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Rojas JT, Oyarzún A, Muñoz JT, García de la Pastora D, Canals A, Viacava A, Carreño H, Águila R. Medial placement of trapezoid tunnel leads to higher reduction loss in acute acromioclavicular joint dislocation treated with anatomic coracoclavicular fixation. Shoulder Elbow 2024; 16:265-273. [PMID: 38818098 PMCID: PMC11135191 DOI: 10.1177/17585732231170322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 03/12/2023] [Accepted: 03/19/2023] [Indexed: 06/01/2024]
Abstract
Aim To analyze the association between clavicular tunnel positioning and postoperative reduction loss in patients with acute acromioclavicular (AC) joint dislocation treated with anatomic coracoclavicular (CC) fixation using double clavicular tunnels. Methods A retrospective review of patients with AC joint dislocation, treated with anatomic CC fixation using double clavicular tunnels, was conducted. Patients with pre-operative, immediate post-operative, and final follow-up Zanca-view X-rays were included. On each X-ray, the obtained measures included: distance from lateral border of clavicle to trapezoid and conoid tunnels, distance between tunnels, clavicle length, and CC distance of affected and un-affected sides. Loss of reduction was calculated as CC distance difference between immediate and final post-operative X-rays. Association between reduction loss and tunnel positioning was analyzed. Results Conoid, trapezoid and tunnel ratios were 24% ± 4, 15% ± 3, and 9% ± 2, respectively. Significant reduction loss was seen in 21(45.7%) patients. Significantly higher probabilities of reduction loss were associated with trapezoid tunnels placed medial to 24 mm (30.8% vs 65.0%, OR 4.2 (IC95%: 1.2-14.4), p: 0.024) or 15% of the clavicle length (32.1% vs 66.7%, OR 4.2 (IC 95%: 1.2-14.9), p: 0.025). Conclusions Trapezoid tunnels placed medial to 24 mm or 15% medial to clavicle length could lead to higher probabilities of significant reduction loss. These findings support the importance of clavicular tunnels' proper placement for decreasing significant reduction loss.
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Affiliation(s)
- J Tomás Rojas
- Shoulder and Elbow Team, Clínica Santa María, Santiago, Chile
- Shoulder and Elbow Team, Hospital San José, Santiago, Chile
| | - Andrés Oyarzún
- Resident of Orthopedic Surgery, Universidad de Chile, Santiago, Chile
| | - J Tomás Muñoz
- Resident of Orthopedic Surgery, Universidad de los Andes, Santiago, Chile
| | | | - Andrea Canals
- Academic unit, Clínica Santa María, Santiago, Chile
- School of Public health, Universidad de Chile, Santiago, Chile
| | | | - Hector Carreño
- Shoulder and Elbow Team, Clínica Santa María, Santiago, Chile
| | - Raúl Águila
- Shoulder and Elbow Team, Clínica Santa María, Santiago, Chile
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Li Y, Cai J, Li P, Pang L, Li J, Tang X. Suture Button Could Result in More Functional Outcomes Improvement and Pain Relief Than Hook Plate Technique for Treating Acute Acromioclavicular Joint Dislocation: A Systematic Review of Comparative Studies. Arthroscopy 2024; 40:553-566. [PMID: 37315745 DOI: 10.1016/j.arthro.2023.05.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 05/12/2023] [Accepted: 05/18/2023] [Indexed: 06/16/2023]
Abstract
PURPOSE To systematically review the current evidence to compare the differences in outcomes of the suture button (SB) versus hook plate (HP) fixations for treating acute acromioclavicular joint dislocation (ACD). METHODS Two independent reviewers performed the literature search based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A literature search of the Embase, PubMed, and Cochrane Library databases was performed and Level I-IV evidence studies comparing the SB and HP procedures for acute ACD were included. Studies that met the following exclusion criteria were excluded: (1) letters, comments, case reports, reviews, animal studies, cadaveric studies, biomechanical studies, and study protocols; (2) incomplete data; and (3) repeated studies and data. The Newcastle-Ottawa Scale was used to evaluate the quality of nonrandomized studies. Constant score, visual analog scale (VAS) score, operation time, coracoclavicular distance (CCD), and complications were recorded and the mean differences of VAS and Constant were compared with preset minimal clinically important difference. RESULTS Fourteen studies with 363 patients treated with SB procedures and 432 patients with the HP procedure were included. In terms of patient-reported outcomes, 5 of the 13 included studies reported significantly greater Constant score in SB group and most (4/5) used arthroscopic SB technique. Statistically significant differences in favor of SB were found in 3 of the 7 included studies in terms of VAS score whereas none of them reached the minimal clinically important difference. In terms of recurrent instability, no statistically significant difference was noted. All studies showed that the SB technique resulted in lower estimated blood loss. No difference was detected in CCD and complications. CONCLUSIONS Based on the current body of evidence, it is suggested that employment of the SB technique may confer advantageous outcomes when compared to the HP technique in acute ACD patients. These potential benefits may include higher Constant scores, lower pain levels, and no discernible increases in operation time, CCD, or complication rates. LEVEL OF EVIDENCE Level IV, systematic review of Level II-IV studies.
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Affiliation(s)
- Yinghao Li
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Jie Cai
- West China School of Medicine, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Pengcheng Li
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China; West China School of Nursing, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Long Pang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Jian Li
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
| | - Xin Tang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
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Zhu S, Chen Y, Wang P, Shi LL, Li G, Li X, Koh JL, Wang S, Yuan Tsai T, Cui G, Wang S, Shao X, Wang J. In Vivo Analysis of Acromioclavicular Kinematics and Distance During Multiplanar Humeral Elevation. Am J Sports Med 2024; 52:474-484. [PMID: 38197156 DOI: 10.1177/03635465231216116] [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] [Indexed: 01/11/2024]
Abstract
BACKGROUND Knowledge of acromioclavicular (AC) joint kinematics and distance may provide insight into the biomechanical function and development of new treatment methods. However, accurate data on in vivo AC kinematics and distance between the clavicle and acromion remain unknown. PURPOSE/HYPOTHESIS The purpose of this study was to investigate 3-dimensional AC kinematics and distance during arm elevation in abduction, scaption, and forward flexion in a healthy population. It was hypothesized that AC kinematics and distance would vary with the elevation angle and plane of the arm. STUDY DESIGN Controlled laboratory study. METHODS A total of 19 shoulders of healthy participants were enrolled. AC kinematics and distance were investigated with a combined dual fluoroscopic imaging system and computed tomography. Rotation and translation of the AC joint were calculated. The AC distance was measured as the minimum distance between the medial border of the acromion and the articular surface of the distal clavicle (ASDC). The minimum distance point (MDP) ratio was defined as the length between the MDP and the posterior edge of the ASDC divided by the anterior-posterior length of the ASDC. AC kinematics and distance between different elevation planes and angles were compared. RESULTS Progressive internal rotation, upward rotation, and posterior tilt of the AC joint were observed in all elevation planes. The scapula rotated more upward relative to the clavicle in abduction than in scaption (P = .002) and flexion (P = .005). The arm elevation angle significantly affected translation of the AC joint. The acromion translated more laterally and more posteriorly in scaption than in abduction (P < .001). The AC distance decreased from the initial position to 75° in all planes and was significantly greater in flexion (P < .001). The MDP ratio significantly increased with the elevation angle (P < .001). CONCLUSION Progressive rotation and significant translation of the AC joint were observed in different elevation planes. The AC distance decreased with the elevation angle from the initial position to 75°. The minimum distance between the ASDC and the medial border of the acromion moved anteriorly as the shoulder elevation angle increased. CLINICAL RELEVANCE These results could serve as benchmark data for future studies aiming to improve the surgical treatment of AC joint abnormalities to restore optimal function.
