title: Complications related to anatomic reconstruction of the coracoclavicular ligaments.
abstract: BACKGROUND
  Anatomic reconstruction of the coracoclavicular (CC) ligaments has become a popular surgical treatment for high-grade acromioclavicular (AC) dislocations, but little has been reported about complications related to these newer surgical techniques.
  
  
  OBJECTIVE
  We sought to review the complications related to several new techniques for the anatomic reconstruction of the CC ligaments for the treatment of AC separations.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  We conducted a retrospective review of the operative treatment of AC separation utilizing anatomic reconstruction of the CC ligaments by reviewing the case logs of 3 fellowship-trained orthopaedic surgeons at a single academic sports medicine center for the past 5 years using appropriate current procedural terminology codes. The medical records and postoperative radiographs were assessed for complications.
  
  
  RESULTS
  Twenty-seven cases of anatomic reconstruction of the CC ligaments were reviewed. All patients had an autograft or allograft ligament reconstruction utilizing either a coracoid tunnel (10 cases) or a loop around the coracoid base (17 cases). Eight complications (80%) were noted in the coracoid tunnel group including 2 coracoid fractures (20%), 5 patients with some loss of reduction (more than 5-mm increased CC interval displacement on subsequent postoperative radiographs) (50%), and 1 patient with an intraoperative failure of the coracoid button fixation (10%). Six patients developed complications in the coracoid loop group (35%) including 3 clavicle fractures (18% within group, 11% overall), 1 patient with loss of reduction (6%), 1 patient with loss of reduction and an infection (6% within group, 4% overall), and 1 patient with adhesive capsulitis postoperatively (6% within group, 4% overall).
  
  
  CONCLUSIONS
  Newer techniques for the anatomic reconstruction of the CC ligaments may have steep learning curves associated with complications such as coracoid and clavicle fractures. Loss of reduction continues to be associated with the operative treatment of high-grade AC separations. Further refinement of surgical technique and experience with the operative treatment of AC separation is warranted.
authors.affiliation: University of Virginia, Charlottesville, Virginia, USA. mdmilewski@gmail.com
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Milewski
authors.forename: Marc
authors.initials: M
authors.lastname: Tompkins
authors.forename: Juan M
authors.initials: JM
authors.lastname: Giugale
authors.forename: Eric W
authors.initials: EW
authors.lastname: Carson
authors.forename: Mark D
authors.initials: MD
authors.lastname: Miller
authors.forename: David R
authors.initials: DR
authors.lastname: Diduch
mesh_terms: D000173:Acromioclavicular Joint / Q000033:anatomy & histology / Q000293:injuries* / Q000601:surgery*; D001182:Arthroscopy; D006801:Humans; D004204:Joint Dislocations / Q000601:surgery*; D008023:Ligaments, Articular / Q000033:anatomy & histology / Q000293:injuries* / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous