Chronic Acromioclavicular Joint Instability: Outcomes after Stabilization without Tendon Graft Augmentation

Chronic acromioclavicular joint (ACJ) instability only rarely causes significant symptoms. In the uncommon cases with substantial pain and impairment, surgical treatment may become necessary. Many surgeons recommend tendon-graft augmentation to reconstruct the coracoclavicular (CC) ligaments. However, it remains unclear whether graft use is mandatory in all chronic cases. This study evaluates clinical and radiographic outcomes after open reduction and stabilization of chronic ACJ dislocations without grafting.

Sixteen consecutive patients with chronic, symptomatic ACJ instability who had initially been managed non-operatively underwent delayed surgical stabilization without tendon-graft augmentation. After diagnostic arthroscopy, CC stabilization was performed using a cortical button construct (modified open MINAR® technique). Temporary acromioclavicular (AC) transfixation with two K-wires was added to ensure anatomical reduction, to assist in horizontal stability, and to protect the CC construct during early healing. Thirteen patients were available for clinical and radiographic follow-up. Outcomes included the subjective shoulder value (SSV), ACJ Instability Score (ACJIS), and Taft score, as well as radiographic assessment of vertical and horizontal alignment.

The mean interval between injury and surgery was 46.5 weeks (range 8-130 weeks). At a mean follow-up of 51 months, mean SSV was 87 %, mean ACJIS was 85.5 points, and mean Taft score was 11.1 points. No complications or revision procedures occurred. Some residual vertical or horizontal radiographic displacement was common but did not correlate with inferior clinical outcome.

Open reduction and stabilization of chronic ACJ dislocations without tendon graft results in favorable mid-term outcomes comparable to those reported for graft-augmented techniques. Tendon-graft augmentation may not be mandatory in chronic cases, and graft-free reconstruction represents a reasonable option. We believe that adequate preparation of the CC space, anatomic reduction, and rigid fixation are key prerequisites.