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Yang C, Liu G, Lan W, Li L, Wang R, Tang J, Wu H, Hu J. Acromioclavicular joint dislocation with loop double endobutton fixation assisted by orthopaedic surgery robot positioning system. BMC Musculoskelet Disord 2024; 25:587. [PMID: 39060990 PMCID: PMC11282833 DOI: 10.1186/s12891-024-07724-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 07/22/2024] [Indexed: 07/28/2024] Open
Abstract
OBJECTIVE Acute acromioclavicular (AC) joint dislocation is a common orthopedic injury that can significantly impair shoulder function and reduce quality of life. Effective treatment methods are essential to restore function and alleviate pain. To investigate the short-term clinical efficacy of the minimally invasive closed-loop double endobutton fixation assisted by orthopaedic surgery robot positioning system (TiRobot) in the treatment of AC joint dislocation, and to evaluate its feasibility and safety. METHODS The clinical data of 19 patients with AC joint dislocation who underwent treatment with closed-loop double Endobutton fixation assisted by TiRobot between May 2020 and December 2022 were retrospectively analyzed. Visual Analog Scale (VAS) pain scores, the Constant Murley Score (CMS), and shoulder abduction range of motion were assessed and compared preoperatively and at the last follow-up. Computed tomography (CT) parameters of the acromioclavicular joint, including acromioclavicular distance (ACD), the distance between the upper and lower Endobutton (DED), the horizontal distance between the anterior edge of the distal clavicle and the anterior edge of the acromion (DACC), the diameter of the clavicular tunnel (DCT), and coracoid tunnel diameter (DC), were compared at 2 days, and 1 month after surgery, as well as at the last follow-up, along with the evaluation of intraoperative and postoperative complications. RESULTS The postoperative VAS, CMS, and shoulder-abduction range of motion were significantly improved compared with the preoperative (all, P<0.05). The statistical analysis showed no significant difference in the CT image parameters of the acromioclavicular joint at 2 days and 1 month after surgery(all, P>0.05). Comparisons of DCT and DC revealed statistically significant differences between the last follow-up and 1 month after surgery (P<0.05), and no statistically significant difference was found in ACD, DED, and DACC(all, P>0.05). There were no complications such as infection or vascular or neurological damage, no cases of rostral or clavicle fractures, loss of reduction, heterotopic ossification, shoulder stiffness, and no loosening or breaking of internal fixations. CONCLUSION Closed-loop double endobutton internal fixation assisted by TiRobot is an ideal method for the treatment of acute acromioclavicular (AC) joint dislocation. This method has the advantages of relatively simple operation, more accurate localization of bone tunnel during operation, less surgical trauma, and good recovery of shoulder function.
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Affiliation(s)
- Chengzhi Yang
- Department of Trauma Center, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou Worker's Hospital, Guangxi, 545005, China
| | - Gang Liu
- Department of Trauma Center, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou Worker's Hospital, Guangxi, 545005, China
| | - Wanjie Lan
- Department of Ultrasound Imaging, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou Worker's Hospital, Guangxi, 545005, China
| | - Lu Li
- Department of Medical Imaging, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou Worker's Hospital, Guangxi, 545005, China
| | - Renchong Wang
- Department of Trauma Center, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou Worker's Hospital, Guangxi, 545005, China
| | - Jingli Tang
- Department of Trauma Center, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou Worker's Hospital, Guangxi, 545005, China
| | - Hao Wu
- Department of Trauma Center, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou Worker's Hospital, Guangxi, 545005, China
| | - Juzheng Hu
- Department of Trauma Center, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou Worker's Hospital, Guangxi, 545005, China.
