Additional acromioclavicular cerclage limits lateral tilt of the scapula in patients with arthroscopically assisted coracoclavicular ligament reconstruction.

Introduction: The current treatment for acromioclavicular (AC) dislocation lacks a gold standard and previous literature concludes that coracoclavicular (CC) fixation with additional AC cerclage fixation adds stability and is a useful adjunct to augment these repairs.

Aim: The purpose of this study was to investigate the clinical and radiological value of an additional AC cerclage. It was hypothesised that an additional AC cerclage would show better clinical results. We further expected the additional AC cerclage to result in lower radiological loss of reduction compared to the technique relying on CC-fixation only.

Methods: A total of 30 male patients with acute (less than 3 weeks) AC-dislocations Rockwood grade IV and V from 2013 to 2014 underwent arthroscopic bi-cortical CC-ligament reconstruction. Patients were assigned to a surgeon depending on the day of clinical presentation. One surgeon used only bi-cortical CC-ligament reconstruction (no-PDS group); the other surgeons used an additional PDS cerclage with an 8-loop configuration over the AC joint (PDS group). Clinical data (Constant Shoulder Score, ASES Score, DASH Score, VAS pain) were assessed 24 months post-operatively, and AP shoulder radiographs used to measure the AC and CC distances.

Results: No significant differences in the Constant (Z = - 0.498, p = 0.624), ASES (Z = 0.263, p = 0.806) and DASH (Z = 1.097, p = 0.305) score as well as VAS pain (Z = 0.498, p = 0.624) were seen for both groups. Factorial ANOVA showed a significant effect of "time" [F(1,28) = 17.54, p < 0.001, r = 0.62], reflecting a significant radiological increase of AC distances over time for both groups. Comparing CC and CC + AC groups, the effect of "OP technique" was significant [F(1,28) = 4.67, p = 0.039, r = 0.38], with AC distances obtained in the PDS group being statistically lower than in the No-PDS group, whereas CC distances did not significantly increase in both groups [F(1,28) = 0.07, p = 0.791]. "Time × OP technique" interaction effects were non-significant [F(1,28) = 0.38, p = 0.545], which reflects similar changes in AC distances over time in both groups. For the CC distances, neither main nor interaction effects were significant (all p > 0.05).

Conclusion: Both the isolated CC reconstruction and the CC reconstruction with an additional AC cerclage showed good clinical results at 2 years' follow-up. AC distances increased in both groups from the post-surgery measurement to the 2-year follow-up, but were generally lower with an additional AC cerclage. CC distances did not increase significantly over time in both groups. Therefore, the presented data suggest adding a fixation of the AC joint.