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Combination of Surgical Techniques Restores Multidirectional Biomechanical Stability of Acromioclavicular Joint. Arthroscopy 2022; 38:1774-1783. [PMID: 34920006 DOI: 10.1016/j.arthro.2021.11.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 11/22/2021] [Accepted: 11/30/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To measure the multiaxial stability of the acromioclavicular joint before and after transection of the acromioclavicular capsule and coracoclavicular ligaments and after sequential repair of acromioclavicular and coracoclavicular ligaments. METHODS Biomechanical testing was performed on fresh-frozen human cadaveric shoulders (N = 6). Translational and rotational stability in the vertical and horizontal planes was measured in intact specimens, after transecting the acromioclavicular and coracoclavicular ligaments, and after sequentially performing the following procedures: single-bundle coracoclavicular repair (CCR), modified Weaver-Dunn procedure (WD), and acromioclavicular stabilization (ACS). RESULTS Resecting the acromioclavicular and coracoclavicular significantly reduced translational stiffness in the inferior and anteroposterior directions, as well as rotational stiffness about the vertical and anteroposterior axes. All 3 surgical procedures increased inferior translational stiffness relative to the intact condition (Intact: 38 ± 9 N/mm, CCR: 54 ± 23 N/mm (P = .03), CCR+WD 52 ± 20 N/mm (P = .07), CCR ± WD+ACS 50 ± 21 N/mm (P = .17)). However, the combination of CCR, modified WD, and ACS resulted in the greatest increase in stiffness in internal rotation (Intact: 12.5 ± 7.4 cNm/deg, CCR: 1.2 ± 1.1 cNm/deg, CCR+WD 7.2 ± 3.0 N∗m/deg [P = .023], CCR+WD+ACS 11.6 ± 4.9 cNm/deg [P = .055]). CONCLUSIONS The cumulative stability of CCR, WD reconstruction, and ACS appears to be additive. Our findings provide a biomechanical justification for combining all three techniques. Biomechanical studies assessing the performance of various acromioclavicular repairs and reconstructions should therefore incorporate multiaxial testing in their protocols. CLINICAL RELEVANCE Multiple points of fixation that provide multidirectional stability have the potential to improve clinical outcomes and reduce failure rates of acromioclavicular joint repair or stabilization.
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Gawel RJ, D'Amore T, Otlans PT, Rao S, Cohen SB, Ciccotti MG. Criteria for return to play after operative management of acromioclavicular joint separation: a systematic review. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:140-148. [PMID: 37587962 PMCID: PMC10426690 DOI: 10.1016/j.xrrt.2021.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background Acromioclavicular (AC) joint separation is a common cause of shoulder injury among athletes. High-grade injuries may require operative fixation, and comprehensive return-to-play guidelines have not yet been established. The purpose of this study was to summarize criteria for return to play after operative management of AC joint separation. Methods A systematic review of the literature was performed from January 1999 to April 2020 to evaluate clinical evidence regarding criteria for return to play after operative management of isolated AC joint separation. Results Sixty-three studies with at least 1 explicitly stated return-to-play criterion were identified out of an initial database search of 1253 published articles. Eight separate categories of return-to-play criteria were identified, the most common of which was time from surgery (95.2%). Return-to-play timelines ranged from 2 to 12 months, the most common timeline being 6 months (37.8%). Only 4 (6.3%) studies used conditional criteria to guide return to play, which included range of motion, strength, clinical stability, radiographic stability, functional assessment, safety assessment, and hardware removal. Conclusion Most published studies use only time-based criteria for return to play after surgery for AC joint separation, and only a small number of studies use additional subjective or objective criteria. While this systematic review helps provide a foundation for developing a comprehensive return-to-play checklist, further investigation is needed to establish safe and effective guidelines that will enable athletes to safely return to sport and minimize the recurrence of injury.
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Affiliation(s)
- Richard J. Gawel
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Taylor D'Amore
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Peters T. Otlans
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Somnath Rao
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Steven B. Cohen
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Michael G. Ciccotti
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
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Kuptniratsaikul S, Kuptniratsaikul V, Itthipanichpong T. Arthroscopic Coracoclavicular Ligament Stabilization Using Coracoid Cortical Suspension in Acute Acromioclavicular Joint Injury; Precision of Drill Tunnel. Arthrosc Tech 2020; 9:e1791-e1795. [PMID: 33294342 PMCID: PMC7695624 DOI: 10.1016/j.eats.2020.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 08/05/2020] [Indexed: 02/03/2023] Open
Abstract
Acute acromioclavicular joint separation is a common injury of the shoulder. There are several methods for treating this condition; however, there is no gold standard established. Herein, we propose an arthroscopic method for the treatment of acute acromioclavicular joint separation using a simple cortical suspension device at the coracoid base via a transclavicular-transcoracoidal tunnel and tieing the suture at the clavicle. This method has the advantages of making a precision drilling tunnel using small implants and small stab incisions, with better cosmetic results and less implant irritation.
