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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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Senel A, Eren M, Batur OC, Kaya O, Sert S, Key S. The Effect of Clavicular Tunnel Position on Reduction Loss in Patients with Acute Acromioclavicular Joint Dislocations Operated with a Single-Bundle Suspensory Loop Device. Orthop Surg 2024; 16:1622-1630. [PMID: 38766809 PMCID: PMC11216842 DOI: 10.1111/os.14095] [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: 01/20/2024] [Revised: 04/23/2024] [Accepted: 04/26/2024] [Indexed: 05/22/2024] Open
Abstract
OBJECTIVE The treatment of acromioclavicular joint (ACJ) dislocations offers numerous options, and ongoing debates persist regarding their comparative effectiveness. Among these options, the suspensory loop device (SLD) is one of the most favored treatment modalities. Despite the observed high reduction loss rate associated with SLD, the treatment yields favorable clinical outcomes. This study aimed to investigate the clinical outcomes of patients with acute type 3 and 5 ACJ dislocations who underwent open and arthroscopic procedures using a single-bundle SLD, and to evaluate the effect of clavicular tunnel position on reduction loss. METHODS Thirty-seven eligible patients diagnosed with acute type 3 and type 5 ACJ dislocation who underwent open and arthroscopic surgery with a single-bundle SLD between January 2015 and March 2022 were evaluated retrospectively. Demographic data and radiological measurements including coracoclavicular (CC) interval, clavicle length (CL), and implant distance (ID) were recorded. The ID/CL ratio was calculated and a value between 0.17 and 0.24 was considered as "acceptable implant position". Reduction loss and other complications were noted. Patients were divided into two groups: open (Group 1) and arthroscopic (Group 2). Constant Murray Score (CMS) and Visual Analog Scale (VAS) were used for clinical and functional outcomes. Non-parametric tests were used for statistical analysis of variables. RESULTS The study included six females (16.2%) and 31 males (83.8%) with a mean age of 40.2 ± 14.7 years (range: 20-75). The mean follow-up period was 22.3 ± 16.7 months (range: 6-72). The average time from trauma to surgery was 6.3 ± 5.3 days (range: 1-18). At the last follow-up, the CMS was 89.3 ± 8.8 and the VAS score was 2.1 ± 0.9. The mean ID/CL ratio was 0.19 ± 0.1 and 19 patients (51.4%) were between 0.17 and 0.24. Reduction loss was observed in nine patients (24.3%). There were no significant differences between Group 1 and Group 2 regarding operation time (p = 0.998), ID/CL ratio (p = 0.442), reduction loss (p = 0.458), CMS (p = 0.325), and VAS score (p = 0.699). Of the 28 patients without reduction loss, 16 had an ID/CL ratio between 0.17 and 0.24 (p = 0.43). Furthermore, within the 0.17-0.24 interval, CMS was higher with an average of 91.8 ± 5.1 compared to the other intervals (p = 0.559). CONCLUSION The clinical and functional outcomes of acute type 3 and type 5 ACJ dislocation operated open and arthroscopically with single-bundle SLD are similar and satisfactory. A clavicular tunnel position in the range of 0.17-0.24 (ID/CL ratio) is recommended to maintain postoperative reduction.
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Affiliation(s)
- Ahmet Senel
- Orthopedics and Traumatology DepartmentIstanbul Training and Research HospitalIstanbulTurkey
| | - Murat Eren
- Orthopedics and Traumatology DepartmentIstanbul Training and Research HospitalIstanbulTurkey
| | - Omer Cihan Batur
- Orthopedics and Traumatology DepartmentElazig Fethi Sekin City HospitalElazigTurkey
| | - Oguz Kaya
- Orthopedics and Traumatology DepartmentElazig Fethi Sekin City HospitalElazigTurkey
| | - Selman Sert
- Orthopedics and Traumatology DepartmentIstanbul Training and Research HospitalIstanbulTurkey
| | - Sefa Key
- Department of Orthopedics and TraumatologyFirat University Faculty of MedicineElazigTurkey
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Jie M, Yang T, Xiang W. A Self-Designed Endobutton Installation Device for Coracoclavicular Stabilization in Acute Rockwood Type III Acromioclavicular Joint Dislocation. Orthop Surg 2024; 16:568-576. [PMID: 38233358 PMCID: PMC10925501 DOI: 10.1111/os.13995] [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: 07/30/2023] [Revised: 11/22/2023] [Accepted: 12/15/2023] [Indexed: 01/19/2024] Open
Abstract
OBJECTIVE Endobutton technique could provide flexible coracoclavicular (CC) stabilization for acromioclavicular joint (ACJ) dislocation and achieved good clinical outcomes. However, the difficult part of this technique was placement of the Endobutton to the coracoid base. In this study, we designed an Endobutton installation device to place the Endobutton at the coracoid base. And we examined the clinical and radiographic outcomes of patients with acute Rockwood type III ACJ dislocation repaired with Endobutton using this device. METHODS We designed an Endobutton installation device to place the Endobutton at the coracoid base to achieve CC stabilization. We retrospectively reviewed 42 patients with acute Rockwood type III ACJ dislocation who underwent CC stabilization with Endobuttons placed either using this novel device (group I, n = 19) or the traditional technique (CC stabilization without using special device, group II, n = 23) from January 2015 to April 2020. The two groups were compared regarding the operative time, intraoperative blood loss, and clinical and radiologic outcomes at final follow-up. The operation-related complications were also evaluated. The Student's t test and the Mann-Whitney U-test were used to compare differences in continuous variables. Differences in categorical variables were assessed with either the Pearson's chi-squared test or Fisher's exact test. RESULTS Forty-two patients were clinically followed up for a minimum of 12 months. Compared with group II, group I had a significantly shorter mean operative time (56.05 ± 7.82 min vs. 65.87 ± 7.43 min, p < 0.01) and significantly lesser mean intraoperative blood loss (67.89 ± 14.75 mL vs. 94.78 ± 25.01 mL, p < 0.01). At final follow-up, there were no significant differences between the two groups in the visual analog scale score for pain, Oxford Shoulder Score, Disabilities of the Arm, Shoulder, and Hand score, and postoperative CC distance of the affected side. Loss of reduction occurred in four patients in group I and three patients in group II (p = 0.68); there were no other operation-related complications in either group. CONCLUSIONS The Endobutton installation device makes placement of the Endobutton at the coracoid base easier and achieves satisfactory clinical and radiologic outcomes without additional complications in acute Rockwood type III ACJ dislocation.
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Affiliation(s)
- Ma Jie
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's HospitalShanghai JiaoTong University School of MedicineShanghaiChina
| | - Tang Yang
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's HospitalShanghai JiaoTong University School of MedicineShanghaiChina
| | - Wang Xiang
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's HospitalShanghai JiaoTong University School of MedicineShanghaiChina
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Chang PS, Murphy CP, Whalen RJ, Apostolakos JM, Provencher MT. Surgical Pearls and Pitfalls for Anatomic Acromioclavicular/Coracoclavicular Ligament Reconstruction. Clin Sports Med 2023; 42:621-632. [PMID: 37716726 DOI: 10.1016/j.csm.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
Injuries to the acromioclavicular (AC) joint are common shoulder injuries in contact/collision athletes. There are a number of different surgical options that can be used to treat these injuries. The majority of these injuries can be treated nonoperatively with an early return to play for type I and II injuries. Surgical intervention and AC/CC (coracoclavicular) ligament reconstruction have excellent postoperative outcomes if complications can be avoided. This review will focus on the pearls and pitfalls for anatomic AC and CC ligament reconstruction for high-grade AC joint injuries.
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Affiliation(s)
- Peter S Chang
- Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 400, Vail, CO 81657, USA
| | - Colin P Murphy
- University of North Dakota Orthopaedic Surgery Residency Program, 1919 Elm Street North, Fargo, ND 58102, USA
| | - Ryan J Whalen
- Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 400, Vail, CO 81657, USA
| | - John M Apostolakos
- Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 400, Vail, CO 81657, USA
| | - Matthew T Provencher
- Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 400, Vail, CO 81657, USA; The Steadman Clinic, 181 West Meadow Drive, Suite 400, Vail, CO 81657, USA.
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Lee YS, Kim DS, Jung JW, Jo YH, Lee CH, Lee BG. Risk factors of loss of reduction after acromioclavicular joint dislocation treated with a hook plate. J Orthop Traumatol 2023; 24:10. [PMID: 36961582 PMCID: PMC10039153 DOI: 10.1186/s10195-023-00685-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 01/21/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Acromioclavicular joint fixation using a hook plate is effective for the treatment of acute acromioclavicular joint dislocation. However, several studies have reported some complications including loss of reduction after surgery for acromioclavicular joint dislocation. This study aimed to identify the risk factors associated with the loss of reduction after acromioclavicular joint dislocation surgery using a hook plate. METHODS This was a retrospective study that assessed 118 patients with acromioclavicular joint dislocation, who were diagnosed between March 2013 and January 2019 and underwent surgical treatment using the hook plate (reduction loss group: n = 38; maintenance group: n = 80). The mean follow-up period was 29.9 months (range, 24-40 months). We assessed the range of motion, the American Shoulder and Elbow Surgeons score (ASES), visual analog scale score for pain, and a subjective shoulder value. Radiological assessment of coracoid clavicular distance was performed. The risk factors of reduction loss were analyzed using multivariable logistic regression analysis. RESULTS Age (p = 0.049), sex (female, p = 0.03, odds ratio OR = 4.81), Rockwood type V (p = 0.049, OR = 2.20), and time from injury to surgery > 7 days (p = 0.018, OR = 2.59) were statistically significant factors in the reduction loss group. There were no significant differences in the clinical outcomes for range of motion, ASES, subjective shoulder value, and visual analog scale scores between the two groups. In the radiological results, preoperative coracoid clavicular distance (p = 0.039) and ratio (p = 0.001), and over-reduction (p = 0.023, OR = 0.40) were significantly different between the two groups. The multivariate logistic regression analysis identified the female sex (p = 0.037, OR = 5.88), a time from injury to surgery > 7 days (p = 0.019, OR = 3.36), and the preoperative coracoid clavicular displacement ratio of the injured shoulder (p < 0.001, OR = 1.03) as risk factors associated with reduction loss following surgery using a hook plate for acromioclavicular dislocation. CONCLUSION A delayed timing of surgery > 7 days, preoperative coracoid clavicular displacement ratio of the injured shoulder, and female sex were identified as risk factors for loss of reduction after surgery using a hook plate for acromioclavicular joint dislocation. LEVEL OF EVIDENCE Level IV; retrospective comparison; treatment study.
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Affiliation(s)
- Young Seok Lee
- Department of Orthopedic Surgery, Hanyang University Guri Hospital, Guri, Republic of Korea
| | - Doo Sup Kim
- Department of Orthopedic Surgery, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Ji Won Jung
- Department of Orthopedic Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Young-Hoon Jo
- Department of Orthopedic Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Chang-Hun Lee
- Department of Orthopedic Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Bong Gun Lee
- Department of Orthopedic Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea.
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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.
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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
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Yu XB, Li T, Hu W, Chen H, Wu YS, Sun LJ. Position of Coracoid Button Predicts Loss of Reduction in Acromioclavicular Joint Dislocation Patients Treated With the Suture-Button. J INVEST SURG 2021; 34:1256-1261. [PMID: 30922136 DOI: 10.1080/08941939.2019.1593557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 03/07/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Loss of reduction is the most common complication after acromioclavicular (AC) joint dislocation treated with the suture-button. Some predictors of it are known, but finding new predictors is an ongoing process. In this study, we evaluate the importance of the position of the coracoid button. MATERIALS AND METHODS Between April 2010 and February 2017, 186 patients with AC joint dislocation were identified. All patients were managed with the same surgical technique and postoperative protocol. The position of the coracoid button was determined immediately after surgery by anterior-posterior views of the operated shoulder and was classified as medial (Group A, 42 cases), central (Group B, 85 cases) and lateral (Group C, 59 cases) positions. The main outcome measurement was loss of reduction. The main analysis was the association between the coracoid button position and loss of reduction. RESULTS No significant difference was found in the baseline characteristics among 3 groups. During follow-up, there were 15 cases (35.7%) developing loss of reduction in Group A, 5 cases (5.9%) in Group B and 26 cases (44.1%) in Group C. The rate of loss of reduction in Groups A and C were higher than that in Group B (p < .05). Moreover, there was no significant difference in the rate of reduction loss between lateral and medial positions of the coracoid buttons (p > .05). CONCLUSION Our results indicated that both lateral and medial positions of the coracoid buttons could predict loss of reduction in AC joint dislocation patients treated with the suture-button.
