Thank you to the AOSSM and Anna for letting us present our work. I'm stepping in for Josh Dines, who's in a Mets game right now. No disclosures relevant to this talk. Several studies have shown satisfactory outcomes after CC ligament reconstruction. Many of these are in relatively small cohorts with short-term follow-up. Recently there have been advances in scope-assisted approaches that have allowed us to concomitantly treat glenohumeral pathology. Oftentimes in these studies, failure is defined as a radiographic loss of reduction, but it remains unclear how this radiographic loss of reduction correlates with clinical outcomes. The purpose of our study was twofold. First of all, to assess the outcomes after this procedure using free tendon allografts. And secondly, to assess the associations between patients' ability to return to their pre-injury activity level, radiographic outcomes, namely loss of reduction, and patient-reported outcomes. So we hypothesized first that patients undergoing this procedure would have a high rate of return to their pre-injury level of activity. And secondly, that clinical outcomes would not necessarily be associated with a radiographic loss of reduction. This is an institutional registry at HSS over a 10-year period, exclusion criteria listed here. They utilized an arthroscopic subcoracoid preparation approach with no holes placed in the coracoid. Free tendon allografts were placed through a mini-incision. Heavy suture was used in all cases as ancillary fixation. And per surgeon preference, excess allograft was brought laterally to reconstruct the AC joint capsule. Radiographic loss of reduction was determined as 25% or more increase in the CC distance compared to the contralateral unaffected side. For clinical assessment, we used the SANE score at final follow-up and assessed the patient's ability to return to their pre-injury level of sport or recreational activity. Treatment failure was defined as any one of the three things. Patient underwent a revision AC joint stabilization surgery, patient was not able to return to their same or higher level of activity, or the patient had a radiographic loss of reduction as defined previously. We had a 67% follow-up rate at a mean of six years and a minimum of two years. It was a male predominance, and the majority of these were chronically fixed with a mean time from injury to surgery of seven months. Concomitant scope procedures were performed in about half of cases, and these were mostly labral debridements and rotator cuff debridements. Overall, we had three patients undergo revision surgery. We had five that had a radiographic loss of reduction, and seven that were not able to return to their preoperative level of injury. Interestingly, all of our patients that had a radiographic loss of reduction did return to their pre-injury activity level. There was no difference in outcomes depending on the number of tunnels placed in the clavicle, zero, one, or two, and whether or not the AC joint capsule was reconstructed with excess graft. When looking at our failures, the patients that had a radiographic loss of reduction had 100% return to activity and excellent SANE scores that were significantly higher than those that were not able to return to their activity level. There were no differences in outcomes depending on the Rockwood grade of injury, whether a grade three or five, and there was no clinically significant difference when looking at concomitant pathology that was treated at the time of surgery. So there were several limitations to this study. This was several surgeons over a 10-year period, and there was heterogeneity in technique with attachments to the clavicle using one, two, or three tunnels. The only postoperative score that we had was the SANE score at final follow-up, and the radiographic loss of reduction was assessed compared to the contralateral side, not compared to the immediate post-op radiograph, which was not obtained in all patients. So in conclusion to our knowledge, this is the largest study reporting outcomes following scope-assisted CC reconstruction. We found no association between radiographic loss of reduction and the patient's ability to return to their pre-injury level of activity, and we also found that the presence of concomitant pathology did not affect clinical outcomes. Thank you for your time.

CC ligament reconstruction

outcomes

free tendon allografts

patient-reported outcomes

pre-injury activity level