Risk factors for coracoclavicular reconstruction failure: a systematic review

Area of Science:

• Orthopedic surgery
• Sports medicine
• Biomechanics

Background:

• Acromioclavicular (AC) joint injuries often require coracoclavicular (CC) ligament reconstruction.
• Various surgical techniques and fixation methods exist for CC reconstruction.
• Understanding risk factors for CC reconstruction failure is critical for improving patient outcomes.

Purpose of the Study:

• To identify risk factors associated with coracoclavicular (CC) ligament reconstruction failure.
• To analyze failure causes irrespective of the specific fixation method employed.

Main Methods:

• A systematic review was conducted following PRISMA guidelines.
• Searched Medline, Embase, and Cochrane databases up to November 2024.
• Included studies quantifying risk factors for CC reconstruction failure.

Main Results:

• Analyzed 7 studies with 781 CC reconstructions; overall failure rate was 19.1%.
• Clavicle tunnel malposition (medial or lateral) was the most cited risk factor.
• Other significant risk factors included osteoporosis, patient age >40, delayed surgery (>6 weeks), osteolysis, and early weight-bearing.

Conclusions:

• Conoid and trapezoid tunnel malposition significantly increases CC reconstruction failure risk.
• Patient factors like age, osteoporosis, and osteolysis are important considerations.
• Surgical timing and post-operative weight-bearing protocols influence success rates.