Acromion Clavicular Joint Reconstruction with LARS Ligament in Acute Dislocation

Document Type : RESEARCH PAPER


1 Orthopedic Department, San Giacomo Apostolo Hospital, Castelfranco Veneto, Italy

2 Veneto Institute of Oncology IOV - IRCCS, Padua, Italy

3 Department of Orthopedic Surgery, University of Palermo (DiChirOnS), Palermo, Italy


Background: The acromion clavicular joint dislocations are common injuries of the shoulder. The severity is dependent
upon the degree of ligamentous injury. Surgical treatment is typically performed in higher grade acromioclavicular
separation with several static and dynamic operative procedures with or without primary ligament replacement.
Methods: 47 patients with acute Rockwood type III, IV, and V injuries were treated surgically with LARS reconstruction.
The success of technique was evaluated by radiographic outcomes for each patient at every follow-up visit (one,
three, 12 months), while to assess pain reduction and clinical evaluation Visual Analogue scale score (VAS) and
Constant-Murley score (CMA) was performed, respectively. An One Way Analysis of Variance (Kruskal-Wallis test), a
multiple comparison Turket test, or a t-test (Mann-Whitney Rank Sum Test) were used when required.
Results: Follow-up radiographs revealed maintenance of anatomical reduction in 41 patients, and no bone erosions
has been identified. In short-term joint functional recovery has been observed. Indeed, after 12 months pain on the
VAS-scale in all groups decreased significantly (P < 0.05), and the CMS revealed a significant overall improvement
(P < 0.05).
Conclusion: These data demonstrate that the use of the LARS allows to provide stability to the joint and especially to
ensure its natural elasticity, relieving pain and improving joint function already one month post-surgery.
Level of evidence: III


