1
|
Focsa LC, Plomion M, Vignes J, Rousseau MA, Boyer P. Quality and stability of reduction of operated acromioclavicular dislocation using dual acromioclavicular and coracoclavicular stabilization. Orthop Traumatol Surg Res 2024; 110:103789. [PMID: 38070729 DOI: 10.1016/j.otsr.2023.103789] [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: 01/19/2023] [Revised: 08/24/2023] [Accepted: 09/27/2023] [Indexed: 12/17/2023]
Abstract
INTRODUCTION Dual stabilization is advocated in acute acromioclavicular dislocation (ACD), but has been little assessed. OBJECTIVE This preliminary study performed clinical and radiological assessment of dual acromioclavicular (AC) and coracoclavicular (CC) stabilization in acute ACD. The study hypothesis was that dual stabilization allows satisfactory reduction that remains stable over time. MATERIALS AND METHODS A button was used under endoscopy for CC stabilization. For AC stabilization, a short approach was used; the joint was cleansed then stabilized by an anchored tape between the acromion and the clavicle to promote ligament healing. Clinical assessment was based on a visual analog pain scale (VAS), joint range of motion and Quick-DASH and Constant scores. Radiological reduction was assessed on the ratio of CC distance between the operated and healthy sides on two views. MRI was used in follow-up to screen for ligament healing: thickening and continuity. RESULTS Thirty-five patients with stage 3-5 acute dislocation were included. At a minimum 24 months' follow-up, mean clinical scores were very satisfactory, with recovery of motion and pain relief. Radiography showed 94% stable reduction in both vertical and horizontal planes. MRI confirmed CC and AC ligament healing. Postoperative complications mainly comprised 4 cases of reduction loss (11%). One clavicle fracture occurred, at 6 months. CONCLUSION Dual AC-CC stabilization provided very good radiographic reduction in both horizontal and vertical planes. Functional results were very satisfactory, and complications were few, with some cases of reduction loss. These good results encourage us to continue with dual stabilization in acute ACD. LEVEL OF EVIDENCE II; prospective cohort.
Collapse
Affiliation(s)
- Laurentiu-Cosmin Focsa
- Service de chirurgie orthopédique et traumatologique, hôpitaux Bichat-Beaujon, Assistance publique-Hôpitaux de Paris, 46, rue Henri-Huchard, 75018 Paris, France.
| | - Marie Plomion
- Service de chirurgie orthopédique et traumatologique, hôpitaux Bichat-Beaujon, Assistance publique-Hôpitaux de Paris, 46, rue Henri-Huchard, 75018 Paris, France
| | - Julien Vignes
- Service de chirurgie orthopédique et traumatologique, hôpitaux Bichat-Beaujon, Assistance publique-Hôpitaux de Paris, 46, rue Henri-Huchard, 75018 Paris, France
| | - Marc-Antoine Rousseau
- Service de chirurgie orthopédique et traumatologique, hôpitaux Bichat-Beaujon, Assistance publique-Hôpitaux de Paris, 46, rue Henri-Huchard, 75018 Paris, France; Faculté de médecine, université Paris Cité, 15, rue de l'école de médecine, 75006 Paris, France
| | - Patrick Boyer
- Service de chirurgie orthopédique et traumatologique, hôpitaux Bichat-Beaujon, Assistance publique-Hôpitaux de Paris, 46, rue Henri-Huchard, 75018 Paris, France; Faculté de médecine, université Paris Cité, 15, rue de l'école de médecine, 75006 Paris, France
| |
Collapse
|
2
|
Finsterwald M, Dao Trong ML, Hollo D, Müller AM, Riede U, Bouaicha S. Conservative treatment of Rockwood type III acromioclavicular joint separation: a randomized controlled trial sling vs. brace. JSES Int 2023; 7:527-531. [PMID: 37426936 PMCID: PMC10328777 DOI: 10.1016/j.jseint.2023.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Abstract
Background Management of Rockwood III acromioclavicular joint separations is a matter of ongoing debate, with nonoperative treatment being favored in recent literature. The aim of this study is to compare clinical and radiological outcomes of nonoperative treatment with a brace, which elicits a direct reduction force to the distal clavicle, to a sling. We hypothesized the brace might yield in better acromioclavicular joint (ACJ) reduction and cosmesis. Methods In this dual center prospective randomized controlled trial, all patients sustaining an acromioclavicular joint separation Rockwood III between July 2017 and August 2020 were included. Patients with previous ipsi- or contralateral ACJ injury or surgery were excluded. Randomization occurred in the emergency department to either the sling or brace group. Patients were followed up at 1, 6, and 12 weeks. Patient-reported outcome measures included subjective shoulder value (SSV) and American Shoulder and Elbow Surgeons (ASES) score at each follow-up and Constant Score at 6 and 12 weeks. Vertical distal clavicle displacement was assessed on bilateral non-weighted panoramic anteroposterior radiographs using coracoclavicular (CC) distance to calculate the CC-index. Results Thirty-five consecutive patients were included across the 2 sites, 18 (all male) in the brace and 17 (14 male) in the sling group. Baseline characteristics did not differ significantly between groups, the average age was 40 years, and body mass index 25.5 kg/m2. Analysis revealed no statistical difference in CC-index between groups at the time of injury, 6 weeks and 12 weeks postinjury (P = .39, P = .11, and P = .21). SSV improved from 30 and 35 postinjury to 81 and 84 at 12 weeks in the sling and brace group, respectively (P = .59). ASES improved from 48 and 38 to 82 and 83, respectively (P = .84). Similarly, Constant Score improved from 64 and 67 to 82 and 81, respectively (P = .90). One patient in the brace group underwent ACJ stabilization with hamstring autograft at 4 months due to persistent pain. Conclusion This randomized controlled trial shows no statistically significant difference between the brace and sling group in clinical (SSV, ASES, Constant Score) or radiological (CC-index) outcomes after conservative treatment of Rockwood III injuries.
Collapse
Affiliation(s)
- Michael Finsterwald
- Department of Orthopaedic Surgery and Traumatology, Bürgerspital Solothurn, Solothurn, Switzerland
| | - Mai Lan Dao Trong
- Department of Orthopaedic Surgery and Traumatology, Bürgerspital Solothurn, Solothurn, Switzerland
| | - David Hollo
- Department of Orthopaedic Surgery, University Hospital Basel and Bethesda Hospital, Basel, Switzerland
| | - Andreas M. Müller
- Department of Orthopaedic Surgery, University Hospital Basel and Bethesda Hospital, Basel, Switzerland
| | - Ulf Riede
- Department of Orthopaedic Surgery and Traumatology, Bürgerspital Solothurn, Solothurn, Switzerland
| | - Samy Bouaicha
- Department of Orthopaedic Surgery and Traumatology, Bürgerspital Solothurn, Solothurn, Switzerland
- Department of Orthopaedic Surgery, Balgrist University Hospital, Zurich, Switzerland
| |
Collapse
|
3
|
Subject-specific computational modeling of acromioclavicular and coracoclavicular ligaments. J Shoulder Elbow Surg 2023; 32:526-532. [PMID: 36243298 DOI: 10.1016/j.jse.2022.09.004] [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: 06/17/2022] [Revised: 08/29/2022] [Accepted: 09/12/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Disruption of the acromioclavicular joint is a common injury. Despite the different surgical procedures described for treating this injury, complications such as loss of reduction and failure of fixation remain unacceptably high. We developed a computer model of the acromioclavicular joint to better understand the biomechanical contributions of the ligaments that are typically injured. METHODS Six fresh frozen human cadaveric shoulders were tested on an AMTI VIVO 6-degree of freedom test platform to measure force-displacement in inferior translation, anteroposterior translation, and internal rotation before and after sequentially transecting the coracoclavicular and acromioclavicular ligaments. These data were used to construct computer models of each specimen. Three-dimensional computed tomographic scans were used to generate a rigid-body dynamics model using the AnyBody Modeling System. The scapula and clavicle were connected by the acromioclavicular joint capsule, the conoid ligament, and the trapezoid ligament. Subject-specific ligament properties were calculated by matching computer predictions to experimental force-displacement data. RESULTS The calculated free lengths of the conoid, trapezoid, and acromioclavicular ligaments were 13.5 (±3.2), 11.8 (±2.4), and 11.0 (±2.7) mm, respectively. The calculated stiffnesses of the conoid, trapezoid, and acromioclavicular ligaments were 34.3 (±6.3), 28.4 (±3.2), and 33.8 (±8.2) N/mm, respectively. Root mean square deviation (RMSD) of predicted force-displacement curves relative to experimental force-displacement curves (during inferior and anteroposterior translation) was less than 1 mm. For validation of subject-specific models, after ligament properties were calculated, the RMSD of the predicted torque over 15° of internal rotation was 12% of maximum rotational torque (average for 6 specimens). DISCUSSION AND CONCLUSION Acromioclavicular disruption results in multidirectional instability, which requires careful consideration of the individual contributions of the injured ligaments. In addition, variations in patient anatomy can significantly affect the biomechanical stability of the reconstruction. Subject-specific models can enhance our understanding of the individual and collective biomechanical contributions of the injured soft tissues to the multiaxial stability of the acromioclavicular joint. These models may also be useful for analyzing and assessing biomechanical stability after various types of surgical reconstruction.
