Continuous Loop Double Endobutton Reconstruction for Acromioclavicular Joint Dislocation

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Traumatology

Background:

• Current acromioclavicular (AC) joint reconstruction methods have limitations, including fixation loss and complications.
• These limitations hinder the widespread adoption of existing surgical techniques for AC joint dislocations.

Purpose of the Study:

• To evaluate the long-term clinical and radiologic outcomes of a novel surgical technique for AC joint reconstruction.
• The technique utilizes a closed-loop double Endobutton device for both acute and chronic dislocations.

Main Methods:

• A case series (Level of evidence, 4) involving 35 patients with Rockwood type III or greater AC joint dislocations.
• Surgical reconstruction included AC joint capsule imbrication, deltotrapezial fascia repair, and biological bridging of the coracoclavicular (CC) interval via coracoacromial (CA) ligament transfer or primary CC ligament repair.
• Follow-up data was obtained for 31 patients, with a mean follow-up of 5.2 years.

Main Results:

• The surgical construct demonstrated high stability, with only 1 failure in 31 patients.
• Mean coracoclavicular (CC) interval difference was 1.1 mm, with 87% of patients showing <2 mm difference.
• Excellent functional outcomes were reported: mean Constant score of 98, mean University of California, Los Angeles Shoulder Rating Scale score of 34, and mean American Shoulder and Elbow Surgeons Shoulder Score of 98.
• Follow-up MRI in 10 patients showed dense scar tissue, indicating robust healing. No perioperative complications were reported.

Conclusions:

• The closed-loop double Endobutton technique offers excellent and durable long-term results for AC joint reconstruction.
• This method effectively eliminates the risk of knot slippage or device breakage, ensuring construct integrity.
• The technique yields superior outcomes compared to historical non-surgical results and is recommended for both acute and chronic AC joint dislocations.