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Kilkenny CJ, Farooq F, Hurley ET, Daly GR, Dowling GP, Whelehan SP, Mullett H. A bibliometric analysis of the top 50 cited studies related to acromioclavicular joint instability. J Orthop 2024; 58:46-51. [PMID: 39050808 PMCID: PMC11263472 DOI: 10.1016/j.jor.2024.06.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Accepted: 06/25/2024] [Indexed: 07/27/2024] Open
Abstract
Background Acromioclavicular joint (ACJ) injury is a common orthopaedic condition accounting for over 40 % of all shoulder injuries. The purpose of this study is to assess the research trends and characteristics of the top 50 cited articles on ACJ instability. Methods A systematic search was conducted in Web of Science to identify articles primarily related to ACJ injury or instability. Characteristics including citation number, country of origin, journal and institution of publication, impact factor, authorship, level of evidence, patient demographics, and study type were analyzed and recorded. Results Research output on ACJ instability has been steadily increasing, with the top 50 cited studies predominantly presenting Level IV evidence. These studies primarily focused on treatment outcomes which included predominantly male patients and exhibited a large variation in citation counts. The American Journal of Sports Medicine was the most productive journal, and the USA was the most productive nation. Conclusion There is an increasing number of publications in the ACJ instability literature, primarily concentrated in a few institutions and journals, and focusing mainly on treatment outcomes. A significant portion of these publications are of low scientific quality, and there is a notable lack of research on outcomes for females.
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Affiliation(s)
| | - Fahad Farooq
- SUNY Upstate Medical University, Syracuse NY, USA
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Jensen G, Dey Hazra RO, Al-Ibadi M, Salmoukas K, Katthagen JC, Lill H, Ellwein A. Arthroscopically assisted single tunnel reconstruction for acute high-grade acromioclavicular joint dislocation with an additional acromioclavicular joint cerclage. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2022; 33:1185-1192. [PMID: 35523973 DOI: 10.1007/s00590-022-03271-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 04/15/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Purpose of this study was to demonstrate that a single tunnel reconstruction of high-grade acromioclavicular (AC) joint instabilities with implants of the second generation is sufficient for stabilisation, especially in combination with an AC cerclage. METHODS Patients with an acute AC-joint dislocation type Rockwood III-B and V were included. Besides clinical follow-up examination, radiographs were analysed. The functional outcome measures were Constant Score (CS), Taft score (TS), ACJI score and patient's satisfaction. Horizontal instability was evaluated by clinical examination and radiological with an Alexander view. RESULTS Thirty-five patients with a mean follow-up of 29 months were included. Ninety-seven per cent were satisfied with their result, with an average Subjective Shoulder Value of 90%. The CS averaged at 90 ± 10 points, TS at 11 ± 1 points and ACJI at 78 ± 18 points. Radiologically, 3 of 29 patients (10%) showed a persisting horizontal instability. The coracoclavicular (CC) distance improved from 22 preoperative to 10 mm postoperative, which was comparable to the contralateral side (10 mm, p = 0.103). At follow-up the CC distance increased to 13 mm (p = 0.0001). CONCLUSION AC-joint stabilisation with a single tunnel reconstruction using a second-generation implant results in good to excellent clinical results with high patient satisfaction. The additional AC augmentation improves stability in horizontal instable AC-joints and is recommended in all high-grade AC joint stabilisations. Nonetheless, reduction was slightly lost over time due to an elongation or suture failure of the coraco-clavicular fixation. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Gunnar Jensen
- Department for Orthopaedic Surgery and Traumatology, DIAKOVERE Friederikenstift, Humboldtstraße 5, 30169, Hannover, Germany.
