Grade III Acromioclavicular Separations Treated With Suspensory Fixation Techniques: A Systematic Review of Level I Through IV Studies

High Vertical and Horizontal Stability at Short-Term Follow-Up After an All-Endoscopic Double Cerclage Endobutton Technique for Acute Acromioclavicular Joint Separations

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.

Complications after operative treatment of high-grade acromioclavicular injuries

BACKGROUND

Treatment of Rockwood type III-V acromioclavicular (AC) joint injuries remains controversial. Numerous reconstruction techniques have been proposed. The purpose of this study was to describe the complication profile in a large cohort of patients who underwent surgical management of AC joint separations using a variety of reconstruction strategies.

METHODS

All patients who underwent surgery for AC joint injuries from 2013 to 2019 at a single institution were identified. Chart review was performed to capture patient demographics, radiographic measurements, operative techniques, postoperative complications, and revision surgery. Structural failure was defined as a radiographic loss of reduction of greater than 50% when comparing immediate and final postoperative imaging. Logistic regression analysis was performed to identify risk factors for complications and revision surgery.

RESULTS

Of the 279 patients included in the study, 66 (24%) had type III separations, 20 (7%) type IV, and 193 (69%) type V. Fifty-three percent underwent surgery acutely (<6 weeks of injury), and 40% were chronic (>3 months). A total of 252 of the 279 surgeries (90%) were performed open and 27 (10%) were arthroscopically assisted. Allograft was used in 164 of 279 (59%) cases. Specific operative techniques (with or without allograft) included hook plating (1%), modified Weaver Dunn (16%), cortical button fixation (18%), and suture fixation (65%). At mean 28-week follow-up, 108 complications were identified in 97 patients (35%). Complications were identified at mean 20 ± 21 weeks. Sixty-nine structural failures (25%) were identified. Persistent AC joint pain requiring injection, clavicle fracture, adhesive capsulitis, and hardware complications were the other most common complications. Twenty-one patients (8%) underwent unplanned revision surgery at mean 38 ± 28 weeks after the index procedure, with the most common indication for structural failure, hardware complications, or fracture of the clavicle or coracoid. Patients who had surgery after 6 weeks from injury had a significantly greater risk of having a complication (odds ratio [OR] 3.19, 95% confidence interval [CI] 1.34-7.77, P = .009) and a significantly greater risk of having structural failure (OR 2.65, 95% CI 1.38-5.28, P = .004). Patients who had an arthroscopic technique had a greater risk of structural failure (P = .002). Complications, structural failure, and revision surgery were not significantly correlated with use of allograft or specific operative techniques.

CONCLUSION

Surgical management of AC joint injuries is associated with a relatively high complication profile. Loss of reduction in the postoperative period is common. However, the revision surgery rate is low. These findings are important for patient preoperative counseling.

Clinical and Patient-Reported Outcomes for Acute Acromioclavicular Joint Fixation are Similar With or Without Allograft Augmentation

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Conclusion

Level of Evidence