Weaver Dunn

ACJ reconstruction

  • Indication

  • Anatomy

  • Considerations

  • Positioning

  • Skin incision

  • Procedure

  • Modifications

  • Post operatively

  • References

  • Indication

    Symptomatic Chronic ACJ dislocation

    Grade III, IV and V ACJ dislocation

     

    Anatomy

    Coraco-acromial ligament

    Acromioclavicular ligaments

    Coraco-clavicular ligaments

     

    Considerations

    Consider arthroscopic (Snow)

    See modifications

     

    Positioning

    Expose shoulder girdle

    (Standard shoulder set up see shoulder arthroscopy positioning)

     

    Skin Incision

    Classic

    - Curved incision extending from the acromion medially along the lower border of the clavicle and curved gently over the coracoid.

      Alternative

      - Sabre incision over shoulder.

     

     

    Procedure

    Expose the anterior portion deltoid, the disrupted ACJ and the insertion of the trapezius on the outer portion of the clavicle.

    Detach the deltoid muscle, reflecting it laterally exposing the distal part of the clavicle, the coracoid process, and the coraco-acromial ligament.

    Detach the coraco-acromial ligament from the acromion and dissect the ligament free to the coracoid process.

    Excise the lateral two cm of clavicle in an oblique fashion so that the inferior portion of the oblique osteotomy overlies the coracoid process.

     

    Asses the length of  coraco-acromial ligament required by holding it to the anatomically reduced clavicle.

    Cut away any excess ligament  and place a No. 1 non-absorbable suture in the coraco-acromial ligament.

    Make two small drill holes in the superior cortex of the clavicle.

    Drill or burr out clavicle medullary cavity to accept ligament.

    Pass the suture material into medullary canal through drill holes and then pull the coraco-acromial ligament into the medullary canal of the clavicle securing the reduction.

    Repair the deltoid muscle and the trapezius muscle.

     

    Modifications

    1. Remove coraco-acromial ligament from acromion with sliver of bone, to improve hold/ fixation.

     

    2. Protect repair (several methods)

            Sling around base of coracoid and clavicle (Absorbable/ Non absorbable eg. PDS/ Ethibond)

            Suture anchors into base of coracoid through clavicle

            Screw through clavicle into base of coracoid etc.

     

    Post operatively

    Place arm in Velpeau bandage or a sling.

    Pendulum and assisted ROM from first day.

    Full active use of shoulder from 4 weeks.

     


    References

    Weaver J, Dunn H. Treatment of acromioclavicular injuries, especially complete acromioclavicular separation. J Bone Joint Surg Am 1972;54:1187-1194
    JBJS-A pdf

    Tienen T, Oyen J, Eggen P. A modified technique of reconstruction for complete acromioclavicular dislocation: a prospective study. Am J Sports Med 2003;31:655-659

    Snow, Martyn MRCS; Funk, Lennard FRCS Technique of Arthroscopic Weaver-Dunn in Chronic Acromioclavicular Joint Dislocation. Techniques in Shoulder & Elbow Surgery. 7(3):155-159, September 2006.


    Page created by: Lee Van Rensburg
    Last updated 11/09/2015