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Kimmeyer M, Hees T, Buijze GA, Lafosse L, Lafosse T. High Vertical and Horizontal Stability at Short-Term Follow-Up After an All-Endoscopic Double Cerclage Endobutton Technique for Acute Acromioclavicular Joint Separations. Arthroscopy 2024:S0749-8063(24)00253-6. [PMID: 38548116 DOI: 10.1016/j.arthro.2024.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 03/17/2024] [Accepted: 03/17/2024] [Indexed: 04/26/2024]
Abstract
PURPOSE To evaluate the clinical and radiological outcomes in the treatment of acute acromioclavicular (AC) joint separations using an all-endoscopic double cerclage endobutton technique compared with an arthroscopic-assisted single-bundle endobutton technique and to analyze the complication, failure, and revision rates of both procedures. METHODS All patients with acute Rockwood type IIIB and V AC joint separations who were operated on using an all-endoscopic double cerclage technique (2019-2022) or an arthroscopic-assisted single-bundle technique (2017-2019) were included. The follow-up period was at least 12 months. Clinical and radiographic assessment was performed at follow-up. Complications, failures, and revisions were also investigated. RESULTS Twenty-eight patients (14 double cerclage group, 14 single-bundle group, all male) with an average age of 37 years (interquartile range [IQR], 15) were available for follow-up after 45 months (IQR, 38). The median time between trauma and surgery was 7 days (IQR, 8). Very good clinical results without significant differences were observed in both groups (Constant score, 94 [IQR, 12] vs 95 [IQR, 15], P = .427, AC joint instability score, 95 [IQR, 11] vs 87 [IQR, 22], P = .210). All patients returned to sport, with an average sports level of 95% compared with preoperative status. The single-bundle group showed significantly increased anteroposterior instability (6 vs 0, P = .006). A total of 5 complications occurred (2 vs 3), leading to 1 revision surgery in each group. CONCLUSIONS Excellent clinical results and high vertical and horizontal stability can be achieved with the all-endoscopic double cerclage technique. Horizontal instability occurred significantly more frequently with the single-bundle technique. The prolonged operation time in the double cerclage group had no negative impact on postoperative outcomes, including complication and failure rates, and a learning curve to reduce this prolonged operative time should be considered. LEVEL OF EVIDENCE Level III, retrospective comparative clinical series.
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Affiliation(s)
- Michael Kimmeyer
- Clinique Générale, Alps Surgery Institute, Annecy, France; Department of Trauma, Hand Surgery and Sports Medicine, ViDia Clinics Karlsruhe, Karlsruhe, Germany.
| | - Tilman Hees
- Clinique Générale, Alps Surgery Institute, Annecy, France; ORTHO EINS Orthopädie, Berlin, Germany
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Kelley N, Tuttle M, Sylvia SM, Dragoo JL, Khodaee M. Acromioclavicular Joint Injuries in Sport. Curr Sports Med Rep 2023; 22:91-99. [PMID: 36866952 DOI: 10.1249/jsr.0000000000001046] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
ABSTRACT Sport-related shoulder injuries, including disruptions to the acromioclavicular joint (ACJ), are common. An ACJ injury is classified by the degree and direction of the clavicle displacement. Although the diagnosis can be made clinically, standard radiographic views are important to determine the severity of the ACJ disruption and assess for concurrent injuries. The majority of ACJ injuries can be managed nonoperatively; however, surgical treatment is indicated in some cases. Long-term outcomes are generally favorable for most ACJ injuries, and athletes generally return to sport without functional limitations. This article provides an in-depth discussion regarding all aspects of ACJ injuries, including clinically relevant anatomy, biomechanics, evaluation, treatment, and complications.
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Affiliation(s)
- Naomi Kelley
- University of Colorado School of Medicine, Aurora, CO
| | - Matthew Tuttle
- Head of Soccer Medicine and Performance, New York Red Bulls, Harrison, NJ
| | - Stephen M Sylvia
- University of Colorado School of Medicine, Department of Orthopedics, Division of Sports Medicine, Englewood, CO
| | - Jason L Dragoo
- University of Colorado School of Medicine, Department of Orthopedics, Division of Sports Medicine, Englewood, CO
| | - Morteza Khodaee
- University of Colorado School of Medicine, Department of Family Medicine and Orthopedics, Division of Sports Medicine, Denver, CO
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Elkalyoby AS, Waly MR, Abdelrazek BHMZ, Mohamed AR, Shohayeb K, Seifeldin AF. No correlation exists between coracoid tunnel widening and loss of reduction after arthroscopic acromioclavicular fixation using tightrope system. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07329-8. [PMID: 36805298 DOI: 10.1007/s00167-023-07329-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 01/30/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE To detect the widening of the tunnel of the coracoid process after arthroscopic fixation of acute acromioclavicular joint (ACJ) dislocation using the TightRope system and its correlation with loss of reduction and functional scores. METHODS From 2016 to 2018, a prospective study was performed on twenty-three patients with acute grade III-V ACJ dislocation. Arthroscopic TightRope repair of the ACJ was performed. Coracoid tunnel widening was measured by CT, and the coracoclavicular distance was measured on the radiographs immediately postoperatively and at 12 months. The Constant Shoulder Score, Oxford Shoulder Score, Nottingham Clavicle Score and Visual analog scale were used as outcome measures at 12 months. RESULTS The coracoid tunnel diameter to horizontal coracoid diameter ratio increased from 22.8 ± 3.7% immediately postoperatively to 38.5 ± 5.5% at 12 months (p < 0.001). The coracoclavicular (CC) distance showed an increase from a mean of 10.8 ± 1.7 mm to a mean of 11.8 ± 2.5 at 12 months (p < 0.001). There was no correlation between the increase in the coracoclavicular distance and the patients' functional clinical scores or coracoid tunnel widening. CONCLUSION Coracoid tunnel widening and radiological loss of reduction occur after arthroscopic fixation of acute ACJ dislocation with the TightRope system. However, they do not correlate with each other or with the functional scores of the patient. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Ahmed Samir Elkalyoby
- Trauma and Orthopedics Faculty of Medicine, Cairo University, Mathaf El-Manial Street, Manial Cairo, 11553, Egypt.
| | - Mohamed Refaat Waly
- Trauma and Orthopedics Faculty of Medicine, Cairo University, Mathaf El-Manial Street, Manial Cairo, 11553, Egypt
| | | | - Ahmed Rizk Mohamed
- Trauma and Orthopedics Faculty of Medicine, Cairo University, Mathaf El-Manial Street, Manial Cairo, 11553, Egypt
| | - Khaled Shohayeb
- Trauma and Orthopedics Faculty of Medicine, Cairo University, Mathaf El-Manial Street, Manial Cairo, 11553, Egypt
| | - Ahmed Fouad Seifeldin
- Trauma and Orthopedics Faculty of Medicine, Cairo University, Mathaf El-Manial Street, Manial Cairo, 11553, Egypt
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Noyes MP, Narbona P, Brady PC, Huberty DP, Adams CR, Ardebol J, Denard PJ. Addition of Allograft and Acromioclavicular Cerclage Improves Outcomes of Arthroscopic-Assisted Reconstruction of Acromioclavicular Separation With a Single Coracoclavicular Tunnel. Cureus 2022; 14:e28539. [PMID: 36185885 PMCID: PMC9518817 DOI: 10.7759/cureus.28539] [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] [Accepted: 08/29/2022] [Indexed: 11/09/2022] Open
Abstract
Objective The purpose of this study was to prospectively evaluate the functional outcome and complications of unstable acromioclavicular (AC) joint separations repaired with a single coracoclavicular tunnel utilizing an arthroscopic-assisted curved button technique. Methods Thirty-five patients with a minimum of 12 months follow-up underwent arthroscopic-assisted AC joint reconstruction with suspensory button and 2 mm suture tape fixation using 3 mm tunnels. Functional outcome scores were analyzed preoperatively and at final follow-up with all complications noted. Results Comparing preoperative to postoperative values, all functional outcome scores improved. Three of the 16 (19%) patients that had a supplementary graft looped around the undersurface of the coracoid demonstrated loss of reduction compared to eight of the 19 (42%) that were treated with button and suture fixation alone (p = .138). No loss of reduction occurred in the subset of patients with AC joint supplementation. One (3%) patient sustained a distal clavicle fracture. Conclusion Arthroscopic-assisted AC joint reconstruction with a suspensory button construct demonstrates improved clinical outcomes with high patient satisfaction. While loss reduction remains problematic, smaller bone tunnels appear to lead to a low rate of iatrogenic fractures. The addition of a free tendon graft, as well as AC cerclage, appears to minimize loss of reduction.