- Department for Orthopaedic Surgery, Medical School Hannover, DIAKOVERE Annastift, Anna-von-Borries-Straße 1-7, 30625, Hannover, Germany.
| | - Rony-Orijit Dey Hazra
- Department for Orthopaedic Surgery and Traumatology, DIAKOVERE Friederikenstift, Humboldtstraße 5, 30169, Hannover, Germany
| | - Mireille Al-Ibadi
- Department for Orthopaedic Surgery and Traumatology, DIAKOVERE Friederikenstift, Humboldtstraße 5, 30169, Hannover, Germany
| | - Katharina Salmoukas
- Unfallkrankenhaus Berlin, Warener Str. 7, 12683, Hannover, Lower Saxony, Germany
| | - Jan Christoph Katthagen
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus, building W1, 48149, Münster, Germany
| | - Helmut Lill
- Department for Orthopaedic Surgery and Traumatology, DIAKOVERE Friederikenstift, Humboldtstraße 5, 30169, Hannover, Germany
| | - Alexander Ellwein
- Department for Orthopaedic Surgery and Traumatology, DIAKOVERE Friederikenstift, Humboldtstraße 5, 30169, Hannover, Germany
- Department for Orthopaedic Surgery, Medical School Hannover, DIAKOVERE Annastift, Anna-von-Borries-Straße 1-7, 30625, Hannover, Germany
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Short-term clinical and radiological outcomes of treatment of acromioclavicular joint dislocations with the TightRope technique. JOURNAL OF SURGERY AND MEDICINE 2021. [DOI: 10.28982/josam.893296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lafosse T, Fortané T, Lafosse L. All-Endoscopic Treatment of Acromioclavicular Joint Dislocation: Coracoclavicular Ligament Suture and Acromioclavicular Ligament Desincarceration. Arthrosc Tech 2020; 9:e1485-e1494. [PMID: 33134050 PMCID: PMC7587138 DOI: 10.1016/j.eats.2020.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 06/06/2020] [Indexed: 02/03/2023] Open
Abstract
Acute acromioclavicular (AC) joint dislocations are common and difficult to manage. The physiopathologic pattern begins with the rupture of the AC ligaments, then the coracoclavicular (CC) ligaments, and with an invasion of the clavicle through the deltotrapezial fascia. Therefore, we tend to perform a true suture of the CC ligaments, along with a release of the AC ligaments from the joint. We thus propose an all-endoscopic CC ligament suture and AC joint release. It starts with glenohumeral exploration enabling a repair of concomitant lesions when necessary. Dissection of the coracoid process is made, along with the lateral border of the conjoint tendon, medially the pectoralis minor tenotomy, and plexus brachial exposition and protection. Superiorly the CC ligaments are tagged and exposed. A major difference with others procedure then arises. We dissect the inferior and superior surfaces of the clavicle and the AC joint, although we maintain the continuity between the deltotrapezoid fascia and the AC ligaments. The AC dislocation is reduced under endoscopic control performing a true suture of the CC ligaments by the mean of 2 suture tapes and dog bones. After surgery, a shoulder brace is used for 6 weeks. Physiotherapy then begins.
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Affiliation(s)
| | - Thibaut Fortané
- Address correspondence to Thibaut Fortané, M.D., Alps Surgery Institute, Clinique Générale d’Annecy; 4 Chemin de la Tour la Reine, 74000 Annecy, France.
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Martetschläger F, Kraus N, Scheibel M, Streich J, Venjakob A, Maier D. The Diagnosis and Treatment of Acute Dislocation of the Acromioclavicular Joint. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 116:89-95. [PMID: 30892184 DOI: 10.3238/arztebl.2019.0089] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 08/09/2018] [Accepted: 11/22/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND The acromioclavicular joint (ACJ) is one of the more common sites of shoulder girdle injury, accounting for 4-12% of all such injuries, with an incidence of 3-4 cases per 100 000 persons per year in the general population. Current topics of debate include the proper standard diagnostic evaluation, the indications for surgery, and the best operative method. METHODS This review is based on publications retrieved by a selective literature search. RESULTS Mechanical trauma of the ACG can tear the ligamentous apparatus that holds the acromion, clavicle, and coracoid process together. Different interventions are indicated depending on the nature of the injury. In recent years, the horizontal component of the instability has received more attention, in addition to its vertical component. Persistent instability can lead to chronic, painful limitation of shoulder function, particularly with respect to working above the head. Surgical stabilization is therefore recommended for high-grade instability of Rockwood types IV and V. Modern reconstruction techniques enable selective vertical and horizontal treatment of the instability and have been found superior to traditional methods, particularly in young athletes. Arthroscopic techniques are advantageous because they are less invasive, do not require removal of implanted material, and afford the opportunity to diagnose any accompanying lesions definitively and to treat them if necessary. Surgery for acute injuries should be performed within three weeks of the trauma. For chronic injuries, additional tendon augmentation is now considered standard treatment. CONCLUSION High-grade ACJ instability is a complex and significant injury of the shoulder girdle that can cause persistent pain and functional impairment. The state of the evidence regarding its optimal treatment is weak. Large-scale, prospective, randomized comparative studies are needed in order to define a clear standard of treatment.
