Comparison of truly anatomic coracoclavicular ligament reconstruction with vs. without acromioclavicular ligament reconstruction for acute Rockwood type V acromioclavicular joint dislocations: a prospective cohort study

This study was designed to compare the 2-year clinical and radiologic results of the truly anatomic coracoclavicular ligament reconstruction (TACCR) vs. TACCR with additional acromioclavicular ligament reconstruction (TACCR-AC) for patients with acute Rockwood type V acromioclavicular (AC) joint dislocations. A prospective analysis of 48 patients with acute Rockwood type V AC joint dislocations between August 2017 and March 2023 was conducted. The patients were grouped according to surgical procedure: TACCR group (n = 24) and TACCR-AC group (n = 24). Patients were prospectively assessed with clinical and radiologic follow-up at 3, 6, 12, and 24 months postoperatively. There were no statistically significant differences in sex, age, and follow-up duration between the TACCR and TACCR-AC groups (P > .05). There were no significant differences when comparing the mean visual analog scale (VAS) score and Constant score between the 2 groups preoperatively and 3 months postoperatively. The mean VAS and Constant scores were statistically different, favoring the TACCR-AC group, but the differences (1 point for VAS and 5 points for Constant score) were below the Minimal Clinically Important Difference (MCID) for the outcome instruments. The mean differences between the TACCR-AC and TACCR groups in VAS and Constant scores remain under the level of the MCID. There were no significant differences in coracoclavicular distance ratio (CCDR) between the 2 groups preoperatively, immediately postoperatively, and 3 months postoperatively. However, the CCDR of the TACCR group were greater than the TACCR-AC group after 6 months postoperatively (6 months: &#x394;CCDR = 21%, P = .020; 12 months: &#x394;CCDR = 31%, P = .001; 24 months: &#x394;CCDR = 40%, P = .004). Reduction loss occurred in 10 patients (42%) in the TACCR group and none in the TACCR-AC group (P = .001). Clavicular tunnel widening was observed in 24 patients (100%) in the TACCR group and 6 patients (25%) in the TACCR-AC group (P < .001). No implant failure or clavicle/coracoid fracture was observed in each group during the follow-up period. As compared with the TACCR technique, the TACCR-AC technique was a safe, reliable, and novel surgical technique that yielded better radiologic results and comparable clinical results for the treatment of acute Rockwood type V AC joint dislocations.