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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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Ertogrul R, Sahin K, Celik H, Kapicioglu M, Ersen A, Bilsel K. Is coracoclavicular ossification a complication or a good prognostic factor after surgical treatment of acromioclavicular joint injury? JSES Int 2022; 6:769-774. [PMID: 36081692 PMCID: PMC9445996 DOI: 10.1016/j.jseint.2022.04.009] [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] [Indexed: 11/29/2022] Open
Abstract
Background The purpose of this study was to investigate whether heterotopic ossification (HO) in the coracoclavicular (CC) space after surgical treatment of acromioclavicular joint (ACJ) injury is a complication or a sign of good prognosis. Methods Fifty-nine consecutive patients who underwent CC reconstruction with or without augmentation of the ACJ for acute ACJ injuries were analyzed. Postoperative American Shoulder and Elbow Surgeons (ASES) score, Constant score (CS), subjective shoulder value (SSV), and visual analog scale (VAS) results were evaluated. For radiological evaluation, HO was evaluated, and CC distances were measured. Results Fifty-one patients (11 women and 40 men; mean age, 36 years [range, 17-68 years]) were evaluated after a mean follow-up of 3 years (range, 2-8 years). The mean ASES score at the follow-up was 82.73 (range, 51.6-100), mean CS was 85 (range, 50-100), mean SSV was 80 (range, 40-100), and mean VAS was 1.9 (range, 0-5). It was observed that the clinical outcomes (ASES, CS, SSV, VAS) of patients who developed ossification in the CC space were better than those who did not although it was not statistically significant. No statistically significant differences were found in the clinical outcomes (ASES, CS, SSV, VAS) between patients who underwent CC reconstruction without augmentation of the ACJ and those who were combined (P > .05). Conclusion HO in the CC space is a common finding following AC joint fixation injury. We suggest that HO is not a complication and might possibly have positive effects on clinical outcomes.
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Affiliation(s)
- Rodi Ertogrul
- Sisli Hamidiye Etfal Training and Research Hospital, Orthopaedics Department, Istanbul, Turkey
| | - Koray Sahin
- Mus State Hospital, Department of Orthopaedics and Traumatology, Muş, Turkey
| | - Haluk Celik
- Hisar Intercontinental Private Hospital, Department of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Mehmet Kapicioglu
- Bezmialem Vakif University, Department of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Ali Ersen
- Istanbul University, Istanbul Medical School, Department of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Kerem Bilsel
- Bezmialem Vakif University, Department of Orthopaedics and Traumatology, Istanbul, Turkey
- Corresponding author: Kerem Bilsel, MD, Bezmialem Vakif Universitesi Tip Fakultesi Hastanesi, vatan street, Fatih, istanbul 34093, Turkey.
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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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Ruiz Ibán MA, Moreno Romero MS, Diaz Heredia J, Ruiz Díaz R, Muriel A, López-Alcalde J. The prevalence of intraarticular associated lesions after acute acromioclavicular joint injuries is 20%. A systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2021; 29:2024-2038. [PMID: 32179968 DOI: 10.1007/s00167-020-05917-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 02/24/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE To synthesise the evidence on the prevalence of associated intraarticular lesions in subjects with acute acromioclavicular joint (ACJ) dislocations. METHODS A search in two electronic databases (PUMBMED and EMBASE) was performed from 1985 to 2019. Two independent reviewers selected studies that complied with the following inclusion criteria: (1) the study included data on surgically treated ACJ dislocation grade III-V in the Rockwood classification, (2) the ACJ injuries were acute (the surgery was performed less than 6 weeks after injury), (3) an arthroscopic evaluation of the glenohumeral joint was performed during surgery. The quality of the studies included was assessed using the tool of the Joanna Briggs Institute. RESULTS A total of 47 studies with acute ACJ injuries met the initial inclusion criteria. Of these, 21 studies (9 retrospective case series, 9 prospective case series and 3 retrospective cohort studies) presented data on associated intraarticular lesions amenable for use in the meta-analysis. The meta-analysed studies included a total of 860 subjects with acute ACJ dislocations with a male/female ratio of 6.5 and a mean age of 32 years. The meta-analysis showed a prevalence of associated intraarticular lesions in subjects with acute ACJ of 19.9% (95% confidence interval [CI] 14.0-26.4%; 21 studies, 860 analysed participants; P = 0.000; I2: 74.5% random-effects model; low risk of bias). CONCLUSION One in five subjects with surgically treated acute ACJ dislocations will have an associated intraarticular lesion that requires further intervention. The case for a customary arthroscopic evaluation of the joint, even when an open procedure is performed to deal with the ACJ dislocation, is strong. Level of evidence IV Trial registry Systematic review registration number: PROSPERO CRD42018090609.
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Affiliation(s)
- Miguel Angel Ruiz Ibán
- Unidad de Hombro Y Codo, Hospital Universitario Ramón Y Cajal, Cta Colmenar km 9,100, Madrid, Spain.
| | | | - Jorge Diaz Heredia
- Unidad de Hombro Y Codo, Hospital Universitario Ramón Y Cajal, Cta Colmenar km 9,100, Madrid, Spain
| | - Raquel Ruiz Díaz
- Unidad de Hombro Y Codo, Hospital Universitario Ramón Y Cajal, Cta Colmenar km 9,100, Madrid, Spain
| | - Alfonso Muriel
- Unidad de Bioestadística Clínica, Hospital Ramón Y Cajal, IRYCIS, CIBERESP, Madrid, Spain.,Departamento de Enfermería, Universidad de Alcalá, Madrid, Spain
| | - Jesus López-Alcalde
- Unidad de Bioestadística Clínica, Hospital Ramón Y Cajal, IRYCIS, CIBERESP, Madrid, Spain.,Faculty of Health Sciences, Universidad Francisco de Vitoria (UFV)-Madrid, Madrid, Spain.,Cochrane Associate Centre of Madrid, Madrid, Spain
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Lamplot JD, Shah SS, Chan JM, Hancock KJ, Gentile J, Rodeo SA, Allen AA, Williams RJ, Altchek DW, Dines DM, Warren RF, Cordasco FA, Gulotta LV, Dines JS. Arthroscopic-Assisted Coracoclavicular Ligament Reconstruction: Clinical Outcomes and Return to Activity at Mean 6-Year Follow-Up. Arthroscopy 2021; 37:1086-1095.e1. [PMID: 33278535 DOI: 10.1016/j.arthro.2020.11.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 11/18/2020] [Accepted: 11/19/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To report clinical and functional outcomes including return to preinjury activity level following arthroscopic-assisted coracoclavicular (CC) ligament reconstruction (AA-CCR) and to determine associations between return to preinjury activity level, radiographic outcomes, and patient-reported outcomes following AA-CCR. METHODS A institutional registry review of all AA-CCR using free tendon grafts from 2007 to 2016 was performed. Clinical assessment included Single Assessment Numeric Evaluation (SANE) score and return to preinjury activity level at final follow-up. Treatment failure was defined as (1) revision acromioclavicular stabilization surgery, (2) unable to return to preinjury activity level, or (3) radiographic loss of reduction (RLOR, >25% CC distance compared with contralateral side). SANE scores, return to activity, and RLOR were compared between patients within each category of treatment failure, by grade of injury, and whether concomitant pathology was treated. RESULTS There were 88 patients (89.8% male) with mean age of 39.6 years and minimum 2-year clinical follow-up (mean 6.1 years). Most injuries were Rockwood grade V (63.6%). Mean postoperative SANE score was 86.3 ± 17.5. Treatment failure occurred in 17.1%: 8.0% were unable to return to activity, 5.7% had RLOR, and 3.4% underwent revision surgery due to traumatic reinjury. SANE score was lower among patients who were unable to return to activity compared with those with RLOR and compared with nonfailures (P = .0002). There were no differences in revision surgery rates, return to activity, or SANE scores according to Rockwood grade or if concomitant pathology was treated. CONCLUSIONS AA-CCR with free tendon grafts resulted in good clinical outcomes and a high rate of return to preinjury activity level. RLOR did not correlate with return to preinjury activity level. Concomitant pathology that required treatment did not adversely affect outcomes. Return to preinjury activity level may be a more clinically relevant outcome measure than radiographic maintenance of acromioclavicular joint reduction. LEVEL OF EVIDENCE IV (Case Series).
