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Jones BK, Fuller C, Kweon C. Failed suspension button acromioclavicular joint reconstruction revised with double-loop suture cerclage: a case report and review of the literature. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:392-397. [PMID: 37588510 PMCID: PMC10426678 DOI: 10.1016/j.xrrt.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
- Brett K. Jones
- Washington State University Elson S. Floyd College of Medicine, Spokane WA, USA
| | - Carson Fuller
- Department of Orthopaedic Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Christopher Kweon
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
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Scheiderer B, Obmann S, Feucht MJ, Siebenlist S, Degenhardt H, Imhoff AB, Rupp MC, Pogorzelski J. The Morphology of the Acromioclavicular Joint Does Not Influence the Postoperative Outcome Following Acute Stabilization—A Case Series of 81 Patients. Arthrosc Sports Med Rehabil 2022; 4:e835-e842. [PMID: 35747655 PMCID: PMC9210376 DOI: 10.1016/j.asmr.2021.09.007] [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: 03/10/2021] [Accepted: 09/07/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose To specifically evaluate the influence of the acromioclavicular (AC)-joint morphology on the outcome after arthroscopically assisted coracoclavicular (CC) stabilization surgery with suspensory fixation systems and to investigate whether an additional open AC-joint reduction and AC cerclage improves the clinical outcome for patients with certain morphologic AC-joint subtypes. Methods Patients with an acute acromioclavicular joint injury, who underwent arthroscopically assisted CC stabilization with suspensory fixation systems with or without concomitant AC cerclage between January 2009 and June 2017 were identified and included in this retrospective cohort analysis. AC-joint morphology was assessed on preoperative radiographs and categorized as “flat” or “non-flat” (“oblique”/“curved”) subtypes. After a minimum of 2 years of follow-up, postoperative Single Assessment Numeric Evaluation (SANE), American Shoulder and Elbow Surgeons (ASES), and visual analog scale (VAS) scores for pain were collected. A subgroup analysis of clinical outcomes depending on the surgical technique and morphological subtype of the AC joint was performed. Results Eighty-one patients (95% male, mean age 35 ± 12 years) could be included at a mean follow-up of 57 ± 14 months. Radiographic assessment of AC-joint morphology showed 24 (30%) cases of flat type, 38 (47%) cases of curved type, and 19 (23%) cases of oblique morphology. Postoperatively, no clinically significant difference could be detected after the treatment of AC joint injury via CC stabilization with or without concomitant AC cerclage (VASrest: P = .067; VASmax: P = .144, ASES: P = .548; SANE: P = .045). No clinically significant differences were found between the surgical techniques for the flat morphologic subtype (VASrest: P = .820; VASmax: P = .251; SANE: P = .104; ASES: P = .343) or the non-flat subtype (VASres: P = .021; VASmax: P = .488; SANE: P = .243, ASES: P = .843). Conclusions In arthroscopically assisted AC stabilization surgery with suspensory fixation systems for acute AC-joint injury, the AC-joint morphology did not influence the postoperative outcome, independent of the surgical technique. No clinical benefit of performing an additional horizontal stabilization could be detected in our collective at mid-term follow-up. Level of Evidence Level IV, therapeutic case series.
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Rupp MC, Kadantsev PM, Siebenlist S, Hinz M, Feucht MJ, Pogorzelski J, Scheiderer B, Imhoff AB, Muench LN, Berthold DP. Low rate of substantial loss of reduction immediately after hardware removal following acromioclavicular joint stabilization using a suspensory fixation system. Knee Surg Sports Traumatol Arthrosc 2022; 30:3842-3850. [PMID: 35451639 PMCID: PMC9568474 DOI: 10.1007/s00167-022-06978-5] [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: 04/11/2021] [Accepted: 04/01/2022] [Indexed: 11/10/2022]
Abstract
PURPOSE To evaluate immediate loss of reduction in patients undergoing hardware removal after arthroscopically assisted acromioclavicular (AC) joint stabilization using a high-tensile suture tape suspensory fixation system and to identify risk factors associated with immediate loss of reduction. MATERIALS AND METHODS Twenty-two consecutive patients with a mean age of 36.4 ± 12.6 years (19-56), who underwent hardware removal 18.2 ± 15.0 months following arthroscopically assisted stabilization surgery using a suspensory fixation system for AC joint injury between 01/2012 and 01/2021 were enrolled in this retrospective monocentric study. The coracoclavicular distance (CCD) as well as the clavicular dislocation/acromial thickness (D/A) ratio were measured on anterior-posterior radiographs prior to hardware removal and immediately postoperatively by two independent raters. Loss of reduction, defined as 10% increase in the CCD, was deemed substantial if the CCD increased 6 mm compared to preoperatively. Constitutional and surgical characteristics were assessed in a subgroup analysis to detect risk factors associated with loss of reduction. RESULTS Postoperatively, the CCD significantly increased from 12.6 ± 3.7 mm (4.8-19.0) to 14.5 ± 3.3 mm (8.7-20.6 mm) (p < 0.001) while the D/A ratio increased from 0.4 ± 0.3 (- 0.4-0.9) to 0.6 ± 0.3 (1.1-0.1) (p = 0.034) compared to preoperatively. In 10 cases (45%), loss of reduction was identified, while a substantial loss of reduction (> 6 mm) was only observed in one patient (4.5%). A shorter time interval between index stabilization surgery and hardware removal significantly corresponded to immediate loss of reduction (11.0 ± 5.6 vs. 30.0 ± 20.8 months; p = 0.007), as hardware removal within one year following index stabilization was significantly associated with immediate loss of reduction (p = 0.027; relative risk 3.4; odds ratio 11.67). CONCLUSIONS Substantial loss of reduction after hardware removal of a high-tensile suture tape suspensory fixation system was rare, indicating that the postoperative result of AC stabilization is not categorically at risk when performing this procedure. Even though radiological assessment of the patients showed a statistically significant immediate superior clavicular displacement after this rarely required procedure, with an increased incidence in the first year following stabilization, this may not negatively influence the results of ACJ stabilization in a clinically relevant way. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Marco-Christopher Rupp
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Pavel M. Kadantsev