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Affiliation(s)
- Siyuan Zhu
- Department of Orthopaedic Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Investigation performed at Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yuzhou Chen
- Department of Orthopaedic Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Investigation performed at Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Peng Wang
- Department of Orthopaedic Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Investigation performed at Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lewis L Shi
- Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago, Chicago, Illinois, USA
- Investigation performed at Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Guoan Li
- Orthopedic Bioengineering Research Center, Newton-Wellesley Hospital, Newton, Massachusetts, USA
- Department of Orthopedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts, USA
- Investigation performed at Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xinning Li
- Department of Orthopaedic Surgery, Chobanian & Avedisian School of Medicine, Boston University, Boston, Massachusetts, USA
- Investigation performed at Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jason L Koh
- Department of Orthopaedic Surgery, NorthShore University HealthSystem, Evanston, Illinois, USA
- Investigation performed at Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shaobai Wang
- Key Laboratory of Exercise and Health Sciences of the Ministry of Education, School of Kinesiology, Shanghai University of Sport, Shanghai, China
- Investigation performed at Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Tsung Yuan Tsai
- Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
- Investigation performed at Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Guoqing Cui
- Institute of Sports Medicine, Peking University Third Hospital, Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
- Investigation performed at Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shaojie Wang
- Department of Joint Surgery and Sports Medicine, Zhongshan Hospital, Xiamen University, Xiamen, China
- Investigation performed at Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiexiang Shao
- Department of Orthopaedic Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Investigation performed at Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jianhua Wang
- Department of Orthopaedic Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Investigation performed at Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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León A, Chavez S, Garcia-Medrano B, García-Fraile R, de Heredia PB, Palencia J, Caballero-García A, Córdova A, Gonzalez DN. Atraumatic Acromioclavicular Joint Dislocation: A Case Report Treated with Excision of the Distal Clavicle Margin and Button Slide System with Allograft Tendon Reinforcement at Coracoclavicular and Acromioclavicular Joint. J Pers Med 2022; 12:jpm12122043. [PMID: 36556263 PMCID: PMC9788457 DOI: 10.3390/jpm12122043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/07/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022] Open
Abstract
Although acromioclavicular joint (ACJ) dislocation is a common injury following trauma involving the shoulder, it is rare in the absence of trauma. In this manuscript, we describe a case of ACJ in a 15-year-old girl who presented a painful dislocation with spontaneous shortening of the right acromioclavicular joint that forced her to temporarily abandon her sports career. After failure of conservative physiotherapy treatment, surgical intervention was proposed by performing an arthroscopic-assisted button slide combined with augmented hamstring allograft reconstruction. After the intervention and the subsequent recovery period, the athlete was able to return to her semi-professional training. The follow-up of the patient is 5.5 years post-surgery. The result obtained could help in planning the treatment of future cases.
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Affiliation(s)
- Alejandro León
- Orthopaedics and Traumatology Surgery, Hospital Clínico Universitario de Valladolid (HCUV), 47005 Valladolid, Spain
| | - Sergio Chavez
- Orthopaedics and Traumatology Surgery, Hospital Clínico Universitario de Valladolid (HCUV), 47005 Valladolid, Spain
| | - Belén Garcia-Medrano
- Orthopaedics and Traumatology Surgery, Hospital Clínico Universitario de Valladolid (HCUV), 47005 Valladolid, Spain
| | - Rubén García-Fraile
- Orthopaedics and Traumatology Surgery, Hospital Clínico Universitario de Valladolid (HCUV), 47005 Valladolid, Spain
| | - Pablo Beltrán de Heredia
- Orthopaedics and Traumatology Surgery, Hospital Clínico Universitario de Valladolid (HCUV), 47005 Valladolid, Spain
| | - Jesús Palencia
- Orthopaedics and Traumatology Surgery, Hospital Universitario Rio Hortega, 47012 Valladolid, Spain
| | - Alberto Caballero-García
- Department of Anatomy and Radiology, Health Sciences Faculty, GIR: “Physical Exercise and Aging”, University of Valladolid, Campus Universitario “Los Pajaritos”, 42004 Soria, Spain
| | - Alfredo Córdova
- Department of Biochemistry, Molecular Biology and Physiology, Health Sciences Faculty, GIR: “Physical Exercise and Aging”, University of Valladolid, Campus Universitario “Los Pajaritos”, 42004 Soria, Spain
- Correspondence: (A.C.); (D.N.G.)
| | - David Noriega Gonzalez
- Orthopaedics and Traumatology Surgery, Hospital Clínico Universitario de Valladolid (HCUV), 47005 Valladolid, Spain
- Correspondence: (A.C.); (D.N.G.)
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Arthroscopic treatment of type III acromioclavicular joint dislocation: a retrospective case series. CURRENT ORTHOPAEDIC PRACTICE 2022. [DOI: 10.1097/bco.0000000000001161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jiang H, Tong J, Shen L, Jin G, Zhu R. Clinical Outcomes of Arthroscopy-Assisted Modified Triple Endobutton Plate Fixation in Rockwood Type III Acute Acromioclavicular Joint Dislocation: A Retrospective Study. Orthop Surg 2022; 14:2436-2446. [PMID: 36000203 PMCID: PMC9531111 DOI: 10.1111/os.13448] [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: 12/22/2020] [Revised: 07/23/2022] [Accepted: 07/25/2022] [Indexed: 11/28/2022] Open
Abstract
Objective The common triple Endobutton plate (CTEP) fixation is a lengthy procedure that is associated with high failure rates. Therefore, we used arthroscopy to improve the Endobutton fixation method by shortening the duration of surgery and reducing operative complications. This study explored the safety and effectiveness of arthroscopy‐assisted modified triple Endobutton plate (MTEP) fixation in Rockwood type III managing acute acromioclavicular joint (ACJ) dislocation. Methods This was a retrospective single‐center study involving 73 patients with Rockwood type III acute ACJ dislocation treated between January 2016 and January 2021. The 73 patients were classified into three groups, the acromioclavicular hook plate (ACHP) group (22 cases), CTEP group (24 cases) and MTEP group (27 cases), based on the type of surgical treatment they received. Clinical outcome data from the patient records, including the Constant–Murley score (CMS), American Shoulder and Elbow Surgeons score (ASES) and University of California at Los Angeles shoulder rating scale score (UCLA), were retrospectively reviewed. The scores were assessed before surgery and at the third and twelfth month after surgery. The clavicle‐coracoid (CC) distance on the affected side was estimated from imaging scans taken before surgery, on the second day after surgery, and within the third and twelfth month after surgery. The student's t‐test was used to compare normally distributed data for independent samples, while homogeneity of variance test was used to compare normally distributed data among multiple groups. Non‐normally distributed data were compared using Mann–Whitney rank‐sum tests. Results There were no differences in age, gender, body mass index (BMI), dislocated side, trauma etiology, and duration of follow‐up among the three groups. There was also no significant difference in the duration of surgery between the ACHP and MTEP groups, although the duration in the two groups was shorter than in the CTEP group (P < 0.05). The duration of hospitalization for the MTEP group was significantly shorter than for the CTEP group which was in turn shorter than for the ACHP group (both P < 0.05). There was no significant difference in postoperative CMS, ASES, and UCLA scores between the CTEP and MTEP groups but the score for the two groups differed significantly from those of the ACHP group (all Ps < 0.05). In addition, there was no significant difference in CC distance among the three groups after surgery (P > 0.05). Conclusion Arthroscopic reconstruction of the coracoclavicular ligament using MTEP fixation to manage acute Rockwood type III ACJ dislocation is minimally invasive, and is associated with rapid functional recovery, few complications and satisfactory early clinical results.