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Affiliation(s)
- Joseph D Lamplot
- Sports Medicine Division, Department of Orthopaedic Surgery, Emory University, Atlanta, Georgia, U.S.A..
| | - Sarav S Shah
- Sports Medicine Division, Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, Massachusetts, U.S.A
| | - Justin M Chan
- Sports Medicine Institute, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Kyle J Hancock
- Sports Medicine Institute, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Joseph Gentile
- Novant Health Orthopaedics & Sports Medicine, Huntersville, North Carolina, U.S.A
| | - Scott A Rodeo
- Sports Medicine Institute, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Answorth A Allen
- Sports Medicine Institute, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Riley J Williams
- Sports Medicine Institute, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - David W Altchek
- Sports Medicine Institute, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - David M Dines
- Sports Medicine Institute, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Russell F Warren
- Sports Medicine Institute, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Frank A Cordasco
- Sports Medicine Institute, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Lawrence V Gulotta
- Sports Medicine Institute, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Joshua S Dines
- Sports Medicine Institute, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
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10
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Walters JD, Ignozzi A, Bustos F, Werner BC, Brockmeier SF. Better Radiographic Reduction and Lower Complication Rates With Combined Coracoclavicular and Acromioclavicular Ligament Reconstruction Than With Isolated Coracoclavicular Reconstruction. Arthrosc Sports Med Rehabil 2021; 3:e441-e448. [PMID: 34027453 PMCID: PMC8129451 DOI: 10.1016/j.asmr.2020.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 10/12/2020] [Indexed: 11/29/2022] Open
Abstract
Purpose To determine whether combined acromioclavicular (AC) ligament reconstruction and coracoclavicular (CC) ligament reconstruction without bone tunnels would improve radiographic reduction maintenance and complication rates for type III to V AC dislocations. Methods This single-institution retrospective study analyzed all patients who underwent a hybrid synthetic/graft wrap CC reconstruction without tunnels with additional AC reconstruction/repair from January 2013 to August 2019. This 26-patient cohort was compared with a 1:1 sex- and age-matched control group who underwent CC reconstruction without AC reconstruction. CC distances on postoperative radiographs were compared with normal contralateral shoulders. Results Of the 93 patients who underwent AC reconstructive surgery during this time period, 26 patients (96% male) met the inclusion criteria. The AC/CC cohort had 23.5% type III injuries, 23.1% type IV injuries, and 53.8% type V injuries, similar to the control group. Final radiographs of the operative shoulder’s CC distance were (mean ± standard deviation) 0.9 ± 4.0 mm greater than that of the contralateral shoulder (9.6 ± 8.7 mm) in the AC/CC cohort. Final radiographs of the operative shoulder’s coracoclavicular distance were 4.0 ± 4.7 mm greater than that of the contralateral shoulder (13.3 ± 9.3 mm) in the CC control group, a significant difference (P = .014). The AC/CC reconstruction group had fewer patients with a loss of reduction >5 mm (11.5% versus 38.5%, P = .025). The complication rate in the CC control group was higher than in the AC/CC cohort (30.7% versus 7.7%, P = .035). The reoperation rate was also greater in the CC control group (8 versus 1, P = .010). Conclusion This cohort study shows that the addition of AC reconstruction to CC reconstruction using synthetic tapes/grafts or allograft tissues without bone tunnels significantly improves durable radiographic outcomes, diminishes complication rates, and improves reoperation rates. Level of Evidence III, retrospective comparative study.
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Affiliation(s)
- Jordan D Walters
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A
| | - Anthony Ignozzi
- University of Virginia School of Medicine, Charlottesville, Virginia, U.S.A
| | - Francis Bustos
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A
| | - Brian C Werner
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A
| | - Stephen F Brockmeier
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A
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11
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Shah SS, Ferkel E, Mithoefer K. High Prevalence of Superior Labral Anterior-Posterior Tears Associated With Acute Acromioclavicular Joint Separation of All Injury Grades. Orthop J Sports Med 2020; 8:2325967120941850. [PMID: 32923497 PMCID: PMC7457667 DOI: 10.1177/2325967120941850] [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: 03/03/2020] [Accepted: 03/13/2020] [Indexed: 11/16/2022] Open
Abstract
Background Despite the relatively high number of cases of acromioclavicular joint (AC) separation in the athletic population, optimal clinical outcomes are not achieved in every case. Limited data exist regarding the prevalence of intra-articular glenohumeral pathologies (IAPs) associated with acute AC separation of all injury grades. Purpose To determine the prevalence of IAPs associated with AC separation, regardless of severity. Study Design Case series; Level of evidence, 4. Methods A total of 62 patients (mean age, 37.6 years) with acute AC separation were included in this study; 41 were nonoverhead recreational athletes. All patients underwent magnetic resonance arthrography (MRA) to evaluate for IAPs. Arthroscopic data from patients undergoing surgical treatment were correlated with MRA results. Results Patients sustained acute AC separation of Rockwood grade 1 (16.1%), grade 2 (46.8%), grade 3 (25.8%), and grade 4 (11.3%). A concomitant IAP was present in 48 of 62 (77.4%) patients and included superior labral anterior-posterior tears (72.6%), anterior labral tears (24.2%), posterior labral tears (4.8%), supraspinatus tears (3.2%), and inferior glenohumeral ligament ruptures (1.6%). There were 18 (29.0%) patients who had a concomitant pathology in >1 intra-articular structure (combined IAPs). Additionally, 71.8% of patients with grade 1 and 2 AC separation had associated IAPs, and 23.1% had combined IAPs. Furthermore, in patients younger than 40 years, 64.0% of those with grade 1 to 3 AC separation demonstrated associated labral pathologies. There was no difference when comparing age or severity of AC separation and the prevalence of concomitant labral tears (P = .36 and .22, respectively). Conclusion There was a high prevalence of IAPs among patients undergoing MRA after AC separation. While an IAP has been described in association with high-grade AC separation previously, the high prevalence of IAPs in low-grade separation in our study was unexpected and suggests that a thorough evaluation and clinical follow-up for patients with all grades of AC separation may be beneficial.
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Affiliation(s)
- Sarav S Shah
- Department of Orthopaedic Surgery and Sports Medicine, New England Baptist Hospital, Boston, Massachusetts, USA
| | - Eric Ferkel
- Southern California Orthopedic Institute, Van Nuys, California, USA
| | - Kai Mithoefer
- Department of Orthopedics and Sports Medicine, Harvard Vanguard Medical Associates, Atrius Health, Chestnut Hill, Massachusetts, USA
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12
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Abstract
Acromioclavicular joint (ACJ) pathology is a common source of shoulder girdle pain, frequently coexisting with and sharing overlapping clinical features of rotator cuff and glenohumeral articular lesions. ACJ trauma and osteoarthritis dominate clinical presentation; however, an array of pathologies can affect the joint. MR imaging of the ACJ is a powerful secondary diagnostic tool in early diagnosis of ACJ pathology and in accurate assessment of ACJ injuries, helping to resolve clinically challenging cases and allowing for individualized treatment planning. Knowledge of ACJ anatomy, biomechanics, and pathology is fundamental to interpreting and providing a clinically relevant ACJ MR imaging report.