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany ,European Clinic of Sports Traumatology and Orthopaedics (ECSTO), Moscow, Russian Federation ,grid.77642.300000 0004 0645 517XPeoples Friendship University of Russia, Moscow, Russian Federation
| | - Sebastian Siebenlist
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Maximilian Hinz
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Matthias J. Feucht
- Orthopaedic Clinic Paulinenhilfe, Diakonie-Hospital, Stuttgart, Germany ,grid.5963.9Department of Orthopaedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Jonas Pogorzelski
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Bastian Scheiderer
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Andreas B. Imhoff
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Lukas N. Muench
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Daniel P. Berthold
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
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Ozan F, Gök S, Okur KT, Altun İ, Kahraman M, Günay AE, Yamak K. Midterm Results of Tension Band Wiring Technique for Acute Rockwood Type III Acromioclavicular Joint Dislocation. Cureus 2020; 12:e12203. [PMID: 33489612 PMCID: PMC7815299 DOI: 10.7759/cureus.12203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background The aim of this study was to evaluate the clinical and radiological results of patients with acute type III Rockwood acromioclavicular joint (ACJ) dislocation treated surgically by employing tension band wiring. Methods The study included 24 patients with traumatic type III ACJ dislocations according to the Rockwood classification. The clinical and radiological outcomes of patients were assessed at the final follow-up visit. Implant failure and reduction loss were assessed using radiographs, whereas the Constant-Murley scoring system was used to assess the patients clinically. Results The mean follow-up period was 3.5 ± 1.3 years (range: 1-6 years). The mean age of the patients was 41.8 ± 11.7 years (range: 19-64 years) and the mean length of hospital stay was 2.3 days (range: 1-6 days). The fixation material was removed postoperatively at an average of 7.2 ± 9.9 months (range: 3-40 months). At the end of the follow-up period, the mean Constant-Murley score was 72.5 ± 12.8 (range: 50-90). The ACJ reduction was stable in 13 (54.2%) patients. Residual subluxation was detected in 11 (45.8%) patients. Distal clavicular osteolysis was noted in six (25%) patients. Acromioclavicular osteoarthritis was detected in five (20.8%) operated shoulders on follow-up radiographs. During the follow-up, Kirschner-wire migration and breakage occurred in four (16.6%) and seven (29.1%) patients, respectively. Conclusions This study showed that surgical treatment with the tension band wiring method provided functionally satisfactory results even if complications developed because of the presence of implants. Independent of age, we can recommend it as the primary treatment method for patients who do not have very high expectations regarding their shoulder function. Additionally, we think that reducing the duration of implant retention will reduce the incidence of complications.
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Affiliation(s)
- Fırat Ozan
- Orthopedics and Traumatology, Kayseri City Hospital, Kayseri, TUR
| | - Sefa Gök
- Orthopedics and Traumatology, Kayseri City Hospital, Kayseri, TUR
| | | | - İbrahim Altun
- Orthopedics and Traumatology, Kayseri City Hospital, Kayseri, TUR
| | - Murat Kahraman
- Orthopedics and Traumatology, Kayseri City Hospital, Kayseri, TUR
| | - Ali Eray Günay
- Orthopedics and Traumatology, Kayseri City Hospital, Kayseri, TUR
| | - Kamil Yamak
- Orthopedics and Traumatology, İzmir Bozyaka Training and Research Hospital, Izmir, TUR
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Jordan RW, Malik S, Bentick K, Saithna A. Acromioclavicular joint augmentation at the time of coracoclavicular ligament reconstruction fails to improve functional outcomes despite significantly improved horizontal stability. Knee Surg Sports Traumatol Arthrosc 2019; 27:3747-3763. [PMID: 30267185 DOI: 10.1007/s00167-018-5152-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 09/19/2018] [Indexed: 01/23/2023]
Abstract
PURPOSE Acromioclavicular joint reconstruction is a well-established and frequently performed procedure. Recent scientific and commercial interest has led to a drive to develop and perform surgical techniques that more reliably restore horizontal stability in order to improve patient outcomes. The aim of this systematic review was to evaluate the biomechanical evidence for procedures directed at restoring horizontal stability and determine whether they are associated with superior clinical results when compared to well-established procedures. METHODS A review of the online databases Medline and EMBASE was conducted in accordance with the PRISMA guidelines on the 23rd December 2017. Biomechanical and clinical studies reporting either static or dynamic horizontal displacement following acromioclavicular joint reconstruction (Coracoclavicular reconstruction or Weaver-Dunn) were included. In addition, biomechanical and clinical studies reporting outcomes after additional augmentation of the acromioclavicular joint were included. The studies were appraised using the Methodological index for non-randomised studies tool. RESULTS The search strategy identified 18 studies eligible for inclusion: six biomechanical and 12 clinical studies. Comparative biomechanical studies demonstrated that acromioclavicular augmentation provided significantly increased horizontal stability compared to the coracoclavicular reconstruction and Weaver-Dunn procedure. Comparative clinical studies demonstrated no significant differences between coracoclavicular reconstruction with and without acromioclavicular augmentation in terms of functional outcomes (American Shoulder and Elbow Surgeon and Constant score), complication or revision rates. However, one comparative study did demonstrate an improvement in Taft (p = 0.018) and Acromioclavicular Joint Instability scores (p = 0.0001) after acromioclavicular augmentation. CONCLUSION In conclusion, coracoclavicular reconstruction with augmentation of the acromioclavicular joint has been shown to provide improved horizontal stability in both biomechanical and clinical studies compared to isolated coracoclavicular reconstruction. However, comparative studies have shown no clinical advantage with respect to American Shoulder and Elbow Surgeon or Constant scores and, therefore, the results of this systematic review do not support acromioclavicular augmentation in routine clinical practice. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Robert W Jordan
- University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK.
