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Vossen RJ, Verstift D, Van Etten-Jamaludin FS, Hamans BJ, van den Bekerom MP, Verweij LP. Choice of Acromioclavicular Dislocation Treatment Should Not Be Influenced by Risk of Development of Acromioclavicular Osteoarthritis: A Systematic Review With Meta-Analysis. JBJS Rev 2024; 12:01874474-202409000-00002. [PMID: 39226400 PMCID: PMC11365602 DOI: 10.2106/jbjs.rvw.24.00085] [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: 09/05/2024]
Abstract
BACKGROUND It is currently unknown to what degree surgical or nonoperative treatment of acromioclavicular (AC) dislocation influences the development of osteoarthritis (OA). The aim of this study was to evaluate AC OA after surgical and nonoperative treatment for AC dislocations, compare OA prevalence between treatment options, and compare OA prevalence between the injured and contralateral shoulder. METHODS Articles reporting on the prevalence of OA after surgical or nonoperative treatment of an AC dislocation with a minimal 2-year follow-up were included. AC OA presence was extracted for the injured and contralateral shoulder. Treatment categories were defined based on anatomical variation in the reattachment of ligaments: AC fixation, coracoclavicular (CC) fixation, AC and CC fixation, Bosworth screw synthetic graft, tendon graft, and conservative. Study quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria. RESULTS Ninety-four articles were included for qualitative analysis, and 7 articles were included for meta-analysis (n = 3,812; follow-up = 2.0-24.2 years; mean age 37.6 ± 10.4 years). A total of 3,483 patients underwent surgical treatment, and 329 patients underwent conservative treatment. OA prevalence ranged from 6.7%-29.3% between 7 pooled treatment categories. Most included studies had a follow-up <10 years (94%) and OA prevalence increased with time, regardless of treatment option. There was no difference in OA prevalence between the injured and contralateral shoulder (p = 0.120). MINORS scores were varied, ranging from poor to very good. CONCLUSION The pooled AC OA prevalence of the 7 treatment categories ranged from 6.7% for the CC fixation surgical group to 29.3% for the conservative treatment group. However, the included studies were predominantly of low quality and had varying follow-up periods, with most having relatively short follow-up durations. No difference in AC OA prevalence was found between the injured and contralateral shoulder. Based on the available evidence, treatment choice for AC dislocation should not be influenced by the potential development of AC AO. LEVEL OF EVIDENCE Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Roderick J.M. Vossen
- Department of Orthopedics, OLVG, Amsterdam, the Netherlands
- Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Amsterdam, the Netherlands
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Daniel Verstift
- Department of Orthopedics, OLVG, Amsterdam, the Netherlands
- Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Amsterdam, the Netherlands
| | | | - Bryan J. Hamans
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Michel P.J. van den Bekerom
- Department of Orthopedics, OLVG, Amsterdam, the Netherlands
- Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Amsterdam, the Netherlands
- Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Lukas P.E. Verweij
- Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Amsterdam, the Netherlands
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, the Netherlands
- Musculoskeletal Health Program, Amsterdam Movement Sciences, Amsterdam, the Netherlands
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Rojas JT, Oyarzún A, Muñoz JT, García de la Pastora D, Canals A, Viacava A, Carreño H, Águila R. Medial placement of trapezoid tunnel leads to higher reduction loss in acute acromioclavicular joint dislocation treated with anatomic coracoclavicular fixation. Shoulder Elbow 2024; 16:265-273. [PMID: 38818098 PMCID: PMC11135191 DOI: 10.1177/17585732231170322] [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: 11/14/2022] [Revised: 03/12/2023] [Accepted: 03/19/2023] [Indexed: 06/01/2024]
Abstract
Aim To analyze the association between clavicular tunnel positioning and postoperative reduction loss in patients with acute acromioclavicular (AC) joint dislocation treated with anatomic coracoclavicular (CC) fixation using double clavicular tunnels. Methods A retrospective review of patients with AC joint dislocation, treated with anatomic CC fixation using double clavicular tunnels, was conducted. Patients with pre-operative, immediate post-operative, and final follow-up Zanca-view X-rays were included. On each X-ray, the obtained measures included: distance from lateral border of clavicle to trapezoid and conoid tunnels, distance between tunnels, clavicle length, and CC distance of affected and un-affected sides. Loss of reduction was calculated as CC distance difference between immediate and final post-operative X-rays. Association between reduction loss and tunnel positioning was analyzed. Results Conoid, trapezoid and tunnel ratios were 24% ± 4, 15% ± 3, and 9% ± 2, respectively. Significant reduction loss was seen in 21(45.7%) patients. Significantly higher probabilities of reduction loss were associated with trapezoid tunnels placed medial to 24 mm (30.8% vs 65.0%, OR 4.2 (IC95%: 1.2-14.4), p: 0.024) or 15% of the clavicle length (32.1% vs 66.7%, OR 4.2 (IC 95%: 1.2-14.9), p: 0.025). Conclusions Trapezoid tunnels placed medial to 24 mm or 15% medial to clavicle length could lead to higher probabilities of significant reduction loss. These findings support the importance of clavicular tunnels' proper placement for decreasing significant reduction loss.