Collapse
|
4
|
Abstract
BACKGROUND Acromioclavicular joint (ACJ) injuries are among the most common injuries in contact and non-contact sports. As winter sports become more popular, there has been an increase in shoulder injuries among recreational skiers and snowboarders. METHODS This was a retrospective analysis of all patients who presented to the Denver Health Winter Park Medical Center with ACJ injury from 2012 to 2017. We examined the incidence of ACJ injuries, the injury mechanism, demographics, and type of ACJ injuries among skiers and snowboarders treated at the clinic. RESULTS A total of 341 ACJ injuries (6.7% of total visits) were encountered during the study period. The majority of ACJ injures were type I (41.3%) and mainly occurred in men (86.5%). Most (96.8%) of the cases were primary ACJ injuries on the right shoulder (56.9%). The average age of patients with ACJ injuries was 30.0 years (range 10-72). More than half (62.2%) of ACJ injuries occurred while snowboarding. The most common mechanism of injury (93.5%) was fall to the snow while skiing/snowboarding. Women were more likely to have a type I ACJ injury than men (80.4% vs 35.4%; P < 0.001). Women with ACJ injuries were more likely to suffer the injury while skiing than snowboarding (71.7% vs 28.3%; P < 0.001), compared to men who were more likely to suffer the injury while snowboarding than skiing (67.5% vs 32.5%; P < 0.001). CONCLUSIONS Most of the ACJ injuries were type I and occurred mostly in men. Snowboarders were more likely to have an ACJ injury than skiers. LEVEL OF EVIDENCE Level IV, Epidemeiology Study.
Collapse
Affiliation(s)
- Naomi Kelley
- University of Colorado School of Medicine, Denver, CO
| | - Lauren Pierpoint
- Center for Outcomes-Based Orthopedic Research, Steadman Philippon Research Institute, Vail, Co
| | - Jack Spittler
- Department of Family Medicine and Orthopedics, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Morteza Khodaee
- Department of Family Medicine and Orthopedics, University of Colorado School of Medicine, Denver, Colorado, USA
| |
Collapse
|
5
|
Chaichana T, Apivatgaroon A, Rujiraphum P, Sanguanjit P, Chernchujit B. Reliability of Upright Chest Radiography as a Diagnostic Screening Tool for Acromioclavicular Joint Dislocations. Orthop J Sports Med 2023; 11:23259671221143767. [PMID: 36644777 PMCID: PMC9837291 DOI: 10.1177/23259671221143767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 09/26/2022] [Indexed: 01/12/2023] Open
Abstract
Background The standard radiographic view for diagnosing acromioclavicular joint (ACJ) dislocations is the Zanca view of both shoulders to assess superior displacement of the distal clavicle by measuring the coracoclavicular distance (CCD) and comparing it with the uninjured shoulder; however, there is no consensus on a gold standard for diagnostic measures to classify acute ACJ injuries. Purpose To compare the CCD from an upright chest radiograph with a standard Zanca view of both shoulders in patients with an ACJ dislocation. Study Design Cohort study (diagnosis); Level of evidence, 3. Methods We reviewed the records of 70 patients with an ACJ dislocation between 2010 and 2021 who had both an upright chest radiograph and a Zanca view. An ACJ dislocation was classified as low grade (Rockwood types 1-3) or high grade (Rockwood type 5). The CCD was measured on the upright chest radiograph and the Zanca view by 2 independent reviewers, and the percentage of the CCD difference compared with the unaffected side (ΔCCD) was calculated and compared between the upright chest radiograph and the Zanca view. Interrater and intrarater reliability were determined using the intraclass correlation coefficient. Results Included were 70 patients (55 male and 15 female; mean age, 46 years). There were 29 patients (41.43%) with a low-grade injury and 41 patients (58.57%) with a high-grade injury. In the overall analysis, the ΔCCD on the upright chest radiograph and Zanca view was significantly different (130.25% ± 88.42% vs 152.69% ± 106.56%, respectively; mean difference, 22.44% [95% CI, 2.40% to 42.48%]; P = .029). The subgroup analysis revealed that the ΔCCD on the upright chest radiograph and Zanca view was significantly different for patients with a low-grade injury (60.71% ± 25.79% vs 91.46% ± 68.54%, respectively; mean difference, 30.76% [95% CI, 7.18% to 54.33%]; P = .012) but not different for patients with a high-grade injury (179.45% ± 83.87% vs 196.00% ± 107.97%, respectively; mean difference, 16.56% [95% CI, -14.06% to 47.18%]; P = .281). The intraclass correlation coefficients for the ΔCCD measurements indicated good to excellent interrater and intrarater reliability. Conclusion The study findings indicated that upright chest radiography can be used as a diagnostic screening tool for high-grade ACJ dislocations, but not for low-grade ACJ injuries, compared with the Zanca view.
Collapse
Affiliation(s)
- Tanakorn Chaichana
- Department of Orthopaedics, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Adinun Apivatgaroon
- Department of Orthopaedics, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand.,Adinun Apivatgaroon, MD, Department of Orthopaedics, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand ()
| | - Possawat Rujiraphum
- Department of Orthopaedics, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Prakasit Sanguanjit
- Department of Orthopaedics, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Bancha Chernchujit
- Department of Orthopaedics, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| |
Collapse
|
6
|
Berthold DP, Muench LN, Dyrna F, Mazzocca AD, Garvin P, Voss A, Scheiderer B, Siebenlist S, Imhoff AB, Beitzel K. Current concepts in acromioclavicular joint (AC) instability - a proposed treatment algorithm for acute and chronic AC-joint surgery. BMC Musculoskelet Disord 2022; 23:1078. [PMID: 36494652 PMCID: PMC9733089 DOI: 10.1186/s12891-022-05935-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 10/30/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND There exists a vast number of surgical treatment options for acromioclavicular (AC) joint injuries, and the current literature has yet to determine an equivocally superior treatment. AC joint repair has a long history and dates back to the beginning of the twentieth century. MAIN BODY Since then, over 150 different techniques have been described, covering open and closed techniques. Low grade injuries such as Type I-II according to the modified Rockwood classification should be treated conservatively, while high-grade injuries (types IV-VI) may be indicated for operative treatment. However, controversy exists if operative treatment is superior to nonoperative treatment, especially in grade III injuries, as functional impairment due to scapular dyskinesia or chronic pain remains concerning following non-operative treatment. Patients with a stable AC joint without overriding of the clavicle and without significant scapular dysfunction (Type IIIA) may benefit from non-interventional approaches, in contrast to patients with overriding of the clavicle and therapy-resistant scapular dysfunction (Type IIIB). If these patients are considered non-responders to a conservative approach, an anatomic AC joint reconstruction using a hybrid technique should be considered. In chronic AC joint injuries, surgery is indicated after failed nonoperative treatment of 3 to 6 months. Anatomic AC joint reconstruction techniques along with biologic augmentation (e.g. Hybrid techniques, suture fixation) should be considered for chronic high-grade instabilities, accounting for the lack of intrinsic healing and scar-forming potential of the ligamentous tissue in the chronic setting. However, complication and clinical failure rates remain high, which may be a result of technical failures or persistent horizontal and rotational instability. CONCLUSION Future research should focus on addressing horizontal and rotational instability, to restore native physiological and biomechanical properties of the AC joint.
Collapse
Affiliation(s)
- Daniel P. Berthold
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany ,grid.411095.80000 0004 0477 2585Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - Lukas N. Muench
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Felix Dyrna
- Department of Trauma, Hand and Reconstructive Surgery University Hospital Münster, Munich, Germany
| | - Augustus D. Mazzocca
- grid.32224.350000 0004 0386 9924Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 USA
| | - Patrick Garvin
- grid.32224.350000 0004 0386 9924Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 USA
| | - Andreas Voss
- grid.7727.50000 0001 2190 5763Department of Trauma Surgery, University Regensburg, Regensburg, Germany
| | - Bastian Scheiderer
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Sebastian Siebenlist
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Andreas B. Imhoff
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Knut Beitzel
- Arthroscopy and Orthopedic Sportsmedicine, ATOS Orthoparc Clinic, Cologne, Germany
| |
Collapse
|
7
|
Peras M, Caubere A, Amar S, De Villeneuve Bargemon JB, Choufani C, Barbier O. Does the choice of the optic portal influence the radiographic and early functional results in acute acromioclavicular disjunctions? Acta Orthop Belg 2022; 88:719-725. [PMID: 36800655 DOI: 10.52628/88.4.10413] [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: 02/20/2023]
Abstract
Exposure of the coracoid process during arthroscopic stabilization of acute acromioclavicular disjunctions (ACDs) can be achieved either by passing an extra- articular optical portal through the subacromial space or by an intra-articular optical route through the glenohumeral joint with opening of the rotator interval. The objective of our study was to compare the impact on the functional results of these two optical routes. This was a retrospective, multicentre study that included patients operated on for an acute acromioclavicular disjunction arthroscopically. The treatment consisted of surgical stabilization under arthroscopy. The surgical indication was retained for an acromioclavicular disjunction of grade 3, 4 or 5, according to the Rockwood classification. Group 1, which consisted of 10 patients, was operated on with an extra-articular subacromial optical route, and group 2, which consisted of 12 patients, was operated on with an intra-articular optical route with opening of the rotator interval according to the habits of the surgeon. A follow-up of 3 months was performed. The functional results were evaluated for each patient using the Constant score, Quick DASH, and SSV. The delays in returning to professional and sports activities were also noted. A precise postoperative radiological analysis made it possible to analyse the quality of the radiological reduction. No significant difference between the two groups was found between the Constant score (88 vs. 90; p = 0.56), Quick DASH (7 vs. 7; p = 0.58), or SSV (88 vs. 93; p = 0.36). The times to return to work (6.8 weeks vs. 7.0 weeks; p = 0.54) and sports activities (15.6 weeks vs. 19.5 weeks; p = 0.53) were also comparable. The quality of the radiological reduction was satisfactory in the two groups and did not depend on the approach. No clinically or radiologically significant differences between the extra-articular and intra-articular optical portals in the surgical treatment of acute ACDs were found. The optical route can be chosen according to the habits of the surgeon.
