ACROMIOCLAVICULAR JOINT RECONSTRUCTION: ANALYSIS OF TECHNIQUE AND OUTCOME AT 2–11 YEAR FOLLOW UP

Abstract

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.