Modified anatomic coracoclavicular ligament reconstruction for the management of Rockwood V acromioclavicular joint dislocation: a case report

Background: Acromioclavicular (AC) joint dislocation is a frequent orthopedic injury, typically resulting from trauma to the shoulder. The severity of the injury can range from mild to severe, with treatment approaches varying accordingly. Higher-grade dislocations, such as Rockwood Type V, are particularly challenging for surgeons due to the complexity of the injury and the need for precise restoration of joint stability and function. This case report aims to present the successful use of a modified anatomic coracoclavicular ligament reconstruction technique in managing a Rockwood V AC joint dislocation, highlighting its potential benefits in restoring joint function and stability. Case Presentation: A 53-year-old female presented with right shoulder pain and stiffness three months after a motor vehicle accident. Physical examination revealed clavicular deformity, tenderness, and swelling. Radiographs showed upward clavicle displacement, widened AC and coracoclavicular (CC) joints, and arthritis of the distal clavicle. Diagnosed with Rockwood type V AC joint dislocation, she underwent surgery. The Mumford procedure addressed distal clavicle arthritis, while the AC joint was reconstructed with a modified anatomic CC ligament reconstruction using a semitendinosus graft. Post-surgery, the patient had favorable outcomes at 2, 4, and 18 months, with a Constant score of 89 at 18 months. A shoulder radiograph showed a CC distance of 12 mm, though a study reported no correlation between CC distance and clinical outcomes. Conclusion: The modified anatomic CC ligament reconstruction offered an effective surgical solution for managing a chronic Rockwood type V AC joint dislocation. The patient showed significant improvement in shoulder function, with no complications observed 18 months post-surgery. This technique mimics the natural ligament anatomy and offers a reliable and effective alternative to traditional methods with promising long-term outcomes.