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Affiliation(s)
- J Tomás Rojas
- Shoulder and Elbow Team, Clínica Santa María, Santiago, Chile
- Shoulder and Elbow Team, Hospital San José, Santiago, Chile
| | - Andrés Oyarzún
- Resident of Orthopedic Surgery, Universidad de Chile, Santiago, Chile
| | - J Tomás Muñoz
- Resident of Orthopedic Surgery, Universidad de los Andes, Santiago, Chile
| | | | - Andrea Canals
- Academic unit, Clínica Santa María, Santiago, Chile
- School of Public health, Universidad de Chile, Santiago, Chile
| | | | - Hector Carreño
- Shoulder and Elbow Team, Clínica Santa María, Santiago, Chile
| | - Raúl Águila
- Shoulder and Elbow Team, Clínica Santa María, Santiago, Chile
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Jones BK, Fuller C, Kweon C. Failed suspension button acromioclavicular joint reconstruction revised with double-loop suture cerclage: a case report and review of the literature. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:392-397. [PMID: 37588510 PMCID: PMC10426678 DOI: 10.1016/j.xrrt.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
- Brett K. Jones
- Washington State University Elson S. Floyd College of Medicine, Spokane WA, USA
| | - Carson Fuller
- Department of Orthopaedic Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Christopher Kweon
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
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Sonnier JH, Kemler B, Coladonato C, Paul RW, Tjoumakaris FP, Freedman KB. Surgical management of acute, high-grade acromioclavicular joint separations: a systematic review. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:10-20. [PMID: 37588062 PMCID: PMC10426581 DOI: 10.1016/j.xrrt.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background While a number of treatment options exist for repair of acute, high-grade acromioclavicular joint (ACJ) separation, none have emerged as the standard of care. The purpose of this study was to systematically review the literature on surgical treatment of acute, high-grade (Rockwood grades III-V) ACJ separations in order to compare outcomes between direct fixation and tendon graft ligament reconstruction. Methods A systematic review of the literature evaluating outcomes for acute ACJ separation treatment with direct fixation or free biologic tendon graft reconstruction was performed. The following databases were examined: the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed (1980-2021), and Embase (1980-2021). Studies were included if they reported a mean time to surgery as <6 weeks, contained >10 patients with a minimum 1-year follow-up, and reported clinical or radiographic outcomes. Results A total of 52 studies met the inclusion criteria. Seven studies reported outcomes following tendon graft ligament reconstruction (n = 128 patients). There were multiple methods of direct fixation. Thirty-three studies utilized suture button constructs (n = 1138), 16 studies used hook plates (n = 567), 2 studies used coracoclavicular screws (n = 94), 2 studies used suture fixation (n = 93), 2 studies used suture anchor (n = 55), 2 studies used suture cerclage fixation (n = 87), 1 used single multistrand titanium cable (n = 24), and 1 used K wire (n = 11). The mean follow-up Constant scores ranged from 77.5 to 97.1 in the fixation group compared to 90.3-96.6 in the tendon graft group. The mean visual analog scale scores ranged from 0 to 4.5 in the fixation group and 0.1-1 in the tendon graft group. Net CC distance ranged from 17.5 to 3.6 mm in the fixation group and 7.4-4 mm in the tendon graft group. The revision rates ranged from 0.0% to 18.18% in the direct fixation group and 5.88%-17% in the tendon graft group. Conclusion Direct fixation and tendon graft reconstruction for management of acute, high-grade ACJ separations have similar patient subjective and radiographic outcomes, as well as complication and revision rates at a minimum 1-year follow-up.
