TREATMENT OF ACROMIOCLAVICULAR DISLOCATION WITH CORACOACROMIAL TRANSFER (WEAVER DUNN PROCEDURE)

Abstract

Airn: Treatment of acromioclavicular joint dislocations depends on the type of the dislocation and the patients symptoms. We present the results of surgical treatment with transfer of the acromical end of coracoacromial ligament in the distal end of the clavicle. (The Weaver Dunn procedure). Material – Method: 32 patients with acromioclavicular dislocation type III, IV and V according Rockwood, 20 acute and 12 chronic, were treated with open reduction and stabilization of the distal end of clavicle and transfer of the coracoacromial ligament. They were 26 men and 6 women, the average age was 28 years. The indications for the operation were: deformity, pain and numbness. On 28 patients resection of the distal end of the clavicle was performed but on 4 acute dislocations the stabilization was made without osteotomy.

Surgery was performed with the patients in the beach chair position and with a horizontal skin incision above the acromioclavicular joint. The length of the coracoacromial ligament was determinant to achieved reduction. The soft tissues were double breasted above the acromioclavicular joint. After surgery the limb was placed in a sling for 15 days and then complete mobilization exercises was began. Draft weight was avoided for 3 months.

Results: The average length of follow up was 4 years. All patients had almost no pain and full range of motion. Constant score was above 80 in all cases. Full range of motion was obtained until 2 months after operation. In 3 cases the primary reduction was not fully achieved. In 3 other cases loss of the primary reduction was observed due to suture rupture. In these cases the displacement was significantly minor than pre operatively. 15 patients had developed ectopic ossification bellow the acromioclavicular joint without consequence in the shoulder motion. The resection of the distal end of the clavicle did not alter the results.

Conclusion: The operation offers low percentage of complications and quick rehabilitation. It is recommended in acute as well in chronic injuries with very good results. The good results were not varied with time during follow up. Advantage of this operation represents the no use of metals. The pull angle of the ligament might create an anterior sublaxation during reduction of the dislocation, but this does not influence the results.