Acromioclavicular Joint Dislocation Repair Using Double Endobutton Technique: Analysis of Functional Outcome

Abstract

Introduction: Many procedures have been described for the operative management of acromioclavicular (AC) joint injuries. Some of these techniques, including hardware fixation and non-anatomical reconstructions, are associated with some serious complications and high failure rates. Recently, AC joint reconstruction techniques have focused more on anatomical restoration of the coracoclavicular ligaments to achieve optimal clinical outcomes. In our study, we have used a Double Endobutton technique to separately reconstruct the trapezoid and the coronoid portions of the coracoclavicular ligament. The purpose of this study was to evaluate the preliminary clinical and radiological results of this technique in patients with acute complete dislocation of the AC joint. Methods: This was a prospective study conducted in Government Medical College, Kota during the period between December 2020 to December 2022, a total of 20 cases of complete Acromioclavicular Joint injuries(Rockwood type III-V) treated by reconstruction of coracoclavicular ligaments using Double Endobutton , Mersilene tape and # 5 Ethibond. We had 9 cases of Rockwood type 5, 6 cases of type 4, 5 cases of type 3. We had 6 right sided cases and 14 left sided cases. All injuries opened with vertical strap incision followed by reduction of AC joint and reconstruction done with this double endobutton technique. Results: Outcome was measured based on DASH questionnaire and Constant score at intervals of 6 weeks, 12 weeks and 24 weeks . Radiological assessment was done at intervals of 6weeks , 12 weeks and 24 weeks with x-ray shoulder Zanca view and x-ray both shoulder AP stress view. Post operative complications were noted .At the last follow-up, 18 patients had an excellent outcome as assessed by Constant score, DASH and Quick DASH scores. One patient had good outcome while one patient had fair outcome. The mean scores at the last follow-up were: Constant score was 96 (range 80 -100), DASH score was 5.3 (range 1-11). Conclusion: In our series double Endobutton technique has good results of functional outcome and pain free shoulder movements at a mean follow-up interval of 12 months (range, 8–14 months). Excellent reduction of the AC joint was maintained. The Double Endobutton technique is a safe and effective for the treatment of complete AC joint dislocations.