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Affiliation(s)
- John Hayden Sonnier
- Rothman Orthopaedic Institute, Division of Sports Medicine, Philadelphia, PA, USA
| | - Bryson Kemler
- Rothman Orthopaedic Institute, Division of Sports Medicine, Philadelphia, PA, USA
| | - Carlo Coladonato
- Rothman Orthopaedic Institute, Division of Sports Medicine, Philadelphia, PA, USA
| | - Ryan W. Paul
- Rothman Orthopaedic Institute, Division of Sports Medicine, Philadelphia, PA, USA
| | | | - Kevin B. Freedman
- Rothman Orthopaedic Institute, Division of Sports Medicine, Philadelphia, PA, USA
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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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Zhang Y, Yu P, Zhuang C, Liu J, Li G, Ye T, Wang L. Revising the modified Neer classification for distal clavicle fractures: Description and reliability. Injury 2021; 54 Suppl 2:S56-S62. [PMID: 34952695 DOI: 10.1016/j.injury.2021.11.018] [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: 07/29/2021] [Revised: 10/09/2021] [Accepted: 11/09/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The modified Neer classification is the most widely used classification system for distal clavicle fractures. However, it provides limited information for treatment decisions. The objective of this study was to revise the modified Neer classification to make it more suitable for treatment decision-making. HYPOTHESIS The revised version of the modified Neer classification has good intra- and interobserver agreements and provides an instructive treating algorithm. STUDY DESIGN Cohort study METHODS: Six observers, including three experienced shoulder specialists and three junior orthopaedic residents, independently reviewed plain radiographs of 52 patients with distal clavicle fractures. They were asked to classify the fracture types according to the modified Neer classification and our revised new classification separately to determine treatment approaches for each patient. Images were mirrored and randomized to verify the intraobserver agreement. Reliabilities were measured using the Fleiss kappa values. RESULTS Both the modified Neer classification and our revised version had near perfect intraobserver agreement (κ values: 0.87-1.00), whereas our revised Neer classification had a better interobserver agreement (κ values: 0.78 vs. 0.70, z = 4.70, p < 0.01) and stronger relevance to treatment decisions (coefficient of contingency: 0.70 vs. 0.44). CONCLUSION Our study demonstrated a near-perfect intraobserver and substantial interobserver agreement of the revised new classification, indicating that our revised new classification was better than the modified Neer classification. Meanwhile, our revised classification brought few disputes in treatment selection. CLINICAL RELEVANCE The modified Neer classification was revised to make it more accurate and suitable for guiding treatment. TYPE OF STUDY Study of diagnostic test LEVEL OF STUDY: Level II.
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Affiliation(s)
- Yin Zhang
- Department of Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, China 200025
| | - Pei Yu
- Department of Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, China 200025
| | - Chengyu Zhuang
- Department of Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, China 200025
| | - Jingfeng Liu
- Department of Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, China 200025
| | - Gen Li
- Shanghai Institute of Traumatology and Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tingjun Ye
- Department of Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, China 200025
| | - Lei Wang
- Department of Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, China 200025.
