title: Complications after arthroscopic coracoclavicular reconstruction using a single adjustable-loop-length suspensory fixation device in acute acromioclavicular joint dislocation.
abstract: OBJECTIVE
  The purpose of this study was to evaluate clinical and radiological outcomes after arthroscopically assisted coracoclavicular (CC) fixation using a single adjustable-loop-length suspensory fixation device for acute acromioclavicular dislocation and to report intraoperative and postoperative complications.
  
  
  METHODS
  Eighteen consecutive patients with acute acromioclavicular dislocation underwent arthroscopically assisted CC fixation using a single TightRope (Arthrex, Naples, FL). Using the Rockwood classification, 3 patients had grade III dislocations, one patient had a grade IV dislocation, and 14 patients had grade V dislocations.
  
  
  RESULTS
  The preoperative CC distance of the injured shoulder was 16.1 ± 2.7 mm (range, 11.2 to 21.0 mm), and it increased by 99% ± 36% (range, 17% to 153%) on average compared with the contralateral shoulder. The average CC distance was 10.5 ± 2.5 mm (range, 7.7 to 15.5 mm), and it increased by 30% ± 30% (range, -9.4% to 90%) at the final follow-up. Compared with immediate postoperative radiographs, the CC distance was maintained in 12 patients, increased between 50% and 100% in 4 patients, and increased more than 100% in 2 patients at final follow-up. However, there was no statistical difference in Constant scores between 6 patients with reduction loss (95.6 ± 4.5) and 12 patients with reduction maintenance (98.4 ± 2.5; P = .17). Perioperative complications occurred in 8 patients, including one case of acromioclavicular arthritis, one case of delayed distal clavicular fracture at the clavicular hole of the device, 3 cases of clavicular or coracoid button failures, and 3 cases of clavicular bony erosion.
  
  
  CONCLUSIONS
  Satisfactory clinical outcomes were obtained after CC fixation using the single adjustable-loop-length suspensory fixation device for acute acromioclavicular joint dislocation. However, CC fixation failure of greater than 50% of the unaffected side in radiological examinations occurred in 33% of the patients within 3 months after the operation. Additionally, 8 patients (44%) had complications associated with the adjustable-loop-length suspensory fixation device and surgical technical problems. Despite acceptable shoulder function restoration, adequate care should be exercised in surgical treatment of acute acromioclavicular dislocation with a single adjustable-loop-length suspensory fixation device for optimal radiological outcomes.
  
  
  METHODS
  Level IV, therapeutic case series.
authors.affiliation: Department of Orthopaedic Surgery, Global Top 5 Research Program, Ewha Womans University School of Medicine, Seoul, Republic of Korea. Electronic address: sjshin622@ewha.ac.kr.
authors.forename: Sang-Jin
authors.initials: SJ
authors.lastname: Shin
authors.affiliation: Department of Orthopaedic Surgery, Global Top 5 Research Program, Ewha Womans University School of Medicine, Seoul, Republic of Korea.
authors.forename: Nam-Ki
authors.initials: NK
authors.lastname: Kim
mesh_terms: D000173:Acromioclavicular Joint / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D000208:Acute Disease; D000328:Adult; D000368:Aged; D002968:Clavicle / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D004867:Equipment Design; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D004204:Joint Dislocations / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects* / Q000295:instrumentation; D011183:Postoperative Complications; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000009:adverse effects* / Q000295:instrumentation