title: Complications after anatomic fixation and reconstruction of the coracoclavicular ligaments.
abstract: BACKGROUND
  Reconstruction of the disrupted acromioclavicular (AC) joint has historically resulted in high complication rates. As a result, there has been a move toward anatomic coracoclavicular (CC) ligament fixation and reconstruction, owing to its numerous biomechanical advantages and perceived clinical advantages.
  
  
  OBJECTIVE
  To report and analyze the unique complications associated with these anatomic CC ligament procedures using either cortical fixation buttons (CFBs) or tendon grafts (TGs) and to evaluate the effect that these complications have on patient outcomes.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  From January 2006 until May 2011, a total of 59 primary anatomic CC ligament procedures were performed using either CFBs or TGs. Demographic, surgical, subjective (including the American Shoulder and Elbow Surgeons [ASES], quick Disabilities of the Arm, Shoulder and Hand [QuickDASH], Short Form-12 [SF-12], and Single Assessment Numeric Evaluation [SANE] scores), and radiographic data along with surgical complications were prospectively collected and retrospectively analyzed. Construct survivorship, defined as the maintenance of reduction of the AC joint, was calculated using the Kaplan-Meier method at 12- and 24-month intervals.
  
  
  RESULTS
  Surgical treatment for AC joint dislocations was performed in 3 women (4 shoulders) and 52 men (55 shoulders) with a mean age of 43.6 years (range, 18-71 years); 13 shoulders (22.0%) underwent fixation using the CFB technique, and 46 shoulders (78.0%) underwent reconstruction using the TG technique. The overall complication rate was 27.1% (16/59) in this study. There were 3 complications (23.1%) in the CFB group, including 1 coracoid fracture and 2 cases of hardware failure resulting in a loss of reduction. There were 13 complications (28.2%) in the TG group, including 4 graft ruptures, 2 clavicle fractures, 1 case of hardware failure, 1 hypertrophic distal clavicle, 2 cases of hardware pain, 1 suture granuloma, 1 case of adhesive capsulitis, and 1 case of axillary neuropathy. Twelve- and 24-month construct survivorship was calculated to be 86.2% and 83.2%, respectively. Of the 43 shoulders that did not have a complication, mean ASES scores significantly improved from 57.5 (range, 0-97) to 91 (range, 63-100) (P < .001), and mean SF-12 physical component summary scores significantly improved from 45 (range, 25-58) to 56 (range, 43-65.8) (P < .001) after a mean 2.4-year follow-up (range, 1.0-5.7 years). There were no significant differences in outcomes between those that did and did not experience a complication, with the exception that those with complications had significantly decreased median patient satisfaction compared with those without complications (3.5 vs 9, respectively; P = .049).
  
  
  CONCLUSIONS
  Anatomic procedures to treat disrupted CC ligaments using either CFBs or TGs resulted in an overall complication rate of 27.1% (16/59). Construct survivorship was calculated to be 86.2% at 12 months and 83.2% at 24 months. Good to excellent outcomes could only be reported in those patients who did not have a complication.
authors.affiliation: Peter J. Millett, Center for Outcomes-Based Orthopaedic Research (COOR Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 1000, Vail, CO 81657. drmillett@thesteadmanclinic.com).
authors.forename: Frank
authors.initials: F
authors.lastname: Martetschläger
authors.forename: Marilee P
authors.initials: MP
authors.lastname: Horan
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Warth
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Millett
mesh_terms: D000173:Acromioclavicular Joint / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D002968:Clavicle / Q000601:surgery; D005260:Female; D050723:Fractures, Bone / Q000601:surgery; D006801:Humans; D008023:Ligaments, Articular / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods; D017060:Patient Satisfaction; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D012540:Scapula / Q000601:surgery; D012782:Shoulder / Q000601:surgery*; D000070599:Shoulder Injuries; D013710:Tendons / Q000637:transplantation; D016896:Treatment Outcome; D055815:Young Adult
keywords: AC joint; acromioclavicular joint; complications; coracoclavicular; outcomes; reconstruction; survivorship