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Biologic and synthetic ligament reconstructions achieve better functional scores compared to osteosynthesis in the treatment of acute acromioclavicular joint dislocation. Knee Surg Sports Traumatol Arthrosc 2021; 29:2175-2193. [PMID: 32797247 DOI: 10.1007/s00167-020-06217-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 08/06/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE To systematically review the outcomes of surgical treatments of acute acromioclavicular joint dislocation. METHODS Studies were identified by electronic databases (Ovid, PubMed). All studies reporting functional and radiological outcomes of surgical treatments of acute acromioclavicular joint dislocations were included. Following data were extracted: authors and year, study design, level of evidence, number of patients, age, classification of acromioclavicular joint dislocation, time to surgery, surgical technique, follow-up, clinical and imaging outcomes, complications, and failures. Descriptive statistics was used, when a data pooling was not possible. Comparable outcomes were pooled to generate summary outcomes reported as frequency-weighted values. Quality appraisal was assessed through the MINORS checklist. RESULTS One hundred and thirty-three studies were included for a total of 4473 shoulders. Mean age of participants was 36.9 years. Mean follow-up was 42.06 months. Arthroscopy showed better ASES (p < 0.0001) and lower VAS pain score (p = 0.0249) compared to an open approach. Biologic and synthetic reconstructions demonstrated better results over osteosynthesis techniques. Biologic techniques showed overall better Constant (p = 0.0001) and DASH (p = 0.0215) scores, while synthetic reconstruction showed better UCLA score (p = 0.0001). Among suture buttons, triple button showed overall better results in Constant (p = 0.0001) and VAS (p = 0.0001) scores, while better results in DASH score (p = 0.0003) were achieved by 2 double button techniques. Overall, the level of evidence was low. CONCLUSION Biological and synthetic reconstructions achieved better functional scores compared to osteosynthesis. Among suture buttons, the triple button showed better functional performance. LEVEL OF EVIDENCE IV.
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Aliberti GM, Mulcahey MK, Brown SM, O'Brien MJ. Restoring Horizontal Stability of the Acromioclavicular Joint: Open Acromioclavicular Ligament Reconstruction and Repair With Semitendinosus Allograft. Arthrosc Tech 2020; 9:e1619-e1626. [PMID: 33134070 PMCID: PMC7587926 DOI: 10.1016/j.eats.2020.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 07/06/2020] [Indexed: 02/03/2023] Open
Abstract
Injuries to the acromioclavicular (AC) joint are common and comprise ∼12% of shoulder injuries. Stability to the AC joint depends on the coracoclavicular (CC) ligaments for vertical stability and AC ligaments and capsular structures for horizontal stability. Injuries to the AC ligaments can lead to horizontal instability of the AC joint. There is no gold standard technique for treating these injuries surgically, and many of the described procedures focus on vertical instability rather than horizontal instability. This article describes an open AC ligament reconstruction with semitendinosus allograft to restore horizontal stability of the AC joint.
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Affiliation(s)
- Gianna M. Aliberti
- Tulane University School of Medicine, New Orleans, Louisiana, U.S.A.,Address correspondence to Gianna Aliberti, 1430 Tulane Ave., New Orleans, LA 70112, U.S.A.
| | - Mary K. Mulcahey
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Symone M. Brown
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Michael J. O'Brien
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
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Özcafer R, Albayrak K, Lapçin O, Çetinkaya E, Arıkan Y, Gül M. Early clinical and radiographic results of fixation with the TightRope device for Rockwood type V acromioclavicular joint dislocation: A retrospective review of 15 patients. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2020; 54:473-477. [PMID: 33155554 DOI: 10.5152/j.aott.2020.18407] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The aims of this study were, first, to assess the loss of reduction after fixation of Rockwood type V acromioclavicular joint dislocation (ACJD) with the TightRope device (Arthrex, Naples, FL, USA) and, second, to present the functional and radiological outcomes of this treatment. METHODS We retrospectively reviewed the medical records of 15 patients (12 males; mean age=39.2 years; age range=23-61) with Rockwood type V ACJD who were treated by the TightRope fixation device. The mean follow-up period was 19.3 (range=12-30) months. Functional status was assessed using the Constant-Murley score (CMS) at the final follow-up examination. To determine the reduction loss of ACJ, we measured and compared the coracoclavicular (CC) distance using radiographs with Zanca view in the early postoperative period and at the final follow-up examination. The fixation procedures were performed with an open technique using the TightRope fixation device. RESULTS The mean CMS at the final follow-up was 93.2 (range=82-100) points. All the patients experienced full recovery of the shoulder's range of motion, were able to return to the activities of daily living, and were satisfied with the treatment. ACJ reduction was successfully achieved in all the patients using the TightRope technique. Postoperative radiographs revealed no reduction loss in the ACJ, and the CC distance was well maintained. The mean CC distance was 19.95 (range=13.1-28.3) mm before surgery. The mean CC distance was 7.47 (range=4.2-11.5) mm in the early postoperative radiographic measurements. This difference was statistically significant (p=0.001). The mean CC distance at the final follow-up examination was 7.70 (range=4.5-11.7) mm. At the final follow-up visit, the shoulders of all the patients were still completely reduced, with a mean difference in the CC of 0.23 (range=0-1.3) mm compared with that in the early postoperative period. The difference in the CC between the early postoperative and final follow-up intervals was not statistically significant (p=0.055). No patient experienced recurrence or required an operation for hardware removal. CONCLUSION It seems that the TightRope device can provide anatomical restoration in patients with acute type V ACJD without subluxation at the final follow-up examination. LEVEL OF EVIDENCE Level IV, Therapeutic study.
