ArticleJournal of orthopaedic case reports2025
Failed Loop Endobutton Acromioclavicular Joint Reconstruction Treated with Duo Figure of 8 FiberTape Augmented Autogenic Graft Wrapping Technique: A Case Report.
Article in Journal of orthopaedic case reports, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Acromioclavicular joint (ACJ) injuries are prevalent among young, active individuals and account for a significant proportion of shoulder girdle and collision sports injuries. The Rockwood classification system categorizes these injuries from Type I to VI, guiding treatment from conservative management to surgical intervention. Despite various surgical techniques, including the Fiber-loop Endobutton method, failure rates, and complications remain a concern, particularly in cases of post-operative instability. Case Report: A 50-year-old male presented with persistent right shoulder pain and deformity following an initial Type-V ACJ injury from a road traffic accident. The patient had undergone surgical stabilization with a Fiber-loop Endobutton construct. However, 17th days post-surgery, he experienced a recurrence of pain and deformity, with radiographs revealing the failure of the initial repair. Subsequent imaging indicated a mal-positioned Endobutton and potential coracoid blowout, likely due to inadequate drill hole placement. Three weeks later, the patient underwent revision surgery using a double figure-of-8 autogenic loop reconstruction with FiberTape and hamstring tendon graft. The procedure involved removing the failed hardware, drilling new holes in the clavicle, and securing the ACJ with FiberTape and a hamstring graft. The graft was looped around the coracoid and clavicle in a figure-of-8 manner to replicate acromioclavicular ligament anatomy and ensure both horizontal and vertical stability. At 6 weeks, follow-up radiographs demonstrated near-anatomic alignment of the ACJ and coracoclavicular. The patient reported minimal pain and regained a near-full range of motion. By 6 months, while slight radiographic changes were noted, the patient remained asymptomatic with excellent functional outcomes and minimal limitations. Conclusion: This case highlights the challenges of managing post-operative instability in ACJ injuries. The successful use of a dual figure-of-8 graft technique provides a viable solution for revision surgery, offering satisfactory stability and functional recovery. Further research is needed to optimize salvage techniques for complex cases.
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