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Affiliation(s)
- Frank Martetschläger
- German Center of Shoulder Surgery, ATOS Clinic Munich, Department of Sports Orthopedics, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Department of Orthopedics and Orthopedic Surgery, University Medicine Greifswald, Greifswald, Germany; Upper Extremity Department, Schulthess Clinic Zurich; Center for Musculoskeletal Surgery (CMSC), Charité-University Medicine Berlin, Berlin, Germany; Department of Orthopedic Surgery, Alfried Krupp Hospital Essen, Essen, Germany; Department of Sports Orthopedics, Marienkrankenhaus Kaiserswerth, Düsseldorf, Germany; Department of Orthopedics and Trauma Surgery, University Hospital Freiburg, Freiburg, Germany; The authors are members of the Shoulder Committee of the German Society of Arthroscopy and Joint Surgery (AGA, Deutsche Gesellschaft für Arthroskopie und Gelenkchirurgie)
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Breuer R, Unterrainer A, Komjati M, Tiefenboeck TM, Trieb K, Pirkl C. Minimally Invasive AC Joint Reconstruction System (MINAR ®) in Modified Triple-Button Technique for the Treatment of Acute AC Joint Dislocation. J Clin Med 2019; 8:jcm8101683. [PMID: 31618809 PMCID: PMC6832357 DOI: 10.3390/jcm8101683] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 09/30/2019] [Accepted: 10/11/2019] [Indexed: 12/13/2022] Open
Abstract
Acute acromioclavicular (AC) joint dislocation is a frequent sports injury with more than 100 different operation methods described. A total of 65 patients with an acute AC joint dislocation were treated with the modified MINAR® system between 2009 and 2013. Clinical outcome, horizontal and vertical instability, as well as concomitant intraarticular injuries were assessed. We used Zanca, stress and axial X-rays for radiological assessment. A Constant score of 95 (±8.8), University of California Los Angeles Shoulder score (UCLA) of 31 (±4.9), Disabilities of Arm, Shoulder and Hand (DASH) of 9.1 (±14.3), and Visual Analogue Scale (VAS) of 0.9 (±0.126) was found. A total of 30 patients (59%) had no signs of reduction loss, nine patients (18%) a slight loss, 11 patients (22%) a partial loss, and one patient (2%) a total loss. No significant influence on the clinical scores could be shown. The postoperative coracoclavicular (CC) distance negatively affected the Constant (p = 0.007) and UCLA scores (p = 0.035). A longer time interval to surgery had a negative influence on all scores (p ≤ 0.001). We could not find any signs of persistent horizontal instability or intraarticular injuries at follow-up. The MINAR® system promises satisfactory functional and radiological results. When setting the correct indication, patients benefit from an early operation. No persisting horizontal instability was observed following suturing of the AC capsule and the delta fascia.
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Affiliation(s)
- Robert Breuer
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria.
| | - Alexandra Unterrainer
- Department of Orthopedics and Trauma Surgery, Klinikum Wels-Grieskirchen, 4600 Wels, Austria.
| | - Micha Komjati
- Department of Orthopedics, Herz-Jesu Hospital, 1030 Vienna, Austria.
| | - Thomas M Tiefenboeck
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria.
| | - Klemens Trieb
- Computed Tomography Research Group, University of Applied Sciences Upper Austria, 4600 Wels, Austria.
| | - Christof Pirkl
- Department of Orthopedics and Trauma Surgery, Klinikum Wels-Grieskirchen, 4600 Wels, Austria.
