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Ranne JO, Kainonen TU, Kanto KJ, Lehtinen JT, Niemi PT, Scheinin H. Tendon graft through the coracoid tunnel versus under the coracoid for coracoclavicular/acromioclavicular reconstruction shows no difference in radiographic or patient-reported outcomes. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05461-9. [PMID: 39025979 DOI: 10.1007/s00402-024-05461-9] [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: 02/05/2024] [Accepted: 07/07/2024] [Indexed: 07/20/2024]
Abstract
INTRODUCTION The purpose of this prospective study was to report the outcomes of two different methods in CC and AC reconstruction for the treatment of AC separation using a tendon graft and knot-hiding titanium clavicular implant. MATERIALS AND METHODS Twenty-seven patients with Rockwood grade III and V acromioclavicular (AC) separations were randomized into two groups. The primary outcome was whether taking the tendon graft through the coracoid risked a fracture. The following were secondary outcomes: follow-up of clavicular wound healing and Nottingham Clavicle score, Constant score, and Simple Shoulder Test results obtained preoperatively and 24 months postoperatively. The anteroposterior radiographic change between the clavicular and coracoid cortexes and the clavicular tunnel diameter was measured postoperatively and 24 months postoperatively. General patient satisfaction with the outcome (poor, fair, good, or excellent) was assessed 2 years postoperatively. RESULTS No coracoid fractures were detected. No issues in clavicular wound healing were detected. The mean Nottingham Clavicle score increased from a preoperative mean of 42.42 ± 13.42 to 95.31 ± 14.20 (P < 0.00). The Constant score increased from a preoperative mean of 50.81 ± 17.77 to 96.42 ± 11.51 (P < 0.001). The Simple Shoulder Test score increased from a preoperative mean of 7.50 ± 2.45 to 11.77 ± 1.18 (P < 0.001). The changes were significant. The coracoclavicular distance increased from 11.88 ± 4.00 to 14.19 ± 4.71 mm (P = 0.001), which was significant. The clavicular drill hole diameter increased from 5.5 to a mean of 8.00 ± 0.75 mm. General patient satisfaction was excellent. CONCLUSIONS There were no significant differences between the two groups. There were no implant related complications in the clavicular wound healing. The results support the notion that good results are achieved by reconstructing both the CC and AC ligaments with a tendon graft. STUDY REGISTRATION This clinical trial was registered on Clinicaltrials.gov.
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Affiliation(s)
- Juha O Ranne
- Hospital Mehiläinen Neo, 20520, Joukahaisenkatu 6Turku, Finland.
- Department of Physical Activity and Health, The Paavo Nurmi Centre, The University of Turku, Turku, Finland.
| | | | | | - Janne T Lehtinen
- Department of Orthopedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Pekka T Niemi
- Hospital Mehiläinen Neo, 20520, Joukahaisenkatu 6Turku, Finland
| | - Harry Scheinin
- Department of Anesthesiology and Intensive Care, University of Turku, Turku, Finland
- Division of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland
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Singhi PK, Raju S, Gowtham A. Double figure of eight technique using fiber tape for acute high-grade acromioclavicular joint dislocations - Reconstruction technique. J Clin Orthop Trauma 2024; 50:102361. [PMID: 38390563 PMCID: PMC10879771 DOI: 10.1016/j.jcot.2024.102361] [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: 03/27/2023] [Revised: 01/17/2024] [Accepted: 02/05/2024] [Indexed: 02/24/2024] Open
Abstract
Acromioclavicular (AC) joint dislocations are not uncommon injuries. High-grade dislocations can be managed by arthroscopic as well as open techniques, but the most important thing is to address both vertical and horizontal stability. The purpose of this study is to evaluate the functional outcome of a cost effective double figure of eight technique of stabilizing both coracoclavicular and acromioclavicular ligaments in acute high-grade disruption (Type IIIB -VI) using fibre tape. This study was performed at our tertiary care centre from 2017 to 2020 after appropriate IRB approval and patient consent. Out of 134 cases, 23 high-grade AC joint disruptions treated with our technique were included in the study. Demographic data analysis, pre-op and post-op Constant score and UCLA scoring were done to assess the functional outcome; Coracoclavicular distance (CCD) and CCD ratio were used to assess the radiological outcome. Significant improvement in Constant and UCLA shoulder scores were observed from pre-op to final follow up. With respect to the radiological outcome, all cases had a significant improvement in CCD and CCD ratio from baseline to final follow-up. To conclude, our double figure of eight technique is more anatomical, addresses both vertical and horizontal stability, easily reproducible, cost-effective and safe technique.
