The Journal of Bone and Joint Surgery (American). 2008;90:299-308.
doi:10.2106/JBJS.H.00438
© 2008 The Journal of Bone and Joint Surgery, Inc.
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Proximally Based Conjoined Tendon Transfer for Coracoclavicular Reconstruction in the Treatment of Acromioclavicular Dislocation

Surgical Technique

Chunyan Jiang, MD, PhD1, Manyi Wang, MD1 and Guowei Rong, MD1

1 Shoulder Service, Department of Orthopedics, Beijing Ji Shui Tan Hospital, School of Medicine, Peking University, No. 31 Xinjiekoudongie, 100035 Beijing, People's Republic of China. E-mail address for C. Jiang: chunyanj{at}hotmail.com

Investigation performed at the Shoulder Service, Department of Orthopedics, Beijing Ji Shui Tan Hospital, School of Medicine, Peking University, Beijing, People's Republic of China

The original scientific article in which the surgical technique was presented was published in JBJS Vol. 89-A, pp. 2408-12, November 2007

DISCLOSURE: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

NOTE: The authors thank Dr. Zhu Yiming, MD, for his help in preparing the figures.

The line drawing in Figure 1 in this article is the work of Joanne Haderer Müller of Haderer & Müller (biomedart{at}haderermuller.com).

BACKGROUND: We report an alternative to the modified Weaver-Dunn technique that can achieve stable coracoclavicular reconstruction while avoiding sacrifice of the coracoacromial arch. The purpose of this study was to retrospectively analyze the functional outcomes and radiographic features of patients treated with coracoclavicular ligament reconstruction with use of a proximally based conjoined tendon transfer.

METHODS: The cases of thirty-eight patients with type-IV, type-V, and selected type-III acromioclavicular dislocations according to the Rockwood classification system, who were followed for an average follow-up of 38.7 months, were evaluated retrospectively. Transfer of the lateral half of the conjoined tendon to the distal aspect of the clavicle in a proximally based fashion, with additional coracoclavicular fixation, was performed in all patients. At the latest follow-up evaluation, radiographic analysis and the scores on the American Shoulder and Elbow Surgeons, Constant and Murley, and Simple Shoulder Test questionnaires were used to provide a final evaluation of shoulder function. The ability to return to work and the ability to return to sports were also recorded.

RESULTS: At the time of final follow-up, the mean American Shoulder and Elbow Surgeons score was 91.4, with a mean pain score on the visual analog scale of 1.8, mean forward flexion of 148.2°, and mean external rotation of 38.0°. The mean Constant and Murley score was 90.6. The new number of positive answers on the Simple Shoulder Test was 10.9. The overall rate of satisfaction (an excellent or good result) was 89% (thirty-four patients). Thirty-five (92%) of the thirty-eight patients returned to their previous work, and thirty-two (84%) returned to their preinjury level of sports.

CONCLUSIONS: The proximally based conjoined tendon transfer is a reliable treatment for a high-grade acromioclavicular dislocation. The lateral half of the conjoined tendon is a safe graft source with ample length, and this technique avoids sacrifice of the coracoacromial ligament.

LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

ORIGINAL ABSTRACT CITATION: "Proximally Based Conjoined Tendon Transfer for Coracoclavicular Reconstruction in the Treatment of Acromioclavicular Dislocation" (2007;89:2408-12).


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