1. Weaver Dunn Technique for AC Joint Repair
Matt Wallace

2. Indications for Surgery
Failure of conservative treatment after 6-12 months of activity modification
Localized tenderness with positive lidocaine injection test
Positive radiographs
Unacceptable deformity of the joint
Unbalanced appearance of the shoulder

3. Surgery and Severity of Injury
Most orthopaedic surgeons agree that injury types 4-6 are best managed operatively
Controversy on surgery for type 3 injuries
in general surgery is usually indicated
injury usually involved has extensive soft tissue dissection and its imperative that the deltotrapezial fascia is closed
surgical prognosis is usually favorable
some orthopaedic surgeons feel will heal on own

4. Type 3 AC Joint Injury
Figure 1: Type III acromioclavicular injuries are defined by complete rupture of both the acromioclavicular and the coracoclavicular ligaments.

5. Goals and Risks of Surgery
1. Relieve pain
2. Restore joint stability
3. Return to functional ability in athletics
or place of work
Risks
1. Infection
2. Loss of ROM
3. Tender scars and wound healing problems

6. Different Surgical Procedures
Coracoclavicular Suture Fixation
Modified Phemister Technique
Modified Bosworth Technique
Stewart/Mumford Technique
- simplest AC joint surgery
Weaver Dunn Technique

7. What is the Weaver-Dunn Technique?
AC Joint repair through 2 inch incision in the shoulder
Distal end of the clavicle is removed
Coracoclavicular ligament is transferred from the underside of the acromion to the top of the clavicle to replace the torn ligaments
newer addition to the procedure

8. Weaver Dunn Technique Part 1
Operative exposure of the ruptured coracoclavicular ligaments

9. Weaver Dunn Technique Part 2
The coracoacromial ligament is isolated for transfer.

10. Weaver Dunn Technique Part 3
Suture anchors are used to secure the coracoid to the clavicle. The coracoacromial ligament is transferred to the clavicle.

11. Weaver Dunn Finished Product
Post-operative radiograph demonstrating restoration of stable, anatomic alignment. The distal clavicle was excised.
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12. History of The Weaver Dunn Technique
First reported ORIF for AC dislocations performed by Cooper in 1861
1972, two people last names Weaver and Dunn first described an open technique for treatment of acute and chronic AC dislocations
Advantages in its development:
1) Avoided AC fixation which may result in the development
of symptomatic AC arthritis
2) Reconstitutes the coracoclavicular ligament with the
transferred coracoclavicular ligament
Modifications since
- addition of coracoclavicular fixation with screws or heavy
sutures to protect the ligament reconstruction

13. Weaver Dunn Surgical Procedure
Position of patient
beach chair position
lateral decubitus
Interscalene regional block anesthesia
Skin incision just posterior to the AC Joint to the coracoid in the direction of the skin creases
longitudinal incision made in the condensed deltotrapezial fascia overlying the reduced position of the clavicle
meniscus removed or detached if torn
distal clavicle exposed for 5cm medial to the AC Joint

14. Surgical Procedure cont
May split 3cm of ant deltoid if needed to expose coracoid process
2 nonabsorbable sutures passed around the base of the coracoid using a curved clamp
2 small drill holes placed in the middle of the clavicle superior to the coracoid an the sutures are passed through the holes
distal clavicle reduced against the acromion and the sutures are tied down
distal clavicle resection performed if needed
coracoacromial ligament transferred to the resected distal surface
deltotrapezial fascia repaired and routine closure performed

15. Modifications to the Weaver-Dunn
No lateral clavicular end resection
coracoacromial ligament graft sutured to the inferior part of the clavicle by transosseal sutures
Bosworth coracoclavicular screw used to protect the graft for 8 wks. post-op
used more for young patients because of post-traumatic arthrosis that occurs more frequently in elderly patients making clavicular end resection necessary
Arthroscopic distal clavicle excision

16. Post Operative Treatment
Shoulder immobilized w/ sling
motion allowed at the wrist and elbow
Shoulder motion begun at 4-6 wks.
PRE added at next 6-8 wks.or after ROM returns
Avoid contact activities till 9 mo. post-surgery

17. Studies on Weaver-Dunn
Minnesota Orthopaedics: Does the Weaver-Dunn AC reconstruction recreate normal passive AC Joint motion
Yes
Creates more inferior location of the clavicle with respect to the medial acromion
Weistein & McCann
ORIF gives patient the best chance to obtain normal shoulder function due to the restoration of the normal anatomy
93% success rate in returning ath. to activity
Oxford texbook describes an estimated complication rate of only 10%

18. Hot Discussion Topic When is best time to have surgery after injury?
Little info. known
trend towards better results with early repair
early repair tends to show less chance for loss of reduction after surgery
age not a factor

19. Conclusions
Weaver-Dunn or other surgical intervention not necessary treatment for all AC dislocations
when surgery is indicated for AC dislocations Weaver-Dunn tends to be surgery of choice due to consistent satisfactory results for patients
decision to operate should be made before 3 months after surgery
after this point less favorable results are achieved

20. References
Acromioclavicular Joint Arhroscopy Distal Clavicle Excision. Arhroscopy Association of America [Online]. Available:
Deshmukh, A., et al. (1998). Biomechanics of Acromioclavicular Instability. Harvard Orthopaedic Journal. 12(4). 1-7.
Injuries to the Acromioclavicular Joint (AC Joint). Sports Medicine Clinic of North Texas. [Online]. Available:
Magee, David J. (1997). Orthopedic Physical Assessment 3rd edition.
Paulik, A., Dezso, C., & Hidas, P. (1998). Surgical Treatment of Chronic Acromioclavicular Joint Dislocation by Modified Weaver-Dunn Procedure. National Institute for Sports Medicine, Department of Sports Surgery. 48(1)
Weistein, D.M., McCann, P.D. (1995). Surgical Treatment of Complete Acromioclavicular Dislocations. American Journal of Sports Medicine. 23(3)

21. The End
AC joint Injury ??
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