Operative treatment of acromioclavicular joint dislocation: a new technique with suture anchors

Objective：To evaluate clinical outcome of suture anchors in strengthening both acromioclavicular and coracoclavicular ligaments in the surgical treatment of acromioclavicular joint dislocation.Methods：Twenty-eight patients with acute traumatic Rockwood Ⅲ,Ⅳ and Ⅴ dislocations of the acromioclavicular joint surgically treated at our institute between October 2010 and January 2012 were recruited.All patients underwent open reduction combined with suture anchors.Function was evaluated using the ConstantMurley shoulder score.Clinical and radiographic shoulder ratings were evaluated using Taft criteria at 3,6 and 12 months.Results：Two cases with fixation loosening were not included in final statistical analysis.Other patients obtained full joint reposition on immediate postoperative radiographs.Follow-up was performed with an average of 15.6 months （range,12-19）.After early range of motion exercises,96.2％ of the patients （25/26） could abduct and elevate their shoulders more than 90 degrees within postoperative 3 months.There was no infection.Average Constant-Murley score was 96.3 points （range,94-100）and mean Taft shoulder rating was 10.7 points （range,8-12） at 12 months.Conclusion：The suture anchor is a relatively simple technique and can avoid screw removal which is helpful in reconstructing both acromioclavicular and coracoclavicular ligaments in acute traumatic acromioclavicular joint dislocation.     

Complete dislocation of the acromioclavicular joint: operative versus conservative treatment

Abstract The preferred treatment for complete acromioclavicular separation is still controversial. The purpose of this study was to compare conservative and operative treatment on the basis of a long follow- up period, including subjective and objective clinical assessments as well as radiological evaluation. Forty-two patients with complete acromioclavicular dislocation treated operatively and 38 patients treated conservatively were examined at a mean follow-up of 6.3 years (SD=2.5). Assessment included the UCLA and the Constant-Murley scores as well as evaluation of pain, function and satisfaction. Shoulder strength was measured objectively using a cable tensiometer in four planes. The operative technique was suturing of the torn ligaments and stabilization of the acromioclavicular joint using resorbable coracoclavicular PDS banding. In conservative treatment, early physiotherapy accepting the deformity was performed in most patients. Clinical results according to the UCLA and Constant-Murley Scores as well as evaluation of pain, function and strength were similar in both groups. Three months postoperatively, the conservatively treated patients had less pain, a better range of motion and a significantly earlier return to work. Post-traumatic osteoarthritis developed only in those patients whose acromioclavicular joint healed in partial dislocation. The persisting deformity, which must be expected in conservative treatment, did not affect the patient’s outcome regarding pain or function and especially not regarding shoulder strength. With respect to the time for recovery, conservative treatment is superior to operative management. Therefore, most patients can be treated conservatively, even those patients who are heavy overhead workers or overhead athletes.     

Minimally Invasive Coracoclavicular Ligament Augmentation With a Flip Button/Polydioxanone Repair for Treatment of Total Acromioclavicular Joint Dislocation

Treatment of complete acromioclavicular joint disruption remains controversial and ranges from rehabilitation to extensive surgical reconstruction. However, high-grade injuries (type IV, V, and VI) are typically treated surgically. Most reconstruction techniques addressing these injuries selectively focus on coracoclavicular ligament augmentation because it has been shown to be the primary stabilizer of the acromioclavicular joint. The conventional coracoclavicular polydioxanone (PDS) loop, which is widely performed, has been detected to have some pivotal disadvantages, including anterior subluxation of the clavicle, extensive preparation of the coracoid, and bony avulsion of the clavicle as a result of rotational clavicle movement. Therefore we present an augmentation technique that reduces these complications by replicating the orientation of the native coracoclavicular ligament complex and providing a minimally invasive subcoracoid and clavicular fixation of a double PDS loop by use of 2 flip buttons, typically used for extracortical anterior cruciate ligament graft fixation. The key step of the procedure includes the anatomic, secure, and stable placement of the double PDS cerclage under the coracoid base transferring a flip button through a coracoid bone tunnel. Our clinical experience shows that the presented technique is easy to perform and has a comparable invasiveness to recently presented arthroscopic techniques.     

