Abstract: Introduction: Approximately 12% of all acute shoulder injuries affect the acromioclavicular joint. Grade I–II injuries are treated conservatively, without surgery, leading to satisfactory results and a return to sporting activity in most cases. The treatment of grade III injuries is controversial. However, surgical treatment is recommended for high grade 4 to 6. Appreciation of anatomical structures that provide the acromioclavicular joints stability is vital for successful and sustainable treatment.
Method and Material: 11 patients (8 males and 3 females) who had high grade acromioclavicular joint injury were operated from July 2019 to January 2020. All patients were assessed clinically, radiologically and classified according to rockwood classification. Patients were selected on basis of inclusion and exclusion criteria. Coracoclavicular Ligament reconstruction was done using ethibond 5.
Post-operative rehabilitation: Post operatively arm sling was given for 6 weeks. Passive range of motion started with pendulum exercise, towel slides, internal and external rotation, scapula protraction, retraction followed by active range of motion wall slides with trunk, bilateral and unilateral pull with trunk rotations, deltotrapezial complex work. Patient returned to his routine work after six month.
Results: All the patients were followed up clinically and radiologically. The mean constant score increased from 51.09 preoperatively to 83.81 postoperatively at followup. All the patients had resumed their activity by 6 months postoperatively. No loss of reduction and no complication was observed at follow-up.
Discussion: Currently, the 4 main surgical options for AC joint disruptions are (1) AC joint fixation with pins, screws, suture wires, plates, and hook plates, (2) coracoacromial (CA) ligament transfer, (3) C Cinterval fixation, and (4) ligament reconstruction. CC interval fixation has been described with screw fixation, suture loop fixation, end button fixation (flip buttons), and suture anchors. Our study reviewed 11 patients (8 males and 3 females) with a complete CC ligament disruption who were each treated with two #5 Ethibond sutures placed through drill holes in the clavicle and looped around the coracoid process. This technique offerded good functional outcomes and no loss of reduction at a minimum follow up of 10 months (average, 11.5 months). At 12 months after surgery, mean constant murley score is 83.5.
Conclusion: Techniques that anatomically restore the AC joint and coracoclavicular ligaments have shown to be superior in biomechanical studies. we conclude that high grade acromioclavicular joint injury require surgical fixation for better functional outcome.