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Affiliation(s)
| | | | - Ajay Gowtham
- Gowtham Ortho Hospital, Coimbatore, Tamilnadu, India
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Elhalawany MF, Abdalla UG, Shwitter L, ElAttar MS, Fahmy FS. Assessment of Coracoclavicular Ligament Healing on MRI After Arthroscopic TightRope Fixation for Acute Acromioclavicular Joint Dislocation. Orthop J Sports Med 2023; 11:23259671231185749. [PMID: 37840901 PMCID: PMC10568992 DOI: 10.1177/23259671231185749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/13/2023] [Indexed: 10/17/2023] Open
Abstract
Background Arthroscopic-assisted fixation of acute high-grade acromioclavicular (AC) joint dislocation has gained popularity in the last decade. Coracoclavicular (CC) fixation using the TightRope device is a less invasive technique. Purpose To investigate CC ligament healing and functional outcomes after arthroscopic fixation using the TightRope device for acute AC joint disruption. Study Design Case series; Level of evidence, 4. Methods The study retrospectively analyzed the data of patients admitted for arthroscopic surgical treatment of acute AC joint injury using a single TightRope device. The data collection commenced in October 2021. The Constant-Murley (CM) score and University of California, Los Angeles (UCLA) shoulder score were used for functional evaluation. The CC distance (CCD) was measured on plain radiographs, whereas healing of the CC ligament was evaluated on magnetic resonance imaging (MRI). Statistical analyses were conducted with the Mann-Whitney U test, independent t test, or paired t test, as appropriate. Results The analysis included 33 patients with a mean age of 37.7 years (range, 24-49 years) and a minimum follow-up of 24 months. Significant preoperative to postoperative increases were noted in both the CM and UCLA scores (from 34.1 ± 7.6 to 93.3 ± 3.6 and from 8.7 ± 2.1 to 32.9 ± 1.7, respectively; P < .0001 for both). The CCD decreased from 21.8 ± 3.02 mm preoperatively to 10.6 ± 1.2 mm postoperatively (P < .0001). All patients displayed CC ligament healing on MRI. Two patients with superficial infection and 1 case of partial reduction loss were confirmed at the end of this study. Conclusion The arthroscopic TightRope technique was found to be a reliable and less invasive method of fixation for acute AC joint disruptions. The CC ligament healed adequately based on MRI evaluation, and the patients regained their preinjury activities, with favorable functional outcomes and minor comorbidities.
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Affiliation(s)
| | - Usama Gaber Abdalla
- Department of Orthopedic Surgery, Faculty of Medicine, AlAzhar University, Cairo, Egypt
| | - Lotfy Shwitter
- Department of Orthopedic Surgery, Faculty of Medicine, AlAzhar University, Cairo, Egypt
| | - Mohammed Said ElAttar
- Department of Orthopedic Surgery, Faculty of Medicine, Zagazig University, Sharkia, Egypt
| | - Fahmy Samir Fahmy
- Department of Orthopedic Surgery, Faculty of Medicine, Zagazig University, Sharkia, Egypt
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de Groot C, Verstift DE, Heisen J, van Deurzen DFP, van den Bekerom MPJ. Management of Acromioclavicular Injuries - Current Concepts. Orthop Res Rev 2023; 15:1-12. [PMID: 36814992 PMCID: PMC9940602 DOI: 10.2147/orr.s340531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 01/23/2023] [Indexed: 02/17/2023] Open
Abstract
Introduction Treatment of a patient with acromioclavicular joint (ACJ) injury remains challenging for orthopedic surgeons. To date, there is debate over the optimal management of ACJ injuries. This review provides an overview of assessment, treatment, and future perspectives for the treatment of and research into ACJ. Material and Methods A scoping literature review was performed. The search was built including the following terms: acromioclavicular joint injuries or dislocation, and pathophysiology, etiology, anatomy, treatment, and trauma mechanism. The papers with evidence levels 1-3 were included in the current narrative review. Results A total of 2242 potential relevant studies were identified in the searches. After removal of duplicates, 432 studies were screened on their titles and abstracts, resulting in 35 studies being included in the review, based on the eligibility criteria. Conclusion The management of acute and chronic ACJ injuries is not clarified in the current literature. However, there is currently insufficient high-level evidence for the overall treatment options for ACJ injuries. If surgical intervention is decided upon in consultation with the patient, the complications may not outweigh the benefits. The multitude of existing techniques is indicative of the uncertainty surrounding this issue, and no gold standard has yet been established for treatment methods. An ideal classification would include not only vertical and horizontal instability, but also the severity of kinematic alterations of the shoulder complex. This indicates the need for a new and improved diagnostic tool for the classification of ACJ injuries.