| | | | | | - Adnan Saithna
- Medical Technologies and Advanced Materials, Clifton Campus, Nottingham Trent University, Nottingham, NG11 8NS, UK
- Consultant Orthopaedic Surgeon, Renacres Hospital, Ormskirk, Lancashire, L39 8SE, UK
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Clinical effectiveness of surgical treatment with polyester tapes and temporary K-wires on complete acromioclavicular dislocation. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 29:567-573. [DOI: 10.1007/s00590-018-2321-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 10/06/2018] [Indexed: 12/26/2022]
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Moatshe G, Kruckeberg BM, Chahla J, Godin JA, Cinque ME, Provencher MT, LaPrade RF. Acromioclavicular and Coracoclavicular Ligament Reconstruction for Acromioclavicular Joint Instability: A Systematic Review of Clinical and Radiographic Outcomes. Arthroscopy 2018; 34:1979-1995.e8. [PMID: 29573931 DOI: 10.1016/j.arthro.2018.01.016] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 01/08/2018] [Accepted: 01/08/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To perform a systematic review of the available literature on clinical and radiographic outcomes after surgical treatment for acromioclavicular (AC) joint instability. METHODS A systematic review was performed according to PRISMA guidelines. Inclusion criteria were AC joint and coracoclavicular (CC) ligament reconstruction outcomes, English language, human studies, more than 10 patients in the study and a 2-year minimum follow-up. Exclusion criteria were animal studies, cadaveric studies, clinical studies without reported follow-up period or patient-reported outcomes, clinical studies of nonoperative treatment, AC reconstructions with concurrent lateral clavicle fracture, editorial articles, abstracts, presentations, reviews, case reports, and surveys. RESULTS The systematic review identified 34 studies (939 patients) after inclusion and exclusion criteria application. Postoperative American Shoulder and Elbow Surgeons (ASES) scores ranged from 93.8 to 96, 81.8 to 97.8, and 88.1 for free tendon graft, suspensory devices, and modified Weaver-Dunn techniques, respectively. Postoperative Constant scores were 76.4 to 96.0, 82.6 to 97.8, 85.9 to 97.0, 81 to 96 and 83.0 to 94.6 for free tendon graft, suspensory devices, synthetic ligament devices, modified Weaver-Dunn, and hook plate/K-wires techniques, respectively. All treatment modalities improved patient outcomes; however, hook plates and K-wires had the highest rate of complications (26.3%). Unplanned reoperation rates were 1.2%, 2.8%, 0.9%, 5.4%, and 2.6% in free tendon graft, suspensory devices, synthetic ligament devices, modified Weaver-Dunn, and hook plate/K-wires techniques, respectively. CONCLUSIONS Comparable subjective outcomes after surgical treatment of AC joint instability was reported for all modalities, with relatively low unplanned reoperation rates. Treatment with hook plate/K-wires was associated with the highest complication rates, and modified Weaver-Dunn had the highest unplanned reoperation rates. LEVEL OF EVIDENCE: Level IV, systematic review of Level I-IV studies.
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Affiliation(s)
- Gilbert Moatshe
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A.; Oslo University Hospital and University of Oslo, Oslo, Norway; OSTRC, Norwegian School of Sports Sciences, Oslo, Norway
| | | | - Jorge Chahla
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | | | - Mark E Cinque
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Matthew T Provencher
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A.; The Steadman Clinic, Vail, Colorado, U.S.A
| | - Robert F LaPrade
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A.; The Steadman Clinic, Vail, Colorado, U.S.A..
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Metwaly RG, Edres K. Biplanar fixation of acromio-clavicular joint dislocation associated with coracoid process fracture: Case report. Trauma Case Rep 2018; 15:4-7. [PMID: 29876495 PMCID: PMC5987262 DOI: 10.1016/j.tcr.2018.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2018] [Indexed: 10/25/2022] Open
Abstract
Introduction Acromioclavicular (AC) joint injury associated with coracoid process (CP) fracture is a rare injury and only case reports had been published in the literature. Although AC joint injury is not uncommon, there is controversy as regard the best stabilization method whether to use wires, hook plate, arthroscopic reconstruction or the recently described techniques of anatomic restoration of both the coracoclavicular (CC) and acromioclavicular (AC) ligaments to add stability in both the vertical as well as the horizontal plane for the AC joint. Isolated CP fracture rarely necessitates surgical intervention; but in association with AC joint injury; a controversy as regard best management, surgical approach, technique of stabilization and implant used is present due to paucity of literature. Patient and method A 36 years old manual worker who sustained a combined injury of AC joint (grade III) and CP comminuted base fracture had been treated surgically in our hospital using a biplanar fixation technique; blind 4 mm cannulated screw for the CP fracture and anatomic reconstruction of the AC ligament using FibreTape (Arthrex, Naples, FL); to add stability in both the vertical and horizontal plane. Follow up was done for one year. Results After completion of rehabilitation program, patient could return to work with no shoulder pain in ten weeks postoperatively. Till the last follow up there was no evidence of loss of reduction or shoulder pain with a Constant score of 86. Conclusion Our technique in combined AC joint and CP fracture, address both injuries to add biplanar AC joint stability allowing accelerated rehabilitation and avoids metal hardware complications.
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Affiliation(s)
- Radwan G Metwaly
- Ain-Shams University Hospital, 56, Ramsis St., El Abbasia, 11566 Cairo, Egypt
| | - Kareem Edres
- Ain-Shams University Hospital, 56, Ramsis St., El Abbasia, 11566 Cairo, Egypt
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Triantafyllopoulos IK, Lampropoulou-Adamidou K, Schizas NP, Karadimas EV. Surgical treatment of acute type V acromioclavicular joint dislocations in professional athletes: an anatomic ligament reconstruction with synthetic implant augmentation. J Shoulder Elbow Surg 2017; 26:e369-e375. [PMID: 28739299 DOI: 10.1016/j.jse.2017.05.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 05/17/2017] [Accepted: 05/27/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Most acromioclavicular (AC) joint injuries occur in men in their third decade of life during high-speed or high-impact body contact sports. The management of acute complete AC joint dislocation is surgical. Current surgical techniques include anatomic reconstruction of the main restraints of the AC joint and aim to improve functional outcomes and to reduce the complication rate. METHODS We present 10 cases of acute type V AC joint dislocation in professional athletes treated surgically with anatomic reconstruction of the coracoclavicular and AC ligaments and augmentation with the use of a synthetic polyester tape. The minimum follow-up of the patients was 2 years (mean, 48 months; range, 24-86 months). The postoperative functional outcome was assessed at 1 year and 2 years using the Constant-Murley, American Shoulder and Elbow Surgeons, and modified University of California-Los Angeles scoring systems. RESULTS In all cases, the postoperative scores were significantly improved (P < .005 in all comparisons with the preoperative scores), and all patients returned to their preinjury high level of activity 6 months postoperatively. Radiographs at 1 month and 6 months revealed the maintenance of reduction. There were no complications. CONCLUSION According to the results of our series of patients, demanding cases of acute AC joint dislocation Rockwood type V, in professional athletes, require anatomic fixation of both coracoclavicular and AC ligaments for return to sports as soon as possible and at the preinjury level of performance.
