Acta Orthopaedica et Traumatologica Turcica
Research Articles

Combined coracoclavicular ligament and transacromial capsule reconstruction for chronic acromioclavicular joint instability: clinical and radiological outcomes

1.

Department of Orthopedics and Traumatology, Dokuz Eylul University Faculty of Medicine, İzmir, Türkiye

2.

Department of Physiotherapy and Rehabilitation, İzmir Demokrasi University Faculty of Health Sciences, İzmir, Türkiye

AOTT 2025; 59: 170-178
DOI: 10.5152/j.aott.2025.25330
Read: 204 Downloads: 121 Published: 28 May 2025

Objective: Acromioclavicular (AC) joint instability remains a challenging clinical problem, particularly in chronic cases where both vertical and horizontal stability must be restored. Traditional techniques have limitations in addressing multidirectional instability and minimizing implant-related complications. The aim of this study was to evaluate the clinical and radiological outcomes of a combined coracoclavicular (CC) ligament and transacromial capsule reconstruction technique in patients with chronic AC joint instability.

Methods: A retrospective study was performed on 40 patients who underwent AC joint reconstruction at a single center from 2019 to 2023. Radiological outcomes (clavicle-coracoid distance) were evaluated preoperatively, immediately postoperatively, and at the last follow-up (6 months). Functional results were assessed using the Constant, American Shoulder and Elbow Surgeons score (ASES), and Disabilities of the Arm, Shoulder, and Hand (DASH) score. Data were analyzed using SPSS v28.0. T-tests and repeated measures of Analysis of Variance (ANOVA) were employed to compare outcomes, with significance set at P < .05.

Results: The preoperative mean CC distance was 20.3 ± 3.4 mm. Early postoperative measurements showed a significant reduction in CC distance, with a mean of 9.5 ± 1.5 mm in the capsule reconstruction group compared to 10.5 ± 1.6 mm in the non-reconstruction group (P=.053). At the 6-month follow-up, the late postoperative CC distance was maintained at 10.1 ± 1.6 mm in the reconstruction group, while it increased to 14.4 ± 2.0 mm in the non-reconstruction group (P < .001). The mean ASES score was 87.1 ± 8.1. The mean Constant score was 86.2 ± 7.6. Pain levels, evaluated using the Visual Analog Scale (VAS), decreased from a mean of 5.8 ± 1.2 preoperatively to 2.1 ± 1.0 postoperatively, indicating significant pain relief and improved functionality. No hardware failure or infection was noted. About 12.5% of patients experienced short-term anterior knee pain.

Conclusion: The results of this study demonstrate that combined CC ligament and transacromial capsule reconstruction improves radiographic outcomes by maintaining the clavicle-coracoid distance and enhances functional scores (ASES and Constant) in patients with chronic AC joint instability. Addressing both vertical and horizontal instability appears to contribute to better short-term clinical recovery. Further studies with larger sample sizes and longer follow-up are needed to confirm these findings.

Level of evidence: Level III (Retrospective Comparative Study).

Cite this article as: Bascı O, Duymaz B, Erdogdu IN, Ozkan MH. Combined coracoclavicular ligament and transacromial capsule reconstruction for chronic acromioclavicular joint instability: clinical and radiological outcomes. Acta Orthop Traumatol Turc., 2025;59(3):170-178.

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ISSN 1017-995X EISSN 2589-1294