Collapse
|
8
|
Phornphutkul C, Rajchawiang K. The “Chiang Mai Lean Forward” Radiographic View for Acromioclavicular Joint Injuries: A Cadaveric Study. Orthop J Sports Med 2022; 10:23259671221084284. [PMID: 35340728 PMCID: PMC8941710 DOI: 10.1177/23259671221084284] [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: 10/11/2021] [Accepted: 12/22/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Operative treatment is suggested for unstable type 3 acromioclavicular (AC)
joint injuries; however, there is no clear consensus regarding the
definition of an unstable type 3 injury. We propose a new radiographic
method, the “Chiang Mai lean forward” view, to verify horizontal
displacement in an unstable AC joint injury. Hypothesis: A radiograph taken with the torso leaning forward would allow the detection
of a higher proportion of AC joint injuries. Study Design: Descriptive laboratory study. Methods: A total of 20 shoulders from 10 fresh whole-body cadaveric specimens (mean
age, 68.8 years) were tested at 3 different torso leaning angles (30°, 45°,
and 60°) to determine the best position for projecting the x-ray beam. The
shoulders were dissected sequentially starting with the AC ligament (stage
1), then additional sectioning of the partial coracoclavicular (CC) ligament
with either the trapezoid ligament cut first (stage 2A) or the conoid
ligament cut first (stage 2B), and finally complete sectioning of the CC
ligament (stage 3). Radiography was performed after each stage to evaluate
the degree of displacement of the anterior border of the acromion relative
to the anterior border of the clavicle. Paired t tests were
used to compare the degree of displacement at each stage to that of the
shoulder before cutting. Results: Leaning at an angle of 30° provided better visualization of the AC joint in
the “Chiang Mai lean forward” view. Compared with the intact condition,
complete isolated cutting of the AC ligament produced 5.21 mm of horizontal
displacement of the AC joint (P < .0001), complete
tearing of the AC ligament and partial cutting of the CC ligament resulted
in a displacement of <12 mm (7.91 mm at stage 2A [P =
.0003] and 8.10 mm at stage 2B [P = .0013]), and complete
tearing of both the AC and the CC ligaments resulted in a displacement of
26.37 mm (P < .0001). Conclusion: The “Chiang Mai lean forward” radiographic view is a potentially useful tool
for determining the degree of the injury and the stability of the AC
joint.
Collapse
Affiliation(s)
- Chanakarn Phornphutkul
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Korakod Rajchawiang
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| |
Collapse
|
9
|
Yan YY, Holmes RD, Mallinson PI, Andrews GT, Munk PL, Ouellette HA. Imaging Review of Hockey-Related Upper Extremity Injuries. Semin Musculoskelet Radiol 2022; 26:3-12. [PMID: 35139555 DOI: 10.1055/s-0041-1731422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Ice hockey is a fast-paced contact sport with a high incidence of injuries. Upper extremity injury is one of the most common regions of the body to be injured in hockey. This imaging review will equip the radiologist with a knowledge of the more common and severe upper extremity injuries that occur in this sport.
Collapse
Affiliation(s)
- Yet Yen Yan
- Musculoskeletal Section, Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada.,Department of Radiology, Changi General Hospital, Singapore, Singapore
| | - R Davis Holmes
- Musculoskeletal Section, Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Paul I Mallinson
- Musculoskeletal Section, Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Gordon T Andrews
- Musculoskeletal Section, Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Peter L Munk
- Musculoskeletal Section, Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Hugue A Ouellette
- Musculoskeletal Section, Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
10
|
Rupp MC, Kadantsev PM, Siebenlist S, Hinz M, Feucht MJ, Pogorzelski J, Scheiderer B, Imhoff AB, Muench LN, Berthold DP. Low rate of substantial loss of reduction immediately after hardware removal following acromioclavicular joint stabilization using a suspensory fixation system. Knee Surg Sports Traumatol Arthrosc 2022; 30:3842-3850. [PMID: 35451639 PMCID: PMC9568474 DOI: 10.1007/s00167-022-06978-5] [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: 04/11/2021] [Accepted: 04/01/2022] [Indexed: 11/10/2022]
Abstract
PURPOSE To evaluate immediate loss of reduction in patients undergoing hardware removal after arthroscopically assisted acromioclavicular (AC) joint stabilization using a high-tensile suture tape suspensory fixation system and to identify risk factors associated with immediate loss of reduction. MATERIALS AND METHODS Twenty-two consecutive patients with a mean age of 36.4 ± 12.6 years (19-56), who underwent hardware removal 18.2 ± 15.0 months following arthroscopically assisted stabilization surgery using a suspensory fixation system for AC joint injury between 01/2012 and 01/2021 were enrolled in this retrospective monocentric study. The coracoclavicular distance (CCD) as well as the clavicular dislocation/acromial thickness (D/A) ratio were measured on anterior-posterior radiographs prior to hardware removal and immediately postoperatively by two independent raters. Loss of reduction, defined as 10% increase in the CCD, was deemed substantial if the CCD increased 6 mm compared to preoperatively. Constitutional and surgical characteristics were assessed in a subgroup analysis to detect risk factors associated with loss of reduction. RESULTS Postoperatively, the CCD significantly increased from 12.6 ± 3.7 mm (4.8-19.0) to 14.5 ± 3.3 mm (8.7-20.6 mm) (p < 0.001) while the D/A ratio increased from 0.4 ± 0.3 (- 0.4-0.9) to 0.6 ± 0.3 (1.1-0.1) (p = 0.034) compared to preoperatively. In 10 cases (45%), loss of reduction was identified, while a substantial loss of reduction (> 6 mm) was only observed in one patient (4.5%). A shorter time interval between index stabilization surgery and hardware removal significantly corresponded to immediate loss of reduction (11.0 ± 5.6 vs. 30.0 ± 20.8 months; p = 0.007), as hardware removal within one year following index stabilization was significantly associated with immediate loss of reduction (p = 0.027; relative risk 3.4; odds ratio 11.67). CONCLUSIONS Substantial loss of reduction after hardware removal of a high-tensile suture tape suspensory fixation system was rare, indicating that the postoperative result of AC stabilization is not categorically at risk when performing this procedure. Even though radiological assessment of the patients showed a statistically significant immediate superior clavicular displacement after this rarely required procedure, with an increased incidence in the first year following stabilization, this may not negatively influence the results of ACJ stabilization in a clinically relevant way. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Marco-Christopher Rupp
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Pavel M. Kadantsev
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany ,European Clinic of Sports Traumatology and Orthopaedics (ECSTO), Moscow, Russian Federation ,grid.77642.300000 0004 0645 517XPeoples Friendship University of Russia, Moscow, Russian Federation
| | - Sebastian Siebenlist
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Maximilian Hinz
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Matthias J. Feucht
- Orthopaedic Clinic Paulinenhilfe, Diakonie-Hospital, Stuttgart, Germany ,grid.5963.9Department of Orthopaedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Jonas Pogorzelski
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Bastian Scheiderer
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Andreas B. Imhoff
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Lukas N. Muench
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Daniel P. Berthold
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| |
Collapse
|
11
|
Lau ETC, Hong CC, Poh KS, Manohara R, Ng DZ, Lim JL, Kumar VP. A relook at the reliability of Rockwood classification for acromioclavicular joint injuries. J Shoulder Elbow Surg 2021; 30:2191-2196. [PMID: 33582181 DOI: 10.1016/j.jse.2021.01.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 12/20/2020] [Accepted: 01/10/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Controversies for treatment of acromioclavicular joint injuries in particular type III injuries may be partially attributed to the lack of a standardized method of radiography and measurement technique. Previous studies looking at the Rockwood classification showed poor inter- and intraobserver reliability (Kappa value approximately 0.20-0.50). We hypothesized that the use of unilateral instead of bilateral acromioclavicular joint radiographs was the cause of this finding. In this article, we standardized the methodology to perform the radiograph and to measure the coracoclavicular distances. We designed the study to focus on the reliability of differentiating type III and type V injuries. METHODS A standardized radiographic protocol for bilateral Zanca view was established in our institution. All patients who underwent this radiographic examination over a 3-year period were reviewed. Radiographs of 55 patients with significant (type III or V) injury met the inclusion criteria. For the interobserver reliability, a retrospective radiographic review was performed by 6 orthopedic surgeons and graded as either type III or V. For intraobserver reliability, a similar process was repeated by 3 observers after a period of 6 weeks. RESULTS Going by the majority agreement of the 6 reviewers, there were 34 type III injuries and 19 type V injuries. The Fleiss kappa for interobserver reliability was calculated to be 0.624. The Cohen kappa for intraobserver reliability was calculated to be 0.696. DISCUSSION The use of a standardized radiographic protocol-taking bilateral Zanca views on the same radiographic plate-would help eliminate a significant amount of variability and improve the reliability of classifying acromioclavicular joint injuries using the Rockwood classification, which uses a relative measure to the contralateral site as its definition criteria. Other possible sources of poor reliability may include the masking of injuries by muscle spasm, resulting in a misdiagnosis of a high-grade injury as a lower-grade one and the possible need to subclassify type III injuries. CONCLUSION Reliability of the Rockwood classification can be improved through the use of a standardized radiographic protocol to improve the detection of vertical instability. Similar to Rockwood dividing up Tossy grade 3 injuries when he noted the differential outcome and intervention, Rockwood type III injuries would likely require further subclassification as it remains an anomalous tool with high variability. Further studies are required to understand the pathologic basis of transition of type III into type V injury.
