case_images: PMC5606104_01
case_images: Anteroposterior left ACJ radiograph demonstrating Rockwood V ACJ dislocation.
case_images: CRIOR2017-3792610.001.jpg
case_images: PMC5606104_01_CRIOR2017-3792610.001.jpg
case_images: fig1
case_images: 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.
case_images: 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.
case_images: CRIOR2017-3792610.002.jpg
case_images: PMC5606104_01_CRIOR2017-3792610.002.jpg
case_images: fig2
case_images: 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.
case_images: Intraoperative photograph demonstrating substantial fraying to LARS four months after insertion.
case_images: CRIOR2017-3792610.003.jpg
case_images: PMC5606104_01_CRIOR2017-3792610.003.jpg
case_images: fig3
case_images: 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).
case_images: Anteroposterior left ACJ radiograph two months after re-do LARS implantation showing anatomically reduced ACJ.
case_images: CRIOR2017-3792610.004.jpg
case_images: PMC5606104_01_CRIOR2017-3792610.004.jpg
case_images: fig4
case_images: 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.
case_images: PMC5606104_02
case_images: 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.
case_images: CRIOR2017-3792610.005.jpg
case_images: PMC5606104_02_CRIOR2017-3792610.005.jpg
case_images: fig5
case_images: On exploration, the LARS had frayed at its medial limb, as seen in Figure 5, between its position at the clavicle and coracoid.