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Affiliation(s)
- Hantao Jiang
- Department of Orthopaedics, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University/ Enze Hospital, Taizhou Enze Medical Center (Group), Taizhou, China
| | - Jingling Tong
- Department of Tradition Chinese Medicine Pharmacy, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University/Enze Hospital, Taizhou Enze Medical Center (Group), Taizhou, China
| | - Liping Shen
- Department of Clinical Laboratory, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University/Enze Hospital, Taizhou Enze Medical Center (Group), Taizhou, China
| | - Gang Jin
- Department of Orthopaedics, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University/ Enze Hospital, Taizhou Enze Medical Center (Group), Taizhou, China
| | - Rangteng Zhu
- Department of Orthopaedics, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University/ Enze Hospital, Taizhou Enze Medical Center (Group), Taizhou, China
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Gawel RJ, D'Amore T, Otlans PT, Rao S, Cohen SB, Ciccotti MG. Criteria for return to play after operative management of acromioclavicular joint separation: a systematic review. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:140-148. [PMID: 37587962 PMCID: PMC10426690 DOI: 10.1016/j.xrrt.2021.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background Acromioclavicular (AC) joint separation is a common cause of shoulder injury among athletes. High-grade injuries may require operative fixation, and comprehensive return-to-play guidelines have not yet been established. The purpose of this study was to summarize criteria for return to play after operative management of AC joint separation. Methods A systematic review of the literature was performed from January 1999 to April 2020 to evaluate clinical evidence regarding criteria for return to play after operative management of isolated AC joint separation. Results Sixty-three studies with at least 1 explicitly stated return-to-play criterion were identified out of an initial database search of 1253 published articles. Eight separate categories of return-to-play criteria were identified, the most common of which was time from surgery (95.2%). Return-to-play timelines ranged from 2 to 12 months, the most common timeline being 6 months (37.8%). Only 4 (6.3%) studies used conditional criteria to guide return to play, which included range of motion, strength, clinical stability, radiographic stability, functional assessment, safety assessment, and hardware removal. Conclusion Most published studies use only time-based criteria for return to play after surgery for AC joint separation, and only a small number of studies use additional subjective or objective criteria. While this systematic review helps provide a foundation for developing a comprehensive return-to-play checklist, further investigation is needed to establish safe and effective guidelines that will enable athletes to safely return to sport and minimize the recurrence of injury.
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Affiliation(s)
- Richard J. Gawel
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Taylor D'Amore
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Peters T. Otlans
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Somnath Rao
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Steven B. Cohen
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Michael G. Ciccotti
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
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Zhang L, Xiong L, He S, Liu J, Zhou X, Tang X, Fu S, Wang G. Classification and morphological parameters of the coracoid process in Chinese population. J Orthop Surg (Hong Kong) 2022; 30:23094990211069694. [PMID: 35041540 DOI: 10.1177/23094990211069694] [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] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION The coracoid process is an important anatomical structure of the scapula, which can be used as a landmark in the diagnosis and treatment of scapula related diseases, such as acromioclavicular joint dislocation, anterior shoulder instability, and coracoid fractures. The aim of this study was to classify the coracoid process according to morphology and to measure the morphological parameters of the coracoid process. MATERIALS AND METHODS A total of 377 dry and intact scapulae were collected and classified in terms of the connection between the shape of coracoid process and common things in life. The anatomical morphology and the position related to acromion and glenoid socket of the coracoid process were measured in each type by three independent researchers with a digital caliper. The measurements were averaged and recorded. RESULTS Based on obvious morphological features, five specific types of the coracoid process were described: Type I, Vertical 8-shape; Type II, Long stick shape; Type III, Short stick shape; Type IV, Water drop shape, and Type V, Wedge shape. Type I (30%) and Type III (29%) were more prevalent in China. The tip width of the coracoid process of Type IV was the shortest and significantly different compared to the other types (p <.05), contrary to the longest in Type V. The tip thickness of the coracoid process of Type I was the shortest and significantly different from the other types (p <.05). CONCLUSIONS The coracoid process was classified into five types based on obvious morphological features. Knowing of morphological classification and anatomical parameters of different types of the coracoid process, to some extent, may be helpful to diagnose and treat the shoulder joint disease, such as acromioclavicular joint dislocation, anterior shoulder instability, and coracoid fractures, and to theoretically reduce postoperative complications.
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Affiliation(s)
- Lei Zhang
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China.,Center for Orthopedic Diseases Research, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China.,Expert Workstation in Luzhou, Sichuan Luzhou, China.,Clinical Base of Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Luzhou, China
| | - Lujing Xiong
- School of Clinical Medicine, Southwest Medical University, Luzhou, China
| | - Siyuan He
- School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Jiaju Liu
- Market Supervision Administration of Luzhou City of Sichuan Province, Luzhou, China
| | - Xin Zhou
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China.,Center for Orthopedic Diseases Research, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China.,Expert Workstation in Luzhou, Sichuan Luzhou, China
| | - Xiaogao Tang
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China.,Center for Orthopedic Diseases Research, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China.,Expert Workstation in Luzhou, Sichuan Luzhou, China
| | - Shijie Fu
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China.,Center for Orthopedic Diseases Research, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China.,Expert Workstation in Luzhou, Sichuan Luzhou, China
| | - Guoyou Wang
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China.,Center for Orthopedic Diseases Research, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China.,Expert Workstation in Luzhou, Sichuan Luzhou, China
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Single tunnel technique versus coracoid sling technique for arthroscopic treatment of acute acromioclavicular joint dislocation. Sci Rep 2022; 12:4244. [PMID: 35273203 PMCID: PMC8913784 DOI: 10.1038/s41598-022-07644-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 02/21/2022] [Indexed: 11/25/2022] Open
Abstract
To evaluate and compare the efficacy of two techniques for the treatment of acute acromioclavicular joint dislocation, the charts of 60 patients diagnosed with acute Rockwood type IV and V acromioclavicular joint dislocation that undergone arthroscopic fixation procedure with single tunnel technique (N = 30, 30.7 ± 5.7 years old) or coracoid sling technique (N = 30, 30.1 ± 5.4 years old) fixation were retrospectively reviewed. The Visual Analog Scale pain score, Constant shoulder functionality score, Karlsson acromioclavicular joint score, the time of return to sports and activity, and plain radiographs of the affected shoulder at different time points of follow-up were recorded for a minimum of 2 years post-op. The majority of the patients recovered to their preoperative activity levels with few complications. The average postoperative acromioclavicular and coracoclavicular distances were significantly narrower than preoperative measurements in both groups without significant difference between the two groups at 2 years post-op (P < 0.05). The coracoid sling technique group had reduced operative time, shorter time of recovery of shoulder movements, higher Constant functionality scores and Karlsson acromioclavicular joint scores, and fewer complications than the single tunnel technique group at the last follow-up (P < 0.05). Therefore, coracoid sling technique achieved superior clinical outcomes with fewer complications compared to the traditional single tunnel technique in arthroscopic treatment of acute acromioclavicular joint dislocation.