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Affiliation(s)
- Xian-Bin Yu
- Department of Orthopaedic Surgery, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, and Zhejiang Provincial Key Laboratory of Orthopaedics, Wenzhou, Zhejiang, China
| | - Tong Li
- Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Wei Hu
- Department of Orthopaedic Surgery, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, and Zhejiang Provincial Key Laboratory of Orthopaedics, Wenzhou, Zhejiang, China
| | - Hua Chen
- Department of Orthopaedic Surgery, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, and Zhejiang Provincial Key Laboratory of Orthopaedics, Wenzhou, Zhejiang, China
| | - Yao-Sen Wu
- Department of Orthopaedic Surgery, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, and Zhejiang Provincial Key Laboratory of Orthopaedics, Wenzhou, Zhejiang, China
| | - Liao-Jun Sun
- Department of Orthopaedic Surgery, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, and Zhejiang Provincial Key Laboratory of Orthopaedics, Wenzhou, Zhejiang, China
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Liendo R, Contreras Fernández JJ, Manosalvas D, Valenzuela A, de Marinis R, Calvo C, Soza F. Distal clavicle fractures with "superior intact cortical bone": minimally invasive surgery. JSES REVIEWS, REPORTS, AND TECHNIQUES 2021; 1:229-235. [PMID: 37588959 PMCID: PMC10426548 DOI: 10.1016/j.xrrt.2021.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Introduction Distal clavicle fractures represent 12%-26% of all clavicle fractures. For unstable cases, surgical fixation is the preferred method of treatment. To date, there is still controversy regarding the best fixation method with a high reoperation and complication rate reported. The purpose of this article is to describe a minimally invasive method for reduction and stabilization of displaced distal clavicle fractures, using cortical buttons. Surgical technique After standard preoperative preparation, a 3-cm incision is made at the coracoclavicular area. Using both coracoid and clavicle tunnels, fracture reduction and fixation is obtained using a cortical fixation button. Standard postoperative care is given. Results A total of 21 patients (19 men) with a mean age of 34.7 years were treated using this technique. The follow-up was between 6 and 41 months, with an average of 23.4 months. The mean simple shoulder test score was 79.4 (range 66-91.7), and the QuickDASH score was 11 (range 6.8-15.9). Consolidation of the fracture was confirmed at the 12-week follow-up radiography, with no cases of nonunion or malunion identified. No patients presented infection or complications at the surgical site. Implant removal was not needed in this series. All the patients returned to work. Conclusion Minimally invasive button fixation of unstable distal clavicle fractures is a safe and reliable alternative treatment. The initial outcome report is promising with excellent clinical and radiological results and no complications or implant removals.
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Affiliation(s)
- Rodrigo Liendo
- Shoulder and Elbow Unit. Pontifical Catholic University of Chile, Santiago, Chile
- Department of Orthopedics and Trauma, Pontifical Catholic University of Chile, Santiago, Chile
| | - Julio J. Contreras Fernández
- Shoulder and Elbow Unit. Pontifical Catholic University of Chile, Santiago, Chile
- Department of Orthopedics and Trauma, Pontifical Catholic University of Chile, Santiago, Chile
- Shoulder and Elbow Unit. Instituto Traumatológico, Santiago, Chile
- Department of Orthopedics and Trauma. Universidad de Chile, Santiago, Chile
| | - Daniel Manosalvas
- Shoulder and Elbow Unit. Pontifical Catholic University of Chile, Santiago, Chile
- Department of Orthopedics and Trauma, Pontifical Catholic University of Chile, Santiago, Chile
| | - Alfonso Valenzuela
- Shoulder and Elbow Unit. Pontifical Catholic University of Chile, Santiago, Chile
- Department of Orthopedics and Trauma, Pontifical Catholic University of Chile, Santiago, Chile
| | - Rodrigo de Marinis
- Shoulder and Elbow Unit. Pontifical Catholic University of Chile, Santiago, Chile
- Department of Orthopedics and Trauma, Pontifical Catholic University of Chile, Santiago, Chile
| | - Claudio Calvo
- Shoulder and Elbow Unit. Pontifical Catholic University of Chile, Santiago, Chile
- Department of Orthopedics and Trauma, Pontifical Catholic University of Chile, Santiago, Chile
| | - Francisco Soza
- Shoulder and Elbow Unit. Pontifical Catholic University of Chile, Santiago, Chile
- Department of Orthopedics and Trauma, Pontifical Catholic University of Chile, Santiago, Chile
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Eigenschink M, Heuberer PR, Pauzenberger L, Garrigues GE, Achenbach L, Dimmen S, Laky B, Laver L. Allo- and autografts show comparable outcomes in chronic acromioclavicular joint reconstruction: a systematic review. Knee Surg Sports Traumatol Arthrosc 2021; 29:2202-2211. [PMID: 33566144 DOI: 10.1007/s00167-021-06445-7] [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] [Received: 03/05/2020] [Accepted: 01/11/2021] [Indexed: 01/19/2023]
Abstract
PURPOSE The aim of this review was to compare clinical and radiological outcome of acromio-clavicular joint reconstruction with allografts versus autografts. METHODS The PubMed, MEDLINE, The Cochrane Library and WEB OF SCIENCE databases were searched in accordance with the PRISMA guidelines until February 2020 using the terms: 'coracoclavicular' OR 'coraco-clavicular' OR 'acromioclavicular' OR 'acromio-clavicular joint', AND 'reconstruction'. All studies reporting on clinical and radiological outcome as well as complications after ACJ reconstruction using allo- and/or autografts were included. RESULTS A total of 29 articles, including 2 prospective and 27 retrospective studies, involving 622 patients, reconstructed with either allo- (n = 360) or auto-grafts (n = 262), for acromio-clavicular joint instability were identified and included in this review. The majority of studies had low sample sizes (66.7% below n = 20), were retrospective (93.3%), with short-term follow-ups (average 26.2 ± 12.6 months; range 6-186). The study with the largest sample size (n = 128) did not report clinical outcome. A comparison between allo- and auto-graft showed no significant differences regarding age, gender, and follow-up times. Clinical outcome was comparable in both groups, loss of reduction (LOR) and complication rates were higher in the allograft group. Overall a reduction of LOR was shown if additional horizontal stabilization was performed. Also a higher LOR and revision rate was documented in allografts without suture or suture-tape augmentation. The use of more clavicular drill-holes correlated with a higher frequency of fracture. CONCLUSIONS A systematic review of the available peer-reviewed literature addressing allograft and autograft reconstruction of unstable coracoclavicular ligaments shows that the published studies are generally of low quality with low levels of evidence. The published literature shows no significant difference in clinical outcomes between the use of autografts or allografts in ACJ reconstruction surgery. Surgical techniques utilizing additional horizontal stabilization may contribute to lower rates of LOR. In cases where allograft tissue is used for ACJ reconstruction the use of suture/tape augmentation may reduce LOR rates as well as revision rates. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Martin Eigenschink
- AURROM, Austrian Research Group for Regenerative and Orthopedic Medicine, Vienna, Austria
| | - Philipp R Heuberer
- Health Pi, Wollzeile 1-3, 1010, Vienna, Austria. .,AURROM, Austrian Research Group for Regenerative and Orthopedic Medicine, Vienna, Austria.
| | - Leo Pauzenberger
- AURROM, Austrian Research Group for Regenerative and Orthopedic Medicine, Vienna, Austria
| | - Grant E Garrigues
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Leonard Achenbach
- Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany
| | | | - Brenda Laky
- AURROM, Austrian Research Group for Regenerative and Orthopedic Medicine, Vienna, Austria
| | - Lior Laver
- The Royal Orthopaedic Hospital - NHS foundation trust, Birmingham, UK
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10
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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: 7] [Impact Index Per Article: 2.3] [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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11
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Theopold J, Henkelmann R, Zhang C, Schöbel T, Osterhoff G, Hepp P. Clinical outcomes of arthroscopic and navigation-assisted two tunnel technique for coracoclavicular ligament augmentation of acute acromioclavicular joint dislocations. BMC Musculoskelet Disord 2021; 22:528. [PMID: 34107940 PMCID: PMC8191052 DOI: 10.1186/s12891-021-04406-2] [Citation(s) in RCA: 3] [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: 01/25/2021] [Accepted: 04/26/2021] [Indexed: 11/12/2022] Open
Abstract
Background The purpose of this study was to present a navigated image-free augmentation technique for the acromioclavicular joint (ACJ) and coracoclavicular (CC) ligaments and to report the clinical and radiological outcomes. Methods From 2013 to 2018, 35 eligible patients were treated with our navigated image-free ACJ- and CC-augmentation technique. The average follow-up was 3 years. Follow-up evaluations included the Constant-Murley Score, subjective shoulder value, Taft score, and the acromioclavicular joint instability (ACJI) score. The patients’ quality of life was assessed using the EuroQol-5D (EQ-5D) questionnaire. In addition, in accordance with the instability criteria, radiographs were evaluated before surgery, after surgery, and during follow-up. Results Overall, 25 patients (71%) suffered an acute type V disruption, 5 (14%) had a type IV disruption, and 5 (14%) had an acute Rockwood type IIIb injury. The mean Constant-Murley Score was 90 (range: 56–100; p = 0.53) on the injured side, and the mean subjective shoulder value was 92% (range: 80–100%). The mean Taft and ACJI scores were 10 (range: 4–12) and 86 (range: 34–100), respectively and the mean EQ-5D was 86 (range: 2–100). The mean CC difference of the injured side was 4 mm (range: 1.9–9.1 mm) at follow-up, which was not significantly different than that of the healthy side (p = 0.06). No fractures in the area of the clavicle or the coracoid were reported. Conclusions The arthroscopic- and navigation-assisted treatment of high-grade ACJ injuries in an anatomical double-tunnel configuration yields similar clinical and radiological outcomes as the conventional technique using an aiming device. Precise positioning of the navigation system prevents multiple drillings, which avoids fractures. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04406-2.
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Affiliation(s)
- Jan Theopold
- Division of Arthroscopy, Joint Surgery and Sport Injuries, Department of Orthopedics, Trauma, and Plastic Surgery, University of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany.
| | - Ralf Henkelmann
- Division of Arthroscopy, Joint Surgery and Sport Injuries, Department of Orthopedics, Trauma, and Plastic Surgery, University of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Claus Zhang
- Division of Arthroscopy, Joint Surgery and Sport Injuries, Department of Orthopedics, Trauma, and Plastic Surgery, University of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Tobias Schöbel
- Division of Arthroscopy, Joint Surgery and Sport Injuries, Department of Orthopedics, Trauma, and Plastic Surgery, University of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Georg Osterhoff
- Division of Arthroscopy, Joint Surgery and Sport Injuries, Department of Orthopedics, Trauma, and Plastic Surgery, University of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Pierre Hepp
- Division of Arthroscopy, Joint Surgery and Sport Injuries, Department of Orthopedics, Trauma, and Plastic Surgery, University of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
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12
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Wang J, Cui Y, Zhang Y, Yin H. Acute high-grade acromioclavicular joint dislocation patients treated with titanium cable insertion under a homemade guider. J Orthop Surg Res 2021; 16:287. [PMID: 33931095 PMCID: PMC8086091 DOI: 10.1186/s13018-021-02442-1] [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: 02/28/2021] [Accepted: 04/20/2021] [Indexed: 11/13/2022] Open
Abstract
Backgrounds To describe a new technique for implanting a double-bundle titanium cable to treat acromioclavicular (AC) joint dislocation via the new guider, and evaluate clinic outcomes. Methods A retrospective study of patients treated for acute high-grade acromioclavicular joint dislocation from June 2016 to January 2020 in our trauma center, twenty patients with AC joint dislocation were managed with double-bundle titanium cable. It includes the following steps: (1) Put the guider under the coracoid close to the cortical; (2) drill proximal clavicle; (3) place the titanium cable; (4) perforate distal clavicle, (5) reset the acromioclavicular joint and lock titanium cable; and (6) suture the acromioclavicular ligament. An independent reviewer conducted functional testing of these patients, including the use of coracoclavicular distance (CCD), visual analog scale (VAS) scores, and Constant–Murley scores (CMS). Results All patients are presented following at a median duration of 15 months (12-24months) after the surgery. All patients based on X-ray evaluation and clinic evaluation. The median CCD was 7.5 (6–14) mm, the VAS score was 0.55 (0-2), the CMS score was 95.5 (92-99). One patient had subluxation again at the final follow-up based on X-ray examination. Conclusions This study demonstrates that the AC joint fixation anatomically with double-bundle titanium, acquired excellent outcomes in terms of the recovery of shoulder joint function and radiographic outcomes. It has a low complication rate and need not remove the hardware.