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Affiliation(s)
- Raşit Özcafer
- Department of Orthopaedic Surgery, Baltalimanı Bone and Joint Diseases Training and Research Hospital, İstanbul, Turkey
| | - Kutalmış Albayrak
- Department of Orthopaedic Surgery, Baltalimanı Bone and Joint Diseases Training and Research Hospital, İstanbul, Turkey
| | - Osman Lapçin
- Department of Orthopaedic Surgery, Aydın University, School of Medicine Hospital, İstanbul, Turkey
| | - Engin Çetinkaya
- Department of Orthopaedic Surgery, Baltalimanı Bone and Joint Diseases Training and Research Hospital, İstanbul, Turkey
| | - Yavuz Arıkan
- Department of Orthopaedic Surgery, Baltalimanı Bone and Joint Diseases Training and Research Hospital, İstanbul, Turkey
| | - Murat Gül
- Department of Orthopaedic Surgery, Aydın University, School of Medicine Hospital, İstanbul, Turkey
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Chernchujit B, Artha A. High grade acromioclavicular injury: Comparison of arthroscopic assisted acromioclavicular joint fixation and anatomic acromioclavicular joint reconstruction. J Orthop 2020; 22:151-157. [PMID: 32382217 DOI: 10.1016/j.jor.2020.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 04/22/2020] [Accepted: 04/23/2020] [Indexed: 12/26/2022] Open
Abstract
Background Injuries to the acromioclavicular (AC) joint disrupting the AC and Coracoclavicular (CC) ligaments could lead to loss of clavicular strut function. A High-grade AC joint injury remain challenging because of highly variety of treatment and limited evidence exists comparing clinical outcomes and complications after surgery. Purpose The purpose of this study was to compare the clinical and radiological outcome after arthroscopic assisted acromioclavicular Joint fixation and anatomic acromioclavicular joint reconstruction. Study design Retrospective Clinical Cohort Study. Methods Twenty-nine patients with a high grade (Rockwood Type III-V) Acromioclavicular Joint Injury, operatively treated with arthroscopic assisted acromioclavicular joint fixation and anatomic acromioclavicular joint reconstruction from 2012 to 2018. The clinical assessment consists of Specific AC Score (SACS) and Nottingham Score. The radiographic evaluations were performed to evaluate the stability of reduction and the complications are assessed. Results There were a significant different between groups with AC joint reconstruction and fixation group (20 vs. 8, p < 0.005) and (19 vs. 10, p < 0.005) in SAC score and Nottingham score, respectively. There were no significant different in CC dstance between two groups. At the last follow up 6 patient develop loss of reduction with CC percentage >50% in AC joint fixation. Complication developed in 5 patients (17%) including 2 mild osteolysis, 1 superficial infection, 1 implant failure, and 1 clavicle fracture. Conclusion Anatomic AC joint reconstruction was associated with functional and radiologic benefits and better restored the stability.