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Hu F, Han S, Liu F, Wang Z, Jia H, Wang F, Hu L, Chen J, Wang B, Yang Y. A modified single-endobutton technique combined with nice knot for treatment of Rockwood type III or V acromioclavicular joint dislocation. BMC Musculoskelet Disord 2022; 23:15. [PMID: 34980065 PMCID: PMC8725473 DOI: 10.1186/s12891-021-04915-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 11/24/2021] [Indexed: 02/08/2023] Open
Abstract
PURPOSE Double-endobutton technique, as a widely accepted strategy for the treatment of acromioclavicular joint dislocation, is undergoing constant improvement. This study aims to assess the clinical effect of a modified single-endobutton combined with the nice knot in the fixation of Rockwood type III or V acromioclavicular joint dislocation. METHODS From January 2016 to June 2019, 16 adult patients (13 males and 3 females) with Rockwood type III or V acromioclavicular joint dislocation were treated with a modified single-endobutton technique combined with the nice knot in our department. The age ranged from 18 to 64 years old with an average of 32.8 years old. Operative time, intraoperative blood loss, post-operative clinical outcomes and radiographic results were recorded and analyzed. Preoperative and last follow-up scores in the Constant-Murley Scale, Neer score, Rating Scale of the American Shoulder and Elbow Surgeons and VAS scale and complications such as infection, re-dislocation, implant loosening, medical origin fracture and hardware pain were recorded and evaluated. RESULTS Sixteen patients were followed up for 6 to 18 months with an average of 10.3 months. The operative time was 50-90 min with an average of (62.5 ± 3.10) min. The intraoperative blood loss was 30-100 ml, with an average of (55.0 ± 4.28) ml. The complications, such as wound infection, internal fixation failure and fractures, were not found in these cases. According to Karlsson criteria, there were excellent in 14 cases, good in 2 cases at the final follow-up. The mean VAS score of the patients was 5.88 ± 0.26 preoperatively, compared with 0.19 ± 0.14 at the final follow-up evaluation. The difference was statistically significant (P < 0.05). The mean Constant score was 45.5 ± 2.0 preoperatively, compared to 94.0 ± 0.73 at the final follow-up evaluation. The difference was statistically significant (P < 0.05). Patients had statistically significant preoperative and postoperative AC (acromioclavicular distance) and CC (coracoclavicular distance) distances (P < 0.05); 6 months postoperatively the AC(P = 0.412) and CC(P = 0.324) distances were not statistically significant compared to the healthy side. CONCLUSION Nice knot provides a reliable fixation for the single-endobutton technique in the treatment of acromioclavicular dislocations. The modified single-endobutton technique combined with the nice knot can achieve good clinical outcomes in the treatment of Rockwood type III or V acromioclavicular joint dislocation.
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Affiliation(s)
- Fangning Hu
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong Province, China
| | - Shumei Han
- Department of Radiotherapy, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Fanxiao Liu
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong Province, China
| | - Zhuang Wang
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong Province, China
| | - Honglei Jia
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong Province, China
| | - Fu Wang
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong Province, China
| | - Lingfei Hu
- Department of Emergency surgery, Linyi People's Hospital, Shandong First Medical University and Shandong Academy of Medical Sciences, Linyi, Shandong Province, China
| | - Jing Chen
- Department of Emergency surgery, Linyi People's Hospital, Shandong First Medical University and Shandong Academy of Medical Sciences, Linyi, Shandong Province, China
| | - Bomin Wang
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong Province, China.
- Department of Hemodialysis, Linyi People's Hospital, Shandong First Medical University and Shandong Academy of Medical Sciences, Linyi, Shandong Province, China.
| | - Yongliang Yang
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong Province, China.
- Department of Hemodialysis, Linyi People's Hospital, Shandong First Medical University and Shandong Academy of Medical Sciences, Linyi, Shandong Province, China.
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Zhang L, Wen Y, Zhang MY, Zhou X, Fu SJ, Wang GY. Efficacy of Transosseous Tunnel Placement for Triple Endobutton Plate in Acromioclavicular Joint Reconstruction: A Three-Dimensional Printing Guide Design Technology. Orthop Surg 2021; 14:422-426. [PMID: 34904392 PMCID: PMC8867420 DOI: 10.1111/os.13091] [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: 02/26/2021] [Revised: 05/11/2021] [Accepted: 05/11/2021] [Indexed: 11/30/2022] Open
Abstract
Objective Explore an accurate transosseous tunnel drilling method based on three‐dimensional (3D) printing technology for acromioclavicular joint reconstruction (ACD), design a guide design, and evaluate its accuracy. Methods Using Mimics software to reconstruct 100 cases of acromioclavicular joint computed tomography (CT) data. In design 2, the non‐collinear tunnel is superimposed on the 3D model, and a virtual drilling is performed between the clavicle and the coracoid using a triple inner gusset. Then, in the Geomagic Studio software model, an elliptical plane is calculated and extracted as a guide design for precise drilling. Then put the design and the 3D shoulder model together for 3D printing. Ten lengths were measured, and the effects of the virtual model, the actual model, and the guide rail design were compared. Results We successfully compared 10 parameters of 3D virtual model and actual model. There was no significant difference between actual and virtual bone tunnels in 10 measurements (P > 0.05). Conclusions The accuracy of ACD combined with 3D printing guidance design technology in the transosseous tunnel of adult shoulder is reliable.
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Affiliation(s)
- Lei Zhang
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China.,Center for Orthopedic Diseases Research, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China.,Expert Workstation in Luzhou, Luzhou, China.,Clinical Base of Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Luzhou, China
| | - Youliang Wen
- School of Rehabilitation Medicine GanNan Medical University, Ganzhou, China
| | - Meng-Yao Zhang
- School of Clinical Medicine, Southwest Medical University, Luzhou, China
| | - Xin Zhou
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China.,Center for Orthopedic Diseases Research, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China.,Expert Workstation in Luzhou, Luzhou, China.,Clinical Base of Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Luzhou, China
| | - Shi-Jie Fu
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China.,Center for Orthopedic Diseases Research, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China.,Expert Workstation in Luzhou, Luzhou, China.,Clinical Base of Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Luzhou, China
| | - Guo-You Wang
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China.,Center for Orthopedic Diseases Research, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China.,Expert Workstation in Luzhou, Luzhou, China.,Clinical Base of Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Luzhou, China
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Nie S, Lan M. Comparison of clinical efficacy between arthroscopically assisted Tight-Rope technique and clavicular hook plate fixation in treating acute high-grade acromioclavicular joint separations. J Orthop Surg (Hong Kong) 2021; 29:23094990211010562. [PMID: 33896269 DOI: 10.1177/23094990211010562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION The purpose of this study was to compare the results of arthroscopically assisted reduction of acute acromioclavicular (AC) joint separations with the Tight-Rope technique with results of clavicular hook plate fixation. MATERIALS AND METHODS The 28 patients with acute high-grade AC joint dislocation were treated with arthroscopic assisted fixation using the Tight-Rope system, the arthroscopic evaluation and treatment of glenohumeral lesions were performed before AC ligament reconstruction. Each Tight-Rope technique group patient was matched with three controls that underwent clavicular hook plate fixation, and preoperation and postoperative visual analogue scale (VAS) and functional recovery (Constant Score) of the shoulder joint was assessed,. Furthermore, the demographics and clinical characteristics were compared between the two groups. RESULTS All patients had clinical and radiological results available at 2 years or greater (mean: 34; range: 24-72 months), they were statistically significant improvement in the constant score and VAS score at the end of follow-up respectively (P < 0.001). Compared with the clavicular hook plate group, Tight-Rope system group patients were incurred significant statistically lower skin incision, hospitalization time and estimated blood loss (P < 0.001), and the constant score and VAS score at the end of follow-up was significantly higher in the Tight-Rope group (P < 0.001). Patients who underwent clavicular hook plate had a higher incidence of fixation failure [10 cases (11.9%) versus 2 cases (7.1%)] than those of the Tight-Rope system group. CONCLUSIONS The Tight-Rope technique is advantageous for treating these patients because it is a minimally invasive procedure with low complications and superior clinical outcomes.
