July 08, 2016
2 min read
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Triple-bundle reconstruction to offer advantages for acromioclavicular joint instability

Patients who underwent triple-bundle reconstruction for ACJ instability had superior horizontal ACJ stability than those undergoing a single-bundle procedure.

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Recently published results showed superior clinical and radiological results with combined arthroscopically assisted anatomic triple-bundle coracoclavicular and acromioclavicular ligament reconstruction using an autologous semi-tendinosus tendon graft in patients with chronic high-grade acromioclavicular joint instability vs. patients who underwent single-bundle reconstruction.

“In symptomatic chronic [acromioclavicular joint] ACJ instabilities, a triple-bundle reconstruction respecting the conoid and trapezoideum ligaments, as well as the acromioclavicular ligaments using an autologous tendon graft, provides reliable clinical and radiologic results,” Mark Tauber, MD, associate professor of shoulder and elbow surgery at ATOS Clinic Munich, Germany, told Orthopedics Today. “The anatomic approach restoring the acromioclavicular ligaments as well leads to superior ACJ stability, especially in terms of horizontal stability.”

Triple-bundle vs single-bundle

Mark Tauber, MD
Mark Tauber

Tauber and his colleagues identified 26 patients with chronic high-grade ACJ instability who underwent ACJ stabilization using autologous hamstring grafts. Of these patients, 12 underwent combined anatomic triple-bundle coracoclavicular and acromioclavicular reconstruction using a semitendinosus tendon with clavicular interference screw fixation and14 underwent isolated single-bundle coracoclavicular reconstruction using the AC GraftRope system (Arthrex Inc.) with a gracilis tendon.

Results showed an increase in mean Constant score from 71.6 preoperatively to 88.8 postoperatively in the triple-bundle group and 67.8 to 82.6 in the single-bundle group. The triple-bundle and single-bundle groups had significantly different mean Taft (10.9 vs. 9) and mean acromioclavicular joint instability scores (84.7 vs. 58.4). Regarding the mean coracoclavicular distance, significant radiological differences were observed between groups. Results showed superior horizontal ACJ stability in the triple-bundle group, which was associated with better clinical outcomes, while the single-bundle group had a higher recurrence of ACJ instability.

“Surgical stabilization of a chronic ACJ instability requires addressing both coracoclavicular and acromioclavicular ligaments,” Tauber said. “Single-bundle techniques aiming on isolated coracoclavicular ligament reconstruction show inferior results when evaluated using AC joint-specific scores. Considering a restrained postoperative rehabilitation protocol, sufficient joint stability restoration is possible in most cases with satisfied patients and a very low complication rate.”

New findings

According to Tauber, this study showed distal clavicle resection did not need to be carried out for treatment of chronic ACJ instability, a new finding.

“Until now, [distal clavicle resection] represented a routinely performed step in chronic ACJ stabilization procedures,” he said. “However, no adverse effects seem to be associated with preservation of the distal clavicle end. In contrast, biomechanical findings are confirmed by our study showing ACJ stability is even higher, especially in the horizontal plane.”

“Our focus will remain on the horizontal component of ACJ instability, which is the key to a successful treatment of this pathology,” Tauber said. – by Casey Tingle

Disclosure: Tauber reports he is a paid consultant for Arthrex.