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Affiliation(s)
- Terence Patrick Farrell
- Department of Radiology, Thomas Jefferson University Hospitals, 132 South 10th Street, 10 Main, Philadelphia, PA 19107, USA.
| | - Adam Zoga
- Department of Radiology, Thomas Jefferson University Hospitals, Sidney Kimmel Medical Center, 132 South 10th Street, Suite 1096, Philadelphia, PA 19107, USA
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13
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Low prevalence of relevant associated articular lesions in patients with acute III-VI acromioclavicular joint injuries. Knee Surg Sports Traumatol Arthrosc 2019; 27:3741-3746. [PMID: 30097689 DOI: 10.1007/s00167-018-5089-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 07/30/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE To define the prevalence of associated articular injuries in patients with severe (Rockwood's III-VI) acute acromioclavicular joint injuries and to find out how many of these were associated with the traumatic event and required surgical treatment. METHODS Retrospective observational multicentric study performed in ten centres included patients who required surgery for acute acromioclavicular joint injuries between 2010 and 2017. The inclusion criteria were: presence of an acute acromioclavicular joint injury (grades III-IV-V-VI) and surgical treatment within 3 weeks of injury that included a full arthroscopic evaluation of the shoulder. Basic epidemiological data, severity of the original injury, prelesional sport level and prelesional work site requirements were recorded. The presence of intraarticular glenohumeral lesions and information of their characteristics, treatment, and whether each lesion was considered acute or pre-existing was also recorded. RESULTS Two-hundred one subjects [mean (SD) age 36.7 (11.7) years] with acute acromioclavicular joint injuries (110 Rockwood type III, 34 type IV, 56 type V and 1 type VI) fulfilled the inclusion criteria. A total of 28 (13.9%) associated articular lesions were found. These lesions were more often found in grade IV injuries (26.5% in grade IV vs 11.4% in grade III, p = 0.037) and presented in males (18.7% in males vs 4% in females, p = 0.015). Age, laterality, sport level or work requirements did not affect the prevalence of associated lesions. Twelve were rotator cuff tears (6 PASTA lesions, 3 partial supscapularis tears, 2 bursal supraspinatus tears and 1 full-thickness supraspinatus tear), 16 were labral tears (9 anterior, 1 posteroinferior and 6 SLAP). Only 14 (50% of lesions, 7% of total subjects) were considered acute and all but one (an SLAP type 2 tear) required further surgical attention. Most pre-existing lesions were left untreated (n = 7) or managed with minimal debridement (n = 6), and only two required further surgery. The prevalence of associated lesions that required surgical management was 7.46%. CONCLUSIONS The prevalence of relevant associated lesions in subjects with acute grade III to VI ACJI is relatively low. Only 14% of subjects have an associated lesion and only half of these required further surgical attention. LEVEL OF EVIDENCE Retrospective case series, level IV.
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14
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Maziak N, Audige L, Hann C, Minkus M, Scheibel M. Factors Predicting the Outcome After Arthroscopically Assisted Stabilization of Acute High-Grade Acromioclavicular Joint Dislocations. Am J Sports Med 2019; 47:2670-2677. [PMID: 31373831 DOI: 10.1177/0363546519862850] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Factors influencing the outcome after arthroscopically assisted stabilization of acute high-grade acromioclavicular (AC) joint dislocations remain poorly investigated. PURPOSE To identify determinants of the radiological outcome and investigate associations between radiological and clinical outcome parameters. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS The authors performed a retrospective analysis of patients who underwent arthroscopically assisted stabilization for acute high-grade AC joint dislocations. The following potential determinants of the radiological outcome were examined using univariable and multivariable regression analyses: timing of surgery, initial AC joint reduction, isolated coracoclavicular (CC) versus combined CC and AC stabilization, ossification of the CC ligaments, age, and overweight status. In addition, associations between radiological (ie, CC difference, dynamic posterior translation [DPT]) and clinical outcome parameters (Subjective Shoulder Value, Taft score [TS] subjective subcategory, and Acromioclavicular Joint Instability Score [ACJI] pain subitem) were evaluated using univariable analysis. RESULTS One hundred four patients with a mean (±SD) age of 38.1 ± 11.5 years were included in this study. The mean postoperative follow-up was 2.2 ± 0.9 years. Compared with patients with an overreduced AC joint after surgery, the CC difference was 4.3 mm (95% CI, 1.3-7.3; P = .006) higher in patients with incomplete reduction. Patients with anatomic reduction were 3.1 times (95% CI, 1.2-7.9; P = .017) more likely to develop DPT than those with an overreduced AC joint. An incompletely reduced AC joint was 5.3 times (95% CI, 2.1-13.4; P < .001) more likely to develop DPT versus an overreduced AC joint. Patients who underwent isolated CC stabilization were 4.8 times (95% CI, 1.1-21.0; P = .039) more likely to develop complete DPT than patients with additional AC stabilization. Significantly higher CC difference values were noted for patients who reported pain on the subjective TS (P = .025). Pain was encountered more commonly in patients with DPT (PTS = .049; PACJI = .038). CONCLUSION Clinicians should consider overreduction of the AC joint because it may lead to favorable radiological results. Because of its association with superior radiographic outcomes, consideration should also be given to the use of additional AC cerclage.
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Affiliation(s)
- Nina Maziak
- Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Laurent Audige
- Department of Shoulder and Elbow Surgery, Schulthess Clinic, Zurich, Switzerland
| | - Carmen Hann
- Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Marvin Minkus
- Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Markus Scheibel
- Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin Berlin, Berlin, Germany.,Department of Shoulder and Elbow Surgery, Schulthess Clinic, Zurich, Switzerland
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15
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Qi W, Xu Y, Yan Z, Zhan J, Lin J, Pan X, Xue X. The Tight-Rope Technique versus Clavicular Hook Plate for Treatment of Acute Acromioclavicular Joint Dislocation: A Systematic Review and Meta-Analysis. J INVEST SURG 2019; 34:20-29. [PMID: 31084402 DOI: 10.1080/08941939.2019.1593558] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Weihui Qi
- Department of Orthopaedic, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, China
- The Second School of Medicine, Wenzhou Medical University, China
| | - Yunyun Xu
- Department of Orthopaedic, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, China
- The Second School of Medicine, Wenzhou Medical University, China
| | - Zijian Yan
- Department of Orthopaedic, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, China
- The Second School of Medicine, Wenzhou Medical University, China
| | - Jingdi Zhan
- Department of Orthopaedic, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, China
- The Second School of Medicine, Wenzhou Medical University, China
| | - Jian Lin
- Department of Orthopaedic, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, China
- The Second School of Medicine, Wenzhou Medical University, China
| | - Xiaoyun Pan
- Department of Orthopaedic, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, China
- The Second School of Medicine, Wenzhou Medical University, China
| | - Xinghe Xue
- Department of Orthopaedic, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, China
- The Second School of Medicine, Wenzhou Medical University, China
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16
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Boileau P, Gastaud O, Wilson A, Trojani C, Bronsard N. All-Arthroscopic Reconstruction of Severe Chronic Acromioclavicular Joint Dislocations. Arthroscopy 2019; 35:1324-1335. [PMID: 31054712 DOI: 10.1016/j.arthro.2018.11.058] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 11/21/2018] [Accepted: 11/23/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To report the outcomes of all-arthroscopic coracoclavicular (CC) ligament reconstruction and simultaneous diagnosis and treatment of glenohumeral pathologies in patients with symptomatic, chronic (>6 weeks), complete (Rockwood type III-V) acromioclavicular joint (ACJ) separations. METHODS We prospectively followed up 57 consecutive patients treated arthroscopically for chronic Rockwood type III (n = 11), type IV (n = 19), and type V (n = 27) ACJ dislocations. Previous ACJ surgery failed in 11 (19%). The mean delay between injury and surgery was 39 months (range, 6 months to 17 years). The mean age at surgery was 42 years (range, 19-71 years). After glenohumeral exploration, an arthroscopic modified Weaver-Dunn procedure with CC suture button fixation (Twinbridge) was performed. The CC reduction and tunnel position were analyzed with radiographs and computed tomography. The mean follow-up period was 36 months (range, 12-72 months). RESULTS Intra-articular pathology was treated arthroscopically in 27 patients (48%): 17 labral tears, 8 rotator cuff tears (3 partial and 5 complete), and 15 biceps lesions (4 SLAP lesions and 11 subluxations). At last follow-up, 7 patients (12%) experienced recurrent ACJ instability: 2 frank dislocations (1 trauma and 1 infection) and 5 ACJ subluxations. There was no significant correlation between subluxation and clinical outcome. The rate of recurrent ACJ instability was significantly higher in patients with higher-grade ACJ dislocations (P < .01) and/or previous failed surgery (P < .001). Recurrent subluxation was observed in 3 cases of lateral migration of the coracoid button with lateral tunnel placement, as well as 2 cases of anterior migration of the clavicular button with anterior tunnel placement. The Constant score increased from 67 (range, 28-89) to 85.5 (range, 66-100), and the mean Subjective Shoulder Value increased from 54% to 85% (P < .001). At last follow-up, 95% of patients (54 of 57) were satisfied. CONCLUSIONS All-arthroscopic treatment allows successful CC ligament reconstruction and simultaneous diagnosis and treatment of frequently associated (48%) glenohumeral lesions. Higher-grade ACJ dislocations, previous ACJ surgery, and misplacement of bone tunnels are risk factors for recurrent instability. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Pascal Boileau
- iULS (Institut Universitaire Locomoteur et du Sport), Hôpital Pasteur 2, University Côte d'Azur, Nice, France.