Surgical Treatment of Fresh Complete Acromioclavicular Dislocation by Coracoid Process Transfer and K-Wire Transfixation

Acromioclavicular dislocations are very common shoulder injuries. The optimal treatment for acute high-grade acromioclavicular joint injury remains a matter of debate. The purpose of this study was to evaluate the results of surgical treatment of complete acromioclavicular dislocation using coracoid process transfer and temporary K-wire transfixation. Twenty-one patients with complete acromioclavicular dislocation underwent coracoid process transfer and temporary K-wire transfixation. Patients were assessed at the follow-up based on visual analog scores (VAS), the Constant–Murley scoring system and the UCLA shoulder rating system. Radiographs were taken to check up vertical instability. The mean follow-up was 32.1 months (25–47 months). The mean Constant and Murley score and UCLA shoulder rating score was 89.9 ± 8.4 and 30.1 ± 4.4. There were fourteen excellent functional results and six results and one poor result. The overall rate of satisfaction, which means an excellent or good result, was 95.2 %. Nineteen patients (90.4 %) maintained their previous jobs or resume their daily activities. The mean final pain score, as measured from 1 to 10 on the visual analog scale, was 1.91 ± 1.09. The radiographic analysis revealed twenty patients had maintained reduction at the final follow-up. The coracoid process transfer and temporary K-wire transfixation is a reliable treatment for a complete acromioclavicular dislocation.     

Arthroscopic Anatomical Acromioclavicular Joint Reconstruction using a Button Device and a Semitendinosus Graft

ObjectiveTo report a new technique for anatomical acromioclavicular (AC) joint reconstruction.MethodsIn order to minimize such complications, the authors describe a new anatomical and biological AC joint repair. This technique aims to provide greater stability by using two anatomically placed clavicular tunnels and a combined construct with a double endobutton cortical fixation for primary stabilization, and to be biologically advantageous by using an autologous semitendinosus (ST) tendon graft. Additionally, the coracoclavicular ligament reconstruction is complemented with an AC joint cerclage and capsular reinforcement, which will protect the biological construction in its initial stage of healing.ResultsThis technique provides adequate primary and secondary biomechanical stability by passing both a semitendinosus autogenous graft and a double endobutton device, through anatomically placed and small diameter clavicle holes, without the need for coracoid drilling. Our technique showed encouraging results regarding pain resolution, range of motion, and function. At final follow‐up we experienced excellent results with average pain score of 1.6, and average ROM of 159° of forward flexion, 160° of abduction, 68° of external rotation, and internal rotation level at T11. Postoperative function also showed great improvements with average ASES of 85 points, an average Constant Score of 87 and a Subjective Shoulder Value of 89 points. This technique also achieved perfectly acceptable radiographic results, with an average coracoclavicular distance increase of 0.8 mm. Regarding complications, our sample showed one case of AC join subluxation, two cases of internal saphenous nerve injury, and two partial graft tears at the suture‐button interface, with none of these requiring surgical revision.ConclusionThis technique is advantageous in treatment of acromioclavicular joint dislocation and can be performed in both the subacute and chronic setting.     

Treatment of complete acromioclavicular separations with a modified Weaver and Dunn technique

The purpose of this article is to describe the indications, operative technique, and postoperative rehabilitation protocol for treatment of complete acromioclavicular separations. A modified Weaver and Dunn technique is described, with a detailed harvesting procedure of the coracoacromial ligament, along with a wafer of bone for anatomical reconstruction of the coracoclavicular ligaments. A suture anchor is used to provide temporary stability to the acromioclavicular joint while the transferred coracoacromial ligament heals in the new position.     

Biomechanics and comparison of two operative methods of treatment of complete acromioclavicular separation

Sixty-three complete acromioclavicular separations were treated by 2 operative methods. Acromioclavicular wiring gave 73% acceptable results while wire or Dacron coracoclavicular loop gave 94% acceptable results. Complications, especially broken, bent, or backed-out wires were common with acromioclavicular wiring. Of 44 patients treated by acromioclavicular wiring, 5 required late distal clavicle resection and 4 of these had retained menisci. Loop fixation is mechanically superior since the loop is in the direction of the tensile forces. In acromioclavicular wiring, however, the fixation Kirschner wires are subjected to high bending moments. Loop fixation avoids violation of the acromioclavicular joint but does not restrict rotation of the clavicle. The operation is simple to perform and postoperative immobilization is minimal. Woven Dacron may be superior to surgical wire for loop fixation in that unlike wire it does not require removal by a second operation. Woven Dacron may also stimulate coracoclavicular ligament reconstitution.     

