Presentation on theme: "Weaver Dunn Technique for AC Joint Repair"— Presentation transcript:
1 Weaver Dunn Technique for AC Joint Repair Matt Wallace
2 Indications for Surgery Failure of conservative treatment after 6-12 months of activity modificationLocalized tenderness with positive lidocaine injection testPositive radiographsUnacceptable deformity of the jointUnbalanced appearance of the shoulder
3 Surgery and Severity of Injury Most orthopaedic surgeons agree that injury types 4-6 are best managed operativelyControversy on surgery for type 3 injuriesin general surgery is usually indicatedinjury usually involved has extensive soft tissue dissection and its imperative that the deltotrapezial fascia is closedsurgical prognosis is usually favorablesome orthopaedic surgeons feel will heal on own
4 Type 3 AC Joint InjuryFigure 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 pain2. Restore joint stability3. Return to functional ability in athleticsor place of workRisks1. Infection2. Loss of ROM3. Tender scars and wound healing problems
6 Different Surgical Procedures Coracoclavicular Suture FixationModified Phemister TechniqueModified Bosworth TechniqueStewart/Mumford Technique- simplest AC joint surgeryWeaver Dunn Technique
7 What is the Weaver-Dunn Technique? AC Joint repair through 2 inch incision in the shoulderDistal end of the clavicle is removedCoracoclavicular ligament is transferred from the underside of the acromion to the top of the clavicle to replace the torn ligamentsnewer 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.html/articles18.html
12 History of The Weaver Dunn Technique First reported ORIF for AC dislocations performed by Cooper in 18611972, two people last names Weaver and Dunn first described an open technique for treatment of acute and chronic AC dislocationsAdvantages in its development:1) Avoided AC fixation which may result in the developmentof symptomatic AC arthritis2) Reconstitutes the coracoclavicular ligament with thetransferred coracoclavicular ligamentModifications since- addition of coracoclavicular fixation with screws or heavysutures to protect the ligament reconstruction
13 Weaver Dunn Surgical Procedure Position of patientbeach chair positionlateral decubitusInterscalene regional block anesthesiaSkin incision just posterior to the AC Joint to the coracoid in the direction of the skin creaseslongitudinal incision made in the condensed deltotrapezial fascia overlying the reduced position of the claviclemeniscus removed or detached if torndistal clavicle exposed for 5cm medial to the AC Joint
14 Surgical Procedure cont May split 3cm of ant deltoid if needed to expose coracoid process2 nonabsorbable sutures passed around the base of the coracoid using a curved clamp2 small drill holes placed in the middle of the clavicle superior to the coracoid an the sutures are passed through the holesdistal clavicle reduced against the acromion and the sutures are tied downdistal clavicle resection performed if neededcoracoacromial ligament transferred to the resected distal surfacedeltotrapezial fascia repaired and routine closure performed
15 Modifications to the Weaver-Dunn No lateral clavicular end resectioncoracoacromial ligament graft sutured to the inferior part of the clavicle by transosseal suturesBosworth coracoclavicular screw used to protect the graft for 8 wks. post-opused more for young patients because of post-traumatic arthrosis that occurs more frequently in elderly patients making clavicular end resection necessaryArthroscopic distal clavicle excision
16 Post Operative Treatment Shoulder immobilized w/ slingmotion allowed at the wrist and elbowShoulder motion begun at 4-6 wks.PRE added at next 6-8 wks.or after ROM returnsAvoid 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 motionYesCreates more inferior location of the clavicle with respect to the medial acromionWeistein & McCannORIF gives patient the best chance to obtain normal shoulder function due to the restoration of the normal anatomy93% success rate in returning ath. to activityOxford texbook describes an estimated complication rate of only 10%
18 Hot Discussion Topic When is best time to have surgery after injury? Little info. knowntrend towards better results with early repairearly repair tends to show less chance for loss of reduction after surgeryage not a factor
19 ConclusionsWeaver-Dunn or other surgical intervention not necessary treatment for all AC dislocationswhen surgery is indicated for AC dislocations Weaver-Dunn tends to be surgery of choice due to consistent satisfactory results for patientsdecision to operate should be made before 3 months after surgeryafter this point less favorable results are achieved
20 ReferencesAcromioclavicular 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)