Arthroscopically assisted 2-bundle anatomical reduction of acute acromioclavicular joint separations

To achieve reduction of an acute acromioclavicular (AC) joint separation, novel procedures aim to provide stability and function by restoring the coracoclavicular anatomy.

Anatomical reconstruction for acute AC joint disruption using 2 flip-button devices results in satisfactory clinical function and provides a stable fixation.

Case series; Level of evidence, 4.

The outcome of 23 consecutive patients (21 men, 2 women; mean age, 37.5 +/- 10.2 years; range, 21-59 years) who underwent anatomical reduction for an acute AC joint dislocation using 2 flip-button devices, each separately replacing 1 coracoclavicular ligament, was evaluated clinically and radiographically preoperatively and 6, 12, and 24 months postoperatively. The evaluation included a visual analog scale for pain, the Constant score, the simple shoulder test, and the Short Form-36. An additional 7 patients had similar surgery during the same period, but 4 were lost to follow-up, 2 required surgical revision, and 1 developed postoperative infection.

There were 3 Rockwood type III, 3 type IV, and 17 type V separations. Mean follow-up was 30.6 +/- 5.4 months (range, 24-40 months). The visual analog scale and Constant score showed significant improvements from preoperative 4.5 +/- 1.9 (range, 1-7) and 34.3 +/- 6.9 (range, 22-44) to postoperative 0.25 +/- 0.5 (range, 0-1) and 94.3 +/- 3.2 (range, 88-98) at 24 months, respectively. Postoperative radiographic AC joint alignment was unsatisfactory in 8 cases, either in the coronal, axillary, or both planes, with no different clinical outcome when compared with the remaining patients.

Immediate anatomical reduction of an acute AC separation with flip-button devices provides satisfactory clinical results at intermediate-term follow-up. This technique should be performed by an experienced arthroscopist; tunnel and button placement are of utmost importance to avoid postoperative failure or loss of reduction.