title: Radiographic failure and rates of re-operation after acromioclavicular joint reconstruction: a comparison of surgical techniques.
abstract: OBJECTIVE
  To compare radiographic failure and re-operation rates of anatomical coracoclavicular (CC) ligament reconstructional techniques with non-anatomical techniques after chronic high grade acromioclavicular (AC) joint injuries.
  
  
  METHODS
  We reviewed chronic AC joint reconstructions within a region-wide healthcare system to identify surgical technique, complications, radiographic failure and re-operations. Procedures fell into four categories: (1) modified Weaver-Dunn, (2) allograft fixed through coracoid and clavicular tunnels, (3) allograft loop coracoclavicular fixation, and (4) combined allograft loop and synthetic cortical button fixation. Among 167 patients (mean age 38.1 years, (standard deviation (sd) 14.7) treated at least a four week interval after injury, 154 had post-operative radiographs available for analysis.
  
  
  RESULTS
  Radiographic failure occurred in 33/154 cases (21.4%), with the lowest rate in Technique 4 (2/42 4.8%, p = 0.001). Half the failures occurred by six weeks, and the Kaplan-Meier survivorship at 24 months was 94.4% (95% confidence interval (CI) 79.6 to 98.6) for Technique 4 and 69.9% (95% CI 59.4 to 78.3) for the other techniques when combined. In multivariable survival analysis, Technique 4 had better survival than other techniques (Hazard Ratio 0.162, 95% CI 0.039 to 0.068, p = 0.013). Among 155 patients with a minimum of six months post-operative insurance coverage, re-operation occurred in 9.7% (15 patients). However, in multivariable logistic regression, Technique 4 did not reach a statistically significant lower risk for re-operation (odds ratio 0.254, 95% CI 0.05 to 1.3, p = 0.11).
  
  
  CONCLUSIONS
  In this retrospective series, anatomical CC ligament reconstruction using combined synthetic cortical button and allograft loop fixation had the lowest rate of radiographic failure.
  
  
  CONCLUSIONS
  Anatomical coracoclavicular ligament reconstruction using combined synthetic cortical button and allograft loop fixation had the lowest rate of radiographic failure.
authors.affiliation: Southern California Permanente Medical Group, 3460 East La Palma Avenue Anaheim, California, 92806, USA.
authors.forename: H T
authors.initials: HT
authors.lastname: Spencer
authors.affiliation: Southern California Permanente Medical Group, 3460 East La Palma Avenue Anaheim, California, 92806, USA.
authors.forename: L
authors.initials: L
authors.lastname: Hsu
authors.affiliation: Southern California Permanente Medical Group, 3460 East La Palma Avenue Anaheim, California, 92806, USA.
authors.forename: J
authors.initials: J
authors.lastname: Sodl
authors.affiliation: Southern California Permanente Medical Group, 3460 East La Palma Avenue Anaheim, California, 92806, USA.
authors.forename: A
authors.initials: A
authors.lastname: Arianjam
authors.affiliation: Southern California Permanente Medical Group, 3460 East La Palma Avenue Anaheim, California, 92806, USA.
authors.forename: E H
authors.initials: EH
authors.lastname: Yian
mesh_terms: D000173:Acromioclavicular Joint / Q000000981:diagnostic imaging* / Q000601:surgery; D000328:Adult; D001175:Arthrography; D019643:Arthroplasty, Replacement / Q000009:adverse effects*; D002968:Clavicle / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D004204:Joint Dislocations / Q000601:surgery; D008023:Ligaments, Articular / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014184:Transplantation, Homologous
keywords: Acromioclavicular joint; Shoulder separation; Coracoclavicular ligament reconstruction; Acromioclavicular reconstruction