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Affiliation(s)
- Somsak Kuptniratsaikul
- Department of Orthopedics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Vanasiri Kuptniratsaikul
- Department of Orthopedics, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Thun Itthipanichpong
- Department of Orthopedics, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand,Address correspondence to Thun Itthipanichpong, M.D., Department of Orthopedics, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
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Liu T, Bao F, Jiang T, Ji G, Li J, Jerosch J. Acromioclavicular Joint Separation: Repair Through Suture Anchors for Coracoclavicular Ligament and Nonabsorbable Suture Fixation for Acromioclavicular Joint. Orthop Surg 2020; 12:1362-1371. [PMID: 32893498 PMCID: PMC7670157 DOI: 10.1111/os.12771] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/07/2020] [Accepted: 07/09/2020] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To evaluate the clinical and radiographic outcomes of patients undergoing coracoclavicular (CC) ligament repair by two suture anchors and acromioclavicular (AC) joint (ACJ) fixation using heavy nonabsorbable sutures for the treatment of types III-V ACJ injuries with a minimum of 1-year follow-up. METHODS The clinical and radiographic outcomes of 36 consecutive patients (26 men and 10 women) who underwent anatomic reduction for acute ACJ dislocation using two suture anchors for CC ligament reconstruction and two strands of non-absorbable stitches for ACJ fixation between December 2013 and December 2018 were reviewed. Two 3.5 mm suture anchors with double-loaded sutures were separately inserted into the anterolateral and posteromedial portions of the coracoid process. The suture strands were passed through the hole created in the clavicle using 2.0 mm drill and tied over the clavicle. Additional ACJ augmentation using two strands of non-absorbable heavy sutures was performed in all patients. At 3, 6, and 12 months and last follow-up visit, the scores on the visual analog scale (VAS), the American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score, and simple shoulder test (SST) questionnaires were used to provide a final evaluation of shoulder function. Comparison between baseline and treatment results was performed. Radiographic analysis included vertical displacement and horizontal shift. RESULTS A total of 29 patients (20 men and nine women) were included in the study. A total of seven, six, and 16 patients had Rockwood type III, type IV, and type V ACJ dislocations, respectively. The mean patient age was 42.8 ± 13.5 years, with a mean follow-up of 28 months (range, 12-56 months). At the 12-month follow-up, the mean ASES score was 92.1 ± 3.5, with a mean pain score of 0.5 ± 0.7 on the VAS and mean Constant-Murley score of 93.0 ± 2.4. The new number of positive answers on the SST was 11.5 ± 0.6. Compared with the baseline, the clinical results improved significantly (P < 0.05). No significant difference could be found between the 6- and 12-month follow-up evaluations (P > 0.05). Radiographs showed two partial loss of reduction, whereas no horizontal displacement was found in all patients. One patient developed a superficial wound infection 3 weeks postoperation. The wound healed after routine wound care. No neurovascular complications were recorded. CONCLUSIONS CC ligament reconstruction using two suture anchors and ACJ augmentation using two strands of non-absorbable heavy sutures on high-grade AC dislocation is a reliable technique for restoring stability to the ACJ and can obtain good to excellent clinical results.