Main Subjects

1. Headey J, Brooks JH, Kemp SP. The epidemiology of
shoulder injuries in English professional rugby union.
Am J Sports Med. 2007; 35(9):1537-43.
2. Fukuda K, Craig EV, An KN, Cofield RH, Chao EY.
Biomechanical study of the ligamentous system of the
acromioclavicular joint. J Bone Joint Surg Am. 1986;
3. Monica J, Vredenburgh Z, Korsh J, Gatt C. Acute
shoulder injuries in adults. Am Fam Physician. 2016;
4. Riand N, Sadowski C, Hoffmeyer P. Acute
acromioclavicular dislocations. Acta Orthop Belg.
1999; 65(4):393-403.
5. Spencer HT, Hsu L, Sodl J, Arianjam A, Yian EH.
Radiographic failure and rates of re-operation after
acromioclavicular joint reconstruction: a comparison
of surgical techniques. Bone Joint J. 2016; 98-
6. Beitzel K, Obopilwe E, Apostolakos J, Cote MP,
Russell RP, Charette R, et al. Rotational and
translational stability of different methods for direct
acromioclavicular ligament repair in anatomic
acromioclavicular joint reconstruction. Am J Sports
Med. 2014; 42(9):2141-8.
7. Virk MS, Apostolakos J, Cote MP, Baker B, Beitzel K,
Mazzocca AD. Operative and nonoperative treatment
of acromioclavicular dislocation: a critical analysis
review. JBJS Rev. 2015; 3(10):1-10.
8. Yoo YS, Tsai AG, Ranawat AS, Bansal M, Fu FH,
Rodosky MW, et al. A biomechanical analysis of the
native coracoclavicular ligaments and their influence
on a new reconstruction using a coracoid tunnel and
free tendon graft. Arthroscopy. 2010; 26(9):1153-61.
9. Arirachakaran A, Boonard M, Piyapittayanun P,
Phiphobmongkol V, Chaijenkij K, Kongtharvonskul J.
Comparison of surgical outcomes between fixation
with hook plate and loop suspensory fixation for
acute unstable acromioclavicular joint dislocation:
a systematic review and meta-analysis. Eur J Orthop
Surg Traumatol. 2016; 26(6):565-74.
10. Iliadis DP, Bourlos DN, Mastrokalos DS, Chronopoulos
E, Babis GC. LARS artificial ligament versus ABC purely
polyester ligament for anterior cruciate ligament
reconstruction. Orthop J Sports Med. 2016; 4(6):1-10.
11. Lu N, Zhu L, Ye T, Chen A, Jiang X, Zhang Z, et al. Evaluation
of the coracoclavicular reconstruction using LARS
artificial ligament in acute acromioclavicular joint
dislocation. Knee Surg Sports Traumatol Arthrosc.
2014; 22(9):2223-7.
12. De Carli A, Lanzetti RM, Ciompi A, Lupariello D, Rota P,
Ferretti A. Acromioclavicular third degree dislocation:
surgical treatment in acute cases. J Orthop Surg Res.
2015; 10(1):13.
13. Bateman JE. Athletic injuries about the shoulder in
throwing and body-contact sports. Clin Orthop. 1962;
14. Bosworth BM. Complete acromioclavicular
dislocation. N Engl J Med. 1949; 241(6):221-5.
15. Vascellari A, Schiavetti S, Battistella G, Rebuzzi E,
Coletti N. Clinical and radiological results after
coracoclavicular ligament reconstruction for type
III acromioclavicular joint dislocation using three
different techniques. A retrospective study. Joints.
2015; 3(2):54-61.
16. Inman VT, Saunders JB, Abbott LC. Observations of the
function of the shoulder joint. 1944. Clin Orthop Relat
Res. 1996; 330(1):3-12.
17. Conway AM. Movements at the sternoclavicular
and acromioclavicular joints. Phys Ther Rev. 1961;
18. Teece RM, Lunden JB, Lloyd AS, Kaiser AP, Cieminski
CJ, Ludewig PM. Three-dimensional acromioclavicular
joint motions during elevation of the arm. J Orthop
Sports Phys Ther. 2008; 38(4):181-90.
19. Wiesel BB, Gartsman GM, Press CM, Spencer EE Jr,
Morris BJ, Zuckerman JD, et al. What went wrong and
what was done about it: pitfalls in the treatment of
common shoulder surgery. Instr Course Lect. 2014;
20. Aslani H, Mirzaee F, Zafarani Z, Salehi S. Modified 
internal fixation technique for acromio-clavicular
(AC) joint dislocation: the “Hidden Knot Technique”.
Arch Bone Jt Surg. 2018; 6(1):81-4.
21. Lee KW, Debski RE, Chen CH, Woo SL, Fu FH. Functional
evaluation of the ligaments at the acromioclavicular
joint during anteroposterior and superoinferior
translation. Am J Sports Med. 1997; 25(6):858-62.
22. González-Erreguí􀆴n V, Morales-Villanueva J. Surgical
treatment of acute acromioclavicular dislocation.
Preliminary report. Acta Ortop Mex. 2015;
23. Fraschini G, Ciampi P, Scotti C, Ballis R, Peretti GM.
Surgical treatment of chronic acromioclavicular
dislocation: comparison between two surgical
procedures for anatomic reconstruction. Injury. 2010;
24. Modi CS, Beazley J, Zywiel MG, Lawrence TM, Veillette
CJ. Controversies relating to the management of
acromioclavicular joint dislocations. Bone Joint J.
2013; 95-B(12):1595-602.
25. Nakazawa M, Nimura A, Mochizuki T, Koizumi M,
Sato T, Akita K. The orientation and variation of the
acromioclavicular ligament: an anatomic study. Am J
Sports Med. 2016; 44(10):2690-5.
26. Trieb K, Blahovec H, Brand G, Sabeti M, Dominkus M,
Kotz R. In vivo and in vitro cellular ingrowth into a
new generation of artificial ligaments. Eur Surg Res.
2004; 36(3):148-51.
27. Marcheggiani Muccioli GM, Manning C, Wright P,
Grassi A, Zaffagnini S, Funk L. Acromioclavicular joint
reconstruction with the LARS ligament in professional
versus non-professional athletes. Knee Surg Sports
Traumatol Arthrosc. 2016; 24(6):1961-7.
28. Milewski MD, Tompkins M, Giugale JM, Carson EW,
Miller MD, Diduch DR. Complications related to
anatomic reconstruction of the coracoclavicular
ligaments. Am J Sports Med. 2012; 40(7):1628-34.
29. Torkaman A, Bagherifard A, Mokhatri T, Haghighi
MH, Monshizadeh S, Taraz H, et al. Doublebutton
fixation system for management of acute
acromioclavicular joint dislocation. Arch Bone Jt
Surg. 2016; 4(1):41-6.