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Athar MS, Ashwood N, Arealis G, Hamlet M, Salt E. Acromioclavicular joint disruptions: A comparison of two surgical approaches 'hook' and 'rope'. J Orthop Surg (Hong Kong) 2019; 26:2309499017749984. [PMID: 29353523 DOI: 10.1177/2309499017749984] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Acromioclavicular joint injuries are common shoulder girdle injuries most commonly resulting from a direct blow to the acromion with the arm adducted. Type-I or type-II acromioclavicular joint injuries can be managed with sling immobilization, early shoulder motion, and physiotherapy. The management of type-III injuries remains controversial and is individualized. Type IV and V injuries should be treated surgically. A myriad of surgical techniques for the management of acromioclavicular joint injuries have been reported. METHODS We present a comparative study of 76 patients treated with two most common modalities of treatment for AC joint disruption and that is Hook plate stabilisation (n=52) or arthroscopically assisted tight rope stabilisation (n=24). The primary objective was to establish whether hook plate stabilization was superior compared to arthroscopic tight rope fixation in reducing pain and increasing function in the short-term and long-term for patients with AC joint disruptions III-IV. We also wanted to assess how quickly patients returned to their work/job. It was a prospective study, we included all the patients operated between 2008 and 2015 for AC joint disruption by the two shoulder surgeons of our department. All patients followed a strict physiotherapy protocol and were assessed at 6 weeks, 3 months and 12 months. We used the Harm and cost criteria of assessment and the patient specific functional outcome scores. RESULTS Both modalities of treatment have high patient satisfaction rate, return to work is faster in tight rope group but after a year both group of patients returned to their premorbid state. Removal of hook plate is not mandatory and lysis of acromion is rare (1% in our series). CONCLUSION Despite the fact that both methods yielded similar results and have statistically similar number of complications, the type of postoperative complications was different between groups. The plate group had more postoperative pain and worse function but both aspects improved after plate removal. The rope group had more complex complications including deep infection and recurrence of deformity and fracture. These differences should be taken into consideration when consenting the patient regarding possible treatment.
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Affiliation(s)
- M S Athar
- 1 Queen's Hospital - Burton Hospitals NHS Foundation Trust Burton upon Trent, UK
| | - Neil Ashwood
- 1 Queen's Hospital - Burton Hospitals NHS Foundation Trust Burton upon Trent, UK
| | | | - Mark Hamlet
- 1 Queen's Hospital - Burton Hospitals NHS Foundation Trust Burton upon Trent, UK
| | - Emma Salt
- 1 Queen's Hospital - Burton Hospitals NHS Foundation Trust Burton upon Trent, UK
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Domos P, Sim F, Dunne M, White A. Current practice in the management of Rockwood type III acromioclavicular joint dislocations-National survey. J Orthop Surg (Hong Kong) 2018; 25:2309499017717868. [PMID: 28681672 DOI: 10.1177/2309499017717868] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Our aim was to conduct this survey among consultant shoulder surgeons in the United Kingdom to document the current management of Rockwood type III acromioclavicular joint (ACJ) injuries. METHODS British Elbow and Shoulder Society Research Committee-approved online survey was used and 137 responses were collected within 3 months. RESULTS One hundred percent of responders would treat type III injuries conservatively initially. Routine physiotherapy would be offered by 86% of surgeons. The patient's factors that influence the decision to consider surgery are pre-injury functional demand, current functional deficit, pain and patient request for surgery. Across all groups the mean time to surgical intervention from injury was 3.8 months. About 45% of all consultants would use the same technique for all cases and there were differences between the varieties of techniques used by surgeons, depending on their degree of experience. LockDown was the most widely used technique in all groups of patients. This was followed by Ligament Augmentation & Reconstruction System (LARS), hook plate and Arthroscopic TightRope/DogBone technique for acute injuries. LARS, modified Weaver-Dunn and ACJ resection were used most commonly after LockDown for delayed cases. CONCLUSION Our survey revealed the current trends in clinical practice to treat symptomatic Rockwood type III ACJ injuries, but it also confirmed the controversial and complex management differences, which vary among shoulder surgeons in the United Kingdom.