| | - Olivier Gastaud
- iULS (Institut Universitaire Locomoteur et du Sport), Hôpital Pasteur 2, University Côte d'Azur, Nice, France
| | - Adam Wilson
- iULS (Institut Universitaire Locomoteur et du Sport), Hôpital Pasteur 2, University Côte d'Azur, Nice, France
| | - Christophe Trojani
- iULS (Institut Universitaire Locomoteur et du Sport), Hôpital Pasteur 2, University Côte d'Azur, Nice, France
| | - Nicolas Bronsard
- iULS (Institut Universitaire Locomoteur et du Sport), Hôpital Pasteur 2, University Côte d'Azur, Nice, France
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17
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Seo JB, Heo K, Kim SJ, Jung JU, Yoo JS. Arthroscopic Acromioclavicular Fixation With Suture Tape Augmentation After Coracoclavicular Fixation With Dog Bone Button: Surgical Technique. Arthrosc Tech 2018; 7:e1197-e1203. [PMID: 30533369 PMCID: PMC6261742 DOI: 10.1016/j.eats.2018.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 08/02/2018] [Indexed: 02/03/2023] Open
Abstract
An arthroscopic technique for the surgical treatment of acute acromioclavicular (AC) joint injuries is presented in this study. This procedure aims to achieve both vertical and horizontal stability through the healing of both coracoclavicular (CC) and AC ligaments. As a routine maneuver, arthroscopic CC stabilization was applied using the dog bone button to obtain only vertical stability. Additional arthroscopic AC joint fixation with suture tape augmentation is simple and easy and provides a safe technique to achieve horizontal stability of the joint and to increase the vertical stability to minimize the complications of standard CC reconstruction techniques.
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Affiliation(s)
| | | | | | | | - Jae-Sung Yoo
- Address correspondence to Jae-Sung Yoo, M.D., Department of Orthopaedic Surgery, Dankook University College of Medicine, 119, Dandae-ro, Dongnam-gu, Cheonan-si, Chungnam 330-715, Republic of Korea.
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18
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Abstract
Injuries to the acromioclavicular joint constitute approximately 3.2% of shoulder injuries. Although the overall goal of treatment continues to be return to activity with a pain-free shoulder, the treatment of acromioclavicular joint separations has been fraught with conflict since the earliest reports in both ancient and modern literature. Accurate diagnosis and classification are important to determine the optimal treatment. Nonsurgical therapy remains the mainstay for treatment of low- and most mid-grade injuries, although recent biomechanical and biokinetic data might suggest that patients are more affected than traditionally thought. High-grade injuries often necessitate surgical intervention, although little consensus exists on the timing or technique. New surgical techniques continue to evolve as more biomechanical data emerge and kinematic understanding improves. Challenges associated with management of this injury abound from diagnosis to reconstruction.
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19
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Koh KH, Shon MS, Choi NH, Lim TK. Anatomic Tunnel Placement Is Not Feasible by Transclavicular-Transcoracoid Drilling Technique for Coracoclavicular Reconstruction: A Cadaveric Study. Arthroscopy 2018; 34:2012-2017. [PMID: 29653796 DOI: 10.1016/j.arthro.2018.01.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 01/16/2018] [Accepted: 01/18/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the feasibility of anatomic tunnel placement by a transclavicular-transcoracoid drilling technique and with reference to the coracoclavicular ligaments' insertional anatomy and their orientations. METHODS We used 12 fresh-frozen human cadaveric shoulders (6 matched pairs; mean age, 70 years; age range, 51-82 years) to simulate intraoperative tunnel placement with the transclavicular-transcoracoid drilling technique. After both the conoid and trapezoid ligaments were identified, two 2.5-mm guide pins were inserted from the clavicle to the coracoid, passing the centers of the clavicular and coracoid insertions of the conoid and the trapezoid ligaments, in a collinear fashion to the orientation of both ligaments. The entry point of the drill at the clavicle and the exit point at the coracoid undersurface, as well as the tunnel orientations, were measured. Complications due to the procedure, including a breach of the bone cortex of the clavicle and/or coracoid process, were recorded. RESULTS The transclavicular-transcoracoid drilling technique for anatomic conoid ligament tunnel placement resulted in a medial cortical breach at the coracoid process in 6 of 12 shoulders. In the remaining 6 shoulders without a breach, the distance of the exit point from the medial cortex of the inferior coracoid process was only 3.6 ± 4.3 mm. For anatomic trapezoid ligament tunnel placement, no medial cortex breaching at the coracoid process occurred. However, the distance of the exit point was 3.1 ± 4.2 mm, indicating an eccentric location to the medial cortex of the coracoid process, similar to the conoid ligament. CONCLUSIONS This cadaveric study showed that anatomic tunnel placement by the transclavicular-transcoracoid drilling technique would not be feasible without breaching or almost breaching the medial cortex of the coracoid process. CLINICAL RELEVANCE The transclavicular-transcoracoid drilling technique for CC ligament reconstruction may not reproduce the anatomy of the CC ligaments but may place the coracoid process at high risk of fracture during tunnel placement.
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Affiliation(s)
- Kyoung Hwan Koh
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Min Soo Shon
- Department of Orthopaedic Surgery, National Medical Center, Seoul, Republic of Korea
| | - Nam Hong Choi
- Department of Orthopaedic Surgery, Eulji Hospital, Eulji University School of Medicine, Seoul, Republic of Korea
| | - Tae Kang Lim
- Department of Orthopaedic Surgery, Eulji Hospital, Eulji University School of Medicine, Seoul, Republic of Korea.
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20
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Jensen G, Millett PJ, Tahal DS, Al Ibadi M, Lill H, Katthagen JC. Concomitant glenohumeral pathologies associated with acute and chronic grade III and grade V acromioclavicular joint injuries. INTERNATIONAL ORTHOPAEDICS 2017; 41:1633-1640. [PMID: 28455736 DOI: 10.1007/s00264-017-3469-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 03/23/2017] [Indexed: 01/02/2023]
Abstract
PURPOSE The purpose of this study was to identify the risk of concomitant glenohumeral pathologies with acromioclavicular joint injuries grade III and V. METHODS Patients who underwent arthroscopically-assisted stabilization of acromioclavicular joint injuries grade III or grade V between 01/2007 and 12/2015 were identified in the patient databases of two surgical centres. Gender, age at index surgery, grade of acromioclavicular joint injury (Rockwood III or Rockwood V), and duration between injury and index surgery (classified as acute or chronic) were of interest. Concomitant glenohumeral pathologies were noted and their treatment was classified as debridement or reconstructive procedure. RESULTS A total of 376 patients (336 male, 40 female) were included. Mean age at time of arthroscopic acromioclavicular joint reconstruction surgery was 42.1 ± 14.0 years. Overall, 201 patients (53%) had one or more concomitant glenohumeral pathologies. Lesions of the biceps tendon complex and rotator cuff were the most common. Forty-five patients (12.0%) had concomitant glenohumeral pathologies that required an additional repair. The remaining 156 patients (41.5%) received a debridement of their concomitant pathologies. Rockwood grade V compared to Rockwood grade III (p = 0.013; odds ratio 1.7), and chronic compared to acute injury were significantly associated with having a concomitant glenohumeral pathology (p = 0.019; odds ratio 1.7). The probability of having a concomitant glenohumeral pathology was also significantly associated with increasing age (p < 0.0001). CONCLUSIONS Concomitant glenohumeral pathologies were observed in 53% of surgically treated patients with an acute or chronic acromioclavicular joint injury of either grade III or V. Twenty-two percent of these patients with concomitant glenohumeral pathologies received an additional dedicated repair procedure. Although a significant difference in occurrence of concomitant glenohumeral pathologies was seen between Rockwood grades III and V, and between acute and chronic lesions, increasing age was identified as the most dominant predictor. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Gunnar Jensen
- Diakovere Friederikenstift, Orthopedics and Traumatology, Humboldtstraße 5, Hannover, Germany.
