Clinical and Radiological Outcomes of Acromio-clavicular Joint Reconstructions with the LARS Ligament
Authors: P Wright & L Funk
References: European Society of Shoulder and Elbow Surgery. Lyon. 2011
Purpose: To assess the clinical and radiological outcome of reconstruction of injuries to the acromioclavicular joint (ACJ) with the LARS ligament.
Methods: Patients who had undergone a LARS ligament reconstruction of the ACJ were identified retrospectively. Clinical outcomes were measured pre- and post-operatively using the Oxford and Constant scoring systems. Patient satisfaction was recorded on a scale of one to ten. Radiographs were reviewed and displacement at the ACJ was measured as a percentage of the ACJ height.
Results: 55 patients were included in the study, with a mean age of 36 years. 8 patients were professional athletes participating in contact sports. According to Rockwoods classification there were 29 type III, 5 type IV and 19 type V injuries. 12 patients were treated within 4 weeks of injury, for those with chronic injuries the mean time to treatment was 7 months. 8 patients were revised for failure of previous ACJ reconstruction. The mean length of follow-up was 15 months (range 2-39).
Postoperatively the mean Oxford score improved from 25 to 43 and the mean Constant score improved from 45 to 93. The mean patient satisfaction score was 90%. The median postoperative residual displacement of the ACJ was 15%. In one patient who did not follow the prescribed rehabilitation protocol the reconstruction failed in the early postoperative period.
Conclusion: Reconstruction of the ACJ using the LARS ligament produces reliable and predictable improvement in pain and function in the short to mid-term following acute or chronic injuries. Radiological outcomes are less predictable but do not preclude a successful clinical result.
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