title: Salvage procedure for chronic acromioclavicular dislocation subsequent to overzealous distal clavicle resection.
abstract: This article presents our surgical technique for reestablishing acromioclavicular stability after overzealous distal clavicular resection. Two cases are presented in which the clavicle of the affected acromioclavicular joint was unstable, causing pain with range of motion (ROM). To address the pathology, reconstruction of the coracoclavicular ligament and reattachment of the trapezius and deltoid to the clavicle were required. We reconstructed the coracoclavicular ligaments using an Achilles tendon calcaneal allograft. The bony end of the Achilles tendon allograft was used as an extension to lengthen the clavicle and the tendinous portion to reconstruct the coracoacromial ligament, thus stabilizing the clavicle. Once allograft reconstruction and stability had been achieved, a 1.5-cm gap remained between the acromion and the new allograft end of the clavicle. There was no evidence of acromioclavicular impingement. Supplemental fixation was not required. The trapezius, pectoralis, and deltoids were all reefed over the clavicle using Vicryl sutures (Ethicon, Inc, West Somerville, New Jersey) to reinforce the reduction and restore the natural contour of the shoulder girdle. Fifteen months postoperatively, both patients had maintained a reduced acromioclavicular joint. They had no pain with ROM, and full muscular strength was evident in all planes. Radiographs of their shoulders revealed a completely incorporated graft and a reduced clavicle. We recommend this novel technique for reestablishing acromiclavicular stability, as it provides good functional and subjective results.
authors.affiliation: UHZ Sports Medicine Institute, 1150 Campo Sano Ave, Ste 200, Coral Gables, FL 33146, USA.
authors.forename: John E
authors.initials: JE
authors.lastname: Zvijac
authors.forename: Charles A
authors.initials: CA
authors.lastname: Popkin
authors.forename: Angie
authors.initials: A
authors.lastname: Botto-van Bemden
mesh_terms: D000173:Acromioclavicular Joint / Q000293:injuries* / Q000601:surgery*; D000328:Adult; D001178:Arthroplasty / Q000379:methods*; D002968:Clavicle / Q000601:surgery*; D005260:Female; D006801:Humans; D004204:Joint Dislocations / Q000209:etiology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016879:Salvage Therapy / Q000379:methods*; D016896:Treatment Outcome