| | - Peter J Millett
- The Steadman Clinic, 181 West Meadow Drive Suite 400, Vail, CO, USA.,Steadman Philippon Research Institute, 181 West Meadow Drive Suite 1000, Vail, CO, USA
| | - Dimitri S Tahal
- Steadman Philippon Research Institute, 181 West Meadow Drive Suite 1000, Vail, CO, USA
| | - Mireille Al Ibadi
- Diakovere Friederikenstift, Orthopedics and Traumatology, Humboldtstraße 5, Hannover, Germany
| | - Helmut Lill
- Diakovere Friederikenstift, Orthopedics and Traumatology, Humboldtstraße 5, Hannover, Germany
| | - Jan Christoph Katthagen
- Diakovere Friederikenstift, Orthopedics and Traumatology, Humboldtstraße 5, Hannover, Germany.,Steadman Philippon Research Institute, 181 West Meadow Drive Suite 1000, Vail, CO, USA.,Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer Campus 1, Münster, Germany
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21
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Jensen G, Ellwein A, Voigt C, Katthagen JC, Lill H. [Injuries of the acromioclavicular joint: Hook plate versus arthroscopy]. Unfallchirurg 2016; 118:1041-53; quiz 1054-5. [PMID: 26601846 DOI: 10.1007/s00113-015-0108-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Acute acromioclavicular (AC) joint injuries are common in clinical practice. The hook plate is a well-established conventional operative treatment option for high grade instability; however, arthroscopically-assisted flexible double button techniques are increasingly being used. Both procedures lead to good or excellent results. The advantages of the hook plate are the simple surgical technique and the possibility of an early functional aftercare. The minimally invasive one-step procedure with the possibility of identification and treatment of frequently concomitant glenohumeral pathologies is advantageous for the arthroscopic technique but mobilization is more restrictive. Available comparative studies have shown no significant clinical differences but a tendency towards better results with a higher degree of acceptance among patients for the arthroscopic and minimally invasive non-rigid double button procedures.
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Affiliation(s)
- G Jensen
- Abteilung des Berufsgenossenschaftlichen Unfallkrankenhauses Hamburg, Klinik für Unfall- und Wiederherstellungschirurgie, Diakoniekrankenhaus Friederikenstift gGmbH Hannover, Humboldtstr. 5, 30169, Hannover, Deutschland.
| | - A Ellwein
- Abteilung des Berufsgenossenschaftlichen Unfallkrankenhauses Hamburg, Klinik für Unfall- und Wiederherstellungschirurgie, Diakoniekrankenhaus Friederikenstift gGmbH Hannover, Humboldtstr. 5, 30169, Hannover, Deutschland
| | - C Voigt
- Abteilung des Berufsgenossenschaftlichen Unfallkrankenhauses Hamburg, Klinik für Unfall- und Wiederherstellungschirurgie, Diakoniekrankenhaus Friederikenstift gGmbH Hannover, Humboldtstr. 5, 30169, Hannover, Deutschland
| | - J C Katthagen
- Abteilung des Berufsgenossenschaftlichen Unfallkrankenhauses Hamburg, Klinik für Unfall- und Wiederherstellungschirurgie, Diakoniekrankenhaus Friederikenstift gGmbH Hannover, Humboldtstr. 5, 30169, Hannover, Deutschland
| | - H Lill
- Abteilung des Berufsgenossenschaftlichen Unfallkrankenhauses Hamburg, Klinik für Unfall- und Wiederherstellungschirurgie, Diakoniekrankenhaus Friederikenstift gGmbH Hannover, Humboldtstr. 5, 30169, Hannover, Deutschland
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Roberson TA, Tokish JM. Acromioclavicular Joint Injuries in the ?>Contact Athlete. OPER TECHN SPORT MED 2016. [DOI: 10.1053/j.otsm.2016.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Boutsiadis A, Baverel L, Lenoir H, Delsol P, Barth J. Arthroscopic-assisted Acromioclavicular and Coracoclavicular Ligaments Reconstruction for Chronic Acromioclavicular Dislocations: Surgical Technique. Tech Hand Up Extrem Surg 2016; 20:172-178. [PMID: 27776006 DOI: 10.1097/bth.0000000000000142] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Chronic acromioclavicular (AC) instability is a rare posttraumatic shoulder condition that can lead to undesirable symptoms like persistent pain, muscle fatigue, loss of strength, or even scapular dyskinesis. It is well known that in these cases the superior functional results depend on the restoration of the anatomy and stability of the AC joint in both vertical and horizontal planes. Considering the ligaments degeneration and atrophy in chronic AC joint dislocations, we present an arthroscopic-assisted reconstruction of both the coracoclavicular and AC ligaments using autograft augmentation. In details the coracoclavicular ligaments component is reconstructed using the Tightrope suspension device augmented with a palmaris longus autograft and by the nonanatomic coracoacromial ligament transfer (modified Weaver-Dunn). The AC part is restored by suturing the remainder palmaris longus autograft on the acromion and on the deltotrapezial fascia. Using the construct provided by this technique all the possible ruptured ligaments are reconstructed, optimizing the vertical and horizontal stability of the area, and promising excellent long-term radiologic and functional results.
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Affiliation(s)
- Achilleas Boutsiadis
- Department of Orthopaedic Surgery, Centre Osteoarticulaire des Cèdres, Grenoble, France
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Natera Cisneros L, Sarasquete Reiriz J. Unstable acromioclavicular joint injuries: Is there really a difference between surgical management in the acute or chronic setting? J Orthop 2016; 14:10-18. [PMID: 27821995 DOI: 10.1016/j.jor.2016.10.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 09/08/2016] [Accepted: 10/13/2016] [Indexed: 12/31/2022] Open
Abstract
AIM To compare the outcomes of unstable ACJ injuries managed with an arthroscopy-assisted anatomic reconstruction of the coracoclavicular (CC) ligaments in the acute and chronic setting. METHODS A retrospective revision was performed. The SF36, visual analog scale for pain, DASH questionnaire, constant score and the global satisfaction were assessed at the last follow-up visit. RESULTS 22 patients were included. Results of the questionnaires assessed at the last follow-up visit showed no significant differences between the study groups. CONCLUSION Management of ACJ injuries in the acute or chronic setting may involve comparable outcomes if biological and mechanical aspects are considered. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Luis Natera Cisneros
- Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Street Sant Quintí 89, Postcode: 08026 Barcelona, Spain; Hospital General de Catalunya, Street Pedro i Pons 1, Postcode: 08190, Sant Cugat del Vallés, Barcelona, Spain
| | - Juan Sarasquete Reiriz
- Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Street Sant Quintí 89, Postcode: 08026 Barcelona, Spain; Hospital Quirón Teknon, Street Vilana 12, Postcode: 08022 Barcelona, Spain
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Cisneros LN, Reiriz JS. Management of acute unstable acromioclavicular joint injuries. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2016; 26:817-830. [PMID: 27541311 DOI: 10.1007/s00590-016-1836-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 08/01/2016] [Indexed: 01/28/2023]
Abstract
Surgical management of acute unstable acromioclavicular joint injuries should be focused on realigning the torn ends of the ligaments to allow for healing potential. The most widely utilized treatment methods incorporate the use of metal hardware, which can alter the biomechanics of the acromioclavicular joint. This leads to a second surgical procedure for hardware removal once the ligaments have healed. Patients with unstable acromioclavicular joint injuries managed with arthroscopy-assisted procedures have shown good and excellent clinical outcomes, without the need for a second operation. These procedures incorporate a coracoclavicular suspension device aimed to function as an internal brace, narrowing the coracoclavicular space thus allowing for healing of the torn coracoclavicular ligaments. The lesser morbidity of a minimally invasive approach and the possibility to diagnose and treat concomitant intraarticular injuries; no obligatory implant removal, and the possibility of having a straight visualization of the inferior aspect of the base of the coracoid (convenient when placing coracoclavicular fixation systems) are the main advantages of the arthroscopic approach over classic open procedures. This article consists on a narrative review of the literature in regard to the management of acute acromioclavicular joint instability.
