Reconstruction of chronic acromioclavicular dislocation with subacromial hook plate and reinforced collagen implant: A surgical technique with histological evaluation

Introduction The most common cause for separation of the acromioclavicular (AC) joint is from a direct force to the shoulder. Injury to the ligaments that surround and stabilize the AC joint leads to shoulder separation with displacement of the acromion and coracoid process with respect to the clavicle. Numerous surgical techniques have been described, but complications are still common with loss of reduction and hardware failure as the most common reasons for decreased patient satisfaction and need for revision. We describe our initial results of an AC joint reconstruction technique with subacromial hook plate fixation combined with a bioinductive collagen structural scaffold which allows for a stable and anatomic restoration of the AC joint. Case Report Patient is a 52 male who presented after a traumatic injury to the right shoulder with a symptomatic chronic grade 5 AC separation. After failed conservative care, he was treated with reconstruction of the AC coracoclavicular (CC) ligaments with the BioBrace® (CONMED Corporation, Largo, FL) bioinductive implant and a hook plate. The patient returned 3 months later for planned hook plate removal and was followed for 7 months postoperatively. Conclusion A combination technique utilizing hook plate fixation augmented with a bioinductive collagen implant was successfully used to treat a chronic AC separation. Histologic analysis of the harvested BioBrace® tissue at the time of hook plate removal at 3 months from index procedure demonstrates ideal and favorable host tissue incorporation with neocollagen tissue and remodeling of the BioBrace® implant. This is the first reported histologic analysis of BioBrace® following human implantation.