Characteristics and Complications of Operative Acromioclavicular Joint Separations in an Active Population (222)

OBJECTIVES: Coracoclavicular ligament reconstruction (CCR) is a commonly performed procedure for surgical management of high-grade acromioclavicular separations however there is a dearth of literature describing complications of this procedure. The purpose of this study was to identify the incidence and characteristics of major complications following CCR in a large cohort of active patients. METHODS: The Military Data Repository was queried for patients with Current Procedural Terminology (CPT) codes for CCR. Medical records and radiographs were evaluated for major postoperative complications including return to the operating room for surgical site infection (SSI), failure requiring revision, and fracture of the clavicle or coracoid. RESULTS: 953 CCR were performed between October 2013 and March 2020. There were 44 failures requiring revision,18 post-operative fractures, and 18 SSI. Of the patients who developed SSI, 13 required removal of the graft and/or hardware, and 4 required revision reconstruction. There were 11 coracoid (61.1%) and 7 clavicle (38.9%) fractures. Seven coracoid fractures (63.6%) involved a bone tunnel in the coracoid whereas 4 coracoid fractures (36.4%) did not. Fracture incidence was 3.122 fractures per 1,000 person-years. Eleven of the fractures were treated with open reduction and internal fixation, 4 with revision CCR, and 3 were treated non-operatively. Most patients who had a fracture regained full range of motion. CONCLUSIONS: This review of a large population who underwent CCR demonstrated an incidence of 1.35 complications per 100 person-years. Clavicle and coracoid fractures after CCR occur in 1.9 out of 100 cases. Fractures occurred after various methods of fixation and most were treated surgically. Coracoid fractures were nearly twice as prevalent as clavicle fractures and occured with and without bone tunnels in the coracoid. This study demonstrates that CCR is a relatively safe procedure in a physically active population. Complications are rare yet typically require surgical management.