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Affiliation(s)
- Peter Domos
- 1 Department of Trauma and Orthopaedics, Peterborough City Hospital, Peterborough, UK
| | - Frank Sim
- 1 Department of Trauma and Orthopaedics, Peterborough City Hospital, Peterborough, UK
| | - Mike Dunne
- 1 Department of Trauma and Orthopaedics, Peterborough City Hospital, Peterborough, UK
| | - Andrew White
- 1 Department of Trauma and Orthopaedics, Peterborough City Hospital, Peterborough, UK
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Helfen T, Siebenbürger G, Haasters F, Böcker W, Ockert B. Concomitant glenohumeral injuries in Neer type II distal clavicle fractures. BMC Musculoskelet Disord 2018; 19:24. [PMID: 29351746 PMCID: PMC5775546 DOI: 10.1186/s12891-018-1944-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 01/15/2018] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND To identify the prevalence of concomitant glenohumeral injuries in surgically treated Neer type II distal clavicle fractures and relate its clinical importance. METHODS Between 11/2011 and 11/2015 41 patients, suffering from a displaced and unstable distal clavicle fracture were included. 20 patients (group 1) received surgical treatment by means of plate osteosynthesis in combination with an arthroscopically assisted coraco-clavicular ligament augmentation. In group 2 (n = 21 patients) the fracture was treated by hooked plating solely, and diagnostic arthroscopy was conducted during hardware retrieval after the fracture had healed. All arthroscopies were performed in a standardized fashion, images were blinded retrospectively, and evaluated by two independent investigators. RESULTS In total, concomitant glenohumeral pathologies were found in 26.8% of cases (41 patients, mean age 43.6 ± 16.6 years). In Group 1 (n = 20, arthroscopically assisted fracture treatment) the prevalence was 25%, in Group 2 (n = 21, diagnostic arthroscopy during implant removal) 28.5% (p = 0.75). Concomitant glenohumeral injuries included Labrum- and SLAP-tears, partial and full thickness rotator cuff tears as well as lesions to the biceps pulley system. Concomitant injuries were addressed in 2 patients of group 1 (10%, 2× labrum repair) and in 3 patients of group 2 (14.3%, of Group 2 (2× arthroscopic cuff repair of full thickness tear, 1× subpectoral biceps tenodesis in an type IV SLAP lesion, p = 0.68). CONCLUSION The present study could clarify the acute and for the first time mid-term implication and clinical relevance of concomitant glenohumeral injuries. They have been observed in averaged 27% of Neer type II distal clavicle fractures at these two times. However, the findings of this study show that not all concomitant lesions remain symptomatic. While lesions are still present after fracture healing, it's treatment may be depicted upon symptoms at the time of implant removal. In turn, early diagnosis and treatment of concomitant injuries seems reasonable, as untreated injuries can remain symptomatic for more than 6 months after the fracture and recovery may be delayed.
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Affiliation(s)
- Tobias Helfen
- Department General, Trauma and Reconstructive Surgery, Ludwig Maximilians University, Munich University Hospital, Nußbaumstr. 20, 80336, Munich, Germany.
| | - Georg Siebenbürger
- Department General, Trauma and Reconstructive Surgery, Ludwig Maximilians University, Munich University Hospital, Nußbaumstr. 20, 80336, Munich, Germany
| | - Florian Haasters
- Department Knee, Hip and Shoulder Surgery, Schön Klinik Munich-Harlaching, Harlachinger Str. 51, 54817, Munich, Germany
| | - Wolfgang Böcker
- Department General, Trauma and Reconstructive Surgery, Ludwig Maximilians University, Munich University Hospital, Nußbaumstr. 20, 80336, Munich, Germany
| | - Ben Ockert
- Department General, Trauma and Reconstructive Surgery, Ludwig Maximilians University, Munich University Hospital, Nußbaumstr. 20, 80336, Munich, Germany
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Zhang L, Zhou X, Qi J, Zeng Y, Zhang S, Liu G, Ping R, Li Y, Fu S. Modified closed-loop double-endobutton technique for repair of rockwood type III acromioclavicular dislocation. Exp Ther Med 2017; 15:940-948. [PMID: 29399102 PMCID: PMC5772745 DOI: 10.3892/etm.2017.5487] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 11/02/2017] [Indexed: 12/15/2022] Open
Abstract
Acromioclavicular dislocation (ACD) is a common injury. According to the Rockwood classification, ACD is classified into six types (type I–VI); however, for type III injuries, it remains controversial whether or not operative treatment should be applied. Numerous studies have advocated early surgical treatment to ensure early rehabilitation activities. Thus, the present study aimed to investigate a modified closed-loop double-endobutton technique (MCDT), that may be used to repair Rockwood type III ACD. In the current study, 61 patients with Rockwood type III ACD were enrolled during a period of 5 years at the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University. Patients were divided into three groups according to the surgical method used, the MCDT group (n=20), the common closed-loop double-endobutton technique (CCDT) group (n=21), and the clavicular hook plate fixation (CHPF) group (n=20). Preoperative and intraoperative information were recorded. Furthermore, the functional scores of injured shoulder were evaluated prior to surgery and following surgery with a 1-year follow-up. Among the three groups, postoperative functional scores were significantly more improved compared with those prior to surgery (P<0.05), and no significant difference was observed regarding the coracoclavicular interval with the 1-year follow-up (P>0.05). Postoperative functional scores in the MCDT and CCDT groups were significantly more improved compared those in the CHPF group (P<0.05). In addition, the duration of surgery in the MCDT group was significantly shorter compared with that in the CCDT group (P<0.05). Furthermore, compared with the CHPF group, the incision length was significantly shorter with reduced hemorrhage in the MCDT group (P<0.05). In conclusion, the results of the current study suggest that MCDT is more simple, convenient and efficient compared with CCDT, and is worth popularizing.