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Affiliation(s)
- Ioannis K Triantafyllopoulos
- Laboratory for Research of the Musculoskeletal System "Th. Garofalidis," Medical School, National and Kapodistrian University of Athens, General Hospital of Athens KAT, Athens, Greece.
| | - Kalliopi Lampropoulou-Adamidou
- Laboratory for Research of the Musculoskeletal System "Th. Garofalidis," Medical School, National and Kapodistrian University of Athens, General Hospital of Athens KAT, Athens, Greece
| | - Nikitas P Schizas
- 4th Orthopaedic Department, General Hospital of Athens KAT, Athens, Greece
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Nakazawa M, Nimura A, Mochizuki T, Koizumi M, Sato T, Akita K. The Orientation and Variation of the Acromioclavicular Ligament: An Anatomic Study. Am J Sports Med 2016; 44:2690-2695. [PMID: 27315820 DOI: 10.1177/0363546516651440] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Several biomechanical studies have shown that the acromioclavicular (AC) ligament prevents posterior translation of the clavicle in the horizontal plane. In anatomy textbooks, however, the AC ligament is illustrated as running straight across the AC joint surface. HYPOTHESIS The AC ligament does not run straight across the joint surface, and the configuration of the AC ligament may vary. STUDY DESIGN Descriptive laboratory study. METHODS We used 16 pairs of shoulder girdles in this study. After identifying the AC ligament, we macroscopically investigated the orientation and attachment of the ligament and measured the angle between the ligament and the line perpendicular to the AC joint surface by using a digital goniometer. In addition, the AC joint inclination angle was measured, and the Spearman rank correlation coefficient between the joint inclination and the ligament angle was calculated. Finally, we sought to classify the AC ligament based on its configuration. Of the 16 pairs of specimens, 3 pairs of shoulders were histologically examined. RESULTS The AC ligament was divided into 2 parts: a bundle at the superoposterior (SP) part and a bundle at the anteroinferior (AI) part of the joint. The well-developed SP bundle was consistent and ran obliquely at an average ± SD 30° ± 6° in relation to the AC joint surface, from the anterior part of the acromion to the posterior part of the distal clavicle. The joint inclination was 70° ± 12°, and a negative moderate correlation was found between the joint inclination and the ligament angle (P = .02, r = -0.46). In comparison, the AI bundle was thin and narrow, and it could be categorized into 3 types according to its various configurations. CONCLUSION The AC ligament could be separated into the SP bundle and the AI bundle. The SP bundle ran posteriorly toward the distal clavicle from the acromion at an average angle of 30° to the joint surface. CLINICAL RELEVANCE Anatomic reconstruction, based on the current findings in combination with findings regarding the coracoclavicular ligament, could facilitate improved outcome in the treatment of AC joint disruption.
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Affiliation(s)
- Masataka Nakazawa
- Department of Clinical Anatomy, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan Faculty of Health Sciences, Tokyo Ariake University of Medical and Health Sciences, Tokyo, Japan
| | - Akimoto Nimura
- Department of Clinical Anatomy, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tomoyuki Mochizuki
- Department of Joint Reconstruction, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masahiro Koizumi
- Faculty of Health Sciences, Tokyo Ariake University of Medical and Health Sciences, Tokyo, Japan
| | - Tatsuo Sato
- Faculty of Health Sciences, Tokyo Ariake University of Medical and Health Sciences, Tokyo, Japan
| | - Keiichi Akita
- Department of Clinical Anatomy, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
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Eisenstein ED, Lanzi JT, Waterman BR, Bader JM, Pallis MP. Medialized Clavicular Bone Tunnel Position Predicts Failure After Anatomic Coracoclavicular Ligament Reconstruction in Young, Active Male Patients. Am J Sports Med 2016; 44:2682-2689. [PMID: 27407087 DOI: 10.1177/0363546516651613] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Recent radiographic data have suggested that medialized conoid tunnel placement greater than 25% of absolute clavicular length is correlated with early failure after anatomic coracoclavicular ligament reconstructions. A comparison with a larger active duty military cohort of clinical and radiographic outcomes can serve as a basis for standardizing surgical technique. PURPOSE To establish the ideal radiographic tunnel position for anatomic coracoclavicular ligament reconstruction and to elucidate variables associated with early loss of reduction and ability to return to active-duty military service. STUDY DESIGN Case series; Level of evidence, 4. METHODS A retrospective review of the military's electronic medical record between the years 2000 and 2013 was performed. All anatomic coracoclavicular reconstructions at a single institution were included for analysis, and nonanatomic or revision reconstructions were excluded. Radiographic failure was defined as 6 mm of superior clavicle displacement on immediate postoperative films. RESULTS A cohort of 38 patients underwent 39 anatomic coracoclavicular reconstructions. Average follow-up time was 26 months (range, 1.2-92 months). A total of 20 radiographic failures were identified, with an average conoid tunnel ratio of 0.27. When conoid tunnel ratios were compared with a reference ratio of 0.20 to 0.25, increased risk of failure was statistically significant with lateralization greater than 0.20 (P = .018; odds ratio [OR] = 40 [95% CI, 1.05-999.06]) or with medialization of 0.251 to 0.30 (P = .002; OR = 39 [95% CI, 1.58-944.36]) or greater than 0.30 (P = .029; OR = 21 [95% CI, 0.77-562.15]). Medialization of the trapezoid position greater than 0.16 (vs a range of 0.13-0.16) was also found to be significant for failure (P < .023; OR = 8 [95% CI, 1.33-48.18]). However, these significant findings did not correlate with symptoms or ability to return to duty (P > .05). CONCLUSION The optimal technique for treating acromioclavicular separations has yet to be determined. Recently, anatomic coracoclavicular reconstruction has demonstrated biomechanical superiority to previously described methods. The findings of optimal tunnel positioning in anatomic reconstructions from this large active-duty military cohort can assist preoperative planning to reduce failure rates when treating these difficult injuries.
