PMC5606104_01
Anteroposterior left ACJ radiograph demonstrating Rockwood V ACJ dislocation.
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fig1
A normally fit and well right hand dominant twenty-six-year-old man sustained a left Rockwood grade V acromioclavicular joint dislocation from a rugby injury in June 2015, complaining of pain and a grinding sensation from his left shoulder on abduction when seen in January 2016.  Figure 1 represents the preimplant radiographs.
Anteroposterior left ACJ radiograph at three months after LARS July 2016 implantation demonstrating relapse of ACJ dislocation and heterotopic ossification medial to the medial clavicular screw.
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fig2
However, three months after operation, he re-presented with an acute history of the distal clavicle again becoming prominent and elevated with no intervening history of trauma, and subsequent radiographs demonstrated the loss of position, as seen in Figure 2. Heterotopic ossification medial to the medial clavicular screw was visualized on postoperative Figures 2 and 4 but not identified intraoperatively and was considered to not be implicated in the failure.
Intraoperative photograph demonstrating substantial fraying to LARS four months after insertion.
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fig3
Intraoperatively, the clavicular screws were secure.  Figure 3 represents the removed LARS intraoperatively. On removal, the ligament was found to be tightly held within the bone canal (on the right in Figure 3; however, the LARS was found to be frayed deep to the coracoid, as seen on the left in Figure 3).
Anteroposterior left ACJ radiograph two months after re-do LARS implantation showing anatomically reduced ACJ.
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fig4
Radiographs, as seen in Figure 4, demonstrated satisfactory reduction and the patient reported good function. Heterotopic ossification medial to the medial clavicular screw was visualized on postoperative Figures 2 and 4 but not identified intraoperatively and was considered to not be implicated in the failure.
PMC5606104_02
Intraoperative photograph demonstrating substantial fraying to LARS three weeks after insertion. The left fragment is the lateral limb of the LARS and the right fragment is the medial limb.
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fig5
On exploration, the LARS had frayed at its medial limb, as seen in Figure 5, between its position at the clavicle and coracoid.