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Affiliation(s)
- Jun Wang
- Department of Orthopedic, Xiaoshan First People's Hospital, Xiaoshan Affiliated Hospital of Wenzhou Medical University, No. 199 Shixin Road, Hangzhou, 311200, Zhejiang Province, China
| | - Yongfeng Cui
- Department of Orthopedic, Xiaoshan First People's Hospital, Xiaoshan Affiliated Hospital of Wenzhou Medical University, No. 199 Shixin Road, Hangzhou, 311200, Zhejiang Province, China
| | - Yuhang Zhang
- Department of Orthopedic, Xiaoshan First People's Hospital, Xiaoshan Affiliated Hospital of Wenzhou Medical University, No. 199 Shixin Road, Hangzhou, 311200, Zhejiang Province, China
| | - Hang Yin
- Department of Orthopedic, Xiaoshan First People's Hospital, Xiaoshan Affiliated Hospital of Wenzhou Medical University, No. 199 Shixin Road, Hangzhou, 311200, Zhejiang Province, China.
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13
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Klabklay P, Chuaychoosakoon C. Functional and Radiographic Outcomes of Intraoperatively Decreasing the Coracoclavicular Distance to 50% of the Unaffected Side in Stabilization of Acute Acromioclavicular Joint Injury: A Retrospective Evaluation. Orthop J Sports Med 2021; 9:2325967120988798. [PMID: 34368373 PMCID: PMC8311390 DOI: 10.1177/2325967120988798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 10/21/2020] [Indexed: 12/15/2022] Open
Abstract
Background: The postoperative failure rate of acromioclavicular (AC) joint
fixation using the coracoclavicular (CC) stabilization technique
is high. Studies have reported that compared with normal
intraoperative anatomic reduction, intraoperative overreduction
of the AC joint is more successful in achieving a satisfactory
anatomic radiographic outcome at 1- to 2-year follow-up. Purpose: To evaluate the functional and radiographic outcomes and
complications in patients with acute AC joint injury who
underwent combined CC stabilization and AC capsular repair in
which the CC distance was intraoperatively decreased to 50% of
the unaffected side. Study Design: Case series; Level of evidence, 4. Methods: In this retrospective study, we collected and analyzed the data of
patients with an acute AC joint injury (Rockwood type 5) who
underwent combined CC stabilization and AC capsular repair
during which the CC distance was decreased 50% compared with the
unaffected side. At 2-year follow-up, we evaluated functional
outcomes (American Shoulder and Elbow Surgeons [ASES] score),
radiographic outcomes (alignment of the AC joint in the vertical
and horizontal planes, tunnel widening), and complications
(infection, clavicular fracture). Results: The study included 20 patients with a mean ± SD age of 42.20 ±
10.10 years. The mean follow-up period was 33.75 ± 11.50 months.
At the 2-year follow-up, the mean ASES score was 95.13 ± 5.61.
The overreduction alignment, anatomic alignment, and loss
reduction alignment rates were 0% (0/20 patients), 95% (19/20
patients), and 5% (1/ 20 patients), respectively. No
statistically significant difference was found in the mean CC
distance between the affected and unaffected sides on
radiographic evaluation. The mean medial clavicular tunnel width
and lateral clavicular tunnel width were 5.03 ± 0.68 mm and 4.47
± 0.67 mm, respectively. None of the patients experienced
fractures or infections. Conclusion: Excellent functional and radiographic outcomes and no complications
were seen at 2-year follow-up in patients with acute AC joint
injury who underwent combined CC stabilization and AC capsular
repair with the CC distance intraoperatively decreased to 50% of
the unaffected side.
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Affiliation(s)
- Prapakorn Klabklay
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Chaiwat Chuaychoosakoon
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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14
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Chen K, Xu B, Lao YJ, Yang Y. Risk factors related to the loss of reduction after acromioclavicular joint dislocation treated with the EndoButton device. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:345. [PMID: 33708972 PMCID: PMC7944339 DOI: 10.21037/atm-21-404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Anatomic ligament reconstruction using the EndobutBon device has been proven an effective technique for the management of acute acromioclavicular (AC) joint dislocation. The aim of this study was to analyze the risk factors causing loss of reduction after AC joint dislocation treated with the EndoButton device for open procedures. Methods A total of 107 patients who met the inclusion and excluded criteria finally were enrolled. We retrospectively analyzed the clinical tests, imaging data, and postoperative rehabilitation of patients in a stable reduction group and a loss of reduction group. Results Among all patients included in the study, the incidence of reduction failure was 14%. Univariate analysis identified that the time between injury to surgery, double or triple EndoButton, coracoid EndoButton position, weight-bearing time of the upper limb, and osteolysis had statistically significant associations with loss of reduction for the AC joint (P=0.022, 0.002, 0.000, 0.000, and 0.000 respectively). By using multivariate logistic regression analysis, we found that coracoid EndoButton position (P=0.002), weight-bearing time of the upper limb (P=0.011), and osteolysis (P=0.036) were the significant independent risk factors related to the loss of reduction after AC joint dislocation treated with the EndoButton device used with open procedures. Conclusions In order to reduce the incidence of reduction failure and improve the prognosis of patients, more accurate placement of EndoButton plates in surgery and guidance for patients in completing planned rehabilitation training are needed.
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Affiliation(s)
- Kai Chen
- Department of Orthopaedics, Tongde Hospital of Zhejiang, Hangzhou, China
| | - Bin Xu
- Department of Orthopaedics, Tongde Hospital of Zhejiang, Hangzhou, China
| | - Yang-Jun Lao
- Department of Orthopaedics, Tongde Hospital of Zhejiang, Hangzhou, China
| | - Yang Yang
- Department of Orthopaedics, Tongde Hospital of Zhejiang, Hangzhou, China
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15
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High degree of consensus achieved regarding diagnosis and treatment of acromioclavicular joint instability among ESA-ESSKA members. Knee Surg Sports Traumatol Arthrosc 2021; 29:2325-2332. [PMID: 32980887 PMCID: PMC8225517 DOI: 10.1007/s00167-020-06286-w] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 09/14/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE To develop a consensus on diagnosis and treatment of acromioclavicular joint instability. METHODS A consensus process following the modified Delphi technique was conducted. Panel members were selected among the European Shoulder Associates of ESSKA. Five rounds were performed between October 2018 and November 2019. The first round consisted of gathering questions which were then divided into blocks referring to imaging, classifications, surgical approach for acute and chronic cases, conservative treatment. Subsequent rounds consisted of condensation by means of an online questionnaire. Consensus was achieved when ≥ 66.7% of the participants agreed on one answer. Descriptive statistic was used to summarize the data. RESULTS A consensus was reached on the following topics. Imaging: a true anteroposterior or a bilateral Zanca view are sufficient for diagnosis. 93% of the panel agreed on clinical override testing during body cross test to identify horizontal instability. The Rockwood classification, as modified by the ISAKOS statement, was deemed valid. The separation line between acute and chronic cases was set at 3 weeks. The panel agreed on arthroscopically assisted anatomic reconstruction using a suspensory device (86.2%), with no need of a biological augmentation (82.8%) in acute injuries, whereas biological reconstruction of coracoclavicular and acromioclavicular ligaments with tendon graft was suggested in chronic cases. Conservative approach and postoperative care were found similar CONCLUSION: A consensus was found on the main topics of controversy in the management of acromioclavicular joint dislocation. Each step of the diagnostic treatment algorithm was fully investigated and clarified. LEVEL OF EVIDENCE Level V.
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16
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Celik H, Chauhan A, Flores-Hernandez C, Dorthe E, D'Lima D, Hoenecke H. Sagittal orientation of coracoclavicular ligament reconstruction affects the stability of surgical repair. J Shoulder Elbow Surg 2020; 29:1901-1911. [PMID: 32197809 DOI: 10.1016/j.jse.2019.11.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/14/2019] [Accepted: 11/23/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND The variation in the anatomic relationship between the coracoid and the clavicle affects the biomechanical stability of coracoclavicular ligament reconstruction (CCLR). METHODS Three-dimensional computed tomography reconstruction of 85 patients was analyzed. Anatomic landmarks were used to derive the coracoclavicular sagittal reconstruction angle (sRA). The lateral concave angle, which indicated the shape of the distal clavicle, and the offsets between the clavicle and coracoid were also measured. To investigate the biomechanical effects of the sRA on CCLR, 7 computed tomography scans with different sRAs were 3D printed. Two reconstructions, a single trans-coracoclavicular tunnel and a looped reconstruction technique, were performed sequentially. Models were cyclically loaded at 70 N in the anterior, posterior, and superior directions. RESULTS The mean sRA was 68° ± 9.3° (range, 47°-85°). The superoinferior offset between the clavicle and the coracoid and the lateral concave angle positively correlated with the sRA (r = 0.359 and 0.837, respectively; P ≤ .001), whereas the anteroposterior offset had a negative correlation (r = -0.925; P < .001). The sRA had a negative correlation with the anterior displacement of the clavicle (rho = -0.96; P < .001) and a positive correlation with the posterior displacement for both surgical techniques (rho = 1.0; P < .001). CONCLUSION The anatomic orientation of the native coracoclavicular ligaments is highly variable in the sagittal plane. Low sagittal angles can reduce anterior stability, whereas high sagittal angles can reduce posterior stability of CCLR.
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Affiliation(s)
- Haluk Celik
- Division of Sports Medicine, Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA, USA; Shiley Center for Orthopaedic Research & Education (SCORE) at Scripps Clinic, La Jolla, CA, USA.
| | - Aakash Chauhan
- Division of Sports Medicine, Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA, USA; Shiley Center for Orthopaedic Research & Education (SCORE) at Scripps Clinic, La Jolla, CA, USA
| | - Cesar Flores-Hernandez
- Shiley Center for Orthopaedic Research & Education (SCORE) at Scripps Clinic, La Jolla, CA, USA
| | - Erik Dorthe
- Shiley Center for Orthopaedic Research & Education (SCORE) at Scripps Clinic, La Jolla, CA, USA
| | - Darryl D'Lima
- Shiley Center for Orthopaedic Research & Education (SCORE) at Scripps Clinic, La Jolla, CA, USA
| | - Heinz Hoenecke
- Division of Sports Medicine, Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA, USA; Shiley Center for Orthopaedic Research & Education (SCORE) at Scripps Clinic, La Jolla, CA, USA
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17
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Pill SG, Rush L, Arvesen J, Shanley E, Thigpen CA, Glomset JL, Longstaffe R, Kissenberth MJ. Systematic review of the treatment of acromioclavicular joint disruption comparing number of tunnels and graft type. J Shoulder Elbow Surg 2020; 29:S92-S100. [PMID: 32643614 DOI: 10.1016/j.jse.2020.04.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 03/28/2020] [Accepted: 04/01/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The management of high-grade acromioclavicular separations remains unclear. The surgical interventions have shifted to more anatomic, less invasive techniques. The purpose of this study was to systematically review the outcomes and complications of anatomic coracoclavicular ligament reconstruction using a tendon graft. METHODS Twenty-one studies (n = 460 patients) met the criteria for inclusion. A double clavicle tunnel tendon graft construct was used in 348 patients (75.7%), whereas a single clavicle tunnel technique was used in 112 patients (24.3%). No significant difference in loss of reduction was found between the 2 techniques. Of 460 patients, 96 (20.9%) demonstrated some form of radiographic displacement at the final follow-up. The overall complication rate was 21.3% (98 of 460), and a higher complication rate was found in the double clavicle tunnel technique (P < .001). The overall reoperation rate was 7.6% (37 of 460). The most common reason for reoperation was clavicle fracture (8 of 37). There was a statistically significant increase in reoperation when allograft was used (P = .003). CONCLUSION The results of this study suggest that despite newer techniques, approximately 20% of patients develop loss of reduction and/or experience a surgical complication. Attempts to minimize trauma to the clavicle and use autograft tendon may reduce the risk of reoperation.