Arthroscopic reconstruction of the acromioclavicular joint disruption: surgical technique and preliminary results

Introduction: Numerous operative procedures have been described for the reconstruction of acromioclavicular joint separation; however, the arthroscopic reconstruction has been rarely reported. Therefore, our objective was to propose a new technique of arthroscopic acromioclavicular joint surgery and to evaluate the preliminary results. Materials and methods: Thirteen patients with a mean follow-up of 18 months underwent the arthroscopic acromioclavicular joint reconstruction using suture anchors and small titanium plate. The average age was 40.2 years (range 23–54 years). The shoulders were evaluated using Constant score and radiographs. The indications for surgery included acromioclavicular joint dislocation Rockwood type IV–V. Results: Twelve patients returned to their work without pain within 3 months after operation. The average Constant score at last follow-up was 95. Postoperative radiographs confirmed anatomic reduction in ten patients, residual subluxation in two patients and redislocation of the joint in one patient. One patient had radiographic evidence of coracoclavicular ossification. All patients but one were satisfied with results and cosmetic appearance. Conclusion: Considering its less morbidity, excellent cosmesis, no need of hardware removal, and minimal complications from breakage or migration of metal implants, this new technique offers an attractive alternative in acromioclavicular joint stabilization.     

Percutaneous endobutton fixation of acute acromioclavicular joint injuries and lateral clavicle fractures

IntroductionThis paper describes a novel technique developed by the senior author to address acute acromioclavicular joint (ACJ) dislocations and certain distal clavicle fractures.MethodsThe procedure employs a four strand, single tunnel, double endobutton repair performed entirely percutaneously, without any arthroscopic guidance or deep surgical dissection.ResultsWe present the preliminary results from our series of 6 consecutive patients performed over a period of 18 months. The mean length of surgery was 36min (range 32–40) and the mean correction of coracoclavicular (CC) distance achieved was 12.6 mm (range 10.3–14.1). There was no restriction of movement in any of the patients post-operatively and their average QuickDASH scores at final follow-up was 4.2 (range 0–6.8).ConclusionResults in the present series were at least comparable to those for other techniques, validating percutaneous treatment as a solution for acute ACJ dislocations.     

A novel treatment of grade III acromioclavicular joint dislocations with a C-hook implant

Introduction: This study evaluates the results of the new surgical treatment of complete acromioclavicular (ac) dislocations using coracoclavicular (cc) fixation with a shape memory metal C-hook implant. Materials and methods: Fifteen patients were prospectively analyzed. They all had a Tossy III ac dislocation due to trauma. The ac ligament was reinserted using a surgical bone anchor, and the position of the joint was restored by fixing it with a C-hook. After 3 months the C-hook was removed. Functional status, symptom severity, X-rays and patient satisfaction were analyzed during clinical control visits. The follow-up time was 1 year. Results: At 12 weeks, full shoulder function had been achieved by 93% of the patients. The final control visit showed full recovery of active ROM in all patients. Two patients had mild pain during certain movements. X-rays showed the precise anatomical position of ac joint with no statistically significant differences compared to the healthy side. Patient contentment was excellent in 14 cases and satisfactory in one case. The average sick-leave was 58 days, including the removal operation. Minor osteolysis of the clavicle was noticed in two patients. Conclusion: The new C-hook implant provides accurate anatomical reduction, conserves the articular surfaces and enables fast functional recovery with excellent patient contentment. Technically, the implant is easy to use. Based on this study, the C-hook presents a reliable novel treatment option in surgical ac repair.     

Biomechanical analysis of acromioclavicular joint dislocation repair using coracoclavicular suspension devices in two different configurations

BackgroundThe best treatment option for some acromioclavicular (AC) joint dislocations is controversial. For this reason, the aim of this study was to evaluate the vertical biomechanical behavior of two techniques for the anatomic repair of coracoclavicular (CC) ligaments after an AC injury.ResultsGroup I reached a maximum force to failure of 635.59 N (mean 444.0 N). The corresponding force was 939.37 N (mean 495.6 N) for group II and 533.11 N (mean 343.9 N) for group III. A comparison of the three groups did not find any significant difference despite the loss of resistance presented by group III.ConclusionAnatomic repair of coracoclavicular ligaments with a double system (double tunnel in the clavicle and in the coracoid) permits vertical translation that is more like that of the acromioclavicular joint. Acromioclavicular repair in a “V” configuration does not seem to be biomechanically sufficient.     

