A long term functional and radiological outcome assessment study of management of high grade acromioclavicular joint injury

Rajesh Goel, Anand Bhushan, Sandeep Kumar, Mohit Kumar


Background: Acromioclavicular joint dislocation (ACD) of Rockwood types III and above require surgical intervention. We used a unique technique for CC interval fixation using endobutton with two separate small incisions, which did not need dissection through the joint at all. It replaces the anatomical course of conoid and trapezoid part of the CC ligament. The purpose of the present study was to describe an innovative method of fixation and evaluate its functional outcome using subjective as well as objective measures. We aimed to determine whether this fixation method could be an optimal alternative to address this injury.

Methods: A total of 24 patients were enrolled for this prospective longitudinal study. Coraco-clavicular distance was calculated radiologically preoperatively and at the final follow up.  Clinically, the final outcome was assessed using the Shoulder Constant score and visual analogue scale (VAS) for residual pain at the final follow up.

Results: There was no statistically significant difference between the two shoulders and results were considered as an excellent in terms of constant shoulder score. The VAS was 0.42 (0-1) at final follow-up. The coraco-clavicular distance (CC) reduced significantly postoperatively and was comparable to the contralateral side.

Conclusions: Our study results suggested that this is a simple, safe and effective technique which needed minimal dissection.


Acromioclavicular joint, Endobutton, Coracoclavicular ligament

Full Text:



Mazzocca AD, Arciero RA, Bicos J. Evaluation and treatment of acromioclavicular joint injuries. Am J Sports Med. 2007;35:316-29.

Rockwood CJ, Williams G and Young D: Disorders of the acromioclavicular joint. In the Shoulder. 2nd edition. Rockwood CJ, Matsen FA III (eds). Philadelphia: WB Saunders.1998;2:483-553.

Guy DK, Wirth MA, Griffin JL and Rockwood CA Jr: Reconstruction of chronic and complete dislocations of the acromioclavicular joint. Clin Orthop Relat Res.1998;3:138-149.

Nishimi AY, Arbex DS, Martins DLC, Gusmão CVB, Bongiovanni RR, Pascarelli L. Preferred surgical technique used by orthopaedists in acute acromioclavicular dislocation. Acta Orthop Bras. 2016;24(5):249-52.

Zhu NF, Rui BY, Zhang YL, Chen YF. Anatomic study of coracoclavicular ligaments for reconstruction of acromioclavicular joint dislocations. Journal of Orthopaedic Science Official J Japanese Orthop Asso. 2016;5:749-52.

Salzmann GM, Jochen P, Sandmann GH, Imhoff AB, Schöttle PB. The coracoidal insertion of the coracoclavicular ligaments: an anatomic study. Am J Sports Med. 2008;36:2392.

Shin SJ, Campbell S, Scott J. Simultaneous anatomic reconstruction of the acromioclavicular and coracoclavicular ligaments using a single tendon graft. Knee Surgery Sports Traumatology Arthroscopy Official J Esska. 2014;22:2216.

Lyons FA, Rockwood CA Jr. Migration of pins used in operations on the shoulder. J Bone Joint Surg Am. 1990;72(8):1262-7.

Motamedi AR, Blevins FT, Willis MC, McNally TP, Shahinpoor M. Biomechanics of the coracoclavicular ligament complex and augmentations used in its repair and reconstruction. Am J Sports Med. 2000;28(3):380-4.

Johansen JA, Grutter PW, McFarland EG, Petersen SA. Acromioclavicular joint injuries: indications for treatment and treatment options. J Shoulder Elbow Surg. 2011;20(2):S70-82.

Baker JE, Nicandri GT, Young DC, Owen JR, Wayne JS. A cadaveric study examining acromioclavicular joint congruity after different methods of coracoclavicular loop repair. J Shoulder Elbow Surg. 2003;12(6):595-8.

Wolf, E. M. & Pennington, W. T. Arthroscopic reconstruction for acromioclavicular joint dislocation. Arthroscopy t J Arthroscopic and Rel Sur. 2001;7:558-63.

Data citation

copyright transfer