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Affiliation(s)
- Stephan G Pill
- Steadman Hawkins Clinic of the Carolinas, Prisma Health-Upstate, Greenville, SC, USA.
| | - Lane Rush
- Rush Health Systems, Meridian, MI, USA
| | - John Arvesen
- Steadman Hawkins Clinic of the Carolinas, Prisma Health-Upstate, Greenville, SC, USA
| | | | | | - John L Glomset
- Oklahoma Sports and Orthopedic Institute, SSM Health Medical Group, Oklahoma City, OK, USA
| | | | - Michael J Kissenberth
- Steadman Hawkins Clinic of the Carolinas, Prisma Health-Upstate, Greenville, SC, USA
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18
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Matsumura N, Kawano Y, Furuhata R, Kimura H, Suzuki T, Iwamoto T. Comparison between Trans-articular and Subacromial Stabilization with Ligament Repair for Acute Acromioclavicular Dislocation. Open Orthop J 2020. [DOI: 10.2174/1874325002014010008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
Background:
Although numerous treatment options for acromioclavicular joint dislocation have been reported, the treatment strategy is not yet standardized.
Objective:
The purpose of this study was to evaluate the clinical and radiographic results of coracoclavicular ligament repair with temporary acromioclavicular stabilization using suture anchors and Kirschner wires, and to compare the results between temporary trans-articular fixation and subacromial stabilization of the acromioclavicular joint.
Methods:
Thirty-three cases with displaced acromioclavicular joint dislocation were retrospectively evaluated. In the first 14 cases, the wires temporarily penetrated the joint for an average of 7 weeks (trans-articular group), while the acromioclavicular joint was temporarily stabilized by wires passing under the acromion that were inserted into the distal clavicle for an average of 13 weeks in the latter 19 cases (subacromial group). Clinical and radiographic results were evaluated and compared between the two groups.
Results:
The average UCLA score was 32.0 points in the trans-articular group and 32.8 points in the subacromial group, indicating no difference between the two groups (P = 0.418). Coracoclavicular distance ratio after surgery was significantly smaller in the subacromial group (P ≤ 0.035), and acromioclavicular dislocation ratio after removal of the wires was also smaller in the subacromial group (P ≤ 0.001) compared with the trans-articular group.
Conclusion:
This study revealed that coracoclavicular ligament repair with temporary acromioclavicular stabilization leads to favorable clinical results, with the subacromial group showing better maintenance of joint reduction compared with the trans-articular group. Subacromial wire stabilization is a viable option for long-term temporary fixation of acute displaced acromioclavicular joint dislocation.
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Nolte PC, Lacheta L, Dekker TJ, Elrick BP, Millett PJ. Optimal Management of Acromioclavicular Dislocation: Current Perspectives. Orthop Res Rev 2020; 12:27-44. [PMID: 32184680 PMCID: PMC7062404 DOI: 10.2147/orr.s218991] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 02/19/2020] [Indexed: 12/14/2022] Open
Abstract
Injuries to the acromioclavicular (AC) joint are common and mostly involve younger, male individuals. Whereas the majority of AC joint dislocations can be treated nonoperatively with a trial of immobilization, pain medication, cryotherapy, and physiotherapy, there are patients that do not respond well to conservative management and may require surgical treatment. Identifying and treating these patients according to the type and chronicity of AC joint dislocation is paramount. To date, a myriad of surgical techniques have been proposed to address unstable AC joint dislocations and are indicative of the uncertainty that exists in optimal management of these injuries. Historically research has focused on the restoration of the coracoclavicular ligament complex. However, recently the importance of the acromioclavicular capsule and ligaments has been emphasized. This review aims to provide the reader with an overview of current treatment strategies and research, as well as future perspectives.
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Affiliation(s)
- Philip C Nolte
- Steadman Philippon Research Institute, Vail, CO, USA.,Department of Trauma and Orthopedic Surgery, BG Trauma Center Ludwigshafen, Ludwigshafen, Germany
| | - Lucca Lacheta
- Steadman Philippon Research Institute, Vail, CO, USA.,Center for Musculoskeletal Surgery, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Travis J Dekker
- Steadman Philippon Research Institute, Vail, CO, USA.,Eglin Air Force Base, 96th Medical Group, United States Air Force, Eglin, FL, USA
| | | | - Peter J Millett
- Steadman Philippon Research Institute, Vail, CO, USA.,The Steadman Clinic, Vail, CO, USA
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20
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Çalışal E, Uğur L. Comparison of two methods for coracoclavicular ligament reconstruction: A finite element analysis. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2020; 54:202-206. [PMID: 32254037 DOI: 10.5152/j.aott.2020.02.288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study aimed to compare two different tendon grafting techniques for coracoclavicular ligament reconstruction from the data obtained using finite element analysis. METHODS Three different finite element models of the shoulder girdle were formulated using computerized tomography images: the reference model, coracoid loop technique (CLT), and drilling technique (DT) model. In all these models, forces were applied to the clavicle along three axes (x, y, and z) of the trapezius and sternocleidomastoid muscles. Thereafter, data regarding the loading values of the tendon grafts, loads on the coracoid base, and coracoclavicular vertical distance were measured. RESULTS While the reference model yielded the lowest values for all the loading conditions as well as the shortest coracoclavicular distance, the DT model demonstrated the highest values for all the loading conditions and the largest coracoclavicular distance. CONCLUSION Different tendon grafting techniques may offer different loading values on both bone surface and tendon graft during coracoclavicular ligament reconstruction. The drilling technique may be associated with increased loading on the tendon graft and bone surface, causing further loss of reduction and consequent complications.
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Affiliation(s)
- Emre Çalışal
- Department of Orthopedics and Traumatology, Amasya University, School of Medicine, Amasya, Turkey
| | - Levent Uğur
- Department of Mechanical Engineering, Amasya University, School of Technology, Amasya, Turkey
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21
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Benavent KA, Zhang D, Matzkin EG, Earp BE. Sex-Based Differences in Optimal Tunnel Placement for Acromioclavicular Joint Reconstruction. Orthop J Sports Med 2020; 8:2325967119893276. [PMID: 32656283 PMCID: PMC7333500 DOI: 10.1177/2325967119893276] [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: 09/24/2019] [Accepted: 09/27/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Tunnel placement is important for outcomes after acromioclavicular (AC) joint reconstruction, yet little has been written on sex-based differences in optimal tunnel positioning. HYPOTHESIS No sex-based or anatomic differences will be found in ideal tunnel position based on radiographic measurements. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS The records of 2382 patients were retrospectively examined for clavicle radiographs over a 20-year period. A random set of radiographs were reviewed until 200 radiographs from each sex met inclusion criteria per a priori power analysis. Anteroposterior clavicle radiographs were used to collect (1) length from lateral clavicle to lateral coracoid (LCLC), (2) length from lateral clavicle to medial coracoid (LCMC), (3) clavicle length (CL), and (4) clavicular depth at the midcoracoid (MCCD). The Student t test was used to compare differences between male and female patients. The Pearson correlation coefficient was used to measure linear correlations. Variables with a P < .1 were included in a multiple regression model. RESULTS The cohort included 200 men and 200 women. LCLC and LCMC were significantly greater for men than for women (P < .0001). Clavicle length was significantly correlated with LCLC (r = 0.63; P < .0001) and LCMC (r = 0.74; P < .0001). MCCD was significantly correlated with LCLC (r = 0.32; P < .0001) and LCMC (r = 0.43; P < .0001). The approximate placement for the trapezoid tunnel was found to be 22.1 mm in women and 26.6 mm in men. The approximate placement for the conoid tunnel was found to be 40 mm in women and 46.6 mm in men. The ratios (LCLC:CL and LCMC:CL) were also significantly different between female and male patients. The LCLC:CL was 0.144 in women and 0.154 in men (P < .0001). The LCMC:CL was 0.261 in women and 0.271 in men (P < .0006). CONCLUSION Significant sex-based differences are found in the position of the coracoid relative to the lateral edge of the clavicle. Coracoid position relative to the lateral edge of the clavicle is correlated with anatomic parameters, most strongly with clavicle length.
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Affiliation(s)
- Kyra A. Benavent
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Dafang Zhang
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Elizabeth G. Matzkin
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Brandon E. Earp
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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22
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Seo JB, Lee DH, Kim KB, Yoo JS. Coracoid clavicular tunnel angle is related with loss of reduction in a single-tunnel coracoclavicular fixation using a dog bone button in acute acromioclavicular joint dislocation. Knee Surg Sports Traumatol Arthrosc 2019; 27:3835-3843. [PMID: 31542815 DOI: 10.1007/s00167-019-05731-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 09/17/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE Despite the high failure rates of techniques used to maintain the reduction of single-tunnel coracoclavicular (CC) fixation, analyses of the etiology of loss of reduction related to surgical techniques are limited. Therefore, it was hypothesized that the initial coracoclavicular tunnel angle was related to loss of reduction in the single-tunnel technique for AC joint dislocation. This study aimed to evaluate the clinical and radiological outcomes of arthroscopic single-tunnel CC suture button fixation according to the initial coracoclavicular tunnel angle. METHODS Thirty-two consecutive patients who underwent arthroscopic single-tunnel CC suture button fixation for AC joint dislocation from 2014 to 2018 were enrolled. The tunneling-first technique was used in the first 11 patients, while the reduction-first technique was used in the remaining 22 consecutive patients. For clinical assessments, the American Shoulder and Elbow Surgeons (ASES) score and Korean Shoulder Score (KSS) were recorded. For radiological evaluation, coracoclavicular distance ratio, coracoclavicular tunnel angle, coracoid, and clavicular tunnel widths were measured. RESULTS The ASES score did not differ significantly between the two groups (n.s.). However, the KSS was significantly better in the reduction-first group (p = 0.031). No significant intergroup differences were observed in the pre- and postoperative coracoclavicular distance ratio. However, at the last follow-up, loss of coracoclavicular distance ratio was significantly smaller in the reduction-first group (p < 0.001). At the final follow-up, loss of the coracoclavicular distance ratio was positively correlated with the postoperative coracoclavicular tunnel angle (p < 0.001, Spearman's rho correlation coefficient = 0.602). The final follow-up clavicular tunnel width was also significantly smaller in the reduction-first group (p = 0.002). Finally, the last follow-up clavicular tunnel width was positively correlated with the postoperative coracoclavicular tunnel angle (p = 0.008, Spearman's rho correlation coefficient = 0.459). CONCLUSION The reduction-first technique showed better clinical and radiological outcomes than the tunneling-first technique in single-tunnel CC fixation for AC joint dislocation. A large postoperative coracoclavicular tunnel angle was associated with loss of reduction and clavicular tunnel widening. Therefore, obtaining a straight coracoclavicular tunnel angle is crucial for achieving better outcomes and minimizing loss of reduction. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Joong-Bae Seo
- Department of Orthopaedic Surgery, Dankook University College of Medicine, Manghyangro 201, Dongnam-gu, Cheonan, Chungnam, 330-715, Republic of Korea
| | - Dong-Ho Lee
- Department of Orthopaedic Surgery, Dankook University College of Medicine, Manghyangro 201, Dongnam-gu, Cheonan, Chungnam, 330-715, Republic of Korea
| | - Kyu-Beom Kim
- Department of Orthopaedic Surgery, Dankook University College of Medicine, Manghyangro 201, Dongnam-gu, Cheonan, Chungnam, 330-715, Republic of Korea
| | - Jae-Sung Yoo
- Department of Orthopaedic Surgery, Dankook University College of Medicine, Manghyangro 201, Dongnam-gu, Cheonan, Chungnam, 330-715, Republic of Korea.
