A Salvage Procedure for Failed Weaver-Dunn Reconstruction

THE PROBLEM: The failure rate after surgical acromioclavicular (AC) joint stabilization is of up to 10%. For revision, several techniques including modifications of the Weaver-Dunn procedure have been suggested. However, patients with failure of such revision techniques represent a special challenge due to the altered anatomic relationships and the lack of stabilizing structures. THE SOLUTION: In this respect, a case of several failed AC joint reconstructions is reported in which a doubled semitendinosus graft was used. The use of either biological autograft or artificial material has been suggested in the literature. However, especially the use of an autograft or allograft tendon has been supported by biomechanical studies. SURGICAL TECHNIQUE: A semitendinosus graft was harvested, passed through a clavicular and a coracoid tunnel, and subsequently doubled around the medial clavicle and the medial coracoid hook. A second pair of tunnels in the distal part of the clavicle and the coracoid was used for tying a 2-mm Fiber-Wire (Arthrex Inc.) cerclage. Then, the tendon graft was sutured beyond itself with # 2 Ethibond (Ethicon Inc., Johnson & Johnson). Consecutively, the deltotrapezial fascia was doubled and closed up with inverted # 1 sutures. After skin closure the left arm was immobilized in a sling. RESULT: 12 months after surgery, the patient was free of pain, presenting with a Constant Score of 87/100 and a Neer Score of 94/100.