Clin Orthop Surg.  2019 Mar;11(1):103-111. 10.4055/cios.2019.11.1.103.

Intraoperative and Postoperative Complications after Arthroscopic Coracoclavicular Stabilization

• Lim TK
• Oh WK

• KMID: 2438340
• DOI: http://doi.org/10.4055/cios.2019.11.1.103

Abstract

BACKGROUND
Arthroscopic stabilization of torn coracoclavicular (CC) ligaments gained popularity recently. However, loss of reduction after the operation and complications unique to this technique involving tunnel placement through the distal clavicle and coracoid process are concerns. The purpose of this study was to report intraoperative and early postoperative complications associated with this procedure.
METHODS
This study retrospectively evaluated 18 consecutive patients who had undergone arthroscopic stabilization for torn CC ligaments between 2014 and 2015. The indications for surgery were acute or chronic acromioclavicular dislocation and acute fracture of the distal clavicle, associated with CC ligament disruption. Clinical outcomes were evaluated with the American Shoulder and Elbow Surgeons (ASES) and the University of California, Los Angeles (UCLA) scores. Intra- and postoperative complications and reoperations were investigated.
RESULTS
There were six female and 12 male patients with a mean age of 47 years (range, 22 to 86 years). At a mean follow-up of 17 ± 10 months (range, 10 to 28 months), the mean ASES score was 88.8 ± 19.9 and the mean UCLA score was 30.9 ± 5.2. Intraoperatively, seven complications developed: breach of lateral cortex of the coracoid process in five patients, medial cortex of the coracoid process in one, and anterior cortex of the clavicle in one. Postoperative complications developed in eight patients: four ossifications of the CC interspace, four tunnel widening of the clavicle, one bony erosion on the clavicle, and one superficial infection. A loss of reduction was found in six patients. Reoperation was performed in three patients for loss of reduction in two and superficial infection in the other.
CONCLUSIONS
Arthroscopic CC stabilization resulted in high rates of intraoperative and early postoperative complications. Most of them were related to the surgical technique involving bone tunnel placement in the coracoid process and the clavicle.

Keyword

Coracoclavicular; Ligaments; Acromioclavicular; Dislocation; Arthroscopic

MeSH Terms

California
Clavicle
Dislocations
Elbow
Female
Follow-Up Studies
Humans
Ligaments
Male
Postoperative Complications*
Reoperation
Retrospective Studies
Shoulder
Surgeons

Figure

• 

  Fig. 1 (A) Arthroscopic coracoclavicular stabilization of the left shoulder in a 27-year-old male patient, viewing from posterior portal. A guide pin was drilled in the center and base of the inferior surface in the coracoid process. (B) The tunnel was made with a 4.0-mm cannulated reamer, and a suture was passed for shuttle relay though the reamer. The cortical button and FiberTape sutures were prepared before fixation (C) and properly placed on the subcoracoidal location (D).

• 

  Fig. 2 Preoperative (A) and 24-month postoperative (B) radiographs of a 27-year-old patient with acromioclavicular dislocation of the left shoulder (Rockwood classification, type 5). Preoperative (C) and 6-month postoperative (D) radiographs of a 45-year-old male patient with a distal clavicle fracture of the left shoulder (Neer classification, type IIB).

• 

  Fig. 3 (A) Arthroscopic image of the right shoulder in a 24-year-old female patient, viewing from posterior portal. A drill guide seemed to be placed properly into the base and center of the inferior surface in the coracoid process; however, lateral cortex breach of the coracoid process occurred after reaming (B) and the bone tunnel was further damaged during pull-out of the FiberTape sutures (C). (D) Arthroscopic image of the right shoulder of a 57-year-old female patient showing lateral cortex breach after placement of the cortical button and sutures.

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  Fig. 4 Arthroscopic images of the right shoulder of a 28-year-old male patient, viewing from the posterior portal. (A) A lateral cortex breach occurred during reaming. (B) The fixation method was converted to the coracoid loop technique where the FiberTape was looped below the coracoid process instead of being passed through the coracoid bone tunnel.

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