[Treatment of acromio-clavicular dislocations using coracoacromial ligament plasty].

PURPOSE

Plasty transfer using the coracoacromial ligament (Cadenat) for the treatment of acromioclavicular separation is usually too weak and too short. The authors used a reinforcement flap, made by a lateral supraclavicular detachment of the superior fibrous-capsular sheath.

MATERIAL AND METHOD

Twenty-six acromioclavicular separations were radiographically studied using an axillary view. Twenty-one patients had a posterior dislocation of the lateral end of the clavicle. A pouch formed by the superior detachment was present in all cases with posterior displacement. In 19 case out of 26, this detachment was used to create a quadrangular flap with acromial support. The end of the coracoacromial ligament was attached to this long flap which provided adequate reinforcement along its entire length.

RESULTS

There was a statistical correlation (p = 0.05) between the posterior component of the separation and the presence of this detachment. In the 19 reinforced plasties, no recurrence of posterior dislocation was reported, a mild undercorrection and 2 overcorrections were noted. Recurrent posterior dislocation was reported in the 7 non-reinforced coracoacromial plasties, and superior dislocation was reported twice.

DISCUSSION

Posterior acromioclavicular dislocation is present in 80 per cent of cases. Diagnosis mainly uses the axillary view. It is always associated with a lateral supraclavicular detachment providing a 3 to 5 cm long downward flap which is used as a natural reinforcement for the coracoacromial ligamentoplasty.