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

Area of Science:

• Orthopedic surgery
• Sports medicine
• Shoulder reconstruction

Background:

• Chronic acromioclavicular joint (ACJ) instability can cause significant pain and impairment, necessitating surgical intervention.
• Tendon-graft augmentation is commonly recommended for coracoclavicular (CC) ligament reconstruction in these cases.
• The necessity of graft use in all chronic ACJ instability cases remains debated.

Purpose of the Study:

• To evaluate the clinical and radiographic outcomes of open reduction and stabilization for chronic ACJ dislocations without using tendon grafts.
• To determine if graft-free reconstruction is a viable alternative to graft-augmented techniques.

Main Methods:

• A cohort of 16 patients with chronic, symptomatic ACJ instability underwent delayed surgical stabilization without tendon grafts.
• The modified open MINAR® technique with a cortical button construct was employed for CC stabilization.
• Temporary K-wire transfixation of the AC joint was used to ensure anatomical reduction and stability.

Main Results:

• At a mean follow-up of 51 months, patients showed favorable outcomes with a mean Subjective Shoulder Value (SSV) of 87%, ACJ Instability Score (ACJIS) of 85.5, and Taft score of 11.1.
• No complications or revision surgeries were reported.
• While some residual radiographic displacement was observed, it did not negatively impact clinical outcomes.

Conclusions:

• Open reduction and stabilization without tendon grafts provide favorable mid-term results for chronic ACJ dislocations, comparable to graft-augmented methods.
• Tendon-graft augmentation may not be essential for all chronic ACJ instability cases.
• Successful graft-free reconstruction relies on adequate CC space preparation, anatomic reduction, and rigid fixation.