title: Early failures with single clavicular transosseous coracoclavicular ligament reconstruction.
abstract: BACKGROUND
  Coracoclavicular (CC) ligament reconstruction remains a challenging procedure. The ideal reconstruction is biomechanically strong, allows direct visualization of passage around the coracoid, and is minimally invasive. Few published reports have evaluated arthroscopic techniques with a single clavicular tunnel and transcoracoid reconstruction. One such report noted early excellent results, but without specific outcome measures. This study reports the clinical and radiographic results of a minimally invasive, arthroscopically assisted technique of CC ligament reconstruction using a transcoracoid and single clavicular tunnel technique.
  
  
  METHODS
  A retrospective review was performed of 10 consecutive repairs in 9 active duty patients who underwent CC ligament reconstruction with the GraftRope (Arthrex, Naples FL, USA). All reconstructions were performed according to the manufacturer's technique by a single, fellowship-trained surgeon. Medical records and radiographs were evaluated for demographics, operative details, loss of reduction, and return to duty.
  
  
  RESULTS
  In 8 of 10 repairs (80%) intraoperative reduction was lost at an average of 7.0 weeks (range, 3-12 weeks). Four patients (40%) required revision. Subjective patient outcomes included 5 excellent/good results, 1 fair result, and 4 poor results. Tunnel widening was universally noted, and the failure mode in most patients appeared to be at the holding suture.
  
  
  CONCLUSIONS
  This transcoracoid, single clavicular tunnel technique was not a reliable approach to CC ligament reconstruction. We noted a high percentage of radiographic redisplacement and clinical failure. This technique, in its current form, cannot be recommended to treat AC joint injuries in our population.
authors.affiliation: Orthopaedic Surgery, Tripler Army Medical Center, HI 96859, USA. jaybcook@yahoo.com
authors.forename: Jay B
authors.initials: JB
authors.lastname: Cook
authors.forename: James S
authors.initials: JS
authors.lastname: Shaha
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Rowles
authors.forename: Craig R
authors.initials: CR
authors.lastname: Bottoni
authors.forename: Steven H
authors.initials: SH
authors.lastname: Shaha
authors.forename: John M
authors.initials: JM
authors.lastname: Tokish
mesh_terms: D000173:Acromioclavicular Joint / Q000293:injuries / Q000601:surgery*; D000328:Adult; D001182:Arthroscopy / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D004204:Joint Dislocations / Q000601:surgery*; D008023:Ligaments, Articular / Q000293:injuries / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013537:Sutures; D013997:Time Factors; D017211:Treatment Failure; D055815:Young Adult