Poster 190: Utilization of Distal Clavicle Bone Grafting in the Treatment of a Mobile Mesoacromion: Rationale and Technique

Objectives: The treatment of symptomatic unstable os acromiale can be fraught with challenges. It is estimated that between 3-5% the population has an unfused mesoacromion, but only a small fraction those shoulders develop painful, mobile mesoacromion requires treatment. variety concomitant shoulder pathology and overlapping symptoms make diagnosis difficult. Furthermore, there remains no consensus for optimal surgical when conservative methods fail. Surgical options include fragment excision, acromioplasty, open reduction internal fixation (ORIF) or without bone grafting. A arthroscopic techniques have been described large amount heterogeneity in literature making comparison these Biomechanical forces through clavicle acromioclavicular (AC) joint throughout range motion literature. These theoretical implications on relationship distal mesoacromion. Shear, rotational, translational compression imparted against acromion, by ligaments, impart same mesoacromial defect via linkage AC joint. There are currently studies describing utility using as graft source during ORIF cross sectional shape surface area remarkably similar to acromial process. We describe technique utilizing grafting present case series 8 patients 100% union rate. Methods: retrospective analysis was done from 2001-2016 who underwent symptomatic, single surgeon. utilizes saber type incision exposure joint, clavicle. Small splits anterior posterior deltoid utilized palpate aspect acromion. Two parallel Kirschner wires (K wires) placed acromion crossing site. proximal aspects site prepared rasped. skeletonized 9mm removed micro saw. sliced 2-3 mm thickness creating "wafer" local graft. narrow slots into wafer rongeur. spaced at exact distance K wires. then allowed straddle slots. clamped front back clamp cannulated screws over K-wires. Supplemental tension band used earlier portion senior author’s practice. Over course technique, development modern screws, supplemental felt unnecessary. Soft tissues were closed standard fashion. Results: median patient age 52.5 (range, 41-59) 75% male 87.5% Caucasian. body mass index (BMI) 29.4 23.9-39.2), 62.5% non-smokers, 25% 2 diabetics, 37.5% had hypertension comorbidities. this procedure follow-up 6 years (range 2-18). All procedures above reinforced patients. Seven which included either partial full rotator cuff tears (n=6), arthritis (n=4), glenohumeral (GH) (n=2) biceps injury (n=2). Six additional including repair (n=3), tenodesis GH debridement (n=5). One acute superficial postoperative infection successfully treated irrigation debridement. Otherwise, complications related procedure. Postoperatively all relief went radiographic Conclusions: paucity help guide Studies largely limited reviews various utilized. Therefore, importance relying experience expert opinion cannot overemphasized. This first study use Use obviates need separate harvest it reduces abutment, rotational maintains length, increases bony union. evolved resulted rate our year follow-up.