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23
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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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24
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Clinical outcome of delayed surgical treatment of grade III acromioclavicular joint dislocation with and without acromioclavicular capsule reconstruction. CURRENT ORTHOPAEDIC PRACTICE 2019. [DOI: 10.1097/bco.0000000000000790] [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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25
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Gowd AK, Liu JN, Cabarcas BC, Cvetanovich GL, Garcia GH, Manderle BJ, Verma NN. Current Concepts in the Operative Management of Acromioclavicular Dislocations: A Systematic Review and Meta-analysis of Operative Techniques. Am J Sports Med 2019; 47:2745-2758. [PMID: 30272997 DOI: 10.1177/0363546518795147] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Acromioclavicular (AC) instability is a frequent injury affecting young and athletic populations. Symptomatic, high-grade dislocations may be managed by a myriad of operative techniques that utilize different grafts to achieve reduction. Comparative data are lacking on the ability of these techniques to achieve excellent patient outcomes and stable AC reduction and to minimize complications. PURPOSE To systematically review the outcomes and complications of different techniques of AC joint reconstruction. STUDY DESIGN Systematic review and meta-analysis. METHODS The MEDLINE, Scopus, Embase, and Cochrane Library databases were accessed to perform a systematic review of the scientific literature from 2000 to 2018 using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria with the following keywords: "acromioclavicular" and "reconstruction." Included articles were evaluated for loss of reduction, complication rate, revision rate, and change in coracoclavicular distance. Articles were stratified by graft and surgical material used: suture only, Endobutton with suture, TightRope, GraftRope, synthetic artificial ligament, tendon graft, and Weaver-Dunn coracoacromial ligament transfer. These outcomes were pooled using a random-effects model and stratified by surgical technique and arthroscopic versus open reconstruction. RESULTS Fifty-eight articles were included in the analysis, with 63 homogeneous populations composed of 1704 patients. The mean age was 37.1 years (range, 15-80 years) with a mean follow-up of 34.3 months (range, 1.5-186 months). The overall failure rate was 20.8% (95% CI, 16.9%-25.2%). The overall pooled complication rate was 14.2% (95% CI, 10.5%-18.8%). The most common complications were infection (6.3% [95% CI, 4.7%-8.2%]), fracture to the coracoid or distal clavicle (5.7% [95% CI, 4.3%-7.6%]), and hardware/button failure (4.2% [95% CI, 3.1%-5.8%]). There were no differences between arthroscopic and open techniques in regard to loss of reduction (P = .858), overall complication rate (P = .774), and revision rate (P = .390). Open surgery had a greater rate of clavicular/coracoid fractures than arthroscopic surgery (P = .048). Heterogeneity, best assessed from the pooled loss of reduction, was measured as I2 = 64.0%. CONCLUSION Open and arthroscopic AC joint reconstruction techniques have no differences in loss of reduction, the complication rate, and the revision rate based on the available literature. Complications are significant, and profiles vary between surgical techniques, which should be evaluated in the decision making of selecting the technique.
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Affiliation(s)
- Anirudh K Gowd
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Joseph N Liu
- Loma Linda University Medical Center, Loma Linda, California, USA
| | - Brandon C Cabarcas
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | | | | | - Brandon J Manderle
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Nikhil N Verma
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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26
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Wang C, Zhang J, Chen H, Zhao D, Zhang Y, Wu Z. [Arthroscopic Twin Tail TightRope combined with distal joint capsule repair technique for acute acromioclavicular dislocation]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:970-975. [PMID: 31407555 PMCID: PMC8337892 DOI: 10.7507/1002-1892.201903019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 06/28/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate arthroscopic treatment for acute acromioclavicular dislocation by using Twin Tail TightRope combined with distal joint capsular repair. METHODS The clinical data of 40 patients with acromioclavicular dislocation treated between February 2016 and December 2017 were retrospectively analyzed. The patients were divided into arthroscopic group (20 cases, using arthroscopic Twin Tail TightRope combined with distal joint capsular repair for anatomical repair of stable structure of acromioclavicular joint) and control group (20 cases, treated with clavicular hook plate internal fixation) according to different surgical methods. There was no significant difference in gender, age, cause of injury, Rockwood classification, time from injury to operation, preoperative visual analogue scale (VAS) score and Constant score between the two groups ( P>0.05), which were comparable. Postoperative VAS score and Constant score were used to assess shoulder function and re-dislocation was also observed. RESULTS The incisions of the two groups healed by first intention, and no early postoperative complications occurred. All patients were followed up 12-18 months (mean, 13.5 months). Postoperative X-ray films showed good anatomical reduction in both groups, but the clavicular hook had a presense in the subacromial space in control group. All patients in arthroscopic group achieved satisfactory shoulder function and returned to work after operation; there was no obvious pain, no complications such as exposure of implant after operation, and no need to remove the implant. In the control group, 4 patients had obvious subacromial impingement pain after operation, and 1 patient had re-dislocation after removal of internal fixator at 1 year after operation; the rest had no complications related to internal fixation, and the internal fixators were removed at 1.0-1.5 years after operation, without re-dislocation. The VAS score and Constant score at 3 months and 1 year after operation in both groups significantly improved when compared with those before operation, and further improved at 1 year after operation ( P<0.05). The VAS score and Constant score at 3 months and 1 year after operation in arthroscopic group were significantly better than those in control group ( P<0.05). CONCLUSION Arthroscopic treatment for acute acromioclavicular joint dislocation by using Twin Tail TightRope combined with distal capsular repair is more effective than traditional incision surgery and can obtain more satisfactory results in patient compliance and function recovery because of minimally invasive surgery.
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Affiliation(s)
- Chaoran Wang
- Department of Orthopedics, the Second Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650101, P.R.China
| | - Jun Zhang
- Department of Orthopedics, the Second Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650101,
| | - Hong Chen
- Department of Sports Medicine, Calmette International Hospital of Kunming First People's Hospital, Kunming Yunnan, 650051, P.R.China
| | - Daohong Zhao
- Department of Orthopedics, the Second Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650101, P.R.China
| | - Yuhao Zhang
- Department of Orthopedics, the Second Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650101, P.R.China
| | - Zhidan Wu
- Department of Orthopedics, the Second Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650101, P.R.China
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Gaweda K. Is the Position of Coracoid Button Important in Acromioclavicular Joint Dislocation Treatment with the Suture-Button? J INVEST SURG 2019; 34:1262-1263. [PMID: 31394958 DOI: 10.1080/08941939.2019.1610118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Krzysztof Gaweda
- Orthopaedic Surgery and Traumatology, Medical University of Lublin, Lublin, Poland
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28
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Shibata T, Izaki T, Miyake S, Doi N, Shibata Y, Irie Y, Tachibana K, Yamamoto T. Anatomical study of the position and orientation of the coracoclavicular ligaments: Differences in bone tunnel position by gender. Orthop Traumatol Surg Res 2019; 105:275-280. [PMID: 30595414 DOI: 10.1016/j.otsr.2018.10.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 10/17/2018] [Accepted: 10/25/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Reconstructing both coracoclavicular ligaments following acromioclavicular dislocation has recently been reported to restore the function of the acromioclavicular joint better than traditional procedures. Knowing the appropriate position and orientation of the bone tunnels and the potential risks of neurovascular injuries leads to safe reconstruction. We aimed to answer the following questions: what is the difference in the accurate clavicular bone tunnel positions (BTPs) during coracoclavicular ligament reconstruction between sex, and what are the potential risks for neurovascular injuries? HYPOTHESIS The BTPs differ by sex at the site of coracoclavicular ligament reconstruction. PATIENTS AND METHODS We introduced two Kirschner wires into 25 cadaver shoulders (17 male, 8 female), one through the insertion center of the trapezoid ligament and one through the conoid ligament, and measured the distance from the respective Kirschner wire insertion points to the bony landmarks of the clavicle and the oblique angle of each Kirschner wire. The shortest distance from the insertion point of each Kirschner wire to the suprascapular nerve and artery was also measured. RESULTS While the distance from the acromioclavicular joint to the respective Kirschner wire insertion points tended to be longer in males, the ratio of these insertion points to total clavicle length was constant. Other measurements for respective Kirschner wire insertions to the bony landmarks and neurovascular structures were comparable, as were abduction and retroversion angles. The distance from the suprascapular nerve to the insertion point of the conoid ligament at the coracoid process was 13.8±4.0mm, while the distance from the suprascapular artery was 7.1±3.3mm. DISCUSSION Appropriate position and orientation of the bone tunnels, and the ratio of the BTPs to the total clavicular length, aid surgeons in performing the reconstruction. The conoid ligament insertion on the coracoid was just proximal to the suprascapular artery, so surgeons should be careful with conoid insertion. LEVEL OF EVIDENCE V, cadaver study.
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Affiliation(s)
- Terufumi Shibata
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan.
| | - Teruaki Izaki
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
| | - Satoshi Miyake
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
| | - Nobunao Doi
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
| | - Yozo Shibata
- Department of Orthopaedic Surgery, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushino, Fukuoka 818-8502, Japan
| | - Yutaka Irie
- Department of Anatomy, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
| | - Katsuro Tachibana
- Department of Anatomy, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
| | - Takuaki Yamamoto
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
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Hippensteel KJ, Brophy R, Smith M, Wright R. Surgical Volume and Postoperative Complications of Acromioclavicular Joint Separations: Analysis of the ABOS Part II Examination. Am J Sports Med 2018; 46:3174-3181. [PMID: 30234997 DOI: 10.1177/0363546518795690] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND High-grade acromioclavicular (AC) joint separations are relatively rare injuries that are often treated surgically, yet more information is needed about the risks of various surgical procedures in terms of considering and counseling patients regarding operative versus nonoperative treatment. PURPOSE To calculate whether the volume of surgical treatment of AC joint separations increased over a recent 12-year period; to examine the nature and frequency of complications, reoperations, and readmissions associated with these procedures; and to assess whether patient- and surgeon-specific factors or surgical technique affected these rates. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS The American Board of Orthopaedic Surgery (ABOS) database for orthopaedic surgeons taking the Part II examination was reviewed from 2005 to 2016 to identify surgical treatment of AC joint separations. The authors calculated the percentage of all surgical cases in the ABOS database and rates of complications, reoperations, and readmissions. Association of these sequelae with patient- and surgeon-specific factors and surgical techniques was assessed. RESULTS There was no difference in the number or percentage of cases per year over the study period. There was an overall complication rate of 24.5%, a reoperation rate of 7.3%, and a readmission rate of 1.9%. Patients ≥40 years of age had significantly higher complication, reoperation, and readmission rates as compared with patients <40 years of age. There were significant differences in complication, reoperation, readmission, and displacement rates dependent on the type of surgical procedure performed. The highest complication rates were seen with open suspensory fixation, screw fixation, open reduction internal fixation, and arthroscopic coracoclavicular ligament repair or reconstruction. The highest reoperation rates were seen with screw fixation, open reduction internal fixation, and open suspensory fixation. CONCLUSION The volume of surgical treatment for AC joint separations did not change significantly over the study period. Complication, reoperation, and readmission rates were dependent on the type of surgical procedure performed and patient age. This information should assist surgeons in discussing risks when considering and counseling patients regarding operative versus nonoperative treatment.