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Affiliation(s)
| | - Joseph T Lanzi
- William Beaumont Army Medical Center, El Paso, Texas, USA
| | | | - Julia M Bader
- William Beaumont Army Medical Center, El Paso, Texas, USA
| | - Mark P Pallis
- William Beaumont Army Medical Center, El Paso, Texas, USA
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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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Lateur G, Boudissa M, Rubens-Duval B, Mader R, Rouchy RC, Pailhé R, Saragaglia D. Long-term outcomes of tension band wiring with a single K-wire in Rockwood type IV/V acute acromio-clavicular dislocations: 25 cases. Orthop Traumatol Surg Res 2016; 102:589-93. [PMID: 27424096 DOI: 10.1016/j.otsr.2016.02.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 01/24/2016] [Accepted: 02/24/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Our objective was to evaluate the long-term functional and radiological outcomes of tension band wiring with a single K-wire for acute Rockwood types IV and V acromio-clavicular dislocation (ACD). METHODS Single-centre cross-sectional non-randomised observational cohort study of 25 shoulders treated surgically between January 2002 and December 2004, in 25 patients, 23 males and 2 females, with a mean age of 35±11years (24-46). The evaluation criteria were the absolute and weighted Constant scores, QuickDASH score, subjective shoulder value (SSV), visual analogue scale (VAS) pain score at rest and during activities, and radiographic features in clinically symptomatic patients. RESULTS Mean values were as follows: follow-up, 150±17months (133-167); absolute Constant score, 88±17 (71-105); weighted Constant score, 92.5±12.5 (80-105); QuickDASH, 15.5±7 (8.5-22.5); SSV, 88±17% (71-105); VAS pain score at rest, 0.2±0.7 (0-0.9); and VAS pain score while active, 1.4±2.3 (0-3.7). The weighted Constant score was less than 70% in only 8% of patients. Of the 17 patients for whom radiographs were obtained, 8 had acromio-clavicular osteoarthritis. Mean coraco-clavicular distance was 12.3±4.3mm (8-16.6) and mean acromio-clavicular distance was 5±5mm (0-10). The recurrence rate was 8%. CONCLUSION Tension band wiring with a single K-wire for acute acromio-clavicular dislocation reliably provides good long-term functional outcomes. Recurrences are uncommon and few patients experience symptoms (8%). LEVEL OF EVIDENCE IV, retrospective study.
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Affiliation(s)
- G Lateur
- Clinique universitaire de chirurgie orthopédique et de traumatologie du sport, hôpital Sud, CHU de Grenoble, 38130 Échirolles, France.
| | - M Boudissa
- Clinique universitaire de chirurgie orthopédique et de traumatologie du sport, hôpital Sud, CHU de Grenoble, 38130 Échirolles, France
| | - B Rubens-Duval
- Clinique universitaire de chirurgie orthopédique et de traumatologie du sport, hôpital Sud, CHU de Grenoble, 38130 Échirolles, France
| | - R Mader
- Clinique universitaire de chirurgie orthopédique et de traumatologie du sport, hôpital Sud, CHU de Grenoble, 38130 Échirolles, France
| | - R C Rouchy
- Clinique universitaire de chirurgie orthopédique et de traumatologie du sport, hôpital Sud, CHU de Grenoble, 38130 Échirolles, France
| | - R Pailhé
- Clinique universitaire de chirurgie orthopédique et de traumatologie du sport, hôpital Sud, CHU de Grenoble, 38130 Échirolles, France
| | - D Saragaglia
- Clinique universitaire de chirurgie orthopédique et de traumatologie du sport, hôpital Sud, CHU de Grenoble, 38130 Échirolles, France
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Wagih AM, Elguindy AM. Percutaneous Reconstruction of the Anterolateral Ligament of the Knee With a Polyester Tape. Arthrosc Tech 2016; 5:e691-e697. [PMID: 27709023 PMCID: PMC5039645 DOI: 10.1016/j.eats.2016.02.028] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 02/10/2016] [Indexed: 02/07/2023] Open
Abstract
Recent advances in surgeons' understanding of the anatomic, biomechanical, and radiologic features of the anterolateral ligament (ALL) of the knee have led to an increased interest in reconstruction of this structure as part of the management of knee instability. Even without any technical flaws and proper positioning of the bone tunnels, there is a small subset of patients, approximately 7% of all patients, who experience some residual anterolateral rotational instability after anterior cruciate ligament reconstruction. For this reason, some researchers have turned again toward the anterolateral aspect of the knee and specifically the ALL. In this technical note, the surgical steps for percutaneous reconstruction of ALL of the knee using a polyester tape are described.
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Affiliation(s)
- Ahmad M. Wagih
- Address correspondence to Ahmad M. Wagih, M.D., M.R.C.S., F.E.O.B., Department of Orthopaedic Surgery, the National Institute of Neuromotor System, Kornish Imbabah, Cairo, Egypt.Department of Orthopaedic Surgerythe National Institute of Neuromotor SystemKornish ImbabahCairoEgypt
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Scillia AJ, Cain EL. Acromioclavicular Joint Reconstruction. Arthrosc Tech 2015; 4:e877-83. [PMID: 27284528 PMCID: PMC4887285 DOI: 10.1016/j.eats.2015.08.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 08/25/2015] [Indexed: 02/03/2023] Open
Abstract
Our technique for acromioclavicular joint reconstruction provides a variation on coracoclavicular ligament reconstruction to also include acromioclavicular ligament reconstruction. An oblique acromial tunnel is drilled, and the medial limb of the gracilis graft, after being crossed and passed beneath the coracoid and through the clavicle, is passed through this acromial tunnel and sutured to the trapezoid graft limb after appropriate tensioning. Tenodesis screws are not placed in the bone tunnels to avoid graft fraying, and initial forces on the graft are offloaded with braided absorbable sutures passed around the clavicle.