Collapse
Affiliation(s)
| | - Choon Chiet Hong
- Department of Orthopaedic Surgery, National University Hospital, Singapore
| | - Keng Soon Poh
- Department of Orthopaedic Surgery, National University Hospital, Singapore
| | - Ruben Manohara
- Department of Orthopaedic Surgery, National University Hospital, Singapore
| | - Dennis Zhaowen Ng
- The Orthopaedic Centre (Gleneagles), Gleneagles Medical Centre, Singapore
| | - Joel Louis Lim
- Department of Orthopaedic Surgery, National University Hospital, Singapore
| | - Veerasingam Prem Kumar
- Department of Orthopaedic Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| |
Collapse
|
12
|
Nordin JS, Mogianos F, Hauggaard A, Lunsjö K. Weighted or internal rotation radiographs are not useful in the classification of acromioclavicular joint dislocations. Acta Radiol 2021; 62:758-765. [PMID: 32660317 DOI: 10.1177/0284185120939270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Weighted radiographs are performed to classify acromioclavicular joint dislocations; however, the evidence regarding their usefulness is conflicting. Laboratory studies suggest that internal rotation views can replace weighted radiographs, but this has not been clinically evaluated. PURPOSE To evaluate whether weighted or internal rotation radiographs uncovers more high-grade acromioclavicular joint dislocations than non-weighted radiographs. MATERIAL AND METHODS A total of 162 patients with acromioclavicular joint dislocations were prospectively included. After applying exclusion criteria, 140 remained. Three panorama radiographs, including both coracoclavicular intervals, were completed of each participant: first, a weighted radiograph with 5-kg weights suspended from the wrists; second, a non-weighted radiograph; and third, an internal rotation radiograph. The coracoclavicular intervals were measured by two radiologists independently, and measurements were translated into Rockwood classifications. The classifications and measurements derived from the different radiographic views were compared. RESULTS Weighted radiographs caused no significant changes in classification. For the internal rotation views, there was a significant change in classification for radiologist 2; however, the reason was that more injuries were downgraded compared to the non-weighted views. Relative to the non-weighted radiographs, the mean increase of the coracoclavicular interval on the injured side in the weighted view was 0.5 mm (95% confidence interval [CI] 0.37-0.65) and in the internal rotation view 0.2 mm (95% CI 0.04-0.33). While these changes were statistically significant, they were small and not clinically important. CONCLUSION This study does not support the use of weighted and internal rotation radiographs in the classification of acromioclavicular joint dislocations.
Collapse
Affiliation(s)
- Jonas S Nordin
- Department of Orthopedics, Helsingborg Hospital, Lund University, Helsingborg, Sweden
| | | | - Anders Hauggaard
- Radiology Department, Helsingborg Hospital, Lund University, Helsingborg, Sweden
| | - Karl Lunsjö
- Department of Orthopedics, Helsingborg Hospital, Lund University, Helsingborg, Sweden
| |
Collapse
|
13
|
Murphy RJ, Moor BK, Lesniewski PJ, Hayoz A, Alcantara W, Zumstein MA. Evaluation of the Circles Measurement and the ABC Classification of Acromioclavicular Joint Injuries. Am J Sports Med 2021; 49:1619-1625. [PMID: 33856933 DOI: 10.1177/03635465211003300] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Acromioclavicular joint (ACJ) injuries are common. Despite this, it remains unclear how best to assess, classify, and manage these cases. A simple, reliable, valid, and accurate radiographic parameter to measure ACJ displacement would allow improved consistency of diagnosis and subsequent treatment pathways. PURPOSE To evaluate "the circles measurement" and associated "ABC classification" as a tool for assessing ACJ displacement and injury classification. STUDY DESIGN Descriptive laboratory study. METHODS The circles measurement is taken from a lateral Alexander radiograph of the shoulder. The measurement is the center-to-center distance between 2 circles drawn to define the lateral extent of the clavicle and the anteromedial extent of the acromion; it is independent of the displacement plane, judging total ACJ displacement in any direction rather than trying to quantify vertical and/or horizontal displacement. When utilized clinically, the circles measurement is a single measurement calculated as the difference between values recorded for the injured and uninjured sides. Validation of the circles measurement was performed using lateral Alexander radiographs (including ±20° projection error in all planes) and computed tomography of standardized ACJ injury simulations. We assessed inter- and intrarater reliability, convergent validity, and discriminant validity of the circles measurement and subsequently generated a classification of ACJ injury based on displacement. RESULTS Reliability and validity of the circles measurement was excellent throughout. Interrater reliability (ICC [intraclass correlation coefficient] [2,1], 95% CI; n = 78; 4 observers) was 0.976 (0.964-0.985). Intrarater reliability (ICC [2,1]; 95% CI; n = 78; 2 measures) was 0.998 (0.996-0.998). Convergent validity (Pearson correlation coefficient, r) was 0.970 for ideal radiographs and 0.889 with ±20° projection error in all planes. Discriminant validity, with 1-way analysis of variance, showed a P value of <.0001 and effect size (η2) of 0.960, with the ability to distinguish between the previously defined stable (Rockwood IIIA) and unstable (Rockwood IIIB) injuries. The results permitted objective, statistically sound parameters for the proposed ABC classification system. CONCLUSION The circles measurement is a simple, reliable, valid, accurate, and resilient parameter for assessing ACJ displacement and can be used in conjunction with the proposed ABC classification to define ACJ injuries more accurately and objectively than previously described. CLINICAL RELEVANCE This novel parameter has the potential to standardize the initial assessment and possibly the subsequent clinical management of ACJ injuries, in addition to providing a standardized measure for future research.
Collapse
Affiliation(s)
- Richard J Murphy
- Shoulder, Elbow and Orthopaedic Sports Medicine, Sonnenhof Orthopaedics, Bern, Switzerland.,Shoulder, Elbow and Orthopaedic Sports Medicine, Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, Bern, Switzerland.,University Hospitals Sussex NHS Foundation Trust, Royal Sussex County Hospital, Brighton, UK
| | - Beat K Moor
- Hôpital du Valais (RSV) - Centre Hospitalier du Valais Romand, Hôpital de Martigny, Martigny, France
| | - Piotr J Lesniewski
- Shoulder, Elbow and Orthopaedic Sports Medicine, Sonnenhof Orthopaedics, Bern, Switzerland.,Shoulder, Elbow and Orthopaedic Sports Medicine, Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Annabel Hayoz
- Shoulder, Elbow and Orthopaedic Sports Medicine, Sonnenhof Orthopaedics, Bern, Switzerland.,Stiftung Lindenhof I Campus SLB, Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland
| | - Wolfan Alcantara
- Shoulder, Elbow and Orthopaedic Sports Medicine, Sonnenhof Orthopaedics, Bern, Switzerland
| | - Matthias A Zumstein
- Shoulder, Elbow and Orthopaedic Sports Medicine, Sonnenhof Orthopaedics, Bern, Switzerland.,Shoulder, Elbow and Orthopaedic Sports Medicine, Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, Bern, Switzerland.,Stiftung Lindenhof I Campus SLB, Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland
| |
Collapse
|
14
|
Ultrasound Evaluation of Anterior Acromioclavicular Relationship in the Horizontal Plane on 40 Healthy Subjects. A New Possibility for Differential Diagnosis of Acromioclavicular Disjunctions Rockwood Stage 3 and 4? A Pilot Study. Clin J Sport Med 2020; 30:e219-e224. [PMID: 30312184 DOI: 10.1097/jsm.0000000000000675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the repeatability and reproducibility of an ultrasound examination of the acromioclavicular joint (ACJ) performed by an orthopaedic surgeon to analyze anterior ACJ relationship in the horizontal plane. DESIGN Prospective observational study on healthy subjects. SETTING The study was conducted in 2017 in a university department of orthopaedic surgery and traumatology. LEVEL OF EVIDENCE III. PATIENTS (OR PARTICIPANTS) Forty consecutive volunteers aged 18 to 40 years were involved. INTERVENTIONS (OR ASSESSMENT OF RISK FACTORS OR INDEPENDENT VARIABLES):: The ultrasound examination was performed by 2 orthopaedic surgeons with a SonoSite M-Turbo portable ultrasound machine (Fujifilm, Japan). Distance measurement between the anterior edge of the clavicle (AECL) and the anterior edge of the acromion (AEAC) was done on the right side, then on the left one and repeated by the same examiner. MAIN OUTCOME MEASURES The intra- and interexaminer reproducibility of measurements was analyzed as primary outcome. Concordance of distance measurements between the right and left sides on the same subject was evaluated, as well as the "typical morphology" of the ACJ in the horizontal plane. RESULTS The intra- and interexaminer reproducibility for AECL-AEAC distance measurements was, respectively, 0.95 (0.93-0.97) and 0.87 (0.84-0.90). The correlation between the right and left sides was significant (P < 0.001), with a reproducibility of 0.86 (0.83-0.89). Twenty-seven (67.5%) volunteers were considered to have a "perfect alignment" of the AECL and AEAC. CONCLUSIONS This study confirms that it is possible to evaluate with good reproducibility the anterior AC relationship in the horizontal plane and that both sides are similar on the same subject.
Collapse
|
15
|
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.