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Affiliation(s)
- Charlotte de Groot
- Department of Orthopaedic Surgery and Trauma Surgery, OLVG, Amsterdam, the Netherlands,Correspondence: Charlotte de Groot, Department of Orthopaedic Surgery and Trauma Surgery, OLVG, P.O. Box 95500, Amsterdam, 1090 HM, the Netherlands, Email
| | - Daniel E Verstift
- Shoulder and Elbow Unit, Joint Research, Department of Orthopaedic Surgery and Trauma Surgery, OLVG, Amsterdam, the Netherlands
| | | | - Derek F P van Deurzen
- Shoulder and Elbow Unit, Joint Research, Department of Orthopaedic Surgery and Trauma Surgery, OLVG, Amsterdam, the Netherlands
| | - Michel P J van den Bekerom
- Shoulder and Elbow Unit, Joint Research, Department of Orthopaedic Surgery and Trauma Surgery, OLVG, Amsterdam, the Netherlands,Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
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Huang J, Huang D, Wang J, Ye Z, Liu H. A Modified Endoscopic Technique with Three Incisions for Rockwood Types III and V Acromioclavicular Joint Dislocation. Orthop Surg 2022; 15:648-654. [PMID: 36519211 PMCID: PMC9891935 DOI: 10.1111/os.13607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 10/27/2022] [Accepted: 10/31/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Acromioclavicular joint dislocation is one of the most common shoulder injuries in young men. With the advancement of minimally invasive technology, arthroscopy of acromioclavicular joint dislocation has been recognized for its good curative effect. This study aimed to explore the technical details and clinical efficacy of a modified minimally invasive endoscopic treatment for acromioclavicular joint dislocation. METHODS Clinical data of patients receiving the three-incision endoscopic treatment were retrospectively reviewed between July 2013 and July 2019. A total of 72 patients with acromioclavicular joint dislocation of Rockwood type III (n = 42) and type V (n = 30) were included in this study. Postoperative routine radiography was performed to evaluate acromioclavicular joint reduction and fixation. In addition, functional recovery of the shoulder joint was assessed using the American Shoulder and Elbow Surgeons (ASES) and Constant-Murley scores. Differences between the preoperative and postoperative data were compared using paired t-tests. RESULTS All patients underwent loop plate elastic fixation under endoscopy during 24 to 48 months of follow-up. Postoperative radiography showed that the acromioclavicular joint achieved anatomical reduction. The ASES score (91.1 ± 4.2) was significantly improved compared to the preoperative ASES score (62.4 ± 3.1) (t = 46.65, P < 0.0001). The Constant-Murley score (93.1 ± 4.6) was also significantly higher than that before the operation (40.7 ± 6.4) (t = 56.41, P < 0.0001). No postoperative complications occurred. During follow-up, four patients had mild acromioclavicular joint degeneration but no obvious pain symptoms. CONCLUSION The modified three-incision endoscopic technique optimizes the surgical incision, reduces trauma, is minimally invasive, and provides rapid rehabilitation with satisfactory clinical outcomes.
