Arthroscopic-Assisted Double-Bundle Coracoclavicular Ligament Reconstruction Using Cortical Fixation Buttons With Suture Tape Provides Superior Vertical Stability Than the Single-Bundle Reconstruction for Acute Acromioclavicular Joint Dislocation

Arthroscopy. 2023 Feb;39(2):213-221. doi: 10.1016/j.arthro.2022.09.018. Epub 2022 Oct 7.


Purpose: This study aimed to compare clinical and radiologic outcomes between single- and double-bundle arthroscopic-assisted coracoclavicular (CC) ligament reconstruction using cortical fixation buttons with suture tapes for acute acromioclavicular (AC) joint dislocation.

Methods: Patients who underwent arthroscopic-assisted CC ligament reconstruction using cortical fixation buttons with suture tapes for acute AC joint dislocation from July 2014 to March 2019 were identified. This study included patients treated for acute AC joint dislocation within 2 weeks after an injury, with a Rockwood classification of III or V and at least 2 years of follow-up. Patients were divided into 2 groups based on the reconstruction technique: group I (single-bundle technique) and group II (double-bundle technique). The clinical outcomes were compared using the American Shoulder Elbow Surgeons (ASES) score, Constant score, and visual analog scale for pain score between the 2 groups. On the plain radiograph, the CC interval ratio (CCIR) was measured to evaluate maintenance of CC interval fixation. Postoperative complications, including reduction failure, were also documented.

Results: Fifty-eight patients (26 in group I, 32 in group II) were enrolled. There were no significant differences in CCIR between the 2 groups preoperatively and 3 months postoperatively. However, the CCIR of group I was significantly greater than that of group II 6 months postoperatively (group I: 160.5% ± 48.5%, group II: 125.4% ± 38.9% at 6 months postoperatively, P = .01; group I: 164.0% ± 57.3%, group II: 123.2% ± 35.9% at the last visit, P = .01). Despite radiologic differences, the clinical outcomes demonstrated no significant differences between 2 the groups (ASES score: 93.5 ± 5.2 in group I, 94.4 ± 4.5 in group II, P = .54; Constant score: 92.9 ± 5.3 in group I, 94.8 ± 4.3 in group II, P = .16). Reduction failure occurred in 4 patients (15.3%) in group I and in 1 patient (3.2%) in group II (P = .16).

Conclusions: Arthroscopic-assisted double-bundle CC ligament reconstruction using cortical fixation buttons with suture tapes provided superior vertical stability than the single-bundle technique.

Level of evidence: Level III, retrospective comparative study.

MeSH terms

  • Acromioclavicular Joint* / injuries
  • Acromioclavicular Joint* / surgery
  • Humans
  • Joint Dislocations* / surgery
  • Ligaments, Articular / surgery
  • Retrospective Studies
  • Shoulder Dislocation* / surgery
  • Sutures
  • Treatment Outcome