Collapse
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
| |
Collapse
|
16
|
Flores DV, Goes PK, Gómez CM, Umpire DF, Pathria MN. Imaging of the Acromioclavicular Joint: Anatomy, Function, Pathologic Features, and Treatment. Radiographics 2020; 40:1355-1382. [PMID: 32762593 DOI: 10.1148/rg.2020200039] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The acromioclavicular joint is an important component of the shoulder girdle; it links the axial skeleton with the upper limb. This joint, a planar diarthrodial articulation between the clavicle and the acromion, contains a meniscus-like fibrous disk that is prone to degeneration. The acromioclavicular capsule and ligaments stabilize the joint in the horizontal direction, while the coracoclavicular ligament complex provides vertical stability. Dynamic stability is afforded by the deltoid and trapezius muscles during clavicular and scapular motion. The acromioclavicular joint is susceptible to a broad spectrum of pathologic entities, traumatic and degenerative disorders being the most common. Acromioclavicular joint injury typically affects young adult males and can be categorized by using the Rockwood classification system as one of six types on the basis of the direction and degree of osseous displacement seen on conventional radiographs. MRI enables the radiologist to more accurately assess the regional soft-tissue structures in the setting of high-grade acromioclavicular separation, helping to guide the surgeon's selection of the appropriate management. Involvement of the acromioclavicular joint and its stabilizing ligaments is also important for understanding and classifying distal clavicle fractures. Other pathologic processes encountered at this joint include degenerative disorders; overuse syndromes; and, less commonly, inflammatory arthritides, infection, metabolic disorders, and developmental malformations. Treatment options for acromioclavicular dysfunction include conservative measures, resection arthroplasty for recalcitrant symptoms, and surgical reconstruction techniques for stabilization after major trauma.
Collapse
Affiliation(s)
- Dyan V Flores
- From the Institute of Radiology, St. Luke's Medical Center Global City, Department of Radiology, Philippine Orthopedic Center, Maria Clara St, Santa Mesa Heights, Quezon City, Metro Manila, Philippines 1100 (D.V.F.); Division of Musculoskeletal Radiology, Laboratorio Delboni Auriemo, DASA, São Paulo, Brazil (P.K.G.); Department of Musculoskeletal Radiology, Ayudas Diagnósticas Sura, Medellín, Colombia (C.M.G.); Department of Radiology, Clínica Internacional, Lima, Peru (D.F.U.); and Department of Radiology, UCSD Health System, San Diego, Calif (M.N.P.)
| | - Paola Kuenzer Goes
- From the Institute of Radiology, St. Luke's Medical Center Global City, Department of Radiology, Philippine Orthopedic Center, Maria Clara St, Santa Mesa Heights, Quezon City, Metro Manila, Philippines 1100 (D.V.F.); Division of Musculoskeletal Radiology, Laboratorio Delboni Auriemo, DASA, São Paulo, Brazil (P.K.G.); Department of Musculoskeletal Radiology, Ayudas Diagnósticas Sura, Medellín, Colombia (C.M.G.); Department of Radiology, Clínica Internacional, Lima, Peru (D.F.U.); and Department of Radiology, UCSD Health System, San Diego, Calif (M.N.P.)
| | - Catalina Mejía Gómez
- From the Institute of Radiology, St. Luke's Medical Center Global City, Department of Radiology, Philippine Orthopedic Center, Maria Clara St, Santa Mesa Heights, Quezon City, Metro Manila, Philippines 1100 (D.V.F.); Division of Musculoskeletal Radiology, Laboratorio Delboni Auriemo, DASA, São Paulo, Brazil (P.K.G.); Department of Musculoskeletal Radiology, Ayudas Diagnósticas Sura, Medellín, Colombia (C.M.G.); Department of Radiology, Clínica Internacional, Lima, Peru (D.F.U.); and Department of Radiology, UCSD Health System, San Diego, Calif (M.N.P.)
| | - Darwin Fernández Umpire
- From the Institute of Radiology, St. Luke's Medical Center Global City, Department of Radiology, Philippine Orthopedic Center, Maria Clara St, Santa Mesa Heights, Quezon City, Metro Manila, Philippines 1100 (D.V.F.); Division of Musculoskeletal Radiology, Laboratorio Delboni Auriemo, DASA, São Paulo, Brazil (P.K.G.); Department of Musculoskeletal Radiology, Ayudas Diagnósticas Sura, Medellín, Colombia (C.M.G.); Department of Radiology, Clínica Internacional, Lima, Peru (D.F.U.); and Department of Radiology, UCSD Health System, San Diego, Calif (M.N.P.)
| | - Mini N Pathria
- From the Institute of Radiology, St. Luke's Medical Center Global City, Department of Radiology, Philippine Orthopedic Center, Maria Clara St, Santa Mesa Heights, Quezon City, Metro Manila, Philippines 1100 (D.V.F.); Division of Musculoskeletal Radiology, Laboratorio Delboni Auriemo, DASA, São Paulo, Brazil (P.K.G.); Department of Musculoskeletal Radiology, Ayudas Diagnósticas Sura, Medellín, Colombia (C.M.G.); Department of Radiology, Clínica Internacional, Lima, Peru (D.F.U.); and Department of Radiology, UCSD Health System, San Diego, Calif (M.N.P.)
| |
Collapse
|
17
|
Kani KK, Porrino JA, Mulcahy H, Chew FS. Surgical techniques for management of acromioclavicular joint separations: review and update for radiologists. Skeletal Radiol 2020; 49:1195-1206. [PMID: 32193563 DOI: 10.1007/s00256-020-03417-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/08/2020] [Accepted: 03/09/2020] [Indexed: 02/02/2023]
Abstract
Imaging plays a central role in the postoperative management of acromioclavicular (AC) joint separations. There are more than 150 described techniques for the surgical management of AC joint injuries. These procedures can be categorized as varying combinations of the following basic techniques: a) soft-tissue repair, b) trans-articular AC joint fixation, c) coracoclavicular (CC) fixation, d) non-anatomic reconstruction of the CC ligaments, e) anatomic reconstruction of the CC ligaments, f) distal clavicle resection, and g) dynamic muscle transfer. The goals of this article are to describe the basic techniques for the surgical management of AC joint separations with an emphasis on technique-specific complications and postoperative imaging assessment.
Collapse
Affiliation(s)
- Kimia Khalatbari Kani
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Jack A Porrino
- Yale School of Medicine, Radiology and Biomedical Imaging, New Haven, CT, 06520-8042, USA
| | - Hyojeong Mulcahy
- Department of Radiology, University of Washington, 4245 Roosevelt Way NE, Box 354755, Seattle, WA, 98105, USA
| | - Felix S Chew
- Department of Radiology, University of Washington, 4245 Roosevelt Way NE, Box 354755, Seattle, WA, 98105, USA
| |
Collapse
|
18
|
Karargyris O, Murphy RJ, Arenas A, Bolliger L, Zumstein MA. Improved identification of unstable acromioclavicular joint injuries in a clinical population using the acromial center line to dorsal clavicle radiographic measurement. J Shoulder Elbow Surg 2020; 29:1599-1605. [PMID: 32147334 DOI: 10.1016/j.jse.2019.12.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/10/2019] [Accepted: 12/10/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Accurate classification and subsequent management of acromioclavicular (AC) joint injuries remains a contentious topic. The updated Rockwood classification acknowledges "stable IIIA" and "unstable IIIB" injuries, a watershed accepted by ISAKOS and important in guiding clinical management. Traditionally, the coracoclavicular distance is used to classify these injuries, despite well-documented limitations. This study aimed to evaluate displacement in AC joint injuries by measuring both coracoclavicular (CC) distance and the newly proposed acromial center line to dorsal clavicle (AC-DC) distance, in a cohort of patients, and correlate the results between the 2 measurements and relationship to Rockwood grade. MATERIALS AND METHODS Ninety consecutive cases of AC joint injury were evaluated radiographically for Rockwood classification, CC distance on anteroposterior radiographs, and AC-DC distance on Alexander view radiographs. Inter- and intraobserver reliability for each measurement was calculated as well as correlation between the 2 measurement types and the degree to which each measurement accurately represented the Rockwood classification. RESULTS Although both CC and AC-DC measurements showed very high inter- and intraobserver reliability, the CC distance systematically underestimated the degree of AC joint displacement when compared with the AC-DC measurement as the severity of injury increased, particularly in the presence of posterior horizontal displacement such as that seen in Rockwood IV injuries. CONCLUSION The AC-DC measurement and use of the Alexander view provides the clinician with a more realistic appreciation of true AC joint displacement, especially in defining watershed cases (ie, IIIA/IIB/IV) and may better inform the decision-making process regarding management options and recommendations.
