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Grossi J, Ackerman G. Surgical Management of the Horizontal Instability of the Acromioclavicular Joint of a Young Athlete: A Case Report. Cureus 2024; 16:e59823. [PMID: 38854251 PMCID: PMC11156574 DOI: 10.7759/cureus.59823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2024] [Indexed: 06/11/2024] Open
Abstract
The acromioclavicular joint (ACJ) is commonly injured due to a force to the lateral aspect of the shoulder with the arm in adduction resulting in vertical or multidirectional instability. However, in this case report, we present a rare case of an athlete with isolated horizontal ACJ instability, which was treated surgically using a hamstring allograft. We highlight the surgical technique use to stabilize the joint in the horizontal (anterior to posterior) plane. Isolated horizontal instability of the ACJ is very rare and, to our knowledge, this surgical technique has not been reported in the case of a young athlete.
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Affiliation(s)
- John Grossi
- Research, Lake Erie College of Osteopathic Medicine, Bradenton, USA
| | - George Ackerman
- Orthopedic Surgery, Optum Orthopedics and Sports Medicine, Lake Success, USA
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Yubran AP, Pesquera LC, Juan ELS, Saralegui FI, Canga AC, Camara AC, Valdivieso GM. Presurgical perspective and postsurgical evaluation of acromioclavicular joint instability. Skeletal Radiol 2024; 53:847-861. [PMID: 38008754 DOI: 10.1007/s00256-023-04526-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 11/28/2023]
Abstract
Acromioclavicular joint (ACJ) dislocations are a common cause of pain in patients of any age. Athletes who participate in contact sports, such as hockey, football, rugby, and soccer, are particularly susceptible to such injuries. The ACJ has an important role in the function of the upper limb, and its complexity of movement makes it susceptible to acute injuries and chronic dysfunction with debilitating effects that must be treated appropriately and promptly to preserve function. Recently, ACJ has received increasing attention due to the development of new surgical techniques for the restoration of normal function and stability. There is some agreement about the treatment of ACJ dislocations, but controversy remains about the treatment of Rockwood grade III dislocations, and a new approach to these injuries is suggested by ISAKOS. Overall, the paper summarizes new concepts in the anatomy of the ACJ and reviews the utility of imaging methods in ACJ dislocations as well as their treatment and complications.
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Affiliation(s)
- Alexeys Perez Yubran
- Department of Radiology, IBERORAD, 1893, Carrer Valencia 226, Principal, Primera, 08007, Barcelona, Spain.
| | | | | | | | - Alvaro Cerezal Canga
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitario La Paz, Madrid, Spain
| | - Antonio Cruz Camara
- Department of Arthroscopic Surgery, Hospital Santa Clotilde, Santander, Spain
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Peebles LA, Akamefula RA, Kraeutler MJ, Mulcahey MK. Management of Acromioclavicular Joint Injuries: A Historic Account. Clin Sports Med 2023; 42:539-556. [PMID: 37716720 DOI: 10.1016/j.csm.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
There has been a rapid evolution in best practice management of acromioclavicular (AC) joint injuries. AP, Zanca, scapular Y, and dynamic axillary radiographic views provide optimal visualization of the joint and may assess for the presence of horizontal AC instability. Severity of AC joint pathology is classified according to the 6-tier Rockwood scoring system. Over 160 surgical techniques have been described for AC joint repair and reconstruction in the last decade; as a result, determining the optimal treatment algorithm has become increasingly challenging secondary to the lack of consistently excellent clinical outcomes.
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Affiliation(s)
- Liam A Peebles
- Tulane University School of Medicine, 1430 Tulane Avenue, #2070, New Orleans, LA, USA
| | - Ramesses A Akamefula
- Tulane University School of Medicine, 1430 Tulane Avenue, #2070, New Orleans, LA, USA
| | - Matthew J Kraeutler
- Department of Orthopedics & Sports Medicine, Houston Methodist Hospital, 6445 Main Street, #2300, Houston, TX, USA
| | - Mary K Mulcahey
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL, USA.
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Moussa MK, Fleurette J, Werthel JD. Dynamic Horizontal Instability of the Acromioclavicular Joint: A Case Report. JBJS Case Connect 2023; 13:01709767-202309000-00044. [PMID: 37556577 DOI: 10.2106/jbjs.cc.23.00113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
CASE A 19-year-old female patient with a history of shoulder trauma 6 years ago presented with dynamic horizontal instability of the acromioclavicular joint (ACJ). She was treated with open ACJ reconstruction using gracilis allograft and showed a satisfactory clinical result at 1-year follow-up. CONCLUSION Dynamic pure horizontal instability of the ACJ is a rare entity with only 6 cases reported in the literature. Till now, all reported patients who necessitated surgical treatment failed because of residual instability and/or pain. We present the seventh case of this type with a successful clinical outcome.
