Revision of failed Acromioclavicular Joint Reconstruction Surgery - Outcomes

OUTCOME OF REVISION ACROMIO-CLAVICULAR JOINT RECONSTRUCTION USING ANATOMICAL MODIFIED LARS LIGAMENT TECHNIQUE 

A Desai, P Robinson, J Phadnis, L Funk 

Aim: 

Revision surgery for Acromio-clavicular joint (ACJ) dislocation can be challenging. We evaluated the results a modified surgical technique using LARS ligament (Corin, UK) for ACJ stabilization aiming at anatomic coraco-clavicular and acromio-clavicular reconstruction in the revision scenario. 

Methods: 

We reviewed twenty three patients who underwent revision ACJ reconstruction, for failed primary fixation, between 2008 to 2015. The average age was 32 years (range: 20-57), with 18 male and 5 females. All patients with failed ACJ reconstructions were included, with 6 patients having had more than two prior reconstructions. Nine patients were professional athletes involved in contact sports. ACJ reconstruction was performed using the LARS ligament with modifications of the manufacturer’s technique to include an additional figure of eight pass around the coracoid and repair of the ACJ ligaments. Where the ACJ ligaments were irreparable or poor quality, then the LARS ligament was passed over the clavicle, through acromion and back under the coracoid. An additional biceps aponeurosis ‘flip’ and/or reverse Coraco-Acromial Ligament transfer was added for biological purposes for the coraco-clavicular and ACJ reconstructions respectively. The mean follow -up period was 36.63 months (12-48 months). 

Results: 

At final follow up the average Constant score was 85.2 points. Six patients had both pre- (mean 51.83) and post- operative (mean 79.17) Constant scores with statistically significant improvement after surgery (p=0.0107). Twenty patients (90%) had no evidence of radiological subluxation at the final follow up. Mean patient satisfaction was 82%. Complications included 3 superficial infections and one temporary suprascapular nerve entrapment requiring removal of the ligament. None of the patients underwent further stabilization surgery. 

Conclusion: 

Our modified technique of ACJ reconstruction using LARS ligament replicating anatomic ligamentous properties and providing stable construct has successful results in challenging revision cases.