Collapse
Affiliation(s)
- Orestis Karargyris
- Inselspital, Department of Orthopaedic Surgery and Traumatology, Shoulder, Elbow and Orthopaedic Sports Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Richard J Murphy
- Shoulder, Elbow and Orthopaedic Sports Medicine, Orthopaedics Sonnenhof, Bern, Switzerland.
| | - Antonio Arenas
- Inselspital, Department of Orthopaedic Surgery and Traumatology, Shoulder, Elbow and Orthopaedic Sports Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lilianna Bolliger
- Inselspital, Department of Orthopaedic Surgery and Traumatology, Shoulder, Elbow and Orthopaedic Sports Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Matthias A Zumstein
- Shoulder, Elbow and Orthopaedic Sports Medicine, Orthopaedics Sonnenhof, Bern, Switzerland; Stiftung Lindenhof I Campus SLB, Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland.
| |
Collapse
|
19
|
Galasso O, Tarducci L, De Benedetto M, Orlando N, Mercurio M, Gasparini G, Castricini R. Modified Weaver-Dunn Procedure for Type 3 Acromioclavicular Joint Dislocation: Functional and Radiological Outcomes. Orthop J Sports Med 2020; 8:2325967120905022. [PMID: 32215276 PMCID: PMC7065288 DOI: 10.1177/2325967120905022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 11/19/2019] [Indexed: 11/16/2022] Open
Abstract
Background Controversy surrounds the indication for treatment of type 3 acromioclavicular joint dislocation, and the optimal reconstructive technique has not yet been defined. Since the first description of the Weaver-Dunn procedure, several studies have described the clinical and radiological results that can be expected postoperatively; however, few studies have evaluated the outcomes of this technique for chronic type 3 acromioclavicular joint dislocation. Purpose/Hypothesis The purpose of this study was to evaluate the functional and radiographic mid- to long-term outcomes of a modified Weaver-Dunn procedure for chronic Rockwood type 3 acromioclavicular joint dislocation. We hypothesized that (1) functional outcomes comparable with sex- and age-matched healthy individuals could be achieved with the modified Weaver-Dunn procedure and (2) joint stability could be restored after surgery. Study Design Case series; Level of evidence, 4. Methods Out of 30 patients who sustained a chronic type 3 acromioclavicular joint dislocation, 27 had a minimum 12-month follow-up and were included in the study. All patients underwent a modified Weaver-Dunn procedure. The Constant-Murley score was used to assess patient postoperative function. Subjective evaluation of patient satisfaction with surgery was also recorded. Radiological assessment was performed postoperatively to evaluate superoinferior and anteroposterior joint stability. Results After a mean follow-up period of 51.6 months, the mean Constant-Murley score was 90.1, which was 97.2% that of a group of sex- and age-matched healthy individuals. In the multivariate analysis, higher Constant-Murley score was associated with male sex (β = 0.385; P = .043) and higher subjective satisfaction scale (β = 0.528; P = .003). All patients returned to their previous work and sport activity levels having high satisfaction with surgery. Successful vertical acromioclavicular joint reduction was obtained in all but 1 patient; however, horizontal joint stability was not completely restored with the modified Weaver-Dunn procedure. No intraoperative complications occurred, and the postoperative complication rate was 7.4%. Conclusion In patients with chronic type 3 acromioclavicular joint dislocation, the modified Weaver-Dunn procedure is an effective technique to restore vertical but not horizontal joint stability 4 years after surgery. High levels of satisfaction with surgery and functional outcomes comparable with sex- and age-matched healthy individuals can be achieved.
Collapse
Affiliation(s)
- Olimpio Galasso
- Magna Græcia University, Mater Domini University Hospital, Catanzaro, Italy
| | - Lorenzo Tarducci
- Magna Græcia University, Mater Domini University Hospital, Catanzaro, Italy
| | - Massimo De Benedetto
- Division of Orthopaedic and Trauma Surgery, Villa Maria Cecilia Hospital, Cotignola, Italy
| | - Nicola Orlando
- Division of Orthopaedic and Trauma Surgery, Villa Maria Cecilia Hospital, Cotignola, Italy
| | - Michele Mercurio
- Magna Græcia University, Mater Domini University Hospital, Catanzaro, Italy
| | - Giorgio Gasparini
- Magna Græcia University, Mater Domini University Hospital, Catanzaro, Italy
| | - Roberto Castricini
- Division of Orthopaedic and Trauma Surgery, Villa Maria Cecilia Hospital, Cotignola, Italy
| |
Collapse
|
20
|
Stelter J, Malik S, Chiampas G. The Emergent Evaluation and Treatment of Shoulder, Clavicle, and Humerus Injuries. Emerg Med Clin North Am 2020; 38:103-124. [DOI: 10.1016/j.emc.2019.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
|
21
|
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.
Collapse
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
| |
Collapse
|
22
|
Azar F, Pfeifer C, Alt V, Pregler B, Weiss I, Mayr A, Kerschbaum M. Clavicle Elevation or Shoulder Girdle Depression in Acromioclavicular Joint Dislocation: A Radiological Investigation. Orthop J Sports Med 2019; 7:2325967119879927. [PMID: 32010727 PMCID: PMC6967197 DOI: 10.1177/2325967119879927] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background: The side-comparative coracoclavicular (CC) distance is used to describe the vertical instability component of acute acromioclavicular (AC) joint dislocations. Elevation of the clavicle or a depression of the shoulder girdle can lead to an increased CC distance. The dislocation direction has not yet been investigated and is not included in common classification systems. Hypothesis: Clavicle elevation is primarily responsible for vertical dislocation in AC joint separation. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Weighted and nonweighted bilateral plain anteroposterior views of the shoulder girdles of patients with AC joint dislocations (Rockwood [RW] types III and V), diagnosed in our trauma department between 2001 and 2018, were included in this study. After determining the CC distance, a side-comparative determination of the positions of both the clavicle and shoulder girdle, with reference to the spinal column, was conducted. Results: In total, 245 bilateral plain anteroposterior views were evaluated (RW III, n = 116; RW V, n = 129). All patients showed a side-comparative clavicle elevation (mean ± SD: RW III, 5 ± 14 mm; RW V, 11 ± 17 mm) in weighted and nonweighted views. While no depression of the shoulder girdle was measured in RW III injuries (weighted and nonweighted views, 0 ± 11 mm), dropping of the shoulder girdle in RW V lesions on nonweighted views was observed (–5 ± 11 mm). Conclusion: Vertical dislocation is mostly associated with clavicle elevation in RW III injures, while in high-grade AC joint dislocations (RW V), a combination of clavicle elevation and shoulder girdle depression is present. A significantly greater superior displacement of the clavicle in RW V injuries was seen in weighted views, while a depression of the shoulder girdle could be detected in nonweighted views. For the first time, these results include the dislocation direction in the classification of an AC joint injury. Further studies are needed to investigate the extent to which dislocation types differ in optimal therapy and outcome.
Collapse
Affiliation(s)
- Fady Azar
- Clinic of Trauma Surgery, Hospital Weiden, Weiden in der Oberpfalz, Germany.,Clinic of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Christian Pfeifer
- Clinic of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Volker Alt
- Clinic of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Benedikt Pregler
- Clinic of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - Isabella Weiss
- Clinic of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Agnes Mayr
- Clinic of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | | |
Collapse
|
23
|
Cibulas A, Leyva A, Cibulas G, Foss M, Boron A, Dennison J, Gutterman B, Kani K, Porrino J, Bancroft LW, Scherer K. Acute Shoulder Injury. Radiol Clin North Am 2019; 57:883-896. [DOI: 10.1016/j.rcl.2019.03.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
24
|
Clavert P. Acromio-clavicular joint dislocation: Time to temper our enthusiasm. Orthop Traumatol Surg Res 2018; 104:741-742. [PMID: 30036724 DOI: 10.1016/j.otsr.2018.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 07/18/2018] [Indexed: 02/02/2023]
Affiliation(s)
- Philippe Clavert
- Service de chirurgie du membre supérieur, CCOM, CHRU Strasbourg, avenue Baumann, 67400 Illkirch, France.
| |
Collapse
|
25
|
Dynamic instability of the acromioclavicular joint: A new classification for acute AC joint separation. ACTA ACUST UNITED AC 2018; 13:279-285. [PMID: 30546493 PMCID: PMC6267370 DOI: 10.1007/s11678-018-0469-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 06/08/2018] [Indexed: 12/03/2022]
Abstract
Background Acute acromioclavicular (AC) dislocation is classified according to Rockwood (RW). Although of clinical relevance, dynamic horizontal translation (DHT) is not listed in this classification or in frequently used clinical evaluation tools. The aim of this study was (a) to evaluate vertical and horizontal AC joint instabilities and assess their combined occurrence and clinical appearance in a consecutive group of patients, as well as (b) to develop a new classification of acute AC joint dislocation. Method A consecutive group of 61 patients (seven female, 54 male) with a mean age of 34.5 years (18.9–60.1) were included in the study. All patients underwent posttraumatic clinical—Taft Score (TF), Acromioclavicular Joint Instability Score (ACJI), Constant Score (CS), Subjective Shoulder Value (SSV)—and radiological (bilateral anteroposterior stress and bilateral Alexander views) evaluation. Results According to the RW classification, the following AC dislocations were present: eight (13.1%) type I, nine (14.8%) type II, 22 (36.1%) type III, and 22 (36.1%) type V. Based on the clinical and radiographic results, a new classification is proposed: Type I instabilities show only a partial vertical displacement (≤30% coracoclavicular distance [CCD]) and type II a complete vertical displacement (>30% CCD). Both type I and II are further graded into none or partial (A) and complete DHT (B) as seen on bilateral Alexander views. Conclusion DHT can be found in low-grade instabilities and lead to inferior clinical results in the posttraumatic situation.
