Introducing a New System for an Old Problem – Surgical Learning Curve for Lockdown CCL Reconstruction

Introduction: The coraco-clavicular ligaments reconstruction system emerged as an acceptable easy single stage procedure for patients with high grade acromio-clavicular joint dislocation. Although presented over a decade ago, clinical data regarding this system is limited.

Patients and Methods: We retrospectively reviewed our intraoperative experience performing open reduction of acromioclavicular joint dislocation in the first two years of using the Lockdown CCL reconstruction system.

Results: In our experience, we suggest possible modification of the original surgical technique that may facilitate an anatomical reduction and improve immediate radiologic results of the procedure depending of the type of dislocation. These may include: 1) horizontal rather than vertical skin incision, 2) reversed fixation screw positioning for overly anterior translation of the clavicle, 3) resisting anterior rolling of the clavicle while measuring for the correct graft length, 4) inverted use of the hard loop to overcome anterior translation and 5) we recommend resection of the distal clavicle.

Discussion: Reconstruction of the coraco-clavicular ligaments presents several potential pitfalls and thus involves a surgical learning curve. We describe our experience introducing a CCL reconstruction system using a synthetic graft focusing on potential obstacles and lessons learnt.