Mid- to Long-term Outcomes of Coracoclavicular Ligament Reconstruction for Acromioclavicular Joint Dislocations: A Systematic Review of Studies With Minimum 5-Year Follow-up.
BACKGROUND Favorable short-term outcomes after coracoclavicular (CC) ligament reconstruction for acromioclavicular (AC) joint dislocations have been reported; however, data on longer-term outcomes remain limited. PURPOSE To evaluate clinical and radiographic outcomes after open and arthroscopic CC ligament reconstruction procedures for AC joint dislocations at a minimum 5-year follow-up. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS A systematic review of the PubMed, Embase, and Web of Science databases was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies reporting outcomes after CC ligament reconstruction for AC joint dislocations with a minimum 5-year follow-up were included. The exclusion criteria included Rockwood type 1 and II injuries, nonoperative management, and non-CC ligament reconstruction techniques. Data collected included study and patient characteristics, surgical approach and reconstruction technique, patient-reported outcomes, satisfaction, return to sport, radiographic findings, complications, and reoperations. RESULTS Sixteen studies, including 326 patients (327 shoulders), met the inclusion criteria. The weighted mean age was 37 ± 5.9 years, and 85.3% were men. The weighted mean follow-up was 98 ± 41 months. AC dislocations were acute in 69.2% of cases, involved the dominant arm in 61.5%, and were classified as Rockwood types III, IV, and V in 33%, 16.8%, and 50.2%, respectively. Patients had excellent functional outcome scores irrespective of surgical approach or reconstruction technique, with weighted mean Constant, American Shoulder and Elbow Surgeons, Simple Shoulder Test, Subjective Shoulder Value, and visual analog scale pain scores of 93.1, 93.1, 11.3, 91.6, and 0.6, respectively. Satisfaction and return to preinjury level of sport rates were high, at 93.1% and 87.7%, respectively. Radiographic analysis showed no significant change in CC distance from the initial postoperative period to the final follow-up (P = .354). CC ligament ossification and AC joint arthritic changes were each observed in around 15% of cases. The overall complication, recurrence, and reoperation rates were 11.9%, 5.2%, and 6.1%, respectively. Arthroscopic procedures and suture button fixation utilizing synthetic ligament and suspensory devices were associated with higher rates of recurrence, implant-related complications, and adverse radiographic findings. CONCLUSION CC ligament reconstruction results in excellent functional outcomes irrespective of surgical approach or technique, with high patient satisfaction, high return to pre-injury level of sport, and low rates of recurrence and reoperation at a minimum 5-year follow-up.