Collapse
|
26
|
Issa SP, Payan C, Le Hanneur M, Loriaut P, Boyer P. Arthroscopically assisted reduction of acute acromioclavicular joint dislocation using a single double-button device: Medium-term clinical and radiological outcomes. Orthop Traumatol Surg Res 2018; 104:33-38. [PMID: 29233762 DOI: 10.1016/j.otsr.2017.11.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 07/26/2017] [Accepted: 11/08/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Double-button devices for endoscopic management of acute acromioclavicular joint dislocation (ACJD) provide satisfactory short-term functional and radiological results. However, little exists in the literature regarding the long- and medium-term results of these implants, especially regarding the evolution of the acromioclavicular joint (ACJ). HYPOTHESIS Satisfactory and steady long- and medium-term outcomes can be achieved in patients with acute ACJD undergoing endoscopically assisted ACJ repair using a single double-button device. MATERIAL AND METHOD A retrospective single-center study was conducted in patients with acute Rockwood III and IV ACJD treated endoscopically with a single double-button device from October 2008 to October 2010, allowing a minimum 5-year follow-up. Functional evaluation used Constant and Quick-DASH scores. Clinical evidence of dislocation recurrence was combined with bilateral Zanca views to assess coracoclavicular distance. Acromioclavicular osteoarthritis was evaluated on the Paxinos test and Zanca views. RESULTS Nineteen of the 25 operated patients were seen at a mean 76.9±8.5 months' follow-up. Mean age was 34.4±8.3 years. Mean Constant and Quick-DASH scores were 96.2±5.1 and 0.9±1.6 points, respectively. Four patients had a recurrence of their initial dislocation, 3 of whom had positive Paxinos test, whereas the 15 patients without recurrence had a negative test (p=0.004). Five patients had radiological evidence of ACJ osteoarthritis: all 4 patients with recurrence and 1 without (p=0.001). CONCLUSION Long- and medium-term radioclinical outcome of endoscopically assisted management of acute ACJD using a single double-button device seems to be satisfactory and steady over time. Recurrence of the initial dislocation appears to be related to onset of degenerative ACJ arthropathy. LEVEL OF EVIDENCE Therapeutic type IV-Retrospective case series.
Collapse
Affiliation(s)
- S-P Issa
- Service de chirurgie orthopédique et de traumatologie, hôpital Cochin, Assistance publique-hôpitaux de Paris (AP-HP), 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
| | - C Payan
- Service de chirurgie orthopédique et de traumatologie, hôpital Bichat-Claude-Bernard, hôpitaux universitaires Paris Nord-Val-de-Seine (HUPNVS), Assistance publique-Hôpitaux de Paris (AP-HP), 46, rue Henri-Huchard, 75018 Paris, France
| | - M Le Hanneur
- Service de chirurgie orthopédique et de traumatologie, hôpital Européen Georges-Pompidou (HEGP), Assistance publique-hôpitaux de Paris (AP-HP), 20, rue Leblanc, 75015 Paris, France
| | - P Loriaut
- Institut de chirurgie orthopédique, clinique des Lilas, 41-49, avenue du Maréchal-Juin, 93260 Les Lilas, France
| | - P Boyer
- Service de chirurgie orthopédique et de traumatologie, hôpital Bichat-Claude-Bernard, hôpitaux universitaires Paris Nord-Val-de-Seine (HUPNVS), Assistance publique-Hôpitaux de Paris (AP-HP), 46, rue Henri-Huchard, 75018 Paris, France
| |
Collapse
|
27
|
Zumstein MA, Schiessl P, Ambuehl B, Bolliger L, Weihs J, Maurer MH, Moor BK, Schaer M, Raniga S. New quantitative radiographic parameters for vertical and horizontal instability in acromioclavicular joint dislocations. Knee Surg Sports Traumatol Arthrosc 2018; 26:125-135. [PMID: 28547587 PMCID: PMC5754414 DOI: 10.1007/s00167-017-4579-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 05/15/2017] [Indexed: 12/30/2022]
Abstract
PURPOSE The aim of this study was to identify the most accurate and reliable quantitative radiographic parameters for assessing vertical and horizontal instability in different Rockwood grades of acromioclavicular joint (ACJ) separations. Furthermore, the effect of projectional variation on these parameters was investigated in obtaining lateral Alexander view radiographs. METHODS A Sawbone model of a scapula with clavicle was mounted on a holding device, and acromioclavicular dislocations as per the Rockwood classification system were simulated with the addition of horizontal posterior displacement. Projectional variations for each injury type were performed by tilting/rotating the Sawbone construct in the coronal, sagittal or axial plane. Radiographic imaging in the form of an anterior-posterior Zanca view and a lateral Alexander view were taken for each injury type and each projectional variation. Five newly defined radiographic parameters for assessing horizontal and vertical displacement as well as commonly used coracoclavicular distance view were measured. Reliability, validity and the effect of projectional variation were investigated for these radiographic measurements. RESULTS All radiographic parameters showed excellent intra- and interobserver reliability. The validity was excellent for the acromial centre line to dorsal clavicle (AC-DC) in vertical displacement and for the glenoid centre line to posterior clavicle (GC-PC) in horizontal displacement, whilst the remaining measurements showed moderate validity. For AC-DC and GC-PC, convergent validity expressed strong correlation to the effective distance and discriminant validity demonstrated its ability to differentiate between various grades of ACJ dislocations. The effect of projectional variation increased with the degree of deviation and was maximal (3 mm) for AC-DC in 20° anteverted malpositioning and for GC-PC in 20° retroverted malpositioning. CONCLUSIONS AC-DC and the GC-PC are two novel quantitative radiographic parameters of vertical and horizontal instability in ACJ dislocations that demonstrate excellent reliability and validity with reasonable inertness to malpositioning. The use of AC-DC for assessing vertical displacement and GC-PC for assessing horizontal displacement in a single Alexander view is recommended to guide the appropriate management of ACJ dislocations. A better appreciation of the degree of horizontal instability, especially in lower Rockwood grades (II, III) of ACJ dislocations, may improve management of these controversial injuries.
Collapse
Affiliation(s)
- Matthias A Zumstein
- Shoulder, Elbow and Orthopaedic Sports Medicine, Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland.
| | - Philippe Schiessl
- Shoulder, Elbow and Orthopaedic Sports Medicine, Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Benedikt Ambuehl
- Shoulder, Elbow and Orthopaedic Sports Medicine, Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Lilianna Bolliger
- Shoulder, Elbow and Orthopaedic Sports Medicine, Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Johannes Weihs
- Shoulder, Elbow and Orthopaedic Sports Medicine, Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Martin H Maurer
- Department of Radiology, Inselspital, Bern University HospitalUniversity of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Beat K Moor
- Shoulder, Elbow and Orthopaedic Sports Medicine, Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Michael Schaer
- Shoulder, Elbow and Orthopaedic Sports Medicine, Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Sumit Raniga
- Shoulder, Elbow and Orthopaedic Sports Medicine, Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| |
Collapse
|
28
|
Pogorzelski J, Beitzel K, Ranuccio F, Wörtler K, Imhoff AB, Millett PJ, Braun S. The acutely injured acromioclavicular joint - which imaging modalities should be used for accurate diagnosis? A systematic review. BMC Musculoskelet Disord 2017; 18:515. [PMID: 29216919 PMCID: PMC5721483 DOI: 10.1186/s12891-017-1864-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 11/20/2017] [Indexed: 12/26/2022] Open
Abstract
Background The management of acute acromioclavicular (AC) joint injuries depends on the degree of injury diagnosed by the Rockwood classification. Inadequate imaging and not selecting the most helpful imaging protocols can often lead to incorrect diagnosis of the injury. A consensus on a diagnostic imaging protocol for acute AC joint injuries does not currently exist. Therefore we conducted a systematic review of the literature considering three diagnostic parameters for patients with acromioclavicular (AC) joint injuries: 1) Assessment of vertical instability; 2) Assessment of horizontal instability; 3) Benefit of weighted panoramic views. Methods Internet databases were searched in March 2016 using the terms (“AC joint” OR “acromioclavicular joint”) AND (MRI OR MR OR radiograph OR X-ray OR Xray OR ultrasound OR “computer tomography” OR “computed tomography” OR CT). Diagnostic, prospective, retrospective, cohort and cross- sectional studies were included to compare their use of different radiological methods. Case reports, cadaveric studies, and studies concerning chronic AC injuries and clinical outcomes were excluded. Results This search returned 1359 citations of which 1151 were excluded based on title, 116 based on abstract and 75 based on manuscript. 17 studies were included for review and were analyzed for their contributions to the three parameters of interest mentioned above. The inter- and intra-observer reliability for diagnosing vertical instabilities of the clavicle using x-ray alone show a high level of reproducibility while for horizontal instabilities the values were much more variable. In general, digitally measured parameters seem to be more precise and reliable between investigators than visual classification alone. Currently, evidence for the value of weighted views and other additional diagnostic imaging to supplement standard x-rays is controversial. Conclusion To date there is no consensus on a gold standard for diagnostic measures needed to classify acute AC joint injuries. The inter- and intra-observer reliability for diagnosing vertical instabilities of the clavicle using bilateral projections show a high level of reproducibility while for horizontal instabilities the results are much more inconsistent. There is currently no clear consensus on a protocol for image-based diagnosis and classification of acute AC joint injuries, leading to a lack of confidence in reproducibility and reliability.
