Acromioclavicular Fusion: An Approach for Painful Clavicular Instability

Abstract

Background The present study aimed to assess efficacy of acromioclavicular fusion as a salvage procedure for the treatment of painful horizontal (transverse) plane instability following distal clavicular excision. Methods A prospective, nonrandomized study of 16 consecutive cases was performed over an 8½ year period, assessing fusion rates, pain relief, subjective instability and range of motion. Results Initial attempts at isolated coracoclavicular fusion were relatively unsuccessful. Subsequent procedures combined acromioclavicular and coracoclavicular fusion. Once stability was achieved, all patients noted a reduction in pain and in instability sensation. Eleven patients had similar or improved ranges of shoulder motion postoperatively. In four patients, elevation > 100 °C was limited by pain. Four patients developed sternoclavicular pain. Six patients had revision fusion procedures, two of them twice. Of these six, three achieved fusion. One other patient remained unfused and painful, declining a second procedure. Thirteen patients were satisfied with their result and all but one would have the surgery again. Conclusions Painful horizontal-plane acromioclavicular instability secondary to distal clavicle excision may be effectively treated by acromioclavicular arthrodesis, usually without excessive loss of movement but often with some sternoclavicular discomfort. Fusion is difficult to achieve, and the use of locking plates and ‘biological supplementation’ is recommended.