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Affiliation(s)
- Anthony J. Scillia
- American Sports Medicine Institute, Birmingham, Alabama, U.S.A.,Department of Orthopaedics, School of Health and Medical Sciences, Seton Hall University, South Orange, New Jersey, U.S.A.,Address correspondence to Anthony J. Scillia, M.D., Department of Orthopaedics, School of Health and Medical Sciences, Seton Hall University, 400 S Orange Ave, South Orange, NJ 07079, U.S.A.
| | - E. Lyle Cain
- American Sports Medicine Institute, Birmingham, Alabama, U.S.A
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Barth J, Duparc F, Andrieu K, Duport M, Toussaint B, Bertiaux S, Clavert P, Gastaud O, Brassart N, Beaudouin E, De Mourgues P, Berne D, Bahurel J, Najihi N, Boyer P, Faivre B, Meyer A, Nourissat G, Poulain S, Bruchou F, Ménard JF. Is coracoclavicular stabilisation alone sufficient for the endoscopic treatment of severe acromioclavicular joint dislocation (Rockwood types III, IV, and V)? Orthop Traumatol Surg Res 2015; 101:S297-303. [PMID: 26514849 DOI: 10.1016/j.otsr.2015.09.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 08/31/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND The primary objective was to evaluate correlations linking anatomical to functional outcomes after endoscopically assisted repair of acute acromioclavicular joint dislocation (ACJD). HYPOTHESIS Combined acromioclavicular and coracoclavicular stabilisation improves radiological outcomes compared to coracoclavicular stabilisation alone. MATERIAL AND METHODS A prospective multicentre study was performed. Clinical outcome measures were pain intensity on a visual analogue scale (VAS), subjective functional impairment (QuickDASH score), and Constant's score. Anatomical outcomes were assessed on standard radiographs (anteroposterior view of the acromioclavicular girdle and bilateral axillary views) obtained preoperatively and postoperatively and on postoperative dynamic radiographs taken as described by Tauber et al. RESULTS Of 116 patients with acute ACJD included in the study, 48% had type III, 30% type IV, and 22% type V ACJD according to the Rockwood classification. Coracoclavicular stabilisation was achieved using a double endobutton in 93% of patients, and concomitant acromioclavicular stabilisation was performed in 50% of patients. The objective functional outcome was good, with an unweighted Constant's score ≥ 85/100 and a subjective QuickDASH functional disability score ≤ 10 in 75% of patients. The radiographic analysis showed significant improvements from the preoperative to the 1-year postoperative values in the vertical plane (decrease in the coracoclavicular ratio from 214 to 128%, p=10(-6)) and in the horizontal plane (decrease in posterior displacement from 4 to 0mm, p=5×10(-5)). The anatomical outcome correlated significantly with the functional outcome (absolute R value=0.19 and p=0.045). We found no statistically significant differences across the various types of constructs used. Intra-operative control of the acromioclavicular joint did not improve the result. Implantation of a biological graft significantly improved both the anatomical outcome in the vertical plane (p=0.04) and acromioclavicular stabilisation in the horizontal plane (p=0.02). The coracoclavicular ratio on the anteroposterior radiograph was adversely affected by a longer time from injury to surgery (p=0.02) and by a higher body mass index (BMI) (p=0.006). High BMI also had a negative effect on the difference in the distance separating the anterior edge of the acromion from the anterior edge of the clavicle between the injured and uninjured sides, as assessed on the axillary views (p=0.009). CONCLUSION This study demonstrates that acute ACJD requires stabilisation in both planes, i.e., at the coracoclavicular junction and at the acromioclavicular joint. Coracoclavicular stabilisation alone is not sufficient, regardless of the type of implant used. Implantation of a biological graft should be considered when the time from injury to surgery is longer than 10days. The weight of the upper limb should be taken into account, with 6weeks of immobilisation to unload the construct in patients who have high BMI values. LEVEL OF EVIDENCE II, prospective non-randomised comparative study.
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Affiliation(s)
- J Barth
- Centre ostéo-articulaire des cèdres, parc Sud-Galaxie, 5, rue des Tropiques, Echirolles, France.
| | - F Duparc
- Centre hospitalier universitaire de Rouen, Rouen, France
| | - K Andrieu
- Centre ostéo-articulaire des cèdres, parc Sud-Galaxie, 5, rue des Tropiques, Echirolles, France
| | - M Duport
- Médipôle Garonne, Toulouse, France
| | | | - S Bertiaux
- Centre hospitalier universitaire de Rouen, Rouen, France
| | - P Clavert
- Service de chirurgie de l'épaule et du coude, CCOM, CHRU de Strasbourg, Strasbourg, France
| | - O Gastaud
- Institut universitaire de l'appareil locomoteur et du sport, hôpital Pasteur 2, CHU de Nice, Nice, France
| | - N Brassart
- Clinique de Cagne-sur-Mer, Cagne-sur-Mer, France
| | - E Beaudouin
- Centre hospitalier régional de Chambéry, Chambéry, France
| | | | - D Berne
- Clinique Kennedy, Montélimar, France
| | - J Bahurel
- Clinique Générale d'Annecy, Annecy, France
| | - N Najihi
- Centre hospitalier universitaire de Rennes, Rennes, France
| | - P Boyer
- Hôpital universitaire Xavier-Bichat, Paris, France
| | - B Faivre
- Hôpital universitaire Ambroise-Paré, Boulogne-Billancourt, France
| | | | - G Nourissat
- Chirurgie de l'épaule, groupe Maussins, 67, rue de Romainville, Paris, France
| | - S Poulain
- Polyclinique du Plateau, Bezons, France
| | - F Bruchou
- Hôpital privé de l'ouest parisien, Trappes, France
| | - J F Ménard
- Unité biostatistique du CHU de Rouen, Rouen, France