应用异体肌腱重建喙锁韧带治疗肩锁关节完全脱位

目的：探索应用异体肌腱重建喙锁韧带治疗肩锁关节完全脱位一种新的手术方法。方法：从1997年10月2001年12月，共21例肩锁关节完全脱位患者，接受了经过深低温处理的同种异体屈指肌腱，采用在喙锁韧带 位置，穿过软组织隧道，行编织缝合，进行立体“8”字重建的治疗方法，恢复喙锁韧带在垂直方向对肩锁关节的稳定。在21例接受此治疗方法患者中，有19例得到了1年以上的随访。随访时间1240个月，平均16．8个月。结果：采用Lazzcano和Karlsson综合评分标准，优15例，良4例。X线片显示重建喙锁韧带部分骨化者2例。结论：异体肌腱重建喙锁韧带治疗肩锁关节完全脱位可以避免自体取材造成的副损伤及其引起的并发症，供材可提前制作，缩短了手术时间，减少了自体创伤。在组织工程移植尚未完全获得成功的今天，是一种可行的手术方法。     

A modified surgical technique for reconstruction of an acute acromioclavicular joint dislocation

We report a modified surgical technique for reconstruction of coracoclavicular and acromioclavicular ligaments after acute dislocation of acromioclavicular joint using suture anchors. We have repaired 3 consecutive type III acromioclavicular dislocations with good results. This technique is simple and safe and allows anatomical reconstruction of the ligaments in acute dislocations.     

喙锁韧带不同重建方法治疗肩锁关节脱位的有限元分析

目的：建立喙锁韧带单束重建、双束解剖重建及双束完全解剖重建有限元模型,比较其位移及受力情况,为喙锁韧带完全解剖重建临床应用提供理论依据。方法：选取1位志愿者,年龄27岁,身高178 cm,体重75 kg,行肩关节CT扫描,运用Mimics17.0、Geomagic studio 2012、UG NX 10.0、Hypermesh14.0、Abaqus 6.14软件建立喙锁韧带单束重建、双束解剖重建及双束完全解剖重建三维有限元模型,各模型分别向前载荷、向后载荷及向上载荷的载荷,记录并比较在主要受力方向上锁骨远端中点的最大位移以及不同载荷情况下重建装置的最大等效应力。结果：施加向前载荷、向后载荷,双束完全解剖重建锁骨远端中点的向前最大位移及向后最大位移最低,分别为7.76 mm和7.27 mm;施加向上载荷,双束解剖重建锁骨远端中点向上最大位移最低,为5.12 mm;施加向前、向后及向上3种不同载荷,双束重建的重建装置最大等效应力均低于单束重建;双束完全解剖重建斜方韧带重建装置最大等效应力较双束解剖重建低,为73.29 MPa,但锥状韧带重建装置的最大等效应力高于双束解剖重建。结论：喙锁韧带双束完全解剖重建能够提高肩锁关节的水平稳定性,降低斜方韧带重建装置的应力,可作为治疗肩锁关节脱位的较好方法。     

应用缝合锚钉解剖重建肩锁关节的临床效果

目的评估应用缝合锚钉重建喙锁韧带,治疗急性肩锁关节脱位的临床结果。 方法自2014年2月至2015年6月接受手术治疗的急性肩锁关节脱位患者13例,其中男性8例、女性5例;平均年龄为（40.0±15.6）岁。应用缝合锚钉重建喙锁韧带,复位固定肩锁关节。术后应用三维CT评估喙突上缝合锚钉的位置情况;通过肩关节正位片评估肩锁关节复位保持情况,并测量喙锁间距;记录肩关节的活动范围、视觉模拟评分（visual analogue scale,VAS）和Constant-Merly评分。 结果所有患者均顺利康复。术后肩关节前屈上举平均为171.5°,体侧外旋为70.8°,体侧内旋为T8。VAS评分为（0.3±0.6）分,Constant-Merly评分为92.4分。术后术侧的喙锁间距平均为（8.9±3.0）mm,健侧的喙锁间距平均为（7.7±1.7）mm,两者之间差异无统计学意义（P=0.119）。26枚锚钉中有23枚位置良好,1枚锚钉刺穿了喙突的下表面,2枚锚钉位置偏向内侧。1例患者肩锁关节复位完全丢失,1例患者肩锁关节复位部分丢失,其Constant-Merly评分分别为74分和84分。 结论通过在喙突基底部准确地置入缝合锚钉,可以解剖重建喙锁韧带,恢复肩锁关节的垂直和水平稳定性。该技术创伤小,可以取得较为满意的临床结果。     

Concomitant Acromioclavicular and Coracoclavicular Ligament Reconstruction with a Duo-Figure-8 Autogenic Graft Wrapping Technique for Treating Chronic Acromioclavicular Separation