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Affiliation(s)
- K J Hippensteel
- Department of Orthopedic Surgery, Naval Hospital Camp Pendleton, Camp Pendleton, California, USA
| | - Robert Brophy
- Department of Orthopedic Surgery, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Matthew Smith
- Department of Orthopedic Surgery, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Rick Wright
- Department of Orthopedic Surgery, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
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30
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Abstract
Injuries to the acromioclavicular joint constitute approximately 3.2% of shoulder injuries. Although the overall goal of treatment continues to be return to activity with a pain-free shoulder, the treatment of acromioclavicular joint separations has been fraught with conflict since the earliest reports in both ancient and modern literature. Accurate diagnosis and classification are important to determine the optimal treatment. Nonsurgical therapy remains the mainstay for treatment of low- and most mid-grade injuries, although recent biomechanical and biokinetic data might suggest that patients are more affected than traditionally thought. High-grade injuries often necessitate surgical intervention, although little consensus exists on the timing or technique. New surgical techniques continue to evolve as more biomechanical data emerge and kinematic understanding improves. Challenges associated with management of this injury abound from diagnosis to reconstruction.
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31
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Banffy MB, van Eck CF, ElAttrache NS. Clinical outcomes of a single-tunnel technique for coracoclavicular and acromioclavicular ligament reconstruction. J Shoulder Elbow Surg 2018; 27:S70-S75. [PMID: 29307671 DOI: 10.1016/j.jse.2017.11.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 11/08/2017] [Accepted: 11/15/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND A large number of surgical techniques have been described to treat acromioclavicular (AC) joint separations. Despite the high success rates with double-tunnel reconstruction, this method has been associated with the risk of coracoid and clavicle fractures. This study aimed to evaluate the outcomes of the first cohort of patients who underwent single-tunnel AC and coracoclavicular (CC) ligament reconstruction. It was hypothesized that this technique would result in maintenance of reduction and a minimal risk of fracture of the coracoid and clavicle. METHODS All patients who underwent single-tunnel AC joint reconstruction between 2012 and 2015 via the technique with 2-year follow-up were included. Objective outcomes recorded were maintenance of reduction as measured by the CC distance on radiographs, shoulder range of motion, strength, return to sports, and complications. Subjective outcomes included maintenance of reduction on visual inspection and various patient-reported outcomes. RESULTS Seventeen patients were included with a mean age of 41 ± 12 years. Separation types included types III, IV, and V. The mean follow-up period was 29 ± 9 months (range, 16-45 months). The CC distance improved from 37.4 to 30.0 mm on plain radiographs (P = .006), the American Shoulder and Elbow Surgeons score improved from 67.0 to 90.1 (P = .094), and the Single Assessment Numeric Evaluation score improved from 30.5 to 91.1 (P = .025). Reduction on visual inspection was maintained in 16 patients (94.1%). Regarding sports participation, 14 patients (82.4%) returned to their preinjury level. The most common complication was a prominent suture knot stack, occurring in 3 patients (17.6%), which was removed in all 3 in a second procedure. There were no clavicle or coracoid fractures. CONCLUSION The described technique results in satisfactory objective and patient-reported outcomes and return to sports while avoiding coracoid and clavicle fractures.
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Affiliation(s)
| | - Carola F van Eck
- Kerlan-Jobe Orthopaedic Clinic, Los Angeles, CA, USA; Rooney Sports Complex, University of Pittsburgh, Pittsburgh, PA, USA.
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Moatshe G, Kruckeberg BM, Chahla J, Godin JA, Cinque ME, Provencher MT, LaPrade RF. Acromioclavicular and Coracoclavicular Ligament Reconstruction for Acromioclavicular Joint Instability: A Systematic Review of Clinical and Radiographic Outcomes. Arthroscopy 2018; 34:1979-1995.e8. [PMID: 29573931 DOI: 10.1016/j.arthro.2018.01.016] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 01/08/2018] [Accepted: 01/08/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To perform a systematic review of the available literature on clinical and radiographic outcomes after surgical treatment for acromioclavicular (AC) joint instability. METHODS A systematic review was performed according to PRISMA guidelines. Inclusion criteria were AC joint and coracoclavicular (CC) ligament reconstruction outcomes, English language, human studies, more than 10 patients in the study and a 2-year minimum follow-up. Exclusion criteria were animal studies, cadaveric studies, clinical studies without reported follow-up period or patient-reported outcomes, clinical studies of nonoperative treatment, AC reconstructions with concurrent lateral clavicle fracture, editorial articles, abstracts, presentations, reviews, case reports, and surveys. RESULTS The systematic review identified 34 studies (939 patients) after inclusion and exclusion criteria application. Postoperative American Shoulder and Elbow Surgeons (ASES) scores ranged from 93.8 to 96, 81.8 to 97.8, and 88.1 for free tendon graft, suspensory devices, and modified Weaver-Dunn techniques, respectively. Postoperative Constant scores were 76.4 to 96.0, 82.6 to 97.8, 85.9 to 97.0, 81 to 96 and 83.0 to 94.6 for free tendon graft, suspensory devices, synthetic ligament devices, modified Weaver-Dunn, and hook plate/K-wires techniques, respectively. All treatment modalities improved patient outcomes; however, hook plates and K-wires had the highest rate of complications (26.3%). Unplanned reoperation rates were 1.2%, 2.8%, 0.9%, 5.4%, and 2.6% in free tendon graft, suspensory devices, synthetic ligament devices, modified Weaver-Dunn, and hook plate/K-wires techniques, respectively. CONCLUSIONS Comparable subjective outcomes after surgical treatment of AC joint instability was reported for all modalities, with relatively low unplanned reoperation rates. Treatment with hook plate/K-wires was associated with the highest complication rates, and modified Weaver-Dunn had the highest unplanned reoperation rates. LEVEL OF EVIDENCE: Level IV, systematic review of Level I-IV studies.
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Affiliation(s)
- Gilbert Moatshe
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A.; Oslo University Hospital and University of Oslo, Oslo, Norway; OSTRC, Norwegian School of Sports Sciences, Oslo, Norway
| | | | - Jorge Chahla
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | | | - Mark E Cinque
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Matthew T Provencher
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A.; The Steadman Clinic, Vail, Colorado, U.S.A
| | - Robert F LaPrade
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A.; The Steadman Clinic, Vail, Colorado, U.S.A..
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Kim SH, Koh KH. Treatment of Rockwood Type III Acromioclavicular Joint Dislocation. Clin Shoulder Elb 2018; 21:48-55. [PMID: 33330151 PMCID: PMC7726372 DOI: 10.5397/cise.2018.21.1.48] [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] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 02/16/2018] [Indexed: 12/04/2022] Open
Abstract
While non-operative treatment with structured rehabilitation tends to be the strategy of choice in the management of Rockwood type III acromioclavicular joint injury, some advocate surgical treatment to prevent persistent pain, disability, and prominence of the distal clavicle. There is no clear consensus regarding when the surgical treatment should be indicated, and successful clinical outcomes have been reported for non-operative treatment in more than 80% of type III acromioclavicular joint injuries. Furthermore, there is no gold standard procedure for operative treatment of type III acromioclavicular joint injury, and more than 60 different procedures have been used for this purpose in clinical practice. Among these surgical techniques, recently introduced arthroscopic-assisted procedures involving a coracoclavicular suspension device are minimally invasive and have been shown to achieve successful coracoclavicular reconstruction in 80% of patients with failed conservative treatment. Taken together, currently available data indicate that successful treatment can be expected with initial conservative treatment in more than 96% of type III acromioclavicular injuries, whereas minimally invasive surgical treatments can be considered for unstable type IIIB injuries, especially in young and active patients. Further studies are needed to clarify the optimal treatment approach in patients with higher functional needs, especially in high-level athletes.
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Affiliation(s)
- Seong-Hun Kim
- Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Kyoung-Hwan Koh
- Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, Goyang, Korea
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Kocadal O, Yüksel K, Güven M. Evaluation of the clavicular tunnel placement on coracoclavicular ligament reconstruction for acromioclavicular dislocations: a finite element analysis. INTERNATIONAL ORTHOPAEDICS 2018; 42:1891-1896. [DOI: 10.1007/s00264-018-3789-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 01/18/2018] [Indexed: 10/18/2022]
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van Bergen CJA, van Bemmel AF, Alta TDW, van Noort A. New insights in the treatment of acromioclavicular separation. World J Orthop 2017; 8:861-873. [PMID: 29312844 PMCID: PMC5745428 DOI: 10.5312/wjo.v8.i12.861] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 11/17/2017] [Accepted: 12/06/2017] [Indexed: 02/06/2023] Open
Abstract
A direct force on the superior aspect of the shoulder may cause acromioclavicular (AC) dislocation or separation. Severe dislocations can lead to chronic impairment, especially in the athlete and high-demand manual laborer. The dislocation is classified according to Rockwood. Types I and II are treated nonoperatively, while types IV, V and VI are generally treated operatively. Controversy exists regarding the optimal treatment of type III dislocations in the high-demand patient. Recent evidence suggests that these should be treated nonoperatively initially. Classic surgical techniques were associated with high complication rates, including recurrent dislocations and hardware breakage. In recent years, many new techniques have been introduced in order to improve the outcomes. Arthroscopic reconstruction or repair techniques have promising short-term results. This article aims to provide a current concepts review on the treatment of AC dislocations with emphasis on recent developments.
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Affiliation(s)
| | - Annelies F van Bemmel
- Department of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp 2134 TM, The Netherlands
| | - Tjarco D W Alta
- Department of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp 2134 TM, The Netherlands
| | - Arthur van Noort
- Department of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp 2134 TM, The Netherlands
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Fan J, Zhang Y, Huang Q, Jiang X, He L. Comparison of Treatment of Acute Unstable Distal Clavicle Fractures Using Anatomical Locking Plates with Versus without Additional Suture Anchor Fixation. Med Sci Monit 2017; 23:5455-5461. [PMID: 29145351 PMCID: PMC5701604 DOI: 10.12659/msm.903440] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background Surgical managements were recommended for unstable distal clavicle fracture owing to the high incidence of nonunion. The present study compared the efficacy of anatomical locking plate with versus without additional suture anchor fixation for the treatment of unstable Neer type II distal clavicle fractures. Material/Methods Between January 2013 to January 2015, 28 consecutive patients with unstable Neer type II fractures were treated by using anatomical locking plate with or without additional suture anchor fixation. The patients were divided into anatomical locking plate group (group A) and anatomical locking plate combined with suture anchor group (group B) according to the surgical method. The operative-related parameters such as operation time, blood loss, length of hospitalization, union time, functional outcomes (Constant score, UCLA score and DASH score) and CC distance were compared. Results The mean follow-up period of the 28 patients was 19.60 months (21.80 versus 18.39 months, respectively). No statistical differences in general and peri-operative parameters were found between 2 groups. The group B had significant higher Constant score than group A (P=0.004, 91.67 versus 83.10). While no statistical differences were reached in the UCLA score and DASH score between 2 groups (P=0.112 and 0.163, respectively). The group A had longer CC distance than group B (11.67 versus 8.94 mm), while no statistic difference was found (P=0.067). Conclusions For the treatment of acute unstable Neer type II distal clavicle fractures, both surgical methods could offer satisfactory outcome. However, anatomical locking plate combined with additional suture anchor fixation had a better functional and radiographic outcome than that without additional suture anchor fixation.
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Affiliation(s)
- Jixing Fan
- School of Clinical Medicine, Tsinghua University, Beijing, China (mainland)
| | - Yufu Zhang
- Department of Orthopedics Traumatology, Beijing Jishuitan Hospital, Beijing, China (mainland)
| | - Qiang Huang
- Department of Orthopedics Traumatology, Beijing Jishuitan Hospital, Beijing, China (mainland)
| | - Xieyuan Jiang
- Department of Orthopedics Traumatology, Beijing Jishuitan Hospital, Beijing, China (mainland)
| | - Liang He
- Department of Orthopedics Traumatology, Beijing Jishuitan Hospital, Beijing, China (mainland)
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Ligament Augmentation and Reconstruction System Failures in Repair of Grade V Acromioclavicular Joint Dislocation. Case Rep Orthop 2017; 2017:3792610. [PMID: 29038741 PMCID: PMC5606104 DOI: 10.1155/2017/3792610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 08/01/2017] [Indexed: 11/17/2022] Open
Abstract
The Ligament Augmentation and Reconstruction System® (LARS®) represents a popular synthetic anatomical reduction method for acromioclavicular joint dislocation by means of coracoclavicular ligament reconstruction. To our knowledge, no early failure has been documented in the literature. We present two unusual cases of LARS failure, one at four months after implant and the other at three weeks, without obvious causes, requiring re-do reconstruction, and discuss potential contributory factors.