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Affiliation(s)
- Lei Zhang
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan 646600, P.R. China.,Department of Orthopedics, School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Xin Zhou
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan 646600, P.R. China
| | - Ji Qi
- Department of Orthopedics, School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Yan Zeng
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan 646600, P.R. China
| | - Shaoqun Zhang
- Department of Orthopedics, School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Gang Liu
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan 646600, P.R. China
| | - Ruiyue Ping
- Department of Dermatology, Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong 510403, P.R. China
| | - Yikai Li
- Department of Orthopedics, School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Shijie Fu
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan 646600, P.R. China
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Cano-Martínez JA, Nicolás-Serrano G, Bento-Gerard J, Picazo-Marín F, Andrés-Grau J. Acute high-grade acromioclavicular dislocations treated with triple button device (MINAR): Preliminary results. Injury 2016; 47:2512-2519. [PMID: 27663286 DOI: 10.1016/j.injury.2016.09.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 09/12/2016] [Accepted: 09/14/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Describe the clinical and radiological results of triple button device in the treatment of high-grade AC dislocations (Rockwood, type V) and assess whether improves vertical and horizontal stability compared to the techniques previously described. MATERIAL AND METHODS This retrospective study included 39 patients with type V acromioclavicular dislocations treated with Twin Tail TightRope™ system (triple button device). Of the 39 patients, 33 (26 men and 7 women) were able to participate in clinical and radiographic follow up. At the time of surgery, the mean age was 25years±7(range, 17-49). All patients underwent bilateral-weighted Zanca (CC distance) and Alexander view (AC distance) as well as the Constant Score (CS) and Acromioclavicular Joint Instability Scoring System (ACJI). Radiological and clinical outcome was assessed during routine follow-up examinations preoperatively, postoperatively, 1, 3, 6 months and every year after the surgery. The presence of calcification, degenerative changes, mobilization of implants and bone resorption were also assessed. RESULTS After a mean follow up of 25±4months (range 14-38), the results of the Constant (CS) were 94.1±5,5 (range 76-100) and test ACJI 87.3±9,8 (range 65-100), showing no significant differences with the uninjured shoulder (CS 95.8±2.5, range 83-100; ACJI 94.1±3.7, range 80-100). At final review, we observed that preoperative coracoclavicular distance (Zanca View) improved from 21,75±1.97mm to 8,73mm±0.75 and the acromioclavicular distance (Alexander View) from 12,65mm±1.99 to 0,35±0.3mm. Compared with healthy shoulder, these differences were not significant. There was no loss of reduction with this system in the vertical plane. 4 patients (12.12%) revealed signs of posterior instability with worse clinical test results. The presence of degenerative joint changes (6,06%), calcifications (27,2%) or mobilization of the implant (18,18%) was not associated with worse clinical outcomes. CONCLUSION Twin Tail device using minimally invasive technique improves stability in the vertical and, specially in the horizontal plane relative to the previously described techniques without increasing number of complications.
