Weaver Dunn
ACJ reconstruction
Indication
Symptomatic Chronic ACJ dislocation
Grade III, IV and V ACJ dislocation
Anatomy
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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
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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.
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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.