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Sella GDV, Miyazaki AN, Nico MAC, Filho GH, Silva LA, Checchia SL. Study on the anatomic relationship between the clavicle and the coracoid process using computed tomography scans of the shoulder. J Shoulder Elbow Surg 2017; 26:1740-1747. [PMID: 28684230 DOI: 10.1016/j.jse.2017.03.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 03/21/2017] [Accepted: 03/27/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND The current trend in the treatment of acromioclavicular dislocations is to reconstruct the coracoclavicular ligaments by using transosseous tunnels in the coracoid process or in the clavicle, yet there is no definition as to the location of these. To study the anatomic relationship between the coracoid process and the clavicle, we made measurements to find a convergence point (cP) between them that has intraoperative applicability for creating transosseous tunnels. METHODS We analyzed 74 computed tomography scans (40 female and 34 male patients). Measurements were taken in the axial and sagittal planes and obtained from a cP, as determined by the intersection of the cortical surface of the clavicle and the coracoid process, with various relationships having been established. RESULTS On average, the cP was determined to be about 2.9 cm and 2.5 cm distant from the coracoid process apex for male and female patients, respectively, whereas the width at this position was determined to be 2.1 cm and 1.9 cm. In the clavicle, this point is on average 2.9 cm and 2.5 cm distant from the acromioclavicular joint in male and female patients, respectively, and its anteroposterior width at this point is on average 1.9 cm and 1.6 cm. CONCLUSION The cP of the clavicle and the coracoid process was determined with the aim of preparing bone tunnels in operations for treating acromioclavicular dislocations.
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Affiliation(s)
- Guilherme do Val Sella
- Orthopedics Department of Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil.
| | - Alberto N Miyazaki
- Orthopedics Department of Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Marcelo A C Nico
- Orthopedics Department of Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Guinel H Filho
- Orthopedics Department of Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Luciana A Silva
- Orthopedics Department of Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Sergio L Checchia
- Orthopedics Department of Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
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Mori D, Yamashita F, Kizaki K, Funakoshi N, Mizuno Y, Kobayashi M. Anatomic Coracoclavicular Ligament Reconstruction for the Treatment of Acute Acromioclavicular Joint Dislocation: Minimum 10-Year Follow-up. JB JS Open Access 2017; 2:e0007. [PMID: 30229219 PMCID: PMC6133097 DOI: 10.2106/jbjs.oa.16.00007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background: The long-term clinical and radiographic outcomes following coracoclavicular (CC) ligament reconstruction for the operative treatment of acute acromioclavicular (AC) joint dislocation remain uncertain. The purpose of the present study was to determine the long-term clinical and radiographic outcomes of CC ligament reconstruction and to identify risk factors for unfavorable outcomes. Methods: We reviewed 20 cases of AC joint dislocation in 19 patients (18 male and 1 female; mean age, 32.3 years) that were treated with single-bundle reconstruction. The mean duration of follow-up was 12.7 years. We measured the CC vertical distance (CCD) on the anteroposterior view and compared the affected and unaffected sides (CCD ratio). We divided the patients into those with a CCD ratio of <25% (Group 1) and those with a CCD ratio of ≥25% (Group 2). We radiographically investigated the clavicular tunnel anteroposterior (CTAP) angle, clavicular tunnel ratio, and coracoid tunnel orientation on the basis of the entry and exit points at the base of the coracoid. For the coracoid tunnel orientation, we compared center-center orientation and noncenter-center orientation. Results: Group 1 comprised 17 cases (85%), and Group 2 comprised 3 cases (15%). At the time of the latest follow-up, Group 1 had a significantly higher mean Constant score than Group 2 (98.2 compared with 90.7; p = 0.038). Of the 3 radiographic parameters, only the CTAP angle was significantly different between the 2 groups (p < 0.0001). Two (67%) of the 3 cases in Group 2 were associated with posterior AC joint displacement. Conclusions: CC ligament reconstruction for the treatment of acute AC joint dislocation resulted in successful long-term clinical and radiographic outcomes. It is important to decrease the CTAP angle and to ensure proper anatomic placement of the clavicular and coracoid tunnels at the time of surgery. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Arthroscopically Assisted Coracoclavicular Fixation Using a Single Flip Button Device Technique: What Are the Main Factors Affecting the Maintenance of Reduction? BIOMED RESEARCH INTERNATIONAL 2017; 2017:4859262. [PMID: 28831394 PMCID: PMC5558640 DOI: 10.1155/2017/4859262] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 05/30/2017] [Indexed: 11/30/2022]
Abstract
Background Among coracoclavicular (CC) fixation techniques, the use of flip button device was demonstrated to have successful outcomes with the advantage of being able to accommodate an arthroscopic procedure. Purpose This study was conducted to investigate the factors associated with loss of fixation after arthroscopically assisted CC fixation using a single flip button device for acromioclavicular (AC) joint dislocations. Materials and Methods We enrolled a total of 47 patients (35 men and 12 women). Plain radiography was performed at a mean of 24 months postoperatively to evaluate the final radiological outcome. The primary outcome measure was a long-term reduction of the AC joint for at least 24 months. Results We found that 29 patients had a high quality reduction (61.7%) and 18 patients had a low quality reduction (38.3%) in initial postoperative CT findings. Our study showed that the duration (5 days) from injury to treatment and the quality of initial postoperative reduction were significantly associated with the maintenance of reduction at final follow-up. Conclusion Our study showed that maintaining stable reduction after arthroscopically assisted CC fixation using a single flip button device technique is difficult especially in patients who received delayed treatment or whose initial reduction quality was poor.
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Shin SJ, Jeon YS, Kim RG. Arthroscopic-Assisted Coracoclavicular Ligament Reconstruction for Acute Acromioclavicular Dislocation Using 2 Clavicular and 1 Coracoid Cortical Fixation Buttons With Suture Tapes. Arthroscopy 2017; 33:1458-1466. [PMID: 28427871 DOI: 10.1016/j.arthro.2017.02.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 01/31/2017] [Accepted: 02/02/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To introduce an arthroscopically assisted coracoclavicular (CC) fixation technique using a cortical fixation button device and to evaluate the clinical and radiologic outcomes in patients with acute acromioclavicular (AC) dislocation who were treated with the technique. METHODS Twenty-one consecutive patients with grade III and V acute AC dislocation who underwent arthroscopically assisted CC ligament reconstruction using a cortical fixation button device were prospectively enrolled. Our fixation technique involved using a cortical fixation button device consisting of 1 coracoid button and 2 clavicular buttons connected with 2 suture tapes to reconstruct the conoid and trapezoid ligaments, respectively. Clinical outcomes were evaluated and CC distance and horizontal displacement of the AC joint were measured. RESULTS The mean follow-up period was 27.2 months (range, 24-32 months). The average CC distance of the injured shoulder was 17.2 ± 5.2 mm preoperatively, which represented an increase of 103% ± 42% compared with the uninjured shoulder. The CC distance was significantly reduced to 8.5 ± 1.5 mm after surgery (P < .001). At the final follow-up, the CC distance was maintained in 20 patients (95%) without loss of reduction. No significant radiologic difference was found in horizontal displacement of the AC joint immediately after the operation and at the final follow-up (P = .422). The average American Shoulder and Elbow Surgeons and Constant scores were 95.7 ± 3.6 and 95.4 ± 3.4, respectively. There were 3 complications, including 1 reduction loss, 1 coracoid process fracture, and 1 CC interval ossification. CONCLUSIONS Satisfactory clinical and radiologic outcomes were obtained simultaneously by arthroscopically assisted CC reconstruction using cortical fixation buttons. This reconstruction technique provided sufficient stability of the AC joint by using 2 clavicular holes to reconstruct the conoid and trapezoid ligaments separately. Therefore, arthroscopically assisted CC ligament reconstruction using a cortical fixation button device for management of acute AC dislocation is considered a viable treatment option for restoring stability to the AC joint. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Sang-Jin Shin
- Department of Orthopaedic Surgery, Ewha Womans University, College of Medicine, Seoul, Republic of Korea.
| | - Yoon Sang Jeon
- Department of Orthopaedic Surgery, Ewha Womans University, College of Medicine, Seoul, Republic of Korea
| | - Rag Gyu Kim
- Department of Orthopaedic Surgery, Ewha Womans University, College of Medicine, Seoul, Republic of Korea
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Schmitt S, Magosch P, Habermeyer P, Lichtenberg S. [Chronic acromioclavicular joint injury of Rockwood V type with concomitant chronic anterior sternoclavicular instability]. Unfallchirurg 2017; 120:795-803. [PMID: 28741077 DOI: 10.1007/s00113-017-0384-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Bipolar dislocation of the clavicle is rare. In the literature, every reported bipolar dislocation of the clavicle is caused by a traumatic injury with loss of function of the affected shoulder. Currently, there is no recommendation to treat. A conservative treatment can be tried first to achieve adequate shoulder function. If this cannot be achieved, surgical treatment will be indicated. In the literature, many options for surgical treatment are described. This article presents a case of a chronic Rockwood V injury with chronic anterior sternoclavicular joint instability. The special feature of this case was the arthroscopically assisted stabilization of the acromioclavicular joint (ACJ) with the ipsilateral semitendinosus tendon graft and the open stabilization of the sternoclavicular joint (SCJ) with the ipsilateral gracilis tendon graft. A lateral fracture of the clavicle in the course of the postoperative treatment was treated with a plate osteosynthesis. At follow-up after six months, the postoperative shoulder function was restored. The ACJ and the SCJ were stable in clinical and radiographic examination. This case report shows the first surgical treatment using two tendon grafts for combined stabilization of the ACJ and SCJ.
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Affiliation(s)
- Sebastian Schmitt
- Schulter- und Ellenbogenchirurgie, Deutsches Gelenkzentrum Heidelberg, ATOS Klinik Heidelberg, Bismarckstraße 9-15, 69115, Heidelberg, Deutschland.
| | - Petra Magosch
- Schulter- und Ellenbogenchirurgie, Deutsches Gelenkzentrum Heidelberg, ATOS Klinik Heidelberg, Bismarckstraße 9-15, 69115, Heidelberg, Deutschland
| | - Peter Habermeyer
- Schulter- und Ellenbogenchirurgie, Deutsches Gelenkzentrum Heidelberg, ATOS Klinik Heidelberg, Bismarckstraße 9-15, 69115, Heidelberg, Deutschland
| | - Sven Lichtenberg
- Schulter- und Ellenbogenchirurgie, Deutsches Gelenkzentrum Heidelberg, ATOS Klinik Heidelberg, Bismarckstraße 9-15, 69115, Heidelberg, Deutschland
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Banaszek D, Pickell M, Wilson E, Ducsharm M, Hesse D, Easteal R, Bardana DD. Anatomical Evaluation of the Proximity of Neurovascular Structures During Arthroscopically Assisted Acromioclavicular Joint Reconstruction: A Cadaveric Pilot Study. Arthroscopy 2017; 33:75-81. [PMID: 27526629 DOI: 10.1016/j.arthro.2016.05.041] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 05/29/2016] [Accepted: 05/31/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to examine the safety of an arthroscopic technique for acromioclavicular joint (ACJ) reconstruction by investigating its proximity to important neurovascular structures. METHODS Six shoulders from 4 cadaveric specimens were used for ACJ reconstruction in this study. The procedure consists of performing an arthroscopic acromioclavicular (AC) reduction with a double button construct, followed by coracoclavicular ligament reconstruction without drilling clavicular tunnels. Shoulders were subsequently dissected in order to identify and measure distances to adjacent neurovascular structures. RESULTS The suprascapular artery and nerve were the closest neurovascular structures to implanted materials. The mean distances were 8.2 (standard deviation [SD] = 3.6) mm to the suprascapular nerve and 5.6 (SD = 4.2) mm to the suprascapular artery. The mean distance of the suprascapular nerve from implants was found to be greater than 5 mm (P = .040), while the distance to the suprascapular artery was not (P > .5). Neither difference was statistically significant (P = .80 for artery; P = .08 for nerve). CONCLUSIONS Mini-open, arthroscopically assisted ACJ reconstruction safely avoids the surrounding nerves, with no observed damage to any neurovascular structures including the suprascapular nerve and artery, and may be a viable alternative to open techniques. However, surgeons must remain cognizant of possible close proximity to the suprascapular artery. CLINICAL RELEVANCE This study represents an evaluation of the safety and feasibility of a minimally invasive ACJ reconstruction as it relates to the proximity of neurovascular structures.
