ORIGINAL STUDY Acromioclavicular joint reconstruction using the ...

170 R. BHATTACHARYA, L. GOODCHILD, A. RANGANTable I. — Postoperative scoresMean Standard RangedeviationPost-op Constant score 83.1 12 61-100Post-op Imatani score 81.2 19.4 51-98Post-op Walsh scores 14.1 4.3 8-20Constant score : 0 to 100. Normal is 100.Imatani score : 0 to 100. Normal is 100.Walsh score : 0 to 20. Normal is 20.Fig. 6. — Pre-operative and post-operative x-raysreasonably well in all three scoring systems(table II). There was a rupture of the central portionof the ligament in one patient after 6 months andthis had to be revised with a clavicular hook plate,hence this patient’s follow-up was considered onlytill 6 months. All the patients in the above studyhad been treated with the unmodified ligament butonly one had the ligament rupture. Followingdetailed analysis of this retrieved ligament, theprosthesis has since been reinforced and strengthenedin the central portion.DISCUSSIONSurgery for A-C joint separation has remained adebated issue over the years. When surgical treatmentis indicated, there are a variety of operationsto choose from that have varying degrees of successreported in the literature (3).The Weaver-Dunn procedure, where the coracoacromialligament is detached from its acromialinsertion and reattached within the intramedullarycavity of the clavicle has gained considerable popularity.Other methods of A-C joint fixation usingthe coraco-acromial ligament have also been proposed(4,6,11,13,20,25). More recently, the importanceof preserving the subacromial arch andspecifically the coraco-acromial ligament has beenstressed (12,14). Biomechanical studies have shownthat release of the coraco-acromial ligament canlead to increased glenohumeral joint translationand laxity (14) while phylomorphic analyses havestressed the role of the coraco-acromial ligamentto provide increased mechanical stability of theshoulder (12). The coraco-acromial ligament alsoacts as a buffer between the acromion and therotator cuff and this buffering action is lost incoraco-acromial ligament transection (19). Anadvantage of the Surgilig is the sparing of thecoraco-acromial arch. Besides, occasionally, patientspresent with failed Weaver-Dunn procedures or arepeat A-C joint disruption after other types ofprevious stabilisation with the coraco-acromialligament. The Nottingham Surgilig would be auseful alternative to consider in these situations.Our series is based mainly on the results of latereconstructions of chronic Rockwood Type 3 A-Cjoint disruption. Although the literature describesvarious forms of surgery in A-C joint disruption,very few papers deal with the results of surgery insymptomatic chronic injuries having late reconstruction(3,4,6,15,25) and even fewer look exclusivelyat grade 3 injuries (25). Most of the papers reporta mixed population of injuries. While some of thesehave a very few chronic cases (24), some fail toreport the results of the chronic group separately(9). Besides the lack of homogeneity in the studyActa Orthopædica Belgica, Vol. 74 - 2 - 2008