BackgroudCoracoacromial ligament transfer is the traditional procedure for treating chronic acromioclavicular separation, but it is significantly inferior to ligament reconstruction according to biomechanical and clinical studies. However, ligament reconstruction carries the risk of complications of graft loosening and peri-tunnel fractures. Currently, there is no ligament reconstruction procedure optimal for preventing such complications. The purpose of this study was to describe and retrospectively analyze the clinical and radiological outcomes of a “duo-figure-8” autogenic graft wrapping technique, which was used to concomitantly reconstruct the acromioclavicular and coracoclavicular ligaments.MethodsPreoperative, immediate postoperative, and final follow-up oputcomes were evaluated in 10 enrolled patients. Radiographic outcomes were indicated by the bilateral difference of the coracoclavicular distance (CCD) and overlapping length of the acromioclavicular joint (OLac). Quality of reduction was classified into 4 grades according to bilateral CCD difference into overreduction (< 0 mm), anatomic reduction (0–4 mm), partial loss of reduction (4–8 mm), and recurrent dislocation (> 8 mm). Clinical outcomes were evaluated using the American Shoulder and Elbow Surgeons (ASES) and Constant scores.ResultsThe mean side-to-side differences for CCD were 11.9 mm (preoperative), −0.1 mm (immediate postoperative), and 3.4 mm (final follow-up); those for OLac were 9.4 mm (preoperative) and 2.7 mm (final follow-up). CCD and OLac outcomes significantly improved at final follow-up (p < 0.05). At the immediate postoperative stage, 6 and 4 patients had overreduction and anatomic reduction, respectively. At final follow-up, 7 and 3 patients had anatomic reduction and partial loss of reduction, respectively. The magnitude of improvement of ASES scores for patients with anatomic reduction and partial loss of reduction (p = 0.20) was 18.1 and 20.0, respectively. The magnitude of improvement of Constant scores in patients with anatomic reduction and partial loss of reduction (p = 0.25) was 19.9 and 22.3, respectively.ConclusionsThe technique yielded acceptable functional outcomes in patients with anatomic reduction or partial loss of reduction. The “duo-figure-8” wrapping method—a single autogenic tendon graft passing beneath the coracoid process with a tendon-knot fixation over the distal clavicle and looping around the acromion intramedullary—did not increase the risk of peri-tunnel fractures over the clavicle, coracoid process, or acromion.     

肩锁关节脱位不同手术方法疗效比较的病例对照研究

目的:分析比较应用单纯肩锁钩板固定术、单纯喙突移植术及肩锁钩板联合改良肌肉动力移位术3种手术方法治疗肩锁关节全脱位的疗效。方法:自2006年1月至2009年11月分别采用单纯肩锁钩板固定术、单纯喙突移植术及肩锁钩板联合改良肌肉动力移位术3种手术方法治疗肩锁关节全脱位65例。65例肩锁关节全脱位患者被分成3组,采用单纯肩锁钩板固定术组(A组)22例,单纯喙突移植术组(B组)21例,肩锁钩板联合改良肌肉动力移位术组(C组)22例。按照Karlsson评分标准评定术后肩关节功能恢复情况。结果:65例均获得术后随访,时间0.5～3年,平均1.5年。A组取出内固定后有8例发生半脱位,2例发生全脱位并有肩锁关节骨关节炎,1例在术后1年发生锁骨钩板钩部断裂。B组取出内固定后有7例发生半脱位,1例取出内固定物后发生全脱位,5例发生肩锁关节骨关节炎出现严重的疼痛和肩部活动受限。C组取出内固定后有2例发生半脱位,无全脱位及肩锁关节骨关节炎。按照Karlsson评分标准评定:A组优12例,良8例,差2例;B组优9例,良7例,差5例;C组优20例,良2例,差0例。肩锁钩板联合改良肌肉动力移位术组与前两组疗效比较差异有统计学意义(P<0.05)。结论:肩锁关节全脱位采用肩锁钩板联合改良肌肉动力移位术治疗,具有手术操作简便、固定牢固、可早期活动等优点,疗效确切,是一种较好的治疗方法。     

