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Acromioclavicular joint augmentation at the time of coracoclavicular ligament reconstruction fails to improve functional outcomes despite significantly improved horizontal stability

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Acromioclavicular joint reconstruction is a well-established and frequently performed procedure. Recent scientific and commercial interest has led to a drive to develop and perform surgical techniques that more reliably restore horizontal stability in order to improve patient outcomes. The aim of this systematic review was to evaluate the biomechanical evidence for procedures directed at restoring horizontal stability and determine whether they are associated with superior clinical results when compared to well-established procedures.

Methods

A review of the online databases Medline and EMBASE was conducted in accordance with the PRISMA guidelines on the 23rd December 2017. Biomechanical and clinical studies reporting either static or dynamic horizontal displacement following acromioclavicular joint reconstruction (Coracoclavicular reconstruction or Weaver-Dunn) were included. In addition, biomechanical and clinical studies reporting outcomes after additional augmentation of the acromioclavicular joint were included. The studies were appraised using the Methodological index for non-randomised studies tool.

Results

The search strategy identified 18 studies eligible for inclusion: six biomechanical and 12 clinical studies. Comparative biomechanical studies demonstrated that acromioclavicular augmentation provided significantly increased horizontal stability compared to the coracoclavicular reconstruction and Weaver–Dunn procedure. Comparative clinical studies demonstrated no significant differences between coracoclavicular reconstruction with and without acromioclavicular augmentation in terms of functional outcomes (American Shoulder and Elbow Surgeon and Constant score), complication or revision rates. However, one comparative study did demonstrate an improvement in Taft (p = 0.018) and Acromioclavicular Joint Instability scores (p = 0.0001) after acromioclavicular augmentation.

Conclusion

In conclusion, coracoclavicular reconstruction with augmentation of the acromioclavicular joint has been shown to provide improved horizontal stability in both biomechanical and clinical studies compared to isolated coracoclavicular reconstruction. However, comparative studies have shown no clinical advantage with respect to American Shoulder and Elbow Surgeon or Constant scores and, therefore, the results of this systematic review do not support acromioclavicular augmentation in routine clinical practice.

Level of evidence

IV.

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Authors and Affiliations

  1. University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK

    Robert W. Jordan

  2. Royal Orthopaedic Hospital, Birmingham, UK

    Shahbaz Malik

  3. University Hospital North Midlands, Stafford, UK

    Kieran Bentick

  4. Medical Technologies and Advanced Materials, Clifton Campus, Nottingham Trent University, Nottingham, NG11 8NS, UK

    Adnan Saithna

  5. Consultant Orthopaedic Surgeon, Renacres Hospital, Ormskirk, Lancashire, L39 8SE, UK

    Adnan Saithna

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  1. Robert W. Jordan
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Correspondence to Robert W. Jordan.

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Jordan, R.W., Malik, S., Bentick, K. et al. Acromioclavicular joint augmentation at the time of coracoclavicular ligament reconstruction fails to improve functional outcomes despite significantly improved horizontal stability. Knee Surg Sports Traumatol Arthrosc 27, 3747–3763 (2019). https://doi.org/10.1007/s00167-018-5152-7

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