 1.57+2.27mm for the lateral border (p=0.40) and 5.53+3.45mm for the medial border (p=0.001). The mean difference for the distances between inferior entry and superior exit from the apex was 16.95+3.11mm (p=0.0001); 6.51+3.2mm for the lateral border (p=0.40) and 1.03+2.32 mm for the medial border (p=0.045).

The most common coracoid process shape observed was a hooked pattern. Both superior to inferior and inferior to superior tunnel drilling directed the tunnel from a more anterior and medial entry to a posterior-lateral exit. Superior to inferior drilling resulted in a more posteriorly angled tunnel. With inferior to superior tunnel drilling cortical breaks were observed at the inferior and medial margin of the tunnel.