This article is more than 5 years old. Information may no longer be current.

Surgical treatment for AC joint separation evolving from Weaver Dunn to coracoclavicular ligament reconstruction

Issue: March 2011

Add topic to email alerts

Receive an email when new articles are posted on

Please provide your email address to receive an email when new articles are posted on .

Subscribe

Added to email alerts

You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

Back to Healio

We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com.

Back to Healio

Popularity of the Weaver Dunn technique is diminishing as surgeons opt for more anatomic reconstruction of acromioclavicular joint separation with coracoclavicular ligament reconstruction, according to a surgeon at Columbia University who presented his technique at Orthopedics Today Hawaii 2011.

Results with the Weaver Dunn technique, which involves transfer of the coracoacromial (CA) ligament to the end of the clavicle, have shown initial encouraging satisfaction rates and a return to sports but poor anatomical outcomes, according to Christopher S. Ahmad, MD, associate professor of orthopedic surgery. In a 1995 study out of Columbia University, Weinstein and colleagues found 24% of patients experienced a loss of reduction with the Weaver Dunn technique.

“Here is the reason: The CA ligament is not that strong; it’s only 20% of the coracoclavicular (CC) ligaments and the CA ligament transfer does not recreate the anatomical position of the CC ligaments,” Ahmad told Orthopedics Today.

In the literature

Jones and colleagues, in the American Journal of Sports Medicine in 2001, presented the first CC ligament reconstruction, performed to revise a failed surgery and incorporated through a drill hole in the clavicle. Mazzocca and colleagues introduced another technique for CC ligament reconstruction in 2004. Their technique involved going around the coracoid or drilling and fixing into the coracoid and the use of two graft limbs, so both ligaments are reconstructed, Ahmad said.

“[Mazzocca and colleagues] took this to the laboratory and showed that … in a Weaver Dunn, there’s more displacement with the cyclic loading … and the ligament reconstruction behaves much more favorably,” Ahmad said.

Technique

Ahmad begins his CC ligament reconstruction with an open incision for adequate exposure while the patient is in the beach chair position. He said he is able to access the coracoid by reflecting the deltoid anteriorly.

Next, Ahmad designs his tunnels for the coracoid and the trapezoid. He typically uses a 6-mm reamer passed over a guide pin for both tunnels to get protection inferiorly. He creates the coracoid tunnel starting 45 mm from the end of the clavicle and the trapezoid tunnel starting 30 mm from the end of the clavicle to ensure an adequate bone bridge between the two tunnels to avoid a fracture.

In the specific case presented, Ahmad used an autogenous semitendinosus graft, but allograft is also an option to reduce morbidity. He passed it around the coracoid and placed a number 2 suture around it, allowing him to more easily pass the graft. He also uses a number 5 suture around the coracoid to augment it. To obtain graft fixation within the two tunnels, in this first case, Ahmad said he used a 5.5 mm × 15 mm nonbioabsorbable screw, but new shorter screws that measure 5.5 mm × 8 mm, which is more consistent with the anatomy, are now available.

Ahmad reduces the clavicle by pushing the humerus up and the clavicle down, fixing on both sides with screws, and then passing the suture that went around the clavicle through the cannulation of the screws.

“Then you can tie that suture so you get a little bit of augmentation, and it’s not going to cut through the bone because it is through the cannulation of the screws,” Ahmad said.

He added: “Part of the goals of AC separation surgery is to minimize and avoid complications, and great attention should be paid to the indications for surgery with the surgical technique that is chosen … to minimize and avoid complications. – by Tina DiMarcantonio

Reference:

• Ahmad CS. AC joint reconstruction — Weaver Dunn Is History. Presented at the Orthopedics Today Hawaii 2011. Jan. 16-19, 2011. Koloa, Hawaii.

• Christopher S. Ahmad, MD, can be reached at the Center for Shoulder, Elbow and Sports Medicine, Columbia University, 622 W. 168th St., New York, NY 10032; (212) 305-5561; e-mail: csa4@columbia.edu.
• Disclosure: Ahmad receives basic science support from Arthrex, Arthrotek and Smith-Nephew and is a consultant for Arthrex and Acumed.