title: Two-Year Outcomes After Primary Anatomic Coracoclavicular Ligament Reconstruction.
abstract: OBJECTIVE
  The purpose of this study was to report the clinical and structural outcomes after anatomic coracoclavicular ligament reconstruction (ACCR) with free tendon allografts in patients with grade III and grade V acromioclavicular (AC) joint dislocations.
  
  
  METHODS
  Thirty-one shoulders underwent primary ACCR with tendon allografts for Rockwood grade III and grade V AC joint dislocations. Preoperative data included patient demographic characteristics, injury characteristics, and surgical history, along with American Shoulder and Elbow Surgeons (ASES) scores, Short Form 12 Physical Component Summary (SF-12 PCS) scores, and various pain scales. Outcome measures were also collected a minimum of 2 years postoperatively with the addition of Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores; Single Assessment Numeric Evaluation (SANE) scores; and patient satisfaction. In addition, preoperative and postoperative coracoclavicular distances were analyzed using standard anteroposterior radiographs.
  
  
  RESULTS
  ACCR was performed in 31 patients (31 shoulders) with a mean age of 43.9 years (range, 21 to 71 years). In 7 patients (22.6%) a complication occurred that required a subsequent surgical procedure including graft rupture/attenuation (2), clavicle fractures (2), distal clavicle hypertrophy (2), and adhesive capsulitis (1). Of the remaining 24 patients, 20 (83.3%) had subjective outcome data available after a minimum 2-year follow-up period (mean, 3.5 years; range, 2.0 to 6.2 years). The mean postoperative ASES and SF-12 PCS scores significantly improved when compared with the preoperative baseline values (58.9 v 93.8 for ASES scores [P < .001] and 45.3 v 54.4 for SF-12 PCS scores [P = .007]). At final follow-up, the SANE and QuickDASH scores were 89.1 and 5.6, respectively, with a median patient satisfaction rating of 9 of 10.
  
  
  CONCLUSIONS
  Patients who did not require revision surgery showed excellent postoperative outcome scores: The mean ASES score was 93.8, the mean SANE score was 89.1, and the mean QuickDASH score was 5.6, with a median patient satisfaction rating of 9 of 10. Further study regarding ACCR techniques should focus on decreasing the risks of complications and maintaining reduction of the AC joint.
  
  
  METHODS
  Level IV, therapeutic case series.
authors.affiliation: Center for Outcomes-based Orthopaedic Research, Steadman Philippon Research Institute, Vail, Colorado, U.S.A.; The Steadman Clinic, Vail, Colorado, U.S.A.. Electronic address: drmillett@thesteadmanclinic.com.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Millett
authors.affiliation: Center for Outcomes-based Orthopaedic Research, Steadman Philippon Research Institute, Vail, Colorado, U.S.A.
authors.forename: Marilee P
authors.initials: MP
authors.lastname: Horan
authors.affiliation: Center for Outcomes-based Orthopaedic Research, Steadman Philippon Research Institute, Vail, Colorado, U.S.A.
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Warth
mesh_terms: D000173:Acromioclavicular Joint / Q000601:surgery*; D000328:Adult; D000368:Aged; D002062:Bursitis / Q000209:etiology; D002968:Clavicle / Q000293:injuries / Q000473:pathology; D004551:Elbow Joint / Q000601:surgery; D005260:Female; D050723:Fractures, Bone / Q000601:surgery; D006801:Humans; D006984:Hypertrophy / Q000209:etiology; D008023:Ligaments, Articular / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010147:Pain Measurement; D017060:Patient Satisfaction; D011184:Postoperative Period; D012783:Shoulder Dislocation / Q000601:surgery; D013710:Tendons / Q000637:transplantation; D013997:Time Factors; D014184:Transplantation, Homologous; D055815:Young Adult