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Affiliation(s)
- Si Nie
- Department of Radiology, 159384Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, People's Republic of China
| | - Min Lan
- Department of Orthopedics, 159384Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, People's Republic of China
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13
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Panagopoulos A, Fandridis E, Rose GD, Ranieri R, Castagna A, Kokkalis ZT, Dimakopoulos P. Long-term stability of coracoclavicular suture fixation for acute acromioclavicular joint separation. Knee Surg Sports Traumatol Arthrosc 2021; 29:2103-2109. [PMID: 32691091 DOI: 10.1007/s00167-020-06158-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 07/14/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE The optimal (SBJI) surgical treatment for acute acromioclavicular (AC) joint disruption remains controversial. What is being presented is the long-term functional outcomes of a double cross-looped coracoclavicular (CC) suture technique with the intention of restoring both anteroposterior and superior displacement of the clavicle. METHODS Between 2007 and 2016, 81 patients underwent surgical reconstruction for acute acromioclavicular joint (AC) disruption in two orthopaedic centers. Two patients died for reasons unrelated to the treatment, and seven missed the final follow-up appointment, leaving 72 patients (67 males; 5 females; age 37 ± 12.4; range 15-64 years) for clinical and radiological assessments. All cases were classified according to the Rockwood classification as type III (n = 34), IV (n = 14) or V (n = 24). The dislocation was repaired with double cross-looped CC fixation using four Ethibond sutures passing underneath the coracoid and through a 4.5 mm drill hole in the clavicle in opposing directions to control both anteroposterior and vertical displacement. Radiological investigation preoperatively and at the last follow-up included anteroposterior and/or Zanca views, axillary or Alexander views, and comparative stress radiography of both AC joints. Patients were evaluated clinically with the Constant-Murley score (CMS) and Acromio Clavicular Joint Instability Score (ACJIS). Loss of reduction, subluxation, CC ligament ossification, post-traumatic arthritis, and peri-implant fractures were also recorded. RESULTS Seventy-two patients were available for the last clinical and radiological evaluations. At a median follow-up period of 6.3 ± 2.1 years (range 3-12 years), the CMS and ACJIS were 92.1 ± 7.2 (range 60-100 points) and 90.4 ± 8.6 (range 45-100 points), respectively. Complications included 9 (12.5%) patients with slight loss of reduction, 2 (1.7%) with dislocation recurrence, 1 (1.3%) with superficial infection, 1 (1.3%) with a fracture of the lateral end of the clavicle, and 2 (1.7%) with persistent tenderness in the AC joint. The incidence of periarticular ossification was 22.4% and did not affect the final outcome. CONCLUSIONS This technique represents an effective and low-cost treatment for acute AC joint separations. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- A Panagopoulos
- Department of Shoulder and Elbow Surgery, Patras University Hospital, Papanikolaou 1, 26504, Patras, Greece.
| | - E Fandridis
- Hand Surgery-Upper Limb and Microsurgery Department, General Hospital "KAT" Athens, Kifissia, Greece
| | - G Delle Rose
- Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, Rozzano, Milan, 20089, Italy
| | - R Ranieri
- Department of Biomedical Sciences, Humanitas University, Via Manzoni 56, Rozzano, Pieve Emanuele-Milan, 20089, Italy
| | - A Castagna
- Department of Biomedical Sciences, Humanitas University, Via Manzoni 56, Rozzano, Pieve Emanuele-Milan, 20089, Italy.,Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, Rozzano, Milan, 20089, Italy
| | - Z T Kokkalis
- Department of Shoulder and Elbow Surgery, Patras University Hospital, Papanikolaou 1, 26504, Patras, Greece
| | - P Dimakopoulos
- Department of Shoulder and Elbow Surgery, Patras University Hospital, Papanikolaou 1, 26504, Patras, Greece
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14
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Biologic and synthetic ligament reconstructions achieve better functional scores compared to osteosynthesis in the treatment of acute acromioclavicular joint dislocation. Knee Surg Sports Traumatol Arthrosc 2021; 29:2175-2193. [PMID: 32797247 DOI: 10.1007/s00167-020-06217-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 08/06/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE To systematically review the outcomes of surgical treatments of acute acromioclavicular joint dislocation. METHODS Studies were identified by electronic databases (Ovid, PubMed). All studies reporting functional and radiological outcomes of surgical treatments of acute acromioclavicular joint dislocations were included. Following data were extracted: authors and year, study design, level of evidence, number of patients, age, classification of acromioclavicular joint dislocation, time to surgery, surgical technique, follow-up, clinical and imaging outcomes, complications, and failures. Descriptive statistics was used, when a data pooling was not possible. Comparable outcomes were pooled to generate summary outcomes reported as frequency-weighted values. Quality appraisal was assessed through the MINORS checklist. RESULTS One hundred and thirty-three studies were included for a total of 4473 shoulders. Mean age of participants was 36.9 years. Mean follow-up was 42.06 months. Arthroscopy showed better ASES (p < 0.0001) and lower VAS pain score (p = 0.0249) compared to an open approach. Biologic and synthetic reconstructions demonstrated better results over osteosynthesis techniques. Biologic techniques showed overall better Constant (p = 0.0001) and DASH (p = 0.0215) scores, while synthetic reconstruction showed better UCLA score (p = 0.0001). Among suture buttons, triple button showed overall better results in Constant (p = 0.0001) and VAS (p = 0.0001) scores, while better results in DASH score (p = 0.0003) were achieved by 2 double button techniques. Overall, the level of evidence was low. CONCLUSION Biological and synthetic reconstructions achieved better functional scores compared to osteosynthesis. Among suture buttons, the triple button showed better functional performance. LEVEL OF EVIDENCE IV.
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15
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Jeong JY, Chun YM. Treatment of acute high-grade acromioclavicular joint dislocation. Clin Shoulder Elb 2020; 23:159-165. [PMID: 33330252 PMCID: PMC7714286 DOI: 10.5397/cise.2020.00150] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/06/2020] [Indexed: 02/07/2023] Open
Abstract
Acromioclavicular (AC) joint dislocations account for about 9% of shoulder injuries. Among them, acute high-grade injury following high-energy trauma accounts for a large proportion of patients requiring surgical treatment. However, there is no gold standard procedure for operative treatment of acute high-grade AC joint injury, and several different procedures have been used for this purpose in clinical practice. This review article summarizes the most recent and relevant surgical options for acute high-grade AC joint dislocation patients and the outcomes of each treatment type.
