Vinod Kumar, Sunil Garg, Ihab Elzein, Tom Lawrence, Paul Manning, W Angus Wallace
Nottingham Shoulder & Elbow Unit, Nottingham University Hospitals NHS Trust, United Kingdom
Journal of Orthopaedic Surgery 2014;22(2):199-203
The study was to compare the outcomes of ACJ reconstruction using the Modified Weaver-Dunn procedure versus the Lockdown™ (formerly Surgilig™) synthetic device.
55 patients aged between 19-72 years underwent ACJ reconstruction of Rockwood Grades 3, 4 and 5. The Modified Weaver-Dunn procedure was used on 31 patients and the Lockdown™ synthetic device on 24 patients based on the surgeon’s preference. The mean period from injury to surgical treatment was 39 months. Generally, the less severe cases were treated with the Modified-Weaver Dunn procedure and more severe cases with the Lockdown™ device.
After a mean follow-up period of 40 months, the Oxford Shoulder Scores improved from 28 to 42 in the Weaver-Dunn group and from 26 to 45 in the Lockdown™ group. The Nottingham Clavicle Scores improved from 53-81 and from 51 to 93 for the Lockdown™ device. The Lockdown™ group achieved significantly better postoperative Oxford Shoulder Score and Nottingham Clavicle Scores. The Lockdown device also achieved earlier return to work and sports, compared with the Modified Weaver-Dunn procedure.
Of the 55 patients, 3 of the Modified Weaver-Dunn group and 1 of the Lockdown group failed. The Lockdown™ failure case occurred when the device ruptured following a fall onto the affected side 8 weeks after surgery. All failures were revised with the Lockdown device.
The paper notes that the tensile strengths of the CC ligament and CC sling from Fiberwire used in the Modified Weaver-Dunn technique are 500N and 483N compared to the pull out strength of the Lockdown™ device being in excess of 1700N. This enables Lockdown™ patients to undergo more aggressive rehabilitation and earlier mobilisation of the shoulder. Therefore, it is more cost effective in terms of reduction in off-work time. Because of this it recommends that the Lockdown™ device is used as a primary treatment for ACJ dislocation as it provides permanent protection to the damaged CC ligament.
You can access the full paper here.