BACKGROUND: We report an alternative to the modified Weaver-Dunn
technique that can achieve stable coracoclavicular reconstruction while
avoiding sacrifice of the coracoacromial arch. The purpose of this study was
to retrospectively analyze the functional outcomes and radiographic features
of patients treated with coracoclavicular ligament reconstruction with use of
a proximally based conjoined tendon transfer.
METHODS: The cases of thirty-eight patients with type-IV, type-V,
and selected type-III acromioclavicular dislocations according to the Rockwood
classification system, who were followed for an average follow-up of 38.7
months, were evaluated retrospectively. Transfer of the lateral half of the
conjoined tendon to the distal aspect of the clavicle in a proximally based
fashion, with additional coracoclavicular fixation, was performed in all
patients. At the latest follow-up evaluation, radiographic analysis and the
scores on the American Shoulder and Elbow Surgeons, Constant and Murley, and
Simple Shoulder Test questionnaires were used to provide a final evaluation of
shoulder function. The ability to return to work and the ability to return to
sports were also recorded.
RESULTS: At the time of final follow-up, the mean American Shoulder
and Elbow Surgeons score was 91.4, with a mean pain score on the visual analog
scale of 1.8, mean forward flexion of 148.2°, and mean external rotation
of 38.0°. The mean Constant and Murley score was 90.6. The new number of
positive answers on the Simple Shoulder Test was 10.9. The overall rate of
satisfaction (an excellent or good result) was 89% (thirty-four patients).
Thirty-five (92%) of the thirty-eight patients returned to their previous
work, and thirty-two (84%) returned to their preinjury level of sports.
CONCLUSIONS: The proximally based conjoined tendon transfer is a
reliable treatment for a high-grade acromioclavicular dislocation. The lateral
half of the conjoined tendon is a safe graft source with ample length, and
this technique avoids sacrifice of the coracoacromial ligament.
LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions to Authors
for a complete description of levels of evidence.
ORIGINAL ABSTRACT CITATION: "Proximally Based Conjoined Tendon
Transfer for Coracoclavicular Reconstruction in the Treatment of