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Affiliation(s)
- Tao Liu
- Department of Orthopaedic SurgeryQilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong UniversityQingdaoChina
| | - Fei‐long Bao
- Department of Orthopaedic SurgeryQilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong UniversityQingdaoChina
| | - Tao Jiang
- Department of Orthopaedic SurgeryQilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong UniversityQingdaoChina
| | - Guang‐wei Ji
- Department of Orthopaedic SurgeryQilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong UniversityQingdaoChina
| | - Jian‐min Li
- Department of Orthopaedic SurgeryCheeloo College of Medicine, Shandong UniversityJinanChina
| | - Jörg Jerosch
- Clinic for Orthopaedics and Orthopaedic SurgeryJohanna‐Etienne HospitalNeussGermany
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Takenaga T, Yoshida M, Debski RE, Fu FH, Musahl V, Lin A. Superior clavicle drilling points and fluoroscopic inclination for anatomic coracoclavicular ligament reconstruction: a cadaveric study. Knee Surg Sports Traumatol Arthrosc 2019; 27:3813-3820. [PMID: 31115607 DOI: 10.1007/s00167-019-05539-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 05/07/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE This study aims to investigate the superior clavicle cortex drilling points and fluoroscopic inclination angles for anatomic tunnel drilling in coracoclavicular ligament reconstruction. METHODS Twelve cadaveric shoulders with a mean age of 55.9 ± 6.2 years were investigated. Two 2.0 mm Kirschner wires were inserted penetrating the footprint centers of conoid and trapezoid both on the clavicle and coracoid. The location of the Kirschner wires on the superior clavicle cortex was measured. Fluoroscopy was used to obtain three views of shoulder: an anteroposterior, lateral, and cortical ring sign view. Reproducible angles were then recorded. RESULTS The Kirschner wire penetrating the conoid was located 40.0 ± 3.9 mm from the distal end and 18.1 ± 3.0 mm from the anterior edge of the clavicle. For the trapezoid, the Kirschner wire was located 19.1 ± 3.6 mm from the distal end and 9.9 ± 3.9 mm from the anterior edge. On the anteroposterior view, the conoid was 11.1° ± 10.1° medially and trapezoid was 26.8° ± 11.8° laterally tilted to the glenohumeral joint line. On the lateral view, the conoid was 42.8° ± 15.1° and trapezoid was 15.5° ± 12.0° superiorly tilted to the scapular spine. On the cortical ring sign view, the conoid was 50.8° ± 12.9° and trapezoid was 14.2 °± 11.0° superiorly tilted to the scapular spine. CONCLUSIONS The superior clavicle cortex drilling points and fluoroscopic inclination angles for anatomic tunnel drilling in coracoclavicular ligament reconstruction were demonstrated. Arthroscopy-assisted anatomic coracoclavicular ligament reconstruction has increased in popularity, and these findings may facilitate a more anatomic approach to coracoclavicular ligament reconstruction.
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Affiliation(s)
- Tetsuya Takenaga
- Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Orthopaedic Surgery, University of Pittsburgh, UPMC Freddie Fu Sports Medicine Center, 3200 South Water Street, Pittsburgh, PA, 15203, USA
| | - Masahito Yoshida
- Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Orthopaedic Surgery, University of Pittsburgh, UPMC Freddie Fu Sports Medicine Center, 3200 South Water Street, Pittsburgh, PA, 15203, USA
| | - Richard E Debski
- Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Orthopaedic Surgery, University of Pittsburgh, UPMC Freddie Fu Sports Medicine Center, 3200 South Water Street, Pittsburgh, PA, 15203, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Freddie H Fu
- Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Orthopaedic Surgery, University of Pittsburgh, UPMC Freddie Fu Sports Medicine Center, 3200 South Water Street, Pittsburgh, PA, 15203, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Volker Musahl
- Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Orthopaedic Surgery, University of Pittsburgh, UPMC Freddie Fu Sports Medicine Center, 3200 South Water Street, Pittsburgh, PA, 15203, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Albert Lin
- Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, PA, USA.
- Department of Orthopaedic Surgery, University of Pittsburgh, UPMC Freddie Fu Sports Medicine Center, 3200 South Water Street, Pittsburgh, PA, 15203, USA.
