Conjoint tendon transfer: Tenodesis for coracoclavicular ligaments reconstruction in acute high grade acromioclavicular dislocation

Abstract

Poor long-term outcomes after Dewar and Barington technique (1965) in the treatment of acromioclavicular joint (ACJ) dislocation were reported. Its modification by conjoint tendon transfer - tenodesis may yield stable and anatomic reduction.The purpose of this study is to evaluate the clinical and radiological results of patients with acute high-grade acromioclavicular joint (ACJ) dislocation treated with conjoint tendon transfer - tenodesis. Thirty-two patients were operated in the period between March 2012 and June 2015 and could be recruited and evaluated at the final follow-up. Preoperative documentation of coracoclavicular distance, VAS (visual analogue scale) for pain, ASES (American Shoulder and Elbow Surgeons) score and Constant score was done. Reconstruction was performed using conjoint tendon transfer - tenodesis. Statistical analysis was done using the statistical package for social science (SPSS) program version 20.0. At a median follow-up of 34.4 (range 24.3-60.2) months after the procedure, the coracoclavicular distance decreased significantly from a mean of 21.5 mm preoperatively to a mean of 11.5 mm postoperatively (P < 0.001). The VAS for pain improved significantly from an average of 8.5 points preoperatively to 1.2 at the last follow-up (P < 0.001). Constant score and ASES score improved significantly from 70.69 and 65 preoperatively to 95.25 and 96.4 respectively at the last follow-up (P < 0.001). A deep infection affected one patient. The study concluded that, coracoclavicular ligaments reconstruction by conjoint tendon transfer - tenodesis technique achieves excellent results and could be considered a valid surgical option of management in acute high grade acromioclavicular dislocations.