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Affiliation(s)
- Jeung Yeol Jeong
- Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Yong-Min Chun
- Department of Orthopedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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16
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Fox HM, Ramsey DC, Thompson AR, Hoekstra CJ, Mirarchi AJ, Nazir OF. Neer Type-II Distal Clavicle Fractures: A Cost-Effectiveness Analysis of Fixation Techniques. J Bone Joint Surg Am 2020; 102:254-261. [PMID: 31809393 DOI: 10.2106/jbjs.19.00590] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Neer type-II distal clavicle fractures are unstable and are generally appropriately managed with operative fixation. Fixation options include locking plates, hook plates, and suture button devices. No consensus on optimal technique exists. METHODS A decision tree model was created describing fixation of Neer type-II fractures using hook plates, locking plates, or suture buttons. Outcomes included uneventful healing, symptomatic implant removal, deep infection requiring debridement, and nonunion requiring revision. Weighted averages derived from a systematic review were used for probabilities. Cost-effectiveness was evaluated by calculating incremental cost-effectiveness ratios (ICERs). The ICER is defined as the ratio of the difference in cost and difference in effectiveness of each strategy, and is measured in cost per quality-adjusted life year (QALY). The model was evaluated using thresholds of $50,000/QALY and $100,000/QALY. Sensitivity analysis was performed on all outcome probabilities for each fixation strategy to assess cost-effectiveness across a range of values. RESULTS Forty-three papers met final inclusion criteria. Using suture buttons as the reference case in the health-care cost model, suture button repair was dominant (both less expensive and clinically superior). Hook plates cost substantially more ($5,360.52) compared with suture buttons and locking plates ($3,713.50 and $4,007.44, respectively). Suture buttons and locking plates yielded similar clinical outcomes (0.92 and 0.91 QALY, respectively). Suture button dominance persisted in the societal perspective model. Sensitivity analysis on outcome probabilities showed that locking plates became the most cost-effective strategy if the revision rate after their use was lowered to 2.2%, from the overall average in the sources of >19%. No other changes in outcome probabilities for any of the 3 techniques allowed suture buttons to be surpassed as the most cost-effective. CONCLUSIONS The cost-effectiveness of suture buttons is driven by low revision rates and high uneventful healing rates. Similar QALY values for locking plate and suture button fixation were observed, which is consistent with existing literature that has failed to identify either as the clinically superior technique. Cost-effectiveness should fit prominently into the decision-making rubric for these injuries. LEVEL OF EVIDENCE Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Henry M Fox
- Departments of Orthopaedics and Rehabilitation (H.M.F., D.C.R., A.R.T., A.J.M., and O.F.N.) and Medical Informatics and Clinical Epidemiology (C.J.H.), Oregon Health & Science University, Portland, Oregon
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Civan O, Atmaca H, Uğur L. Biomechanical comparison of double versus triple button reconstruction techniques in patients with acromioclavicular joint dislocation. Int J Med Robot 2019; 16:e2057. [DOI: 10.1002/rcs.2057] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 10/10/2019] [Accepted: 11/06/2019] [Indexed: 01/18/2023]
Affiliation(s)
- Osman Civan
- Elmalı State Hospital, Department of Orthopaedics and Traumatology Antalya Turkey
| | - Halil Atmaca
- ArtroKlinik, Department of Orthopaedics and Traumatology Kocaeli Turkey
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Sun LJ, Lu D, Tao ZY, Yu XB, Hu W, Ma YF, Yu B. Analysis of risk factors for loss of reduction after acromioclavicular joint dislocation treated with the suture-button. J Orthop Sci 2019; 24:817-821. [PMID: 30777362 DOI: 10.1016/j.jos.2019.01.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 01/21/2019] [Accepted: 01/29/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND The most commonly reported complication after acromioclavicular (AC) joint dislocation treated with the Suture-button is loss of reduction. Loss of reduction is a major factor influencing the patient's joint function and subjective satisfaction. The objective of this study is to analyze the risk factors causing loss of reduction after AC joint dislocation treated with the Suture-button. METHODS One hundred and thirty patients with AC joint dislocation who were surgically treated the Suture-button in our hospital from February 2009 to February 2015, were recorded their age, sex, BMI, time from injury to surgery, Rockwood's classification, with or without osteoporosis, double or triple button technique, position of the clavicle tunnel, tunnel diameter, coracoid button position, alignment of the button, acromioclavicular ligament repair or not, different methods of postoperative limb immobilization, and so on. Mean comparisons or chi-square test was used for univariate analysis of the above factors, and then multivariate logistic regression analysis was performed to predict risk factors. RESULTS Reduction was lost in 23.1% of the patients. Univariate analysis showed that button alignment, double or triple button technique, coracoid button position, position of the clavicle tunnel, acromioclavicular ligament repair or not and osteoporosis had statistically significant association with loss of reduction for AC joint (P = 0.031, 0.034, 0.000, 0.042, 0.047 and 0.000 respectively). Multivariate logistic regression analysis demonstrated that osteoporosis (P = 0.003), position of the clavicle tunnel (P = 0.032) and coracoid button position (P < 0.001) were the risk factors that significantly associated with the loss of reduction after AC joint dislocation treated with the Suture-button. CONCLUSIONS Clavicle tunnel location using relative ratio method, accurate placement of button plate under coracoid process (inside or outside deviation <20°), various reinforcement operations for patients with osteoporosis are important factors in preventing loss of reduction.
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Affiliation(s)
- Liao-Jun Sun
- Department of Orthopaedic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China; Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Zhejiang Provincial Key Laboratory of Orthopaedics, Wenzhou, Zhejiang, China
| | - Di Lu
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Zhejiang Provincial Key Laboratory of Orthopaedics, Wenzhou, Zhejiang, China
| | - Zhen-Yu Tao
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Zhejiang Provincial Key Laboratory of Orthopaedics, Wenzhou, Zhejiang, China
| | - Xian-Bin Yu
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Zhejiang Provincial Key Laboratory of Orthopaedics, Wenzhou, Zhejiang, China
| | - Wei Hu
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Zhejiang Provincial Key Laboratory of Orthopaedics, Wenzhou, Zhejiang, China
| | - Yun-Fei Ma
- Department of Orthopaedic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Bin Yu
- Department of Orthopaedic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China.
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Porschke F, Schnetzke M, Studier-Fischer S, Gruetzner PA, Guehring T. Return to work after acromioclavicular joint stabilization: a retrospective case control study. J Orthop Surg Res 2019; 14:45. [PMID: 30755238 PMCID: PMC6373092 DOI: 10.1186/s13018-019-1071-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 01/15/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Considering the epidemiology of acromioclavicular (AC) dislocation related to young and active patients, the impact on working capacity is highly relevant. The purpose of this study was to determine the capacity of work and time to return to work (RTW) after AC joint stabilization. We hypothesized that manual working patients show more restrictions returning to work. METHODS In this retrospective case series, pre- and posttraumatic working capacity of 54 patients (FU-rate 80.1%, FU time 23, range 18-45 month) stabilized in single TightRope technique was analyzed. Clinical outcome (DASH, Constant-Murley score) and complications were evaluated in addition. RESULTS Fifty one of 54 patients (94.5%) were returned to work at final follow-up. The median time to return was 13 (5-143) weeks. Manual working patients showed lower RTW-rates (91.2% vs. 100%; p = .151), longer RTW-time (15.5 vs. 6 weeks; p = .008), and more often persistent shoulder symptoms at work (55.9% vs. 5%; p < .001). CONCLUSION After stabilization of AC joint dislocation, the majority of patients returned to work, needing substantial time to return. Manual working patients required more time and often suffer under persistent symptoms at work.
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Affiliation(s)
- Felix Porschke
- BG Trauma Center Ludwigshafen, Heidelberg University Hospital, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen, Germany
| | - Marc Schnetzke
- BG Trauma Center Ludwigshafen, Heidelberg University Hospital, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen, Germany
| | - Stefan Studier-Fischer
- BG Trauma Center Ludwigshafen, Heidelberg University Hospital, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen, Germany
| | - Paul Alfred Gruetzner
- BG Trauma Center Ludwigshafen, Heidelberg University Hospital, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen, Germany
| | - Thorsten Guehring
- BG Trauma Center Ludwigshafen, Heidelberg University Hospital, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen, Germany.