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Affiliation(s)
- Mohamad K Moussa
- Department of Orthopedic Surgery, Hôpital Ambroise Paré, Boulogne-Billancourt, France
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Velasquez Garcia A, Abdo G. Reliability of the ISAKOS Modification to Subclassify Rockwood Type III Acromioclavicular Joint Injuries. Orthop J Sports Med 2022; 10:23259671221133379. [PMID: 36570359 PMCID: PMC9772956 DOI: 10.1177/23259671221133379] [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: 05/14/2022] [Accepted: 08/10/2022] [Indexed: 12/23/2022] Open
Abstract
Background To improve clinical management, the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) developed a specific subclassification of Rockwood type III acromioclavicular (AC) injuries: IIIA (no overriding distal clavicle) and IIIB (overriding distal clavicle). Purpose/Hypothesis The study aimed to determine the inter- and intraobserver reliability of the radiographic classification proposed by ISAKOS for AC injuries. It was hypothesized that the strength of agreement for the ISAKOS modification will be substantial to almost perfect. Study Design Cohort study (diagnosis); Level of evidence, 3. Methods We evaluated 40 radiographs of all types of AC joint injuries from patients at a single institution. The images were distributed to 6 shoulder and elbow fellowship-trained orthopaedic surgeons, along with standardized assessment questionnaires. The evaluators measured the bilateral coracoclavicular distance and the coracoclavicular ratio and classified the severity of the injuries according to the modified ISAKOS Rockwood classification. Four of the surgeons repeated the evaluation 6 weeks later to calculate intraobserver agreement. The kappa (κ) statistic was calculated for categorical inter- and intraobserver reliability. Intraclass correlation coefficient (ICC) estimates were calculated for the reliability of the coracoclavicular distance measurement. A 2-tailed test was performed to assess statistical significance. Results Overall interobserver agreement was substantial (κ = 0.637; 95% CI, 0.595-0.680) among the 6 evaluators, and intraobserver agreement was also substantial among the 4 evaluators (κ = 0.616; 95% CI, 0.549-0.638). The interobserver agreement for evaluating types IIIA and IIIB was fair (κ = 0.215; 95% CI, 0.135-0.295) and moderate (κ = 0.473; 95% CI, 0.393-0.553), respectively. The agreement on the coracoclavicular distance measurements was excellent among the 6 evaluators on both the affected side (ICC, 0.982; 95% CI, 0.970-0.990) and the unaffected side (ICC, 0.930; 95% CI, 0.894-0.958). Conclusion Substantial agreement was found when categorizing AC joint injuries using the ISAKOS modification of the Rockwood classification, with excellent reliability demonstrated for the quantitative assessment of vertical displacement of the clavicle. Visual examination was unreliable in differentiating type IIIA injuries from type IIIB injuries.
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Affiliation(s)
- Ausberto Velasquez Garcia
- Department of Orthopedic Surgery, Clinica Universidad de los Andes, Santiago, Chile.,Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Ausberto Velasquez Garcia, MD, Clinica Universidad de los Andes, Av Plaza 2501, Las Condes, Santiago, Chile, 7620157 ()
| | - Glen Abdo
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Basic Sciences, Touro College of Osteopathic Medicine, New York, New York, USA
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Peebles LA, Aman ZS, Kraeutler MJ, Mulcahey MK. Qualitative and Quantitative Anatomic Descriptions of the Coracoclavicular and Acromioclavicular Ligaments: A Systematic Review. Arthrosc Sports Med Rehabil 2022; 4:e1545-e1555. [PMID: 36033198 PMCID: PMC9402469 DOI: 10.1016/j.asmr.2022.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 04/28/2022] [Indexed: 11/28/2022] Open
Abstract
Purpose Methods Results Conclusions Clinical Relevance
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Affiliation(s)
- Liam A. Peebles
- Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Zachary S. Aman
- Sidney Kimmel Medical College, Philadelphia, Pennsylvania, U.S.A
| | - Matthew J. Kraeutler
- Department of Orthopaedic Surgery, St. Joseph’s University Medical Center, Paterson, New Jersey, U.S.A
| | - Mary K. Mulcahey
- Department of Orthopaedic Surgery, New Orleans, Louisiana, U.S.A
- Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
- Address correspondence to Mary K. Mulcahey, M.D., 1430 Tulane Ave., #8632, New Orleans, LA 70112.