三重固定纽扣钢板解剖重建陈旧性Ⅲ度肩锁关节脱位

目的探讨三重固定纽扣钢板解剖重建喙锁韧带治疗陈旧性Ⅲ度肩锁关节脱位的手术方法及临床疗效。方法 2009年1月-2010年6月,对14例陈旧性Ⅲ度肩锁关节脱位行三重固定纽扣钢板解剖重建喙锁韧带治疗。男10例,女4例;年龄26～52岁,平均38.5岁。致伤原因:交通事故伤7例,摔伤5例,砸伤2例。左侧9例,右侧5例。受伤至手术时间29～75 d,平均49d。肩锁关节有不同程度压痛,关节主、被动活动明显受限,X线片示肩锁关节完全脱位。按Allman分型标准,均为Ⅲ度完全性脱位。结果术后切口均Ⅰ期愈合,无血管、神经损伤及感染等早期并发症发生。患者均获随访,随访时间13～30个月,平均18.3个月。术后1周1例患者发生复位部分丢失,X线片检查见肩锁关节半脱位,未给予特殊处理,其余患者无再脱位或其他相关并发症发生。末次随访时,根据美国肩肘外科协会(ASES)评分标准,获(90.8±4.1)分,与术前的(65.3±4.4)分比较,差异有统计学意义(t=-17.57,P=0.00);Constant-Murley评分为(91.7±3.9)分,与术前的(71.5±4.6)分比较,差异有统计学意义(t=-75.02,P=0.00)。简明肩关节功能测试问卷(SST)的肯定答案为7～12个,平均9.7个。结论三重固定纽扣钢板解剖重建喙锁韧带可有效治疗陈旧性Ⅲ度肩锁关节脱位,早期疗效满意。     

Hook plate fixation for acute acromioclavicular dislocations without coracoclavicular ligament reconstruction: a functional outcome study in military personnel

The aim of our study was to evaluate the shoulder function after clavicular hook plate fixation of acute acromioclavicular dislocations (Rockwood type III) in a population group consisting exclusively of high-demand military personnel. This prospective study was carried out at a tertiary care military orthopaedic centre during 2012–2013 using clavicular hook plate for management of acromioclavicular injuries without coracoclavicular ligament reconstruction in 33 patients. All patients underwent routine implant removal after 16 weeks. The functional outcome was assessed at 3, 6 and 12 months after hook plate removal and 2 years from the initial surgery using the Constant Murley and UCLA Scores. All the patients were male serving soldiers and had sustained acromioclavicular joint dislocation (Rockwood type III). Mean age of the patient group was 34.24 years (21–55 years). The mean follow-up period in this study was 23.5 months (20–26 months) after hook plate fixation and an average of 19.9 months (17–22 months) after hook plate removal. The average Constant Score at 3 months after hook plate removal was 60.3 as compared to 83.7 and 90.3 at 6 months and 1 year, respectively, and an average of 91.8 at the last follow-up that was approximately 2 years after initial surgery which was statistically significant (p value <0.05). The UCLA Score was an average of 15.27, 25.9 and 30.1 at 3, 6 months and 1 year, respectively, after removal of hook plate which improved further an average of 32.3 at the last follow-up, which was also statistically significant (p value <0.05). Clavicular hook plate fixation without coracoclavicular ligament reconstruction is a good option for acute acromioclavicular dislocations producing excellent medium-term functional results in high-demand soldiers.     

Quantification of acromioclavicular reduction parameters after the Weaver–Dunn procedure

Background  The combination of the reconstruction of the coracoclavicular ligaments with the resection arthroplasty of the distal end of the clavicle is a commonly used technique in acromioclavicular separations. Hypothesis  The purpose of the current study was to quantify the reduction parameters using 3-D CT and to analyze their effects on clinical outcomes. Study design  Case series. Methods  The patients with chronic symptoms after acromioclavicular dislocation (type III) were treated with reconstruction of the coracoclavicular ligaments. The average follow-up was 69.5 months. The patient group consisted of 21 men and 8 women. The initial treatment at the time of injury was nonoperative in 26 of 29 patients. CT was used to document anteroposterior (APD), craniocaudal (CCD) and mediolateral (MLD) acromioclavicular reduction parameters. Constant Shoulder scoring system was used. Results  The mean preoperative Constant score was 56.62 ± 18.63 points while the postoperative score was 89.93 ± 10.79 points. The mean APD was 9.2 mm, the mean CCD was 1.1 mm and the mean MLD was 8.4 mm. There was no correlation between the APD, MLD and the Constant Scores. However, an inverse correlation between the CCD and the postoperative Constant Scores was found. Conclusions  CCD plays an important role on the postoperative function. If the CCD is larger, the Constant score is lower. Clinical relevance  The reduction loss is a distinctive parameter of the functional outcome, even when the reconstructed coracoclavicular ligament is intact. Secure fixation may be achieved with techniques preserving CCD.