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Affiliation(s)
- Jianming Huang
- Department of OrthopaedicsChenggong Hospital of Xiamen University (the 73th Group Military Hospital of People's Liberation Army)Xiamen CityChina
| | - Danlei Huang
- Department of OrthopaedicsChenggong Hospital of Xiamen University (the 73th Group Military Hospital of People's Liberation Army)Xiamen CityChina
| | - Jun Wang
- Department of OrthopaedicsChenggong Hospital of Xiamen University (the 73th Group Military Hospital of People's Liberation Army)Xiamen CityChina
| | - Zhiyang Ye
- Department of OrthopaedicsChenggong Hospital of Xiamen University (the 73th Group Military Hospital of People's Liberation Army)Xiamen CityChina
| | - Haoyuan Liu
- Department of OrthopaedicsChenggong Hospital of Xiamen University (the 73th Group Military Hospital of People's Liberation Army)Xiamen CityChina
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Lee CY, Chen PC, Liu YC, Tsai YC, Chou PH, Fu YC, Liu WC, Jupiter JB. Does coracoclavicular augmentation additional to hook plate fixation provide benefits in acute unstable acromioclavicular dislocation? A meta-analysis. BMC Musculoskelet Disord 2022; 23:205. [PMID: 35246100 PMCID: PMC8897880 DOI: 10.1186/s12891-022-05142-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 02/22/2022] [Indexed: 11/10/2022] Open
Abstract
Background Acromioclavicular joint (ACJ) dislocation is a common shoulder injury. In treating acute unstable ACJ dislocation, a hook plate (HP) is a straightforward and popular option for ensuring proper reduction and rigid fixation while promoting AC and coracoclavicular (CC) ligament healing. Surgeons typically remove the HP to prevent subacromial impingement and acromial osteolysis; however, concerns about redislocation after implant removal remain. Therefore, additional CC augmentation may be helpful in combination with HP fixation. The aim of this meta-analysis is to compare the outcomes and complications of HP fixation with or without additional CC augmentation for acute unstable ACJ dislocation. Methods We searched the PubMed, EMBASE, and Web of Science databases for relevant case–control studies. The primary outcomes were patient-reported outcome measures; the secondary outcomes were pain measured using a visual analog scale (VAS), CC distance (CCD), and complications. Continuous data were assessed using weighted standardized mean differences (SMDs) with 95% confidence intervals (CIs), and dichotomous data were evaluated with Mantel–Haenszel odds ratio (ORs) with 95% CIs. Results We analyzed one randomized control trial and four case–control studies comparing HP fixation with or without CC augmentation. A total of 474 patients with Rockwood type III or V ACJ dislocation were included. We found no differences in Constant–Murley score (SMD, − 0.58, 95% CI − 1.41 to 0.26; P = 0.18), American Shoulder and Elbow Surgeons score (SMD, 0.21, 95% CI − 0.10 to 0.52; P = 0.19), University of California at Los Angeles shoulder rating scale score (SMD, − 0.02, 95% CI − 1.27 to 1.23; P = 0.97), or VAS pain score (SMD, 0.36, 95% CI − 0.16 to 0.88; P = 0.17) between groups. The CC augmentation group had lower odds of osteolysis (OR, 0.27, 95% CI 0.10 to 0.74; P = 0.01) and a shorter CCD (SMD, − 0.29, 95% CI − 0.57 to − 0.01; P = 0.04). Conclusion HP fixation with CC augmentation is preferable for acute unstable ACJ dislocations. Although CC augmentation did not provide additional benefits related to functional outcomes or pain, it resulted in greater reduction maintenance after implant removal and a 73% lower risk of acromial osteolysis. Trial registration PROSPERO (CRD42021271118).