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Gosselin MM, Denney BS, Gregory JM. Treatment of Acromioclavicular Joint Instability With a Tunnel-Free Reconstruction Technique. Arthrosc Tech 2022; 11:e895-e901. [PMID: 35646574 PMCID: PMC9134482 DOI: 10.1016/j.eats.2022.01.008] [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: 11/16/2021] [Accepted: 01/08/2022] [Indexed: 02/03/2023] Open
Abstract
Acromioclavicular joint injuries are a common shoulder injury encountered by orthopaedic surgeons. Many different surgical techniques have been described for the operative treatment of these injuries with no single, clear gold standard technique on which surgeons agree. Among the most common complications after surgical management of acromioclavicular injuries are loss of reduction, infection, fracture of clavicle or coracoid, and need for reoperation. We propose an arthroscopic-assisted, tunnel-free surgical technique using a tibialis anterior allograft combined with a FiberTape Cerclage (Arthrex, Naples, FL) to manage both acute and chronic acromioclavicular joint injuries. No bony tunnels are drilled and no hardware is implanted, which should obviate the risk for subsequent bony failure through a fracture, nor require subsequent hardware removal. In addition, the combination of suspensory and allograft fixation should impart sufficient stability to maintain an adequate reduction even in the face of failure of one of the fixation methods.
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Affiliation(s)
- Michelle M. Gosselin
- Department of Orthopaedic Surgery, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Brandon S. Denney
- Department of Orthopaedic Surgery, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - James M. Gregory
- McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA,Address correspondence to James M. Gregory, M.D., McGovern Medical School, University of Texas Health Science Center at Houston, 10125 Katy Freeway, Suite 100, Houston, TX 77024.
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Samitier G, Vinagre G, González-Martín D. Acromioclavicular Fracture-Dislocation Fixation Technique With Cerclages and Osteosutures: The "Invisible" Repair. Arthrosc Tech 2022; 11:e523-e529. [PMID: 35493045 PMCID: PMC9051664 DOI: 10.1016/j.eats.2021.12.002] [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: 10/17/2021] [Accepted: 12/04/2021] [Indexed: 02/03/2023] Open
Abstract
Surgical treatment usually is indicated for the management of acromioclavicular fracture-dislocations. These are unstable injuries and have shown a high rate of nonunion when managed conservatively. However, surgical strategies often require a second surgery for hardware removal. We describe an arthroscopic-assisted technique to repair the acromioclavicular fracture-dislocation without implants, using a double cerclage and osteosutures. This technique does not require specific instrumentation, avoids clavicle/coracoid drilling, and minimizes secondary irritation related to hardware. This can be used in different anatomic locations and can theoretically reduce the chances of symptomatic hardware, reoperation rates, and iatrogenic fractures.
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Affiliation(s)
- Gonzalo Samitier
- Department of Orthopaedic Surgery and Traumatology, Centro Quirónsalud Aribau, Barcelona, Spain
| | - Gustavo Vinagre
- Department of Orthopaedic Surgery and Traumatology, Complexo Hospitalar do Médio Ave, Porto, Portugal,Department of Orthopaedic Surgery and Traumatology, Hospital Lusíadas, Porto, Portugal,Address correspondence to Gustavo Vinagre, M.D., Ph.D., Department of Orthopaedic Surgery and Traumatology, Complexo Hospitalar do Médio Ave, Porto, Portugal.
| | - David González-Martín
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitario de Canarias, Tenerife, Spain,Universidad de La Laguna, Tenerife, Spain
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Buckley PJ, Jildeh TR, Abbas MJ, Okoroha KR. Acromioclavicular Joint Reconstruction with Recessed Clavicular Implant Technique Guide. Arthrosc Tech 2021; 10:e2577-e2582. [PMID: 34868864 PMCID: PMC8626818 DOI: 10.1016/j.eats.2021.07.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 07/29/2021] [Indexed: 02/03/2023] Open
Abstract
Acromioclavicular (AC) joint injuries are common and often require operative intervention. Although there are many described surgical techniques, there remains a lack of consensus on the optimal technique. The purpose of this Technical Note is to provide our preferred method of AC reconstruction with a recessed clavicular implant and semitendinosus allograft, which mitigates hardware pain associated with arthroscopic techniques.
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Affiliation(s)
- Patrick J. Buckley
- Henry Ford Hospital, Department of Orthopaedic Surgery, Detroit, Michigan,Address correspondence to Patrick J. Buckley, B.S., Henry Ford Hospital, Department of Orthopaedic Surgery, 2799 W. Grand Blvd, Detroit, MI 48202, U.S.A.
| | - Toufic R. Jildeh
- Henry Ford Hospital, Department of Orthopaedic Surgery, Detroit, Michigan
| | - Muhammad J. Abbas
- Henry Ford Hospital, Department of Orthopaedic Surgery, Detroit, Michigan
| | - Kelechi R. Okoroha
- Mayo Clinic Department of Orthopedic Surgery, Minneapolis, Minnesota, U.S.A
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