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Loriaut P, Casabianca L, Alkhaili J, Dallaudière B, Desportes E, Rousseau R, Massin P, Boyer P. Arthroscopic treatment of acute acromioclavicular dislocations using a double button device: Clinical and MRI results. Orthop Traumatol Surg Res 2015; 101:895-901. [PMID: 26545942 DOI: 10.1016/j.otsr.2015.09.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 08/26/2015] [Accepted: 09/08/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Arthroscopic treatment of acute grade 3 and 4 acromioclavicular dislocation is controversial, due to the risk of recurrence and of postoperative reduction defect. The purpose of the present study was to investigate whether the healing of the acromioclavicular (AC) and coracoclavicular (CC) ligaments and the accurate 3D positioning parameters of the AC joint using MRI were correlated with satisfactory functional outcome. MATERIAL Thirty-nine patients were enrolled from 2009 to 2011 and managed arthroscopically by CC lacing using a double-button device. METHODS Clinical assessment included the Shoulder and Hand (QuickDash) score, Constant-Murley score and visual analog scale (VAS) for residual pain. Time and rate to return to work and return to sport were assessed according to type of sport and work. Postoperative complications were recorded. Radiological examination consisted of anteroposterior clavicle and lateral axillary radiographs. AC ligament healing and 3D joint congruency were assessed on MRI and correlated to the clinical results. RESULTS Mean patient age was 35.7 years (range, 20-55). Mean follow-up was 42.3±10.6 months (range, 24-60). At final follow-up, mean QuickDash score, Constant score and VAS were respectively 1.7±4 (range, 0-11), 94.7±7.3 (range, 82-100) and 0.5±1.4 (range, 0-2). Thirty-five (90%) patients were able to resume work, including heavy manual labor, and sport. Radiology found accurate 3D joint congruency in 34 patients (87%) and CC and AC ligament healing in 36 (93%). Complications included reduction loss at 6 weeks in 3 patients, requiring surgical stabilization. Satisfactory functional results were associated with accurate AC joint congruency in the coronal and axial planes (P<0.05) and good AC and CC ligament healing (P<0.04). An initial 25% reduction defect in the coronal plane was not associated with poor functional results (P=0.07). CONCLUSION Arthroscopic treatment by CC lacing satisfactorily restored ligament and joint anatomy in the present series. These satisfactory anatomic results correlated with good clinical outcome encourage continuing with this technique. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- P Loriaut
- Service de chirurgie orthopédique et de traumatologie, hôpital de la Pitié-Salpêtrière, université Pierre-et-Marie-Curie, 47, boulevard de l'Hôpital, 75013 Paris, France; Institut de chirurgie orthopédique, clinique des Lilas, 41-49, avenue du Maréchal-Juin, 93260 Les Lilas, France.
| | - L Casabianca
- Service de chirurgie orthopédique et de traumatologie, hôpital de la Pitié-Salpêtrière, université Pierre-et-Marie-Curie, 47, boulevard de l'Hôpital, 75013 Paris, France
| | - J Alkhaili
- Service de chirurgie orthopédique et de traumatologie, hôpitaux universitaires Paris Nord - Val-de-Seine, 46, rue Henri-Huchard, 75877 Paris cedex 18, France
| | - B Dallaudière
- Service de radiologie, clinique du sport, Bordeaux-Mérignac, 2, rue Negrevergne, 33700 Mérignac, France; Service de radiologie, hôpital Pellegrin, Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - E Desportes
- Service de radiologie, hôpitaux universitaires Paris Nord - Val-de-Seine, 46, rue Henri-Huchard, 75877 Paris cedex 18, France
| | - R Rousseau
- Service de chirurgie orthopédique et de traumatologie, hôpital de la Pitié-Salpêtrière, université Pierre-et-Marie-Curie, 47, boulevard de l'Hôpital, 75013 Paris, France
| | - P Massin
- Service de chirurgie orthopédique et de traumatologie, hôpitaux universitaires Paris Nord - Val-de-Seine, 46, rue Henri-Huchard, 75877 Paris cedex 18, France
| | - P Boyer
- Service de chirurgie orthopédique et de traumatologie, hôpitaux universitaires Paris Nord - Val-de-Seine, 46, rue Henri-Huchard, 75877 Paris cedex 18, France
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Saier T, Venjakob AJ, Minzlaff P, Föhr P, Lindell F, Imhoff AB, Vogt S, Braun S. Value of additional acromioclavicular cerclage for horizontal stability in complete acromioclavicular separation: a biomechanical study. Knee Surg Sports Traumatol Arthrosc 2015; 23:1498-1505. [PMID: 24554242 DOI: 10.1007/s00167-014-2895-7] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 02/03/2014] [Indexed: 12/22/2022]
Abstract
PURPOSE To evaluate whether isolated anatomical coracoclavicular (CC) ligament reconstruction with two suture-button devices provides equal horizontal acromioclavicular joint (ACJ) stability compared to additional ACJ suture tape cerclage. METHODS A servohydraulic testing machine was used to assess horizontal ACJ translation in 12 fresh-frozen human shoulders during 5,000 cycles of dynamic anteroposterior directed loading (70 N). Horizontal ACJ stability was assessed for native specimen (n = 6) and compared to specimen with dissected AC ligaments but intact CC ligaments (n = 6). After complete AC/CC dissection, an anatomical CC reconstruction was performed with two suture-button devices (n = 6) and compared to the additional ACJ suture tape cerclage (n = 6). RESULTS Native specimen showed an mean horizontal amplitude of 10.8 mm [standard deviation (SD) 3.29]. After 5,000 cycles of horizontal loading (70 N), mean amplitude increased by 1.5 mm (SD 0.75, p = 0.005). Specimen with dissected AC ligaments started at an mean amplitude of 14.1 mm (SD 4.11), which was increased by 0.9 mm (SD 0.56, n.s.) after loading. Initially, amplitude of specimen with anatomical CC reconstruction was 13.2 mm (SD 2.75), which increased by 2.9 mm (SD 1.45, p = 0.001) after loading. The specimen with additional AC cerclage initially showed an amplitude of 10.6 mm (SD 2.35). After loading, translation was increased by 3.0 mm (SD 0.97, p = 0.001). There was no failure of any surgical reconstruction in the tests. CONCLUSION The results of this study suggest that only combined AC and CC reconstruction can adequately re-establish physiological horizontal ACJ stability. Therefore, it is likely that a combined surgical procedure with double suture-button devices and AC suture tape cerclage can adequately re-establish horizontal AC joint stability in case of an acute injury (≥type Rockwood IV and may allow superior clinical outcomes for patients, especially if early functional rehabilitation is intended).