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Affiliation(s)
- Bancha Chernchujit
- Department of Orthopaedics, Faculty of Medicine, Thammasat University Hospital, Thailand
| | - Arrisna Artha
- Department of Orthopaedics, Faculty of Medicine, Thammasat University Hospital, Thailand
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Aliberti GM, Kraeutler MJ, Trojan JD, Mulcahey MK. Horizontal Instability of the Acromioclavicular Joint: A Systematic Review. Am J Sports Med 2020; 48:504-510. [PMID: 31013137 DOI: 10.1177/0363546519831013] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Injuries to the acromioclavicular (AC) joint are common and should be suspected in patients who have shoulder pain in the region of the acromion and clavicle. Injuries to the AC ligament can cause horizontal instability and are often neglected or underdiagnosed, which can lead to poor patient outcomes. PURPOSE To perform a systematic review of the literature on the diagnosis and treatment of horizontal instability of the AC joint. STUDY DESIGN Systematic review. METHODS The authors performed a systematic review using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed and EMBASE were searched for studies that investigated diagnosis, treatment, and failure of operative management of acute and chronic AC separations. Studies that did not specifically evaluate AC joint injuries, were not written in English, or were specific only to vertical instability of the AC joint were excluded. RESULTS Overall, 23 articles met the inclusion criteria and were therefore included in this systematic review. Diagnosing horizontal AC instability is difficult using plain radiographs; dynamic views were shown in some cases to better detect horizontal instability than with static views. More than 60 procedures for treating AC joint injuries have been published, but many focus on vertical rather than horizontal instability. Modifications to current surgical procedures to incorporate reconstruction of the horizontal component showed improved patient outcomes. Such modifications included additional AC joint suture cord cerclage, combined AC and coracoclavicular ligament reconstruction, and the Twin Tail TightRope triple button technique. Failure after surgical stabilization of AC joint separation has been reported to occur in 15% to 80% of cases. CONCLUSION No consensus is available regarding the best practices for diagnosis, evaluation, and treatment of acute or chronic horizontal instability of the AC joint. Moreover, horizontal instability injuries are often neglected or poorly understood, making diagnosis difficult, which may lead to high complication rates and failure after surgical stabilization.
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Affiliation(s)
| | - Matthew J Kraeutler
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, New Jersey, USA
| | - Jeffrey D Trojan
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Mary K Mulcahey
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
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Jordan RW, Malik S, Bentick K, Saithna A. Acromioclavicular joint augmentation at the time of coracoclavicular ligament reconstruction fails to improve functional outcomes despite significantly improved horizontal stability. Knee Surg Sports Traumatol Arthrosc 2019; 27:3747-3763. [PMID: 30267185 DOI: 10.1007/s00167-018-5152-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 09/19/2018] [Indexed: 01/23/2023]
Abstract
PURPOSE Acromioclavicular joint reconstruction is a well-established and frequently performed procedure. Recent scientific and commercial interest has led to a drive to develop and perform surgical techniques that more reliably restore horizontal stability in order to improve patient outcomes. The aim of this systematic review was to evaluate the biomechanical evidence for procedures directed at restoring horizontal stability and determine whether they are associated with superior clinical results when compared to well-established procedures. METHODS A review of the online databases Medline and EMBASE was conducted in accordance with the PRISMA guidelines on the 23rd December 2017. Biomechanical and clinical studies reporting either static or dynamic horizontal displacement following acromioclavicular joint reconstruction (Coracoclavicular reconstruction or Weaver-Dunn) were included. In addition, biomechanical and clinical studies reporting outcomes after additional augmentation of the acromioclavicular joint were included. The studies were appraised using the Methodological index for non-randomised studies tool. RESULTS The search strategy identified 18 studies eligible for inclusion: six biomechanical and 12 clinical studies. Comparative biomechanical studies demonstrated that acromioclavicular augmentation provided significantly increased horizontal stability compared to the coracoclavicular reconstruction and Weaver-Dunn procedure. Comparative clinical studies demonstrated no significant differences between coracoclavicular reconstruction with and without acromioclavicular augmentation in terms of functional outcomes (American Shoulder and Elbow Surgeon and Constant score), complication or revision rates. However, one comparative study did demonstrate an improvement in Taft (p = 0.018) and Acromioclavicular Joint Instability scores (p = 0.0001) after acromioclavicular augmentation. CONCLUSION In conclusion, coracoclavicular reconstruction with augmentation of the acromioclavicular joint has been shown to provide improved horizontal stability in both biomechanical and clinical studies compared to isolated coracoclavicular reconstruction. However, comparative studies have shown no clinical advantage with respect to American Shoulder and Elbow Surgeon or Constant scores and, therefore, the results of this systematic review do not support acromioclavicular augmentation in routine clinical practice. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Robert W Jordan
- University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK.
