title: Treatment of Symptomatic Acromioclavicular Joint Instability by a Docking Technique: Clinical Indications, Surgical Technique, and Outcomes.
abstract: OBJECTIVE
  To report functional and objective outcomes resulting from surgical treatment of patients with symptomatic type III through V acromioclavicular (AC) joint injury by use of a modification of the anatomic AC joint reconstruction developed by Carofino and Mazzocca.
  
  
  METHODS
  The study included all patients treated in 2009-2014 who presented with a history of direct trauma to the shoulder; deformity of the AC joint on clinical examination; radiographic findings that would classify the injury as a Rockwood type III, IV, or V injury; AC joint instability on clinical examination; and self-reported deficits of arm function on initial presentation, in whom a comprehensive and directed nonoperative program failed. The surgical procedure used an allograft with reinforcing internal sutures passed around the coracoid and through anatomically positioned clavicular holes for the coracoclavicular (CC) ligaments, used a docking technique for reconstruction of the superior AC ligaments, and included repair of the native AC ligaments. Outcomes were reported for patients with a minimum follow-up period of 1.5 years. Outcome measurements included dynamic-static stability evaluation and Disabilities of the Arm, Shoulder and Hand (DASH) scores.
  
  
  RESULTS
  The study included 15 patients with 15 affected shoulders. The postsurgical follow-up period averaged 3 years (range, 1.5-5 years). Postoperatively, one patient showed loss of reduction after a fall. All others showed 2-dimensional radiographic stability and 3-dimensional dynamic clinical stability. Static radiographic measurement of the CC distance at discharge averaged 0.93 cm compared with 2.7 cm on initial examination (P < .0001). Patient-reported outcomes at an average of 3 years' follow-up showed a DASH score of 13 compared with a preoperative DASH score of 51 (P < .0001).
  
  
  CONCLUSIONS
  This study confirms that anatomic CC ligament reconstruction and repair or reconstruction of the AC ligaments help restore arm function as shown by the patient-specific and clinical outcome metrics. These results were achieved by correction of the deformity, which in turn allowed for the obtainment of static and dynamic stability.
  
  
  METHODS
  Level IV.
authors.affiliation: Shoulder Center of Kentucky, Lexington, Kentucky, U.S.A.
authors.forename: W Ben
authors.initials: WB
authors.lastname: Kibler
authors.affiliation: Shoulder Center of Kentucky, Lexington, Kentucky, U.S.A.. Electronic address: aaron.sciascia@eku.edu.
authors.forename: Aaron D
authors.initials: AD
authors.lastname: Sciascia
authors.affiliation: Shoulder Center of Kentucky, Lexington, Kentucky, U.S.A.
authors.forename: Brent J
authors.initials: BJ
authors.lastname: Morris
authors.affiliation: Shoulder Center of Kentucky, Lexington, Kentucky, U.S.A.
authors.forename: David C
authors.initials: DC
authors.lastname: Dome
mesh_terms: D000173:Acromioclavicular Joint / Q000293:injuries / Q000503:physiopathology / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D064591:Allografts; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology / Q000601:surgery*; D008023:Ligaments, Articular / Q000293:injuries / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D053441:Suture Anchors; D013536:Suture Techniques; D013710:Tendons / Q000637:transplantation*; D055815:Young Adult