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Affiliation(s)
- Luis Natera Cisneros
- Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Street Sant Quintí 89, 08026, Barcelona, Catalunya, Spain. .,Hospital General de Catalunya, Street Pedro i Pons 1, 08190, Sant Cugat del Vallés, Catalunya, Spain.
| | - Juan Sarasquete Reiriz
- Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Street Sant Quintí 89, 08026, Barcelona, Catalunya, Spain.,Hospital Quirón Teknon, Street Vilana 12, 08022, Barcelona, Catalunya, Spain
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Tauber M, Valler D, Lichtenberg S, Magosch P, Moroder P, Habermeyer P. Arthroscopic Stabilization of Chronic Acromioclavicular Joint Dislocations: Triple- Versus Single-Bundle Reconstruction. Am J Sports Med 2016; 44:482-9. [PMID: 26657259 DOI: 10.1177/0363546515615583] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Arthroscopically assisted single-bundle (SB) or double-bundle coracoclavicular (CC) ligament reconstruction using autologous tendon grafts has been reported to provide acromioclavicular (AC) joint (ACJ) stability in chronic instability cases. Recently, additional AC ligament reconstruction to provide triple-bundle (TB) stabilization has been introduced but lacks a comparison of clinical and radiological outcomes. HYPOTHESIS Arthroscopically assisted anatomic TB CC and AC reconstruction yields superior clinical and radiological results when compared with nonanatomic SB CC reconstruction. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Twenty-six patients (mean [±SD] age, 46.9 ± 12.8 years) suffering from chronic high-grade ACJ instability underwent ACJ stabilization using autologous hamstring grafts. Twelve patients underwent combined anatomic TB CC and AC reconstruction using a semitendinosus tendon with clavicular interference screw fixation (TB group), and 14 underwent isolated SB CC reconstruction using the AC GraftRope system with a gracilis tendon (SB group). After a minimum follow-up of 2 years (mean, 29.0 ± 7.4 months), patients were evaluated radiologically and clinically using the Constant, American Shoulder and Elbow Surgeons (ASES), Taft, and Acromioclavicular Joint Instability Score (ACJI) outcome measures. RESULTS The mean Constant score increased significantly in both groups, from 71.6 preoperatively to 88.8 postoperatively in the TB group and from 67.8 to 82.6 in the SB group (P ≤ .009). No intergroup difference was found regarding the final Constant or ASES scores. Regarding the ACJ-specific scores, the final outcomes were significantly different: 10.9 (TB group) versus 9.0 (SB group) for the mean Taft score (P = .018) and 84.7 versus 58.4, respectively, for the mean ACJI score (P = .0001). No significant radiological difference was found regarding the mean CC distance (10.7 mm [TB group] vs 13.1 mm [SB group]). The TB group showed superior horizontal ACJ stability (P = .011), which was associated with a better clinical outcome according to the ACJI and Taft scores. In the SB group, the rate of ACJ instability recurrence was higher (21% vs 8% [TB group]). CONCLUSION Combined arthroscopically assisted anatomic TB CC and AC ligament reconstruction using an autologous semitendinosus tendon graft provides superior clinical and radiological results compared with isolated nonanatomic SB CC ligament reconstruction using the AC GraftRope system. In particular, the TB technique can better restore horizontal ACJ stability, which is associated with superior ACJ-specific outcome scores.
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Affiliation(s)
- Mark Tauber
- Shoulder and Elbow Surgery, ATOS Clinic Munich, Munich, Germany Department of Traumatology and Sports Injuries, Paracelsus Medical University, Salzburg, Austria
| | - Dennis Valler
- Shoulder and Elbow Surgery, ATOS Clinic Munich, Munich, Germany
| | - Sven Lichtenberg
- Shoulder and Elbow Surgery, ATOS Clinic Heidelberg, Heidelberg, Germany
| | - Petra Magosch
- Shoulder and Elbow Surgery, ATOS Clinic Heidelberg, Heidelberg, Germany
| | - Philipp Moroder
- Department of Traumatology and Sports Injuries, Paracelsus Medical University, Salzburg, Austria
| | - Peter Habermeyer
- Shoulder and Elbow Surgery, ATOS Clinic Munich, Munich, Germany Shoulder and Elbow Surgery, ATOS Clinic Heidelberg, Heidelberg, Germany
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Natera-Cisneros L, Sarasquete-Reiriz J, Escolà-Benet A, Rodriguez-Miralles J. Acute high-grade acromioclavicular joint injuries treatment: Arthroscopic non-rigid coracoclavicular fixation provides better quality of life outcomes than hook plate ORIF. Orthop Traumatol Surg Res 2016; 102:31-9. [PMID: 26747735 DOI: 10.1016/j.otsr.2015.10.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 09/16/2015] [Accepted: 10/19/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Treatment of acute high-grade acromioclavicular joint (ACJ) injuries with metal hardware alters the biomechanics of the ACJ, implying a second surgery for hardware removal. The period during which the plate is present involves functional limitations, pain and a risk factor for the development of hardware-related-injuries. Arthroscopy-assisted procedures compared to open-metal hardware techniques offer: less morbidity, the possibility to treat associated lesions and no need for a second operation. The aim was to compare the Quality of life (QoL) of patients with acute high-grade ACJ injuries (Rockwood grade III-V), managed arthroscopically with a non-rigid coracoclavicular (CC) fixation versus the QoL of patients managed with a hook plate, 24 months or more after their shoulder injury. PATIENTS AND METHODS A retrospective revision of high-grade ACJ injuries managed in three institutions was performed. Patients treated by means of an arthroscopy-assisted CC fixation or by means of a hook plate were included. The inclusion period was between 2008 and 2012. The QoL was evaluated at the last follow-up visit by means of the SF36, the visual analog scale (VAS), the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, the Constant score and the global satisfaction (scale from 0 to 10). The presence of scapular dyskinesis and remaining vertical instability were evaluated. Comparison between groups was performed. RESULTS Thirty-one patients were included: 20 arthroscopy-group (ARTH group: 3 Rockwood III, 3 IV and 14 V) and 11 hook plate-group (HOOK group: 5 Rockwood III and 6 V). The mean age was 36 [25-52] year-old for the ARTH group and 41 [19-55] for the HOOK group (P=0.185). The mean results of the questionnaires were: (1) physical SF36 score (ARTH group 58.24±2.16 and HOOK group 53.70±4.33, P<0.001); (2) mental SF36 score (ARTH group 56.15±2.21 and HOOK group 53.06±6.10, P=0.049); (3) VAS (ARTH group 0.40±0.50 and HOOK group 1.45±1.51, P=0.007); (4) DASH (ARTH group 2.98±2.03 and HOOK group 4.79±5.60, P=0.200); (5) Constant score (ARTH group 95.30±2.45 and HOOK group 91.36±6.84, P=0.026); (6) global satisfaction (ARTH group 8.85±0.93 and HOOK group 8.00±1.18, P=0.035). There was evidence of scapular dyskinesis in 15% (3/20) of the patients of the ARTH group and in 18% (2/11) of the patients of the HOOK group (P=1.000). Remaining vertical ACJ instability was observed in 40% (8/20) of the patients of the ARTH group and in 36.36% (4/11) of the patients of the HOOK group (P=1.000). CONCLUSION Patients with acute high-grade ACJ injuries managed arthroscopically with a non-rigid CC fixation seem to have a better QoL than patients managed with a hook plate. LEVEL OF EVIDENCE Level IV therapeutic; retrospective comparative study.
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Affiliation(s)
- L Natera-Cisneros
- Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, street Sant Quintí 89, 08026 Barcelona, Spain; Hospital General de Catalunya, Street Pedro i Pons 1, 08190 Sant Cugat del Vallés, Barcelona, Spain.