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Affiliation(s)
- Chih-Yao Lee
- Department of Orthopedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 807, Kaohsiung, Taiwan
| | - Po-Cheng Chen
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung, Taiwan.,Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ying-Chun Liu
- School of Post-Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yun-Che Tsai
- Department of Orthopedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 807, Kaohsiung, Taiwan
| | - Pei-Hsi Chou
- Department of Orthopedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 807, Kaohsiung, Taiwan.,Ph.D Program in Biomedical Engineering, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yin-Chih Fu
- Department of Orthopedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 807, Kaohsiung, Taiwan.,Ph.D Program in Biomedical Engineering, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Orthopedic surgery, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiug Medical University, Kaohsiung, Taiwan.,Department of Orthopedic Surgery, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Wen-Chih Liu
- Department of Orthopedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 807, Kaohsiung, Taiwan. .,Ph.D Program in Biomedical Engineering, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Department of Orthopedic Surgery, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
| | - Jesse Bernard Jupiter
- Hand and Arm center, Department of Orthopedic surgery, Massachusetts General Hospital, Boston, MA, USA
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Ranne JO, Salonen SO, Kainonen TU, Kosola JA, Lempainen LL, Siitonen MT, Niemi PT. Arthroscopic Coracoclavicular Reconstruction Combined with Open Acromioclavicular Reconstruction Using Knot Hiding Clavicular Implants Is a Stable Solution. Arthrosc Sports Med Rehabil 2021; 3:e1745-e1753. [PMID: 34977629 PMCID: PMC8689262 DOI: 10.1016/j.asmr.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 08/04/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose The purpose of this noninterventional, register-based study was to report the outcomes and wound healing of surgically treated chronic acromioclavicular (AC) dislocations using a tendon graft and knot-hiding titanium implants. Methods Thirty-two cases with chronic AC separation underwent an arthroscopic coracoclavicular (CC) ligament reconstruction and an open AC ligament reconstruction using knot-hiding titanium implants. The wound healing was assessed 2 months after the operation. The Nottingham Clavicle score, Constant score, and Simple Shoulder Test were obtained postoperatively and at a minimum of one-year postsurgery. The radiographic change in distance between the clavicular and coracoid cortices and clavicular tunnel diameter was measured. General patient satisfaction with the outcome (poor, fair, good, or excellent) was also assessed 1 year postoperatively. Results The mean Nottingham Clavicle score increased from a preoperative mean of 41.66 ± 9.86 to 96.831 ± 5.86 (P ≤ .05). The Constant score increased from a preoperative mean of 44.66 ± 12.54 to 93.59 ± 7.01 (P ≤ .05). The Simple Shoulder Test score increased from a preoperative mean of 7.00 ± 2.14 to 11.84 ± .63 (P ≤ .05). The coracoclavicular distance increased from 11.32 ± 3.71 to 13.48 ± 3.79 mm (P ≤ .05). The clavicular drill hole diameter increased from 6 mm to a mean of 6 to a mean of 8.13 ± 1.12 mm. Twenty-three (71.9%) patients reported an excellent outcome, and nine (28.1%) reported a good outcome. One clavicular fracture occurred but no coracoid fractures. There was one reconstruction failure leading to a reoperation. Conclusions In this series, combining the arthroscopic CC ligament reconstruction to an open reconstruction of the AC joint with a tendon graft proved to be a stable solution. The knot-hiding titanium implant effectively eliminated the problems related to the clavicular wound healing. Level of Evidence Level IV, therapeutic case series.
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Affiliation(s)
- Juha O. Ranne
- Hospital Mehilainen Neo, Turku, Finland, Turku, Finland
- Address correspondence to Juha O. Ranne, M.D., Ph.D., Hospital Mehiläinen Neo, Joukahaisenkatu 6, 20520 Turku, Finland.
| | - Severi O. Salonen
- The Paavo Nurmi Centre, Department of Physical Activity and Health, the University of Turku, Turku, Finland
| | | | - Jussi A. Kosola
- Department of Orthopaedics and Traumatology, Helsinki University Hospital, Helsinki, Finland
| | - Lasse L. Lempainen
- Hospital Mehilainen Neo, Turku, Finland, Turku, Finland
- The Paavo Nurmi Centre, Department of Physical Activity and Health, the University of Turku, Turku, Finland
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Milano G, Martetschläger F, Kovačič L. Evolving concepts and consensus in challenging shoulder problems: a European perspective. Knee Surg Sports Traumatol Arthrosc 2021; 29:2021-2023. [PMID: 33991209 DOI: 10.1007/s00167-021-06593-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 04/26/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Giuseppe Milano
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy. .,Department of Bone and Joint Surgery, ASST Spedali Civili, Piazzale Spedali Civili 1, 25123, Brescia, Italy.
| | - Frank Martetschläger
- Department for Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany.,Center for Shoulder and Elbow Surgery, ATOS Clinic, Effnerstrasse 38, 81925, Munich, Germany
| | - Ladislav Kovačič
- University Medical Centre of Ljubljana, Zaloška cesta 2, 1000, Ljubljana, Slovenia
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