| | | | | | - Adnan Saithna
- Medical Technologies and Advanced Materials, Clifton Campus, Nottingham Trent University, Nottingham, NG11 8NS, UK
- Consultant Orthopaedic Surgeon, Renacres Hospital, Ormskirk, Lancashire, L39 8SE, UK
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Breuer R, Unterrainer A, Komjati M, Tiefenboeck TM, Trieb K, Pirkl C. Minimally Invasive AC Joint Reconstruction System (MINAR ®) in Modified Triple-Button Technique for the Treatment of Acute AC Joint Dislocation. J Clin Med 2019; 8:jcm8101683. [PMID: 31618809 PMCID: PMC6832357 DOI: 10.3390/jcm8101683] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 09/30/2019] [Accepted: 10/11/2019] [Indexed: 12/13/2022] Open
Abstract
Acute acromioclavicular (AC) joint dislocation is a frequent sports injury with more than 100 different operation methods described. A total of 65 patients with an acute AC joint dislocation were treated with the modified MINAR® system between 2009 and 2013. Clinical outcome, horizontal and vertical instability, as well as concomitant intraarticular injuries were assessed. We used Zanca, stress and axial X-rays for radiological assessment. A Constant score of 95 (±8.8), University of California Los Angeles Shoulder score (UCLA) of 31 (±4.9), Disabilities of Arm, Shoulder and Hand (DASH) of 9.1 (±14.3), and Visual Analogue Scale (VAS) of 0.9 (±0.126) was found. A total of 30 patients (59%) had no signs of reduction loss, nine patients (18%) a slight loss, 11 patients (22%) a partial loss, and one patient (2%) a total loss. No significant influence on the clinical scores could be shown. The postoperative coracoclavicular (CC) distance negatively affected the Constant (p = 0.007) and UCLA scores (p = 0.035). A longer time interval to surgery had a negative influence on all scores (p ≤ 0.001). We could not find any signs of persistent horizontal instability or intraarticular injuries at follow-up. The MINAR® system promises satisfactory functional and radiological results. When setting the correct indication, patients benefit from an early operation. No persisting horizontal instability was observed following suturing of the AC capsule and the delta fascia.
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Affiliation(s)
- Robert Breuer
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria.
| | - Alexandra Unterrainer
- Department of Orthopedics and Trauma Surgery, Klinikum Wels-Grieskirchen, 4600 Wels, Austria.
| | - Micha Komjati
- Department of Orthopedics, Herz-Jesu Hospital, 1030 Vienna, Austria.
| | - Thomas M Tiefenboeck
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria.
| | - Klemens Trieb
- Computed Tomography Research Group, University of Applied Sciences Upper Austria, 4600 Wels, Austria.
| | - Christof Pirkl
- Department of Orthopedics and Trauma Surgery, Klinikum Wels-Grieskirchen, 4600 Wels, Austria.
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Huang YC, Yang SW, Chen CY, Lin KC, Renn JH. Single coracoclavicular suture fixation with Mersilene tape versus hook plate in the treatment of acute type V acromioclavicular dislocation: a retrospective analysis. J Orthop Surg Res 2018; 13:110. [PMID: 29769141 PMCID: PMC5956760 DOI: 10.1186/s13018-018-0831-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 05/08/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Here, we compared the clinical and radiographic outcomes between coracoclavicular (CC) fixation with Mersilene tape and hook plate for acute unstable acromioclavicular (AC) joint dislocation treatment. METHODS We enrolled 49 patients with unstable acute AC dislocation who, between January 2010 and January 2014, underwent surgery with single CC suture fixation with Mersilene tape (M group, 25 cases) or clavicle hook plate (H group, 24 cases). In M and H groups, the average age was 43.7 (range 18-72) and 42.0 (range 17-84) years, the male to female ratio of each group was 15:20 and 19:5, and the injured side left to right ratio was 12:13 and 11:13, respectively. All patients were right-handed. We retrospectively compared the operation time, complication rate, visual analog scale (VAS), University of California at Los Angeles (UCLA) shoulder rating scale, Oxford shoulder scores, and the radiographic outcomes based on reduction loss of CC distance on postoperative follow-up. RESULTS No significant difference in patient demographics between the two groups in age (p = 0.709), gender (p = 0.217), time from injury to surgery (p = 0.863), and injured side (p = 1.000). The mean follow-up was 26.2 months (range 24-35 months). Nine cases of reduction loss (36%) and one of distal clavicle osteolysis (4%) were noted in the M group. CC distance improvement in the H group was significantly superior to that in the M group at 3 months (before hook plate removal, p < 0.001) and 12 months postoperatively (after hook plate removal, p = 0.004), while subacromial erosions were revealed in nine cases (37.5%) in the H group. No significant difference in operative time (p = 0.846), complication rate (p = 1.000), VAS (p = 0.199), mean UCLA shoulder rating scale (p = 0.353), and Oxford shoulder (p = 0.224) scores between the two groups. CONCLUSIONS Both hook plate and Mersilene tape fixations provided temporary stabilization of acute type V AC dislocation and yielded comparable clinical outcomes. The hook plate provided better maintenance of reduction of radiographic outcomes. CC suture fixation with Mersilene tape may serve as an alternative method of stabilization which provides acceptable outcome without the need of implant removal.