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Affiliation(s)
| | | | - Evan Wilson
- Queen's University, Kingston, Ontario, Canada
| | | | - Daniel Hesse
- Kingston General Hospital, Kingston, Ontario, Canada
| | - Ron Easteal
- Queen's University, Kingston, Ontario, Canada
| | - Davide D Bardana
- Kingston General Hospital, Kingston, Ontario, Canada; Queen's University, Kingston, Ontario, Canada.
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Roberson TA, Tokish JM. Acromioclavicular Joint Injuries in the ?>Contact Athlete. OPER TECHN SPORT MED 2016. [DOI: 10.1053/j.otsm.2016.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Lu D, Wang T, Chen H, Sun LJ. A comparison of double Endobutton and triple Endobutton techniques for acute acromioclavicular joint dislocation. Orthop Traumatol Surg Res 2016; 102:891-895. [PMID: 27496662 DOI: 10.1016/j.otsr.2016.07.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 06/10/2016] [Accepted: 07/05/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE OF THE STUDY The purpose of this study was to evaluate the results of patients treated with either double Endobutton device or triple Endobutton device for acute acromioclavicular joint dislocations. PATIENTS AND METHODS Eighty patients were randomized to operative stabilization either by double Endobutton device (group A, 40) or by triple Endobutton device (group B, 40). Preoperative variables included the patients' age, sex, the affected side, cause of injury, Rockwood classification and time from injury to surgery. Peri-operative variables were incision length, blood loss, the operative time and the radiation time, length of hospitalization and hospital costs. Postoperative variables were complications, the Constant and VAS scores and the ability to return to previous work. The coracoclavicular (CC) distance of the affected shoulder was assessed on a standard radiograph and compared with the contralateral normal one. RESULTS The average follow-up time of group A was 26.5±7.3months and group B was 24.2±6.6months. The overall complication rate was similar in both groups (26/40 vs. 24/40, P=0.644). There were no significant differences in the mean incision length, blood loss, the operative and radiation time, length of hospitalization, the Constant and VAS scores, and the ability to return to previous work between the two groups. However, the patients of group B had more hospital costs (3802.5±258.5 vs. 2433.6±182.5 USD, P=0.000). The radiological assessment revealed no significant difference in the CC distance between the two groups (P=0.625). DISCUSSIONS Triple Endobutton technique did not show significant clinical advantages over double Endobutton technique. LEVEL OF EVIDENCE Level II prospective randomized study.
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Affiliation(s)
- D Lu
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical College, 109 Xueyuanxi Road, 325000 Wenzhou, China
| | - T Wang
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical College, 109 Xueyuanxi Road, 325000 Wenzhou, China
| | - H Chen
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical College, 109 Xueyuanxi Road, 325000 Wenzhou, China
| | - L-J Sun
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical College, 109 Xueyuanxi Road, 325000 Wenzhou, China.
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Anatomic study of coracoclavicular ligaments for reconstruction of acromioclavicular joint dislocations. J Orthop Sci 2016; 21:749-752. [PMID: 27576109 DOI: 10.1016/j.jos.2016.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 07/28/2016] [Accepted: 08/01/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND There has been a trend to reconstruct the coracoclavicular (CC) ligaments anatomically for management of acromioclavicular (AC) joint dislocations. PURPOSE The aim of this study was to determine the location and orientation of the CC ligaments for anatomic reconstruction of the AC joint. METHODS The subjects were a total of 40 shoulders from 20 Chinese cadavers. Two K-wires were drilled through the insertion center of the conoid and trapezoid ligaments respectively. The distance from the center of the CC ligaments to the bone landmarks of the clavicle and the oblique angle of the two K-wires was measured respectively. RESULTS The distance from the center of the trapezoid ligament to the lateral end and the anterior border of the clavicle was 21.7 ± 1.1 mm and 6.4 ± 0.5 mm, respectively. The valgus angle and retroversion angle of the trapezoid ligament was 39.3°±0.9° and 6.0°±0.6°, respectively. The distance from the center of the conoid ligament to the lateral end and the posterior border of the clavicle was 36.6 ± 0.9 mm and 5.5 ± 0.4 mm, respectively. The valgus angle and retroversion angle of the conoid ligament was 6.6°±0.7° and 11.0°±0.9°, respectively. CONCLUSIONS These findings are important for the anatomic reconstruction of the AC joint dislocations, by predicting the location and orientation of the conoid and trapezoid ligaments accurately.
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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.
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Eisenstein ED, Lanzi JT, Waterman BR, Bader JM, Pallis MP. Medialized Clavicular Bone Tunnel Position Predicts Failure After Anatomic Coracoclavicular Ligament Reconstruction in Young, Active Male Patients. Am J Sports Med 2016; 44:2682-2689. [PMID: 27407087 DOI: 10.1177/0363546516651613] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Recent radiographic data have suggested that medialized conoid tunnel placement greater than 25% of absolute clavicular length is correlated with early failure after anatomic coracoclavicular ligament reconstructions. A comparison with a larger active duty military cohort of clinical and radiographic outcomes can serve as a basis for standardizing surgical technique. PURPOSE To establish the ideal radiographic tunnel position for anatomic coracoclavicular ligament reconstruction and to elucidate variables associated with early loss of reduction and ability to return to active-duty military service. STUDY DESIGN Case series; Level of evidence, 4. METHODS A retrospective review of the military's electronic medical record between the years 2000 and 2013 was performed. All anatomic coracoclavicular reconstructions at a single institution were included for analysis, and nonanatomic or revision reconstructions were excluded. Radiographic failure was defined as 6 mm of superior clavicle displacement on immediate postoperative films. RESULTS A cohort of 38 patients underwent 39 anatomic coracoclavicular reconstructions. Average follow-up time was 26 months (range, 1.2-92 months). A total of 20 radiographic failures were identified, with an average conoid tunnel ratio of 0.27. When conoid tunnel ratios were compared with a reference ratio of 0.20 to 0.25, increased risk of failure was statistically significant with lateralization greater than 0.20 (P = .018; odds ratio [OR] = 40 [95% CI, 1.05-999.06]) or with medialization of 0.251 to 0.30 (P = .002; OR = 39 [95% CI, 1.58-944.36]) or greater than 0.30 (P = .029; OR = 21 [95% CI, 0.77-562.15]). Medialization of the trapezoid position greater than 0.16 (vs a range of 0.13-0.16) was also found to be significant for failure (P < .023; OR = 8 [95% CI, 1.33-48.18]). However, these significant findings did not correlate with symptoms or ability to return to duty (P > .05). CONCLUSION The optimal technique for treating acromioclavicular separations has yet to be determined. Recently, anatomic coracoclavicular reconstruction has demonstrated biomechanical superiority to previously described methods. The findings of optimal tunnel positioning in anatomic reconstructions from this large active-duty military cohort can assist preoperative planning to reduce failure rates when treating these difficult injuries.
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Affiliation(s)
| | - Joseph T Lanzi
- William Beaumont Army Medical Center, El Paso, Texas, USA
| | | | - Julia M Bader
- William Beaumont Army Medical Center, El Paso, Texas, USA
| | - Mark P Pallis
- William Beaumont Army Medical Center, El Paso, Texas, USA
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Abstract
Acromioclavicular joint separations are a common cause of shoulder pain in the young athletic population. In high-grade injuries, acromioclavicular joint reconstruction procedures may be indicated for functional improvement. There is currently no gold standard for the surgical management of these injuries. Multiple reconstructive options exist, including coracoclavicular screws, hook plates, endobutton coracoclavicular fixations, and anatomic ligament reconstructions with tendon grafts. This article aims to review pertinent acromioclavicular joint anatomy and biomechanics, radiographic evaluation, classification system, as well as reconstruction options, outcomes, and complications.
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Affiliation(s)
- Simon Lee
- Orthopaedic Surgery House Officer, University of Michigan Health System, 1500 E. Medical Center Dr., TC2912, Ann Arbor, MI, 48109-5328, USA
| | - Asheesh Bedi
- Harold and Helen W. Gehring Professor of Orthopaedic Surgery, Chief, Sports Medicine and Shoulder Surgery, University of Michigan Health System, Domino's Farms - MedSport, 24 Frank Lloyd Wright Drive, Lobby A, P.O. Box 391, Ann Arbor, MI, 48106, USA.
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Spencer HT, Hsu L, Sodl J, Arianjam A, Yian EH. Radiographic failure and rates of re-operation after acromioclavicular joint reconstruction: a comparison of surgical techniques. Bone Joint J 2016; 98-B:512-8. [PMID: 27037434 DOI: 10.1302/0301-620x.98b4.35935] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 11/02/2015] [Indexed: 12/17/2022]
Abstract
AIMS To compare radiographic failure and re-operation rates of anatomical coracoclavicular (CC) ligament reconstructional techniques with non-anatomical techniques after chronic high grade acromioclavicular (AC) joint injuries. PATIENTS AND METHODS We reviewed chronic AC joint reconstructions within a region-wide healthcare system to identify surgical technique, complications, radiographic failure and re-operations. Procedures fell into four categories: (1) modified Weaver-Dunn, (2) allograft fixed through coracoid and clavicular tunnels, (3) allograft loop coracoclavicular fixation, and (4) combined allograft loop and synthetic cortical button fixation. Among 167 patients (mean age 38.1 years, (standard deviation (sd) 14.7) treated at least a four week interval after injury, 154 had post-operative radiographs available for analysis. RESULTS Radiographic failure occurred in 33/154 cases (21.4%), with the lowest rate in Technique 4 (2/42 4.8%, p = 0.001). Half the failures occurred by six weeks, and the Kaplan-Meier survivorship at 24 months was 94.4% (95% confidence interval (CI) 79.6 to 98.6) for Technique 4 and 69.9% (95% CI 59.4 to 78.3) for the other techniques when combined. In multivariable survival analysis, Technique 4 had better survival than other techniques (Hazard Ratio 0.162, 95% CI 0.039 to 0.068, p = 0.013). Among 155 patients with a minimum of six months post-operative insurance coverage, re-operation occurred in 9.7% (15 patients). However, in multivariable logistic regression, Technique 4 did not reach a statistically significant lower risk for re-operation (odds ratio 0.254, 95% CI 0.05 to 1.3, p = 0.11). CONCLUSION In this retrospective series, anatomical CC ligament reconstruction using combined synthetic cortical button and allograft loop fixation had the lowest rate of radiographic failure. TAKE HOME MESSAGE Anatomical coracoclavicular ligament reconstruction using combined synthetic cortical button and allograft loop fixation had the lowest rate of radiographic failure.
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Affiliation(s)
- H T Spencer
- Southern California Permanente Medical Group, 3460 East La Palma Avenue Anaheim, California, 92806, USA
| | - L Hsu
- Southern California Permanente Medical Group, 3460 East La Palma Avenue Anaheim, California, 92806, USA
| | - J Sodl
- Southern California Permanente Medical Group, 3460 East La Palma Avenue Anaheim, California, 92806, USA
| | - A Arianjam
- Southern California Permanente Medical Group, 3460 East La Palma Avenue Anaheim, California, 92806, USA
| | - E H Yian
- Southern California Permanente Medical Group, 3460 East La Palma Avenue Anaheim, California, 92806, USA
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