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Affiliation(s)
- Tim Saier
- Department for Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany
- Berufsgenossenschaftliche Unfallklinik Murnau, Prof.-Küntscher-Str. 8, 82418, Murnau, Germany
| | - Arne J Venjakob
- Department for Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany
| | - Philipp Minzlaff
- Department for Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany
| | - Peter Föhr
- Department of Biomechanics, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany
| | - Filip Lindell
- Department of Biomechanics, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany
| | - Andreas B Imhoff
- Department for Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany.
| | - Stephan Vogt
- Department for Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany
| | - Sepp Braun
- Department for Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany
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Campbell ST, Heckmann ND, Shin SJ, Wang LC, Tamboli M, Murachovsky J, Tibone JE, Lee TQ. Biomechanical evaluation of coracoid tunnel size and location for coracoclavicular ligament reconstruction. Arthroscopy 2015; 31:825-30. [PMID: 25633818 DOI: 10.1016/j.arthro.2014.11.037] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Revised: 11/14/2014] [Accepted: 11/21/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to determine the effect of coracoid tunnel size and location on the biomechanical characteristics of cortical button fixation for coracoclavicular ligament reconstruction. METHODS Thirteen matched pairs of cadaveric scapulae were used to determine the effects of coracoid tunnel size, and 6 matched pairs were used to determine the effects of coracoid tunnel location. For tunnel size, a 4.5-mm hole was drilled in the base of the coracoid of one scapula and a 6-mm hole was drilled in the contralateral scapula. For tunnel location, 2 holes were drilled: (1) The first group received a hole centered in the coracoid base and a hole 1.5 cm distal from the first, along the axis of the coracoid. (2) The second group received holes that were offset anteromedially from the first set of holes (base eccentric and distal eccentric). A cortical button-suture tape construct was placed through each tunnel, and constructs were then loaded to failure. RESULTS For tunnel size specimens, load at ultimate failure was significantly greater for the 4.5-mm group compared with the 6-mm group (557.6 ± 48.5 N v 466.9 ± 42.2 N, P < .05). For tunnel location, load at ultimate failure was significantly greater for the centered-distal tunnel group compared with the eccentric-distal group (538.1 ± 70.2 N v 381.0 ± 68.6 N, P < .05). CONCLUSIONS A 4.5-mm tunnel in the coracoid provided greater strength for cortical button fixation than a 6-mm tunnel. In the distal coracoid, centered tunnels provided greater strength than eccentric tunnels. CLINICAL RELEVANCE When performing cortical button fixation at the coracoid process for coracoclavicular ligament reconstruction, a 4.5-mm tunnel provides greater fixation strength than a 6-mm tunnel. The base of the coracoid is more forgiving than the distal coracoid regarding location.
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Affiliation(s)
- Sean T Campbell
- Orthopaedic Biomechanics Laboratory, VA Healthcare System, Long Beach, California, U.S.A
| | - Nathanael D Heckmann
- Orthopaedic Biomechanics Laboratory, VA Healthcare System, Long Beach, California, U.S.A; Department of Orthopaedic Surgery, University of Southern California, Los Angeles, California, U.S.A
| | - Sang-Jin Shin
- Orthopaedic Biomechanics Laboratory, VA Healthcare System, Long Beach, California, U.S.A
| | - Lawrence C Wang
- Orthopaedic Biomechanics Laboratory, VA Healthcare System, Long Beach, California, U.S.A
| | - Mallika Tamboli
- Orthopaedic Biomechanics Laboratory, VA Healthcare System, Long Beach, California, U.S.A
| | - Joel Murachovsky
- Department of Orthopaedics and Traumatology, Faculdade de Medicina do ABC, Santo André, Sao Paulo, Brazil
| | - James E Tibone
- Department of Orthopaedic Surgery, University of California, Irvine, Irvine, California, U.S.A
| | - Thay Q Lee
- Orthopaedic Biomechanics Laboratory, VA Healthcare System, Long Beach, California, U.S.A; Department of Orthopaedic Surgery, University of California, Irvine, Irvine, California, U.S.A.
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Glanzmann MC, Buchmann S, Audigé L, Kolling C, Flury M. Clinical and radiographical results after double flip button stabilization of acute grade III and IV acromioclavicular joint separations. Arch Orthop Trauma Surg 2013; 133:1699-707. [PMID: 24077779 DOI: 10.1007/s00402-013-1858-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Persistent horizontal instability after acute acromioclavicular (AC) joint separation may provoke unsatisfactory results of conservative treatment. HYPOTHESIS the arthroscopically assisted double flip button stabilization of acute horizontally unstable grade III and IV AC joint disruptions results in full functional restoration and stable radiological reposition. MATERIALS 21 patients treated for an acute grade III or IV AC joint separation were enrolled. Clinical assessment at least 2-year postoperative included the constant score (CS) and the simple shoulder test. A panorama stress view, bilateral axial view and an AC view were obtained for radiographic evaluation. RESULTS 19 individuals (mean 37 years; 17 men) with 16 Rockwood type III and 3 type IV injuries were available for examination 24–51 months postoperatively. The mean CS was 90.2 points (SD 6.5) with no statistically significant difference between CS and age-adjusted normative values. The mean Simple Shoulder Test scored 11.5 points (range 8–12). Loss of reduction of more than 2 mm in the coronal plane stress views was present in 6 patients (32 %) with no associated loss of functional outcome. Two of four reported complications in four patients were treated surgically (one open revision with graft augmentation for coracoid implant break out, one arthroscopic capsular release for persistent glenohumeral stiffness). CONCLUSION Arthroscopically assisted double flip button stabilization for acute grade III and IV AC joint separation restores fully horizontal stability and age-expected shoulder function, resulting in high patient satisfaction, despite a loss of reduction observed radiographically in approximately one-third of patients. LEVEL OF EVIDENCE IV.
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