Abstract
Background: Management of acromioclavicular joint (ACJ) injuries have wide variety of classification systems, surgical indications and operative techniques. Our study describes the QUASR (Queensland Unit for Advanced Shoulder Research) 3-Tunnel Technique with LARS (Ligament Augmentation and Reconstruction System; Surgical Implants and Devices, Arc sur Tille, France) artificial ligament to reconstruct the superior shoulder suspensory complex (SSSC) in acute, chronic and revision ACJ dislocations and lateral clavicle fractures.
Methods: Our prospective cohort series of patients undergoing the QUASR 3-Tunnel Technique using LARS artificial ligament. This technique reconstructs the SSSC using two 4mm clavicle tunnels, one acromion tunnel, and is arthroscopically assisted to pass the artificial ligament under the coracoid. The ligament is secured with braided composite sutures and no interference screw is used. Pre and postoperative functional outcome scores were compared in patients with minimum 12-months follow-up.
Results: Of 26 patients in this series, 7 (27%) were operated within 4 weeks of injury, two (8%) were revision cases, and six (23%) were lateral clavicle fractures. Mean time to surgery was 14 weeks (2-650). Mean postoperative scores with associated 95% CI were Specific Acromioclavicular Score 87.38 (CI 75.38, 99.37), American Shoulder and Elbow Surgeons score 94.60 (87.85, 101.35), Constant 79.47 (71.87, 87.07), Simple Shoulder Test 85.44 (72.34, 98.54) and Visual Analogue Score 0.50 (-0.15, 1.15). There were two infections and one atraumatic loss of reduction, however there were no tunnel fractures.
Conclusion: The QUASR 3-Tunnel Technique with LARS artificial ligament is a safe and efficient technique for both acute and chronic acromioclavicular joint reconstruction, lateral clavicle fractures with coracoclavicular ligament disruption and complex revision cases with favorable outcomes at mid-term follow-up.