Collapse
Affiliation(s)
- Jonas Pogorzelski
- Department of Orthopaedic Sports Medicine, Hospital Rechts der Isar, University of Munich, Ismaninger Street 22, 81675, Munich, Germany
| | - Knut Beitzel
- Department of Orthopaedic Sports Medicine, Hospital Rechts der Isar, University of Munich, Ismaninger Street 22, 81675, Munich, Germany
| | - Francesco Ranuccio
- Department of Orthopaedic Sports Medicine, Hospital Rechts der Isar, University of Munich, Ismaninger Street 22, 81675, Munich, Germany
| | - Klaus Wörtler
- Department of Radiology, Hospital Rechts der Isar, University of Munich, Munich, Germany
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Hospital Rechts der Isar, University of Munich, Ismaninger Street 22, 81675, Munich, Germany.
| | | | - Sepp Braun
- Department of Orthopaedic Sports Medicine, Hospital Rechts der Isar, University of Munich, Ismaninger Street 22, 81675, Munich, Germany
| |
Collapse
|
29
|
Barth J, Boutsiadis A, Narbona P, Lädermann A, Arrigoni P, Adams CR, Burkhart SS, Denard PJ. The anterior borders of the clavicle and the acromion are not always aligned in the intact acromioclavicular joint: a cadaveric study. J Shoulder Elbow Surg 2017; 26:1121-1127. [PMID: 28372971 DOI: 10.1016/j.jse.2017.01.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 12/28/2016] [Accepted: 01/19/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aim of this study was to find reliable anatomic landmarks of the normal acromioclavicular joint (ACJ) that could enable the precise evaluation of the horizontal displacement of the clavicle after dislocation. The hypothesis was that the anterior borders of the acromion and the clavicle are always aligned in intact ACJs. MATERIALS AND METHODS In 30 cadaveric specimens, the anterior and posterior borders of the ACJ's articular facets and the most prominent anterior and posterior bony landmarks of the acromion and the clavicle were identified. The anterior and posterior overhang of the acromion and the clavicle was measured in relation to the borders of the articular facets. Therefore, the possible anterior and posterior alignment of the ACJ was evaluated. RESULTS Anteriorly, only 18 ACJs (60%) were aligned whereas 7 (24%) had major overhang of the acromion and 3 (10%) had major overhang of the clavicle. Similarly, 18 cases (60%) were posteriorly aligned, whereas 6 (20%) had major clavicular overhang and 4 (14%) had major overhang of the acromion. In 78% of these cases, the ACJ was aligned as well anteriorly as posteriorly (P < .001). Finally, the larger the width of the acromion (P = .032) or the clavicle (P = .049), the better the posterior joint alignment. CONCLUSION Our hypothesis was not verified. The acromion and clavicle are not perfectly aligned in a significant number of specimens with intact ACJs (40% of cases). The most reliable landmarks remain their articular facets.
Collapse
Affiliation(s)
- Johannes Barth
- Department of Orthopaedic Surgery, Centre Osteoarticulaire des Cèdres, Grenoble, France.
| | - Achilleas Boutsiadis
- Department of Orthopaedic Surgery, Centre Osteoarticulaire des Cèdres, Grenoble, France
| | - Pablo Narbona
- Department of Shoulder Surgery, Sanatorio Allende, Córdoba, Argentina
| | - Alexandre Lädermann
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland; Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Paolo Arrigoni
- Università degli studi di Milano-Policlinico San Donato, Milano, Italy
| | | | | | | |
Collapse
|
30
|
Horst K, Garving C, Thometzki T, Lichte P, Knobe M, Dienstknecht T, Hofman M, Pape HC. Comparative study on the treatment of Rockwood type III acute acromioclavicular dislocation: Clinical results from the TightRope ® technique vs. K-wire fixation. Orthop Traumatol Surg Res 2017; 103:171-176. [PMID: 27940250 DOI: 10.1016/j.otsr.2016.11.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 10/28/2016] [Accepted: 11/11/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND HYPOTHESIS The aim of this study was to address the inconsistency regarding the operative treatment of Rockwood type III acromioclavicular joint separation. We compared results after single- and double TightRope® reduction with results after acromioclavicular transfixation via K-wires only and additional ligament augmentation in acute acromioclavicular (AC) joint separations graded Rockwood type III, and hypothesized that the TightRope® technique leads to better clinical and radiological results. MATERIALS AND METHODS We conducted a retrospective clinical cohort study and included 42 consecutive patients (mean age 43 years [24-66]) diagnosed and operatively treated between 2004 and 2012 (mean follow-up was 54.6 months [15-118]). Specific shoulder scores as well as scores reflecting the patients' overall mental and physical health status were used. Radiological evaluation was also performed. RESULTS The SF12 test revealed comparability between all subgroups. Specific shoulder tests and a visual analogue scale demonstrated comparable results. Radiographic measurements showed a significant reduction in the AC distance and CC distance after surgery in all subgroups. The early complication rate was 9.5% for all patients, while late complications occurred in 14.3% of all cases. CONCLUSIONS Compared to the established methods, the operative TightRope® procedures represent a safe alternative in Rockwood III injuries. All investigated techniques predominantly led to good and excellent clinical results in acute Rockwood type III AC joint instabilities. Avoidance of material removal and shorter hospital stays appear to speak in favour for the TightRope® technique. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- K Horst
- Department of Orthopaedic Trauma at Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany.
| | - C Garving
- Klinik für Unfall-, Schulter- und Handchirurgie, Krankenhaus Agatharied, Norbert-Kerkel-Platz, 83734 Hausham, Germany
| | - T Thometzki
- Department of Orthopaedic Trauma at Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany
| | - P Lichte
- Department of Orthopaedic Trauma at Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany
| | - M Knobe
- Department of Orthopaedic Trauma at Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany
| | - T Dienstknecht
- Department of Orthopaedic Trauma at Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany
| | - M Hofman
- Department of Orthopaedic Trauma at Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany
| | - H-C Pape
- Department of Orthopaedic Trauma at Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany
| |
Collapse
|
31
|
Abstract
INTRODUCTION This study investigated nonsurgical management of type V acromioclavicular (AC) injuries to determine functional outcomes and to attempt to identify factors associated with positive results. METHODS In a retrospective chart review, patients with radiographic and clinical evidence of type V AC injuries per the Rockwood classification were included in the study. Patients treated nonsurgically for ≥6 months were considered eligible for analysis. Functional outcomes were assessed using Disabilities of the Arm, Shoulder, and Hand (DASH) and American Shoulder and Elbow Surgeons (ASES) scores. RESULTS Twenty-two patients with a mean age of 42.2 ± 12.8 years were included in the study. The average coracoclavicular distance at the time of presentation was 26.3 mm (+199%). Mean DASH and ASES scores were 27.8 ± 17.7 and 62.8 ± 17.1, respectively, at an average of 34 months from the time of injury. Patients with normal DASH (≤10) and ASES (>92) scores were younger than those with abnormal scores. At final assessment, 77% of the patients were currently working, with nine patients performing manual labor. CONCLUSION Following nonsurgical management of type V AC injuries, most patients are able to return to work but have limited functional outcome scores. A small subset of patients with type V AC injuries can achieve normal functional outcomes with nonsurgical management. LEVEL OF EVIDENCE Level IV, Case Series.
Collapse
|
32
|
Lateur G, Boudissa M, Rubens-Duval B, Mader R, Rouchy RC, Pailhé R, Saragaglia D. Long-term outcomes of tension band wiring with a single K-wire in Rockwood type IV/V acute acromio-clavicular dislocations: 25 cases. Orthop Traumatol Surg Res 2016; 102:589-93. [PMID: 27424096 DOI: 10.1016/j.otsr.2016.02.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 01/24/2016] [Accepted: 02/24/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Our objective was to evaluate the long-term functional and radiological outcomes of tension band wiring with a single K-wire for acute Rockwood types IV and V acromio-clavicular dislocation (ACD). METHODS Single-centre cross-sectional non-randomised observational cohort study of 25 shoulders treated surgically between January 2002 and December 2004, in 25 patients, 23 males and 2 females, with a mean age of 35±11years (24-46). The evaluation criteria were the absolute and weighted Constant scores, QuickDASH score, subjective shoulder value (SSV), visual analogue scale (VAS) pain score at rest and during activities, and radiographic features in clinically symptomatic patients. RESULTS Mean values were as follows: follow-up, 150±17months (133-167); absolute Constant score, 88±17 (71-105); weighted Constant score, 92.5±12.5 (80-105); QuickDASH, 15.5±7 (8.5-22.5); SSV, 88±17% (71-105); VAS pain score at rest, 0.2±0.7 (0-0.9); and VAS pain score while active, 1.4±2.3 (0-3.7). The weighted Constant score was less than 70% in only 8% of patients. Of the 17 patients for whom radiographs were obtained, 8 had acromio-clavicular osteoarthritis. Mean coraco-clavicular distance was 12.3±4.3mm (8-16.6) and mean acromio-clavicular distance was 5±5mm (0-10). The recurrence rate was 8%. CONCLUSION Tension band wiring with a single K-wire for acute acromio-clavicular dislocation reliably provides good long-term functional outcomes. Recurrences are uncommon and few patients experience symptoms (8%). LEVEL OF EVIDENCE IV, retrospective study.
Collapse
Affiliation(s)
- G Lateur
- Clinique universitaire de chirurgie orthopédique et de traumatologie du sport, hôpital Sud, CHU de Grenoble, 38130 Échirolles, France.
| | - M Boudissa
- Clinique universitaire de chirurgie orthopédique et de traumatologie du sport, hôpital Sud, CHU de Grenoble, 38130 Échirolles, France
| | - B Rubens-Duval
- Clinique universitaire de chirurgie orthopédique et de traumatologie du sport, hôpital Sud, CHU de Grenoble, 38130 Échirolles, France
| | - R Mader
- Clinique universitaire de chirurgie orthopédique et de traumatologie du sport, hôpital Sud, CHU de Grenoble, 38130 Échirolles, France
| | - R C Rouchy
- Clinique universitaire de chirurgie orthopédique et de traumatologie du sport, hôpital Sud, CHU de Grenoble, 38130 Échirolles, France
| | - R Pailhé
- Clinique universitaire de chirurgie orthopédique et de traumatologie du sport, hôpital Sud, CHU de Grenoble, 38130 Échirolles, France
| | - D Saragaglia
- Clinique universitaire de chirurgie orthopédique et de traumatologie du sport, hôpital Sud, CHU de Grenoble, 38130 Échirolles, France
| |
Collapse
|