Two-Year Outcomes After Primary Anatomic Coracoclavicular Ligament Reconstruction

Acromioclavicular (AC) joint injuries account for up to 50% of all shoulder injuries, with an overall incidence of 9.2 injuries per 1,000 person-years in young athletes. These injuries most commonly result from a direct blow to the acromion in an adducted shoulder. The AC capsuloligamentous structures initially fail, followed by failure of the coracoclavicular (CC) ligaments when there is sufficient force. The classification of AC joint injuries was described by Rockwood6dgrade I and grade II injuries are typically treated nonoperatively, whereas grade IV, grade V, and grade VI injuries are typically treated operatively. The mode of treatment for grade III injuries is currently controversial; however, many surgeons offer surgery acutely to high-level athletes and manual laborers with grade III injuries in addition to patients whose shoulders become chronically symptomatic.

Transfer of the coracoacromial ligament to the distal clavicle was first performed by Weaver and Dunn in 1972 as a method to restore AC joint stability in patients with AC joint dislocations. The so-called Weaver-Dunn method of AC joint reconstruction has since undergone several modifications because of significant complication rates and poor clinical results. Recently, anatomic coracoclavicular ligament reconstruction (ACCR) with soft-tissue grafts has become a popular method of reconstruction because it yields superior biomechanical strength and stability when compared with the Weaver-Dunn method. In 2006 Mazzocca randomly allocated 42 fresh-frozen cadaveric shoulders into 3 reconstruction groups looking at time-zero load to failure: (1) ACCR with allograft, (2) arthroscopic suture sling, and (3) open modified Weaver-Dunn technique. The open modified Weaver-Dunn reconstruction resulted in significantly increased laxity and anteroposterior translation compared with either the ACCR technique with tendon graft or the arthroscopic suture sling technique. In addition, the ACCR technique afforded improved posterior stability compared with the arthroscopic suture sling technique. ACCR was therefore found to be the most stable of the 3 tested AC reconstruction methods.

It has since been theorized that because ACCR techniques with soft-tissue grafts more closely approximate the native biomechanics of the intact state, these tech- niques may result in improved clinical results and patient satisfaction. The purpose of this study was to report the clinical and structural outcomes after ACCR with free tendon allografts in patients with grade III and grade V AC joint dislocations. We hypothesized that primary ACCR in patients with grade III and grade V AC joint dislocations would provide excellent clinical and structural outcomes after a minimum 2-year follow-up period.

Full Article: Two-Year Outcomes After Primary Anatomic Coracoclavicular Ligament Reconstruction

Peter Millett, MD

Average rating:

39 reviews

Alexandra Thompson

Mar 23, 2024

by Alexandra Thompson on Peter Millett, MD

110%

Dr. Millett and his team did a SLAP tear repair and bicep tenodesis on my left shoulder. I use my arms as an artist, and love to swim in the ocean, surf, paddle, and telemark ski. So regaining full use of my shoulder and keeping my bicep attached was very important to me. Now, over two years later, my shoulder has the equivalent range of motion as my other arm and as before the injury, and no pain. After the first three months it felt so good and was so strong that - to my horror - I completely forgot my six-month follow-up.

Not only did Dr. Millett and his team make my arm as good as new, but having had the experience of such kindness and expertise throughout the process of surgery and recovery is like an added shoulder superpower.

Thank you Rita, Brooke, Jason, Sarah, Camille, Olivia, Dr. Millett and everyone! And see you soon when my husband comes in for his knee...

Jeff Chandler

Jan 31, 2022

by Jeff Chandler on Peter Millett, MD

Flawless procedure, Easy recovery

Dr. Millet's repaired my knee and tibia, following a botched operation by a different surgeon. That procedure was virtually pain free and I was weight bearing within a few days. That was 18 years ago and the knee is still strong. A few years after the knee incident, Dr Millet repaired my shoulder. My insurance company approved me for 3 months of disability following that surgery. I was off pain medication in 2 days and had 90% range of motion within a week. I withdrew my disability claim and returned to work within two weeks of surgery. I’m not a famous athlete—just a regular guy. Nonetheless, I was treated like an NFL at the Steadman clinic. Most notable was the time for recovery. Other surgeons perform their hour-long task in the OR and don’t involve themselves in the other functions. Peter and his team manages the entire process from diagnosis, anesthesia, nursing care, and therapy. He takes a holistic approach to patient care and doesn’t skip any steps.

Jenn West

Jul 2, 2021

by Jenn West on Peter Millett, MD

Saved My Life

I went to Dr. Millett after 7 knee surgeries (6 on my right and 1 on my left) and had seen 11 different surgeons who all refused to remove femur metal from my right leg. I am highly allergic to metal and the chronic pain was leaving me bedridden for 3.5wks out of a month. He personally wrote me back on my inquiry, listened to my concerns, scheduled my surgery within a week (due to insurance issues) and personally followed up with my recovery. The level of patient care from Dr. Millett and his ENTIRE team is above any care I have ever received in my 20 years of dealing with orthopedic surgeons. There are not enough words to describe the level of care, dedication and professionalism you receive from Dr. Millett and his staff.
My only disappointment is that I did not find him sooner!!!

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Two-Year Outcomes After Primary Anatomic Coracoclavicular Ligament Reconstruction

About the Author: Peter Millett, MD