| | - J Sarasquete-Reiriz
- Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, street Sant Quintí 89, 08026 Barcelona, Spain; Hospital Quirón Teknon, Street Vilana 12, 08022 Barcelona, Spain
| | - A Escolà-Benet
- Hospital General de Catalunya, Street Pedro i Pons 1, 08190 Sant Cugat del Vallés, Barcelona, Spain
| | - J Rodriguez-Miralles
- Hospital General de Catalunya, Street Pedro i Pons 1, 08190 Sant Cugat del Vallés, Barcelona, Spain; Consorci Hospitalari de Vic, Street Francesc Pla 'El Vigatà' 1, 8500 Vic Barcelona, Spain
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Barth J, Duparc F, Baverel L, Bahurel J, Toussaint B, Bertiaux S, Clavert P, Gastaud O, Brassart N, Beaudouin E, De Mourgues P, Berne D, Duport M, Najihi N, Boyer P, Faivre B, Meyer A, Nourissat G, Poulain S, Bruchou F, Ménard JF. Prognostic factors to succeed in surgical treatment of chronic acromioclavicular dislocations. Orthop Traumatol Surg Res 2015; 101:S305-11. [PMID: 26470802 DOI: 10.1016/j.otsr.2015.09.002] [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: 07/02/2015] [Accepted: 08/31/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Treatment of chronic acromioclavicular joint dislocation (ACJD) remains a poorly known and controversial subject. Given the many surgical options, it is not always easy to determine which steps are indispensable. METHODS This article reports a multicenter prospective study. The clinical and radiological follow-up involved a comparative analysis of the preoperative and postoperative data at 1 year, including pain (visual analogue scale), subjective functional incapacity (QuickDASH), and the objective Constant score, as well as a comparative analysis of vertical and horizontal movements measured on simple x-rays. RESULTS Based on a series of 140 operated ACJDs, we included 24 chronic ACJDs. The mean time to surgery was 46 weeks (range, 1 month to 4 years). The patients' mean age was 41 years, with a majority of males (75%), 72% of whom participated in recreational sports. Professionally, 40% of the subjects had jobs involving manual labor. We noted 40% grade III, 24% grade IV, and 36% grade V injury according to the Rockwood classification. In 92% of cases, coracoclavicular stabilization was provided by a double button implant, reinforced with a biological graft in 88% of the cases. In 29%, millimeters to centimeters of the distal clavicle were resected and acromioclavicular stabilization was associated in 54%. We observed complications in 33% of the cases. At 1 year postoperative, 21 patients underwent clinical and radiological follow-up (87.5%). Only 35% of the patients were satisfied or very satisfied, whereas 100% of them would recommend the operation. Full-time work was resumed in 91% of the cases and all sports could be resumed in 86%. The pre- and postoperative values at 1 year changed as follows: the mean Constant score improved from 61 to 87 (p=0.00002); the subjective QuickDASH score decreased from 41 to 9 (p=0.00002); and radiologically significant reduction of the initial displacement was observed in the vertical plane (p<10(-3)) and the horizontal plane (p=0.022). CONCLUSION In this study, the favorable prognostic factors found were: time to surgery less than 3 months (p=0.02), associated acromioclavicular stabilization, and postoperative immobilization with a sling extended to 6 weeks. However, resection of the distal clavicle did not influence the final result. LEVEL OF PROOF Level II prospective non-randomized comparative study.
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Affiliation(s)
- J Barth
- Centre ostéo-articulaire des Cèdres, parc Sud Galaxie, 5, rue des Tropiques, 38130 Échirolles, France.
| | - F Duparc
- CHU de Rouen, 76000 Rouen, France
| | - L Baverel
- Centre ostéo-articulaire des Cèdres, parc Sud Galaxie, 5, rue des Tropiques, 38130 Échirolles, France
| | - J Bahurel
- Clinique générale, 74000 Annecy, France
| | | | | | - P Clavert
- Service de chirurgie de l'épaule et du coude, CCOM, CHRU de Strasbourg, 67000 Strasbourg, France
| | - O Gastaud
- Hôpital Pasteur 2, institut universitaire de l'appareil locomoteur et du sport, CHU de Nice, 30, voie Romaine, CS51069, 06001 Nice cedex 1, France
| | - N Brassart
- Clinique de Cagne-sur-Mer, 06800 Cagne-sur-Mer, France
| | - E Beaudouin
- Centre hospitalier régional de Chambéry, 73000 Chambéry, France
| | | | - D Berne
- Clinique Kennedy, 26200 Montélimar, France
| | - M Duport
- Médipôle Garonne, 31000 Toulouse, France
| | - N Najihi
- CHU de Rennes, 35000 Rennes, France
| | - P Boyer
- Hôpital universitaire Xavier-Bichat, 75018 Paris, France
| | - B Faivre
- Hôpital universitaire Ambroise-Paré, 92100 Boulogne-Billancourt, France
| | - A Meyer
- CMC Paris V, 75005 Paris, France
| | - G Nourissat
- Chirurgie de l'épaule Groupe Maussins, 67, rue de Romainville, 75019 Paris, France
| | - S Poulain
- Polyclinique du Plateau, 21, rue de Sartrouville, 95870 Bezons, France
| | - F Bruchou
- Hôpital privé de l'Ouest Parisien, 78190 Trappes, France
| | - J F Ménard
- Unité biostatistique du CHU de Rouen, Rouen, France
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Cisneros LN, Sarasquete Reiriz J, Besalduch M, Petrica A, Escolà A, Rodriguez J, Fallone JC. Horizontal and Vertical Stabilization of Acute Unstable Acromioclavicular Joint Injuries Arthroscopy-Assisted. Arthrosc Tech 2015; 4:e721-9. [PMID: 26870653 PMCID: PMC4738758 DOI: 10.1016/j.eats.2015.07.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 07/24/2015] [Indexed: 02/03/2023] Open
Abstract
We describe the technical aspects of an arthroscopy-assisted procedure indicated for the management of acute unstable acromioclavicular joint injuries, consisting of a synthetic augmentation of both the coracoclavicular and acromioclavicular ligaments, that anatomically reproduces the coracoclavicular biomechanics and offers fixation that keeps the torn ends of the ligaments facing one another, thus allowing healing of the native structures without the need for a second surgical procedure for metal hardware removal.
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Affiliation(s)
- Luis Natera Cisneros
- Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain,Hospital General de Catalunya, Sant Cugat del Vallés, Spain,Address correspondence to Luis Natera Cisneros, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Carrer Sant Quintí 89, Barcelona, Catalunya 08026, Spain.
| | - Juan Sarasquete Reiriz
- Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain,Hospital Quirón Teknon, Barcelona, Spain
| | - Marina Besalduch
- Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alexandru Petrica
- Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ana Escolà
- Hospital General de Catalunya, Sant Cugat del Vallés, Spain
| | | | - Jan Carlo Fallone
- Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain,Mutua de Accidentes Laborales Egarsat, Terrassa, Spain
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[Therapy of acute acromioclavicular joint instability. Meta-analysis of arthroscopic/minimally invasive versus open procedures]. Unfallchirurg 2015; 118:415-26. [PMID: 25964021 DOI: 10.1007/s00113-015-0005-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND A variety of surgical procedure are desrcibed for the treatment of acute acromioclavicular (AC-) joint injuries. Beside open techniques arthroscopic assisted procedures spread widely. Each surgical technique offers advantages and disadvantages, but none is currently accepted as a gold standard. Therefore, the study aims to review the evidence for arthroscopic and open surgical procedures in the treatment of acute AC joint instabilities. MATERIAL AND METHODS According to the Cochrane Handbook for Systematic Reviews of Interventions we conducted a defined search of Medline and Embase database for articles publisher over the last ten years. RESULTS The search resulted in 961 studies of which 32 were included in this review and 3 studies were suitable for a meta-analysis. The functional outcome (Constant score) showed a tendency towards better results after arthroscopic procedures (weighted mean difference 5.60, 95% confidence interval 0.36-10.64). There were no significant differences with respect to complication rates, secondary dislocation in the vertical plane, revision surgery and AC joint instability. CONCLUSION There is insufficient evidence to inform the surgical management of acute AC joint instability. Due to inconsistent study designs there is no evidence for a general superiority of any of the open or arthroscopic procedures. Randomized, controlled studies are necessary to demonstrate whether arthroscopic techniques show a potential benefit in terms of a better functional outcome.
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[Combined ac joint dislocation and distal clavicle fracture. Closed reduction and arthroscopically assisted coracoclavicular fixation]. Unfallchirurg 2015; 118:427-31. [PMID: 25964022 DOI: 10.1007/s00113-015-0006-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND A 55-year-old male patient sustained a dislocation of the acromioclavicular (AC) joint in combination with a distal clavicle fracture. METHODS Following closed reduction of the fractured clavicle, arthroscopically assisted coracoclavicular fixation was performed. DISCUSSION AND CONCLUSION A combined injury of a complete ac joint dislocation and a distal clavicle fracture is rare and is not included in currently available classification systems; therefore, in this article a classification and assessment of the stability of this injury as well as appropriate treatment options are discussed.
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Inestabilidad acromioclavicular aguda: epidemiología, historia natural e indicaciones de cirugía. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.reaca.2015.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Jensen G, Katthagen C, Voigt C, Lill H. Arthroskopisch assistierte Versorgung lateraler Klavikulafrakturen und akuter Instabilitäten des Schultereckgelenks. ARTHROSKOPIE 2014. [DOI: 10.1007/s00142-014-0842-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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