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Dyrna F, Imhoff FB, Haller B, Braun S, Obopilwe E, Apostolakos JM, Morikawa D, Imhoff AB, Mazzocca AD, Beitzel K. Primary Stability of an Acromioclavicular Joint Repair Is Affected by the Type of Additional Reconstruction of the Acromioclavicular Capsule. Am J Sports Med 2018; 46:3471-3479. [PMID: 30419178 DOI: 10.1177/0363546518807908] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The synergistic effect of the acromioclavicular (AC) capsule and coracoclavicular (CC) ligaments on AC joint stability has gained recent recognition for its importance. Biomechanical and clinical studies have shown the benefit of combined reconstruction with multiple variations of surgical techniques for AC capsule augmentation. The ideal configuration remains unknown for such capsular repair aimed at achieving optimal stability with anatomic reconstruction. HYPOTHESIS Primary AC joint stability can be restored by AC capsule augmentation, while position of the additional suture construct is critical. It was hypothesized that techniques that reconstruct the anterior capsular structures would restore native stability against rotations and translations. STUDY DESIGN Controlled laboratory study. METHODS Thirty fresh-frozen human cadaveric shoulders were used. Each sample was tested in the native state and served as its own control. After complete capsulotomy, 1 of 5 AC capsular repair configurations was performed: anterior, superior, posterior, O-frame, and X-frame. After testing of the AC capsular repair configurations, the tests were repeated after dissection of the CC ligaments and after CC ligament reconstruction with a suture button system. AC joint stability was immediately tested after each step under rotation and horizontal translation. To accomplish this, the AC joints were anatomically positioned on a custom fixture linked to a servohydraulic testing system. A 3-dimensional optical measuring system was used to evaluate the 3-dimensional joint motion. Clavicle posterior translation in relation to the acromion, rotation around the long axis of the clavicle, and displacement of the lateral clavicle in relation to the center of rotation were measured. The torques and forces required to rotate and translate the clavicle were recorded. RESULTS In terms of translational testing, after the complete capsulotomy, a significant reduction of resistance force was found across all groups, with a mean 13% to 20% remaining ( P < .05). All AC suture augmentations were able to significantly increase the average resistance force as compared with the native ( P = .01) against posterior translation. Subsequent cutting of the CC ligaments did not result in a significant change in any of the groups ( P = .23). The synergistic effect of AC capsule augmentation and CC ligament reconstruction could be demonstrated without exception. In terms of rotational testing, the complete capsulotomy resulted in a significant reduction of resistance torque in all groups ( P < .05), with a remaining torque ranging between 2% and 11% across the groups. However, all AC suture constructs significantly increased the resistance torque as compared with the capsulotomy ( P = .01). The subsequent cutting of the CC ligaments resulted in a significant change in 2 of the 5 groups (O-frame, P = .01; X-frame, P = .02) and an overall remaining torque reduction ranging from 3% and 42%. The combined reconstruction of the AC capsule and CC ligaments achieved the highest percentage of regained resistance torque but remained significantly weaker than the native specimen ( P = .01). CONCLUSION Native translational stability could be restored by the addition of AC capsule augmentation, while partial rotational instability remained. The tested constructs revealed no significant individual differences. CLINICAL RELEVANCE Combined stabilization of the AC capsule and CC ligaments demonstrated the greatest capacity to restore the native stability against translational and rotational loads, with the specific configuration of the AC capsule repair to be chosen according to the personal preferences of the surgeon.
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Affiliation(s)
- Felix Dyrna
- Department of Orthopaedic Sportsmedicine, Technical University, Munich, Germany.,Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Florian B Imhoff
- Department of Orthopaedic Sportsmedicine, Technical University, Munich, Germany.,Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - B Haller
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA.,Institute of Medical Statistics and Epidemiology, Technical University, Munich, Germany
| | - Sepp Braun
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Elifho Obopilwe
- Department of Orthopaedic Sportsmedicine, Technical University, Munich, Germany
| | - John M Apostolakos
- Department of Orthopaedic Sportsmedicine, Technical University, Munich, Germany
| | - Daichi Morikawa
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA.,Department of Orthopaedic Surgery, Juntendo University, Tokyo, Japan
| | - Andreas B Imhoff
- Department of Orthopaedic Sportsmedicine, Technical University, Munich, Germany
| | - Augustus D Mazzocca
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Knut Beitzel
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
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Fukutake K, Hattori H, Sekiguchi M, Inoue Y, Kamakura D, Tsuji K, Kojimahara Y, Takahashi H, Tsuchiya K. Percutaneous fixation of avulsion fracture at the plantar lateral base of the first metatarsal using ZipTight Fixation System: A case report. Foot Ankle Surg 2018; 24:e13-e17. [PMID: 29933964 DOI: 10.1016/j.fas.2018.02.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 02/26/2018] [Indexed: 02/04/2023]
Abstract
Isolated avulsion fracture of the peroneus longus tendon insertion at the base of the first metatarsal without injury of the tarsometatarsal joint is very rare. Similar to most avulsion fractures, this type of injury is caused by strong tension exerted by the peroneus longus tendon. The mechanism leading to this lesion and treatment options are not clearly defined. Several surgical techniques have been advocated for this fracture, including excision of an avulsion fragment and open reduction for internal fixation through the medial aspect of the foot or minimal plantar incision. We have described a method of percutaneous fixing of the avulsion fracture at the plantar lateral base of the first metatarsal using the ZipTight Fixation System (Zimmer Biomet Warsaw, Indiana, USA), which offers the advantage of allowing a rigid fixation and minimal invasive surgical technique for a small fragment.