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20
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Biomechanical Analysis of Single-, Double-, and Triple-Bundle Configurations for Coracoclavicular Ligament Reconstruction Using Cortical Fixation Buttons With Suture Tapes: A Cadaveric Study. Arthroscopy 2018; 34:2983-2991. [PMID: 30292596 DOI: 10.1016/j.arthro.2018.06.048] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 06/18/2018] [Accepted: 06/25/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the acromioclavicular (AC) joint stability of single-bundle (SB), double-bundle with an anterolateral limb (DBa), double-bundle with a posterolateral limb (DBp), and triple-bundle (TB) coracoclavicular (CC) ligament reconstructions using cortical fixation buttons with suture tapes. METHODS Eight cadaveric shoulders were used. AC joint translation and rotational stability were tested for intact and following 4 different CC reconstruction techniques: SB, DBa, DBp, and TB configurations using cortical fixation buttons with suture tapes. For each reconstruction and native AC joint as control, anteroposterior (AP) and superoinferior translations were quantified using 10- and 15-N translational loads and anterior and posterior rotations were measured using 0.16- and 0.32-Nm rotational torque. RESULTS DBp reconstruction showed significantly better AP stability compared with SB and DBa reconstruction at 10 and 15 N (DBp: 4.1 ± 0.6 mm, SB: 7.8 ± 1.1 mm, P < .001; DBa: 6.5 ± 0.7 mm, P = .02 at 10 N; DBp: 5.5 ± 0.8 mm, SB: 10.1 ± 1.0 mm, P = .003; DBa: 9.1 ± 0.7 mm, P = .02 at 15 N). The degree of total rotation showed tendency to decrease according to increasing number of bundles; however, there were no significant differences (SB: 43.1 ± 9.2°, DBa: 37.9 ± 7.3°, DBp: 33.9 ± 6.8°, TB: 32.2 ± 6.6°, P = .37 at 0.32 Nm). CONCLUSIONS An additional posterolateral clavicular hole for CC ligament reconstruction using cortical fixation buttons with suture tapes resulted in better AP stability compared with SB reconstruction, whereas use of additional anterolateral clavicular hole did not show any improvement compared with SB reconstruction. Reconstruction using both anterolateral and posterolateral clavicular holes did not guarantee better stability compared with SB reconstruction. There was an increasing tendency of rotational stability with number of bundle increases, although they did not reach statistical difference. CLINICAL RELEVANCE When surgeons consider double-bundle CC ligament reconstruction using cortical fixation buttons with suture tapes, it is better to position the lateral clavicular hole posteriorly to restore AP stability.
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Xu J, Liu H, Lu W, Li D, Zhu W, Ouyang K, Wu B, Peng L, Wang D. A retrospective comparative study of arthroscopic fixation in acute Rockwood type IV acromioclavicular joint dislocation: single versus double paired Endobutton technique. BMC Musculoskelet Disord 2018; 19:170. [PMID: 29793464 PMCID: PMC5968503 DOI: 10.1186/s12891-018-2104-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 05/18/2018] [Indexed: 12/23/2022] Open
Abstract
Background Rockwood type IV acromioclavicular joint (ACJ) dislocation is a trauma usually needs surgical treatment. Paired EndoButton technique (PET) is used in treating such condition. However, the effect of using different types of PET (single versus double PET) for fixation remains controversial. This study aims to evaluate and compare the efficacy of single and double PET and to provide a suitable option for the surgeons. Methods We retrospectively reviewed the charts of patients with acute Rockwood type IV ACJ dislocation who had undergone arthroscopic fixation using single or double PET fixation between March 2009 and March 2015. Seventy-eight consecutive patients identified from chart review were picked and were divided into the single and double PET group with 39 cases in each group. The indexes of visual analog scale score (VAS) for pain, the radiographs of the affected shoulder at different time points of the follow-up, the time of return to activities and sports, the constant functional score, and the Karlsson acromioclavicular joint (ACJ) score, were assessed in a minimum of 2 years postoperation. Results The average coracoclavicular (CC) and acromioclavicular (AC) distances of the affected joints in the double PET group were significantly smaller than those of the single PET group 2 years postoperation (P < 0.05). The average AC and CC distances in the healthy shoulder joints were significantly smaller than those of the affected joints in the single PET group (P < 0.05); however, these values were not significantly different from those of the affected joints in the double PET group (P > 0.05). The mean VAS pain score was not significantly different, while significant difference was found for the number and times of cases return to activities and sports, constant functional score, and Karlsson ACJ score (P < 0.05) between the two groups. Therefore, the double PET group has better outcome than the single PET group. Complications including redislocation, button slippage, erosion, or AC joint instability occurred in the single PET group, while the complication in the double PET group was rare. Conclusions Compared with the single PET, the double PET group achieved better outcome with less complications in arthroscopically treating acute Rockwood type IV ACJ dislocation.
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Affiliation(s)
- Jian Xu
- Department of Sports Medicine, Shenzhen Second People's Hospital, Shenzhen First Affiliated Hospital, Shenzhen University, No.3002 Sungang West Road, Futian district, Shenzhen City, 518000, Guangdong Province, China
| | - Haifeng Liu
- Department of Sports Medicine, Shenzhen Second People's Hospital, Shenzhen First Affiliated Hospital, Shenzhen University, No.3002 Sungang West Road, Futian district, Shenzhen City, 518000, Guangdong Province, China
| | - Wei Lu
- Department of Sports Medicine, Shenzhen Second People's Hospital, Shenzhen First Affiliated Hospital, Shenzhen University, No.3002 Sungang West Road, Futian district, Shenzhen City, 518000, Guangdong Province, China.
| | - Dingfu Li
- Department of Sports Medicine, Shenzhen Second People's Hospital, Shenzhen First Affiliated Hospital, Shenzhen University, No.3002 Sungang West Road, Futian district, Shenzhen City, 518000, Guangdong Province, China
| | - Weimin Zhu
- Department of Sports Medicine, Shenzhen Second People's Hospital, Shenzhen First Affiliated Hospital, Shenzhen University, No.3002 Sungang West Road, Futian district, Shenzhen City, 518000, Guangdong Province, China
| | - Kan Ouyang
- Department of Sports Medicine, Shenzhen Second People's Hospital, Shenzhen First Affiliated Hospital, Shenzhen University, No.3002 Sungang West Road, Futian district, Shenzhen City, 518000, Guangdong Province, China
| | - Bing Wu
- Department of Sports Medicine, Shenzhen Second People's Hospital, Shenzhen First Affiliated Hospital, Shenzhen University, No.3002 Sungang West Road, Futian district, Shenzhen City, 518000, Guangdong Province, China
| | - Liangquan Peng
- Department of Sports Medicine, Shenzhen Second People's Hospital, Shenzhen First Affiliated Hospital, Shenzhen University, No.3002 Sungang West Road, Futian district, Shenzhen City, 518000, Guangdong Province, China
| | - Daping Wang
- Department of Sports Medicine, Shenzhen Second People's Hospital, Shenzhen First Affiliated Hospital, Shenzhen University, No.3002 Sungang West Road, Futian district, Shenzhen City, 518000, Guangdong Province, China.
