Evaluation of High-Grade Acromioclavicular Dislocations Fixed by Coracoid Sling Procedure

Abstract

Background

Acromioclavicular (AC) joint injuries are common shoulder injuries, particularly among athletes and individuals engaged in high-risk activities. The Rockwood classification system categorizes these injuries into different grades based on ligamentous involvement and displacement. High-grade AC dislocations (Grade III and above) require surgical intervention to restore joint stability and prevent long-term complications such as chronic pain and functional impairment. The coracoid sling procedure is an emerging technique for AC joint reconstruction that utilizes Ethibond sutures to restore ligamentous stability while minimizing complications associated with hardware-based fixation techniques.

Objective

This study aims to evaluate the clinical and functional outcomes of patients with high-grade AC dislocations (Rockwood Grade III and above) treated using the coracoid sling procedure with Ethibond sutures. The primary outcome measures include radiological reduction, postoperative stability, and functional improvement assessed using the Visual Analog Scale (VAS) and Disability of the Arm, Shoulder, and Hand (DASH) score.

Methods

This prospective study was conducted at the Department of Orthopaedics, tertiary centre of eastern region, India, over a period of six months. A total of 20 patients with high-grade AC dislocations (Grade III and above) were included based on strict inclusion criteria. All patients underwent preoperative radiographic assessment, including AP and Zanca views, followed by a CT scan for accurate typing of the injury. The surgical procedure involved placing patients in a beach-chair position under an interscalene block, followed by coracoid sling reconstruction using double-stranded Ethibond sutures. Postoperatively, patients were immobilized in an arm sling and underwent a structured rehabilitation program. Clinical and radiological assessments were performed at 15-day intervals for three months, with functional scoring recorded at the final follow-up.

Results

The mean age of the study population was 36.4 years, with a male predominance (85%). The mean time from injury to surgery was 5.7 days. Postoperative radiographs confirmed satisfactory reduction of the AC joint in all patients. The mean VAS score improved significantly from 6.8 preoperatively to 1.2 at the final follow-up (p < 0.001), while the DASH score improved from 65.3 to 12.7 (p < 0.001). No cases of implant-related complications, coracoid fractures, or infections were reported. One patient experienced mild loss of reduction but retained functional stability.

Conclusion

The coracoid sling procedure using Ethibond sutures provides a reliable and effective method for the surgical management of high-grade AC dislocations. The technique offers stable fixation, excellent functional recovery, and a low complication rate, making it a viable alternative to conventional hardware-based fixation methods. Further studies with larger sample sizes and long-term follow-up are recommended to validate these findings.