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Affiliation(s)
- Katsunori Fukutake
- Department of Orthopedic Surgery, Toho University Omori Medical Center, 6-11-1, Omori-Nishi, Ota-Ku, Tokyo, 143-8541, Japan.
| | - Hiroyuki Hattori
- Department of Orthopedic Surgery, Japan Community Health Care Organization Tokyo Kamata Medical Center 2-19-2, Minamikamata, Ota-Ku, Tokyo, 144-0035, Japan
| | - Masayuki Sekiguchi
- Department of Orthopedic Surgery, Toho University Omori Medical Center, 6-11-1, Omori-Nishi, Ota-Ku, Tokyo, 143-8541, Japan
| | - Yasuhiro Inoue
- Department of Orthopedic Surgery, Toho University Omori Medical Center, 6-11-1, Omori-Nishi, Ota-Ku, Tokyo, 143-8541, Japan
| | - Daisuke Kamakura
- Department of Orthopedic Surgery, Toho University Omori Medical Center, 6-11-1, Omori-Nishi, Ota-Ku, Tokyo, 143-8541, Japan
| | - Kentaro Tsuji
- Department of Orthopedic Surgery, Toho University Omori Medical Center, 6-11-1, Omori-Nishi, Ota-Ku, Tokyo, 143-8541, Japan
| | - Yousuke Kojimahara
- Department of Orthopedic Surgery, Japan Community Health Care Organization Tokyo Kamata Medical Center 2-19-2, Minamikamata, Ota-Ku, Tokyo, 144-0035, Japan
| | - Hiroshi Takahashi
- Department of Orthopedic Surgery, Toho University Omori Medical Center, 6-11-1, Omori-Nishi, Ota-Ku, Tokyo, 143-8541, Japan
| | - Kazuaki Tsuchiya
- Department of Orthopedic Surgery, Toho University Omori Medical Center, 6-11-1, Omori-Nishi, Ota-Ku, Tokyo, 143-8541, Japan
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Cisneros LN, Reiriz JS. Prevalence of remaining horizontal instability in high-grade acromioclavicular joint injuries surgically managed. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 27:323-333. [PMID: 28054147 DOI: 10.1007/s00590-016-1898-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 12/15/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine the prevalence of remaining horizontal instability in high-grade acromioclavicular joint (ACJ) injuries surgically managed by means of four different surgical strategies and to assess its relation to the clinical outcomes and the quality of life. METHODS In this multicentric non-randomized retrospective study, 53 patients with high-grade ACJ injuries surgically managed (by means of open or arthroscopic surgery) were clinically and radiographically assessed at 24 months or more after shoulder surgery. The presence of post-surgical remaining horizontal instability was evaluated by means of Alexander or axillary X-ray views. The study population was divided into two groups: patients with evidence of post-surgical remaining horizontal instability and patients without evidence of post-surgical remaining horizontal instability at the last follow-up visit. The relationship between remaining horizontal instability and the quality-of-life questionnaires was analyzed. RESULTS 18.87% (10/53) of the Alexander or axillary X-rays views showed post-surgical remaining horizontal instability at the last follow-up visit (INSTAB-group). Results of the questionnaires were: (1) physical SF36 score (INSTAB-group 57.02 ± 3.17 and NO-INSTAB-group 57.66 ± 3.30, p = 0.583); (2) mental SF36 score (INSTAB-group 53.95 ± 3.98 and NO-INSTAB-group 55.71 ± 3.30, p = 0.150); (3) NRS for pain (INSTAB-group 1.30 ± 1.49 and NO-INSTAB-group 0.83 ± 1.08, p = 0.260); (4) DASH questionnaire (INSTAB-group 5.27 ± 5.42 and NO-INSTAB-group 3.06 ± 2.30, p = 0.049); (5) Constant score (INSTAB-group 93.4 ± 3.5 and NO-INSTAB-group 94.83 ± 4.3, p = 0.333); and Global satisfaction (INSTAB-group 8.7 ± 0.95 and NO-INSTAB-group 8.64 ± 1.03, p = 0.874). CONCLUSION Independently of the type of procedure, post-surgical remaining horizontal instability was present in almost one-fifth of the patients, and this group of patients showed a significantly worse DASH score. The addition of an acromioclavicular augmentation might have to be considered, taking into account that its absence may have a negative impact in terms of shoulder disabilities. LEVEL OF EVIDENCE Level IV, prognostic case series.
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Affiliation(s)
- Luis Natera Cisneros
- Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Sant Quintí 89, 08026, Barcelona, Spain.
- Hospital General de Catalunya, Pedro i Pons 1, 08190, Sant Cugat del Vallés, Barcelona, Spain.
| | - Juan Sarasquete Reiriz
- Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Sant Quintí 89, 08026, Barcelona, Spain
- Hospital Quirón Teknon, Vilana 12, 08022, Barcelona, Spain
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9
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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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10
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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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