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Affiliation(s)
- Ying-Cheng Huang
- Department of Orthopedics, Kaohsiung Veterans General Hospital, No. 386, Ta-Chung 1st Rd, Kaohsiung, 81346, Taiwan, Republic of China
| | - Shan-Wei Yang
- Department of Orthopedics, Kaohsiung Veterans General Hospital, No. 386, Ta-Chung 1st Rd, Kaohsiung, 81346, Taiwan, Republic of China
| | - Chun-Yu Chen
- Department of Orthopedics, Kaohsiung Veterans General Hospital, No. 386, Ta-Chung 1st Rd, Kaohsiung, 81346, Taiwan, Republic of China
| | - Kai-Cheng Lin
- Department of Orthopedics, Kaohsiung Veterans General Hospital, No. 386, Ta-Chung 1st Rd, Kaohsiung, 81346, Taiwan, Republic of China
| | - Jenn-Huei Renn
- Department of Orthopedics, Kaohsiung Veterans General Hospital, No. 386, Ta-Chung 1st Rd, Kaohsiung, 81346, Taiwan, Republic of China.
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A comparison between two double-button endoscopically assisted surgical techniques for the treatment acute acromioclavicular dislocations. Musculoskelet Surg 2017; 102:73-79. [PMID: 28861851 DOI: 10.1007/s12306-017-0501-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 08/23/2017] [Indexed: 12/18/2022]
Abstract
PURPOSE To compare clinical and radiological outcomes between two endoscopically assisted double-button techniques in high-grade acute acromioclavicular separations. METHODS A retrospective single-center study was conducted in patients with acute acromioclavicular joint dislocation Rockwood types III and V, from 2009 to 2014. All were treated endoscopically, with a 1-year minimum follow-up. Two consecutive series were conducted; the first (TR group) received the TightRope® system, whereas last series (DB group) was treated with the Dog Bone® button technology (Arthrex, Naples, FL, USA). Primary endpoints were last follow-up values of Constant score (CS) and Quick-DASH (QD) score. Moreover, the posttraumatic displacement and its evolution were assessed on bilateral Zanca radiographs. A displacement of 5 mm or greater the day after surgery was considered as a lack of reduction; the same difference on last follow-up X-rays was considered as a loss of reduction. RESULTS Forty patients were reviewed: 22 in the TR group and 18 in the DB group. After a mean follow-up of 27.7 ± 8.3 months, CS and QD averaged, respectively, 94.3 ± 4.4 and 2.0 ± 2.6 in the TR series, whereas they averaged, respectively, 95 ± 6.1 and 3.4 ± 3.3 in the DB series after a mean follow-up of 24.1 ± 5 months (PCS = 0.16, PQDS = 0.08). Lack of reduction and loss of reduction rates were significantly higher in the DB group, with P = 0.0005 and P < 0.0001, respectively. CONCLUSIONS Both techniques provided good to excellent functional outcomes. However, considering inferior radiological results using the Dog Bone® device, we would prefer the TightRope® device in acute acromioclavicular dislocations. LEVEL OF EVIDENCE IV: Therapeutic study-cases series.
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