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Yin J, Yin Z, Gong G, Zhu C, Sun C, Liu X. Comparison of hook plate with versus without double-tunnel coracoclavicular ligament reconstruction for repair of acute acromioclavicular joint dislocations: A prospective randomized controlled clinical trial. Int J Surg 2018; 54:18-23. [PMID: 29679723 DOI: 10.1016/j.ijsu.2018.04.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 03/21/2018] [Accepted: 04/09/2018] [Indexed: 12/30/2022]
Abstract
PURPOSE This study was designed to compare the surgical outcomes of a hook plate with double-tunnel coracoclavicular (CC) ligament reconstruction by conjoined tendon transfer versus single hook plate surgery for the repair of acute type of Rockwood type III and V acromioclavicular (AC) joint dislocations. METHODS The study cohort included 62 patients with acute (within 6 weeks after trauma) Rockwood type III and V AC joint dislocations who underwent surgery from February 2012 to September 2015. The patients were randomly allocated to the ligament reconstruction group (LR group, n = 31) or the single hook plate group (HP group, n = 31). In both groups, reduction of the AC joint by hook plate and repair of the ruptured AC ligament with absorbable Vicryl sutures were performed homoplastically. The lateral half of the short tendon of the biceps brachii muscle and the lateral half of the flexor tendon were used to reconstruct the trapezoid and conoid ligaments, respectively. Differences in surgical duration, intraoperative blood loss, incision length, and total cost were compared between the two groups. Furthermore, the preoperative and postoperative visual analogue score (VAS), postoperative American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score (CMS), Karlsson score, complication rates, and patient satisfaction at the last follow-up were compared to evaluate the curative effects of the surgical treatments. Magnetic resonance imaging (MRI) after hook plate removal was used to evaluate the reconstructed ligaments and tendon-bone interface. RESULTS In total, 25 patients in the LR group and 26 in the HP group completed the follow-up. There were no statistically significant differences in age, sex, Rockwood type, placing time, total cost, and follow-up duration between the LR and HP groups (p > 0.05). However, as compared with the HP group, the surgical duration and incision length were longer in the LR group (92.08 ± 19.25 vs. 56.54 ± 21.29 min and 13.64 ± 0.90 vs. 6.65 ± 1.01 cm, respectively, p < 0.05). In addition, there was no significant difference in preoperative VAS scores, but the postoperative VAS score was lower in LR group than in the HP group (2.52 ± 1.19 vs. 4.12 ± 1.45, respectively, p < 0.05). Moreover, patients in LR group had a remarkable higher CMS and ASES score (89.56 ± 2.80 vs. 79.31 ± 4.97 and 92.60 ± 2.79 vs. 82.35 ± 3.44, respectively, p < 0.05). The overall excellent or good result rate, as evaluated by the Karlsson score, was 92.00% (23/25) and 50.00% (13/26), respectively (p < 0.05). MRI findings revealed good condition of the reconstructed ligaments and tendon-bone interface. The incidence of complications was lower and the satisfaction rate was higher in the LR group than in the HP group (1/25 vs. 16/26 and 23/25 vs. 14/26, respectively, p < 0.05). CONCLUSIONS The overall surgical effect of the use of a hook plate combined with double-tunnel CC ligament reconstruction is superior to single hook plate surgery for the repair of acute Rockwood type III and V AC joint dislocations.
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Affiliation(s)
- Jian Yin
- Department of Orthopedics, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing 211100, China.
| | - Zhaoyang Yin
- Department of Geriatrics, Jinling Hospital, Medical School of Nanjing University, Nanjing, 211002, China.
| | - Ge Gong
- Research Center for Geriatrics of Nanjing General Hospital of Nanjing Military Region, Nanjing 211100, China.
| | - Chao Zhu
- Department of Orthopedics, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing 211100, China.
| | - Chao Sun
- Department of Orthopedics, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing 211100, China.
| | - Xinhui Liu
- Department of Orthopedics, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing 211100, China.
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Zhang L, Zhou X, Qi J, Zeng Y, Zhang S, Liu G, Ping R, Li Y, Fu S. Modified closed-loop double-endobutton technique for repair of rockwood type III acromioclavicular dislocation. Exp Ther Med 2017; 15:940-948. [PMID: 29399102 PMCID: PMC5772745 DOI: 10.3892/etm.2017.5487] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 11/02/2017] [Indexed: 12/15/2022] Open
Abstract
Acromioclavicular dislocation (ACD) is a common injury. According to the Rockwood classification, ACD is classified into six types (type I–VI); however, for type III injuries, it remains controversial whether or not operative treatment should be applied. Numerous studies have advocated early surgical treatment to ensure early rehabilitation activities. Thus, the present study aimed to investigate a modified closed-loop double-endobutton technique (MCDT), that may be used to repair Rockwood type III ACD. In the current study, 61 patients with Rockwood type III ACD were enrolled during a period of 5 years at the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University. Patients were divided into three groups according to the surgical method used, the MCDT group (n=20), the common closed-loop double-endobutton technique (CCDT) group (n=21), and the clavicular hook plate fixation (CHPF) group (n=20). Preoperative and intraoperative information were recorded. Furthermore, the functional scores of injured shoulder were evaluated prior to surgery and following surgery with a 1-year follow-up. Among the three groups, postoperative functional scores were significantly more improved compared with those prior to surgery (P<0.05), and no significant difference was observed regarding the coracoclavicular interval with the 1-year follow-up (P>0.05). Postoperative functional scores in the MCDT and CCDT groups were significantly more improved compared those in the CHPF group (P<0.05). In addition, the duration of surgery in the MCDT group was significantly shorter compared with that in the CCDT group (P<0.05). Furthermore, compared with the CHPF group, the incision length was significantly shorter with reduced hemorrhage in the MCDT group (P<0.05). In conclusion, the results of the current study suggest that MCDT is more simple, convenient and efficient compared with CCDT, and is worth popularizing.
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Affiliation(s)
- Lei Zhang
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan 646600, P.R. China.,Department of Orthopedics, School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Xin Zhou
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan 646600, P.R. China
| | - Ji Qi
- Department of Orthopedics, School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Yan Zeng
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan 646600, P.R. China
| | - Shaoqun Zhang
- Department of Orthopedics, School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Gang Liu
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan 646600, P.R. China
| | - Ruiyue Ping
- Department of Dermatology, Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong 510403, P.R. China
| | - Yikai Li
- Department of Orthopedics, School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Shijie Fu
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan 646600, P.R. China
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A comparison between two double-button endoscopically assisted surgical techniques for the treatment acute acromioclavicular dislocations. Musculoskelet Surg 2017; 102:73-79. [PMID: 28861851 DOI: 10.1007/s12306-017-0501-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 08/23/2017] [Indexed: 12/18/2022]
Abstract
PURPOSE To compare clinical and radiological outcomes between two endoscopically assisted double-button techniques in high-grade acute acromioclavicular separations. METHODS A retrospective single-center study was conducted in patients with acute acromioclavicular joint dislocation Rockwood types III and V, from 2009 to 2014. All were treated endoscopically, with a 1-year minimum follow-up. Two consecutive series were conducted; the first (TR group) received the TightRope® system, whereas last series (DB group) was treated with the Dog Bone® button technology (Arthrex, Naples, FL, USA). Primary endpoints were last follow-up values of Constant score (CS) and Quick-DASH (QD) score. Moreover, the posttraumatic displacement and its evolution were assessed on bilateral Zanca radiographs. A displacement of 5 mm or greater the day after surgery was considered as a lack of reduction; the same difference on last follow-up X-rays was considered as a loss of reduction. RESULTS Forty patients were reviewed: 22 in the TR group and 18 in the DB group. After a mean follow-up of 27.7 ± 8.3 months, CS and QD averaged, respectively, 94.3 ± 4.4 and 2.0 ± 2.6 in the TR series, whereas they averaged, respectively, 95 ± 6.1 and 3.4 ± 3.3 in the DB series after a mean follow-up of 24.1 ± 5 months (PCS = 0.16, PQDS = 0.08). Lack of reduction and loss of reduction rates were significantly higher in the DB group, with P = 0.0005 and P < 0.0001, respectively. CONCLUSIONS Both techniques provided good to excellent functional outcomes. However, considering inferior radiological results using the Dog Bone® device, we would prefer the TightRope® device in acute acromioclavicular dislocations. LEVEL OF EVIDENCE IV: Therapeutic study-cases series.
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