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Affiliation(s)
- José Antonio Cano-Martínez
- Department of Orthopaedic Surgery, University of Murcia, Los Arcos del Mar Menor General Hospital, Paraje Torre Octavio, 54, CP: 30739, Pozo Aledo, San Javier, Murcia, Spain.
| | - Gregorio Nicolás-Serrano
- Department of Orthopaedic Surgery, University of Murcia, Los Arcos del Mar Menor General Hospital, Paraje Torre Octavio, 54, CP: 30739, Pozo Aledo, San Javier, Murcia, Spain
| | - Julio Bento-Gerard
- Department of Orthopaedic Surgery, University of Murcia, Los Arcos del Mar Menor General Hospital, Paraje Torre Octavio, 54, CP: 30739, Pozo Aledo, San Javier, Murcia, Spain
| | - Francisco Picazo-Marín
- Department of Orthopaedic Surgery, University of Murcia, Los Arcos del Mar Menor General Hospital, Paraje Torre Octavio, 54, CP: 30739, Pozo Aledo, San Javier, Murcia, Spain
| | - Josefina Andrés-Grau
- Department of Orthopaedic Surgery, University of Murcia, Los Arcos del Mar Menor General Hospital, Paraje Torre Octavio, 54, CP: 30739, Pozo Aledo, San Javier, Murcia, Spain
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Anatomic study of coracoclavicular ligaments for reconstruction of acromioclavicular joint dislocations. J Orthop Sci 2016; 21:749-752. [PMID: 27576109 DOI: 10.1016/j.jos.2016.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 07/28/2016] [Accepted: 08/01/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND There has been a trend to reconstruct the coracoclavicular (CC) ligaments anatomically for management of acromioclavicular (AC) joint dislocations. PURPOSE The aim of this study was to determine the location and orientation of the CC ligaments for anatomic reconstruction of the AC joint. METHODS The subjects were a total of 40 shoulders from 20 Chinese cadavers. Two K-wires were drilled through the insertion center of the conoid and trapezoid ligaments respectively. The distance from the center of the CC ligaments to the bone landmarks of the clavicle and the oblique angle of the two K-wires was measured respectively. RESULTS The distance from the center of the trapezoid ligament to the lateral end and the anterior border of the clavicle was 21.7 ± 1.1 mm and 6.4 ± 0.5 mm, respectively. The valgus angle and retroversion angle of the trapezoid ligament was 39.3°±0.9° and 6.0°±0.6°, respectively. The distance from the center of the conoid ligament to the lateral end and the posterior border of the clavicle was 36.6 ± 0.9 mm and 5.5 ± 0.4 mm, respectively. The valgus angle and retroversion angle of the conoid ligament was 6.6°±0.7° and 11.0°±0.9°, respectively. CONCLUSIONS These findings are important for the anatomic reconstruction of the AC joint dislocations, by predicting the location and orientation of the conoid and trapezoid ligaments accurately.
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NISHIMI ALEXANDREYUKIO, ARBEX DEMETRIOSIMÃO, MARTINS DIOGOLUCASCAMPOS, GUSMÃO CARLOSVINICIUSBUARQUEDE, BONGIOVANNI ROBERTORANGEL, PASCARELLI LUCIANO. PREFERED SURGICAL TECHNIQUE USED BY ORTHOPEDISTS IN ACUTE ACROMIOCLAVICULAR DISLOCATION. ACTA ORTOPEDICA BRASILEIRA 2016; 24:249-252. [PMID: 28149190 PMCID: PMC5266655 DOI: 10.1590/1413-785220162405156380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Objective: To determine whether training on shoulder and elbow surgery influences the orthopedist surgeons' preferred technique to address acute acromioclavicular joint dislocation (ACD). Methods: A survey was conducted with shoulder and elbow specialists and general orthopedists on their preferred technique to address acute ACD. Results: Thirty specialists and forty-five general orthopedists joined the study. Most specialists preferred the endobutton technique, while most general orthopedists preferred the modified Phemister procedure for coracoclavicular ligament repair using anchors. We found no difference between specialists and general orthopedists in the number of tunnels used to repair the coracoclavicular ligament; preferred method for wire insertion through the clavicular tunnels; buried versus unburied Kirschner wire insertion for acromioclavicular temporary fixation; and time for its removal; and regarding the suture thread used for deltotrapezoidal fascia closure. Conclusion: Training on shoulder and elbow surgery influences the surgeons' preferred technique to address acute ACD. Level of Evidence V, Expert Opinion.
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