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Böhringer A, Gebhard F, Dehner C, Eickhoff A, Cintean R, Pankratz C, Schütze K. 3D C-arm navigated suture button implantation for AC joint dislocations - the pilot study. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02582-z. [PMID: 38995404 DOI: 10.1007/s00068-024-02582-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 06/12/2024] [Indexed: 07/13/2024]
Abstract
PURPOSE The surgical treatment of acute traumatic AC joint dislocations is still a subject of scientific debate in the literature. The arthroscopically assisted stabilization procedure with a suture button system has been successfully established and is widely used in daily practice. It is minimally invasive and allows the anatomical reconstruction of the torn coracoclavicular ligaments in one step with a permanent implant that does not have to be removed in a second operation. This clinical pilot study is the first to describe the new method of navigated suture button implantation with the future aim of further reducing surgical invasiveness and further increasing surgical precision. MATERIALS AND METHODS 10 patients with a Rockwood 3b/5 injury could be included in the prospective study (DRKS00031855) within 5 months according to inclusion and exclusion criteria. Surgical stabilization was performed with a suture button system via a navigated coracoclavicular drill tunnel. Demographic and radiological data as well as information on health and shoulder function were collected from patient records, X-rays, DVT scan and 3 questionnaires (DASH, NHS and Eq. 5D) at the preoperative, intraoperative and postoperative (discharge, 6 weeks and 3 months) time points. RESULTS All operations could be performed within 8.8 days (± 6.81) after trauma. The average operation time was 50.3 min (± 8.81). The mean distance of the drill hole in the clavicle to the AC joint was 26.6 mm (± 2.63). The radiologically measured vertical coracoclavicular distance was 38.8 mm (± 6.16) at discharge and 41.11 mm (± 7.51) at 3 months. This loss of reduction was not statistically significant. In contrast, the DASH, NHS and Eq. 5D results showed significant improvement from discharge to 3 months postoperatively. CONCLUSION Image-guided 3D C-arm navigated AC joint suture button stabilization is feasible in everyday surgical practice. It may be possible to achieve a further reduction in invasiveness while at the same time increasing the accuracy of implant positioning. Further clinical studies with a larger number of patients and a longer follow-up period are necessary to enable a comparison with conventional methods.
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Affiliation(s)
- Alexander Böhringer
- Department of Trauma Hand and Reconstructive Surgery Ulm University, Albert-Einstein-Allee 23, Ulm, 89081, Germany.
| | - Florian Gebhard
- Department of Trauma Hand and Reconstructive Surgery Ulm University, Albert-Einstein-Allee 23, Ulm, 89081, Germany
| | - Christoph Dehner
- Department of Trauma Hand and Reconstructive Surgery Ulm University, Albert-Einstein-Allee 23, Ulm, 89081, Germany
| | - Alexander Eickhoff
- Department of Trauma Hand and Reconstructive Surgery Ulm University, Albert-Einstein-Allee 23, Ulm, 89081, Germany
| | - Raffael Cintean
- Department of Trauma Hand and Reconstructive Surgery Ulm University, Albert-Einstein-Allee 23, Ulm, 89081, Germany
| | - Carlos Pankratz
- Department of Trauma Hand and Reconstructive Surgery Ulm University, Albert-Einstein-Allee 23, Ulm, 89081, Germany
| | - Konrad Schütze
- Department of Trauma Hand and Reconstructive Surgery Ulm University, Albert-Einstein-Allee 23, Ulm, 89081, Germany
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İğrek S, Şahbat Y, Yiğit O, Yuvacı F, Keskin A, İğde N, Dedeoğlu SS. Arthroscopy-assisted procedure provides less residual horizontal instability and optimal coracoid tunnel creation with less radiation exposure compared to percutaneous procedure after endo-button fixation of type III AC joint dislocations. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38984915 DOI: 10.1002/ksa.12358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 06/21/2024] [Accepted: 06/28/2024] [Indexed: 07/11/2024]
Abstract
PURPOSE The aim of this study was to evaluate the postoperative radiological and functional results of patients treated with arthroscopy-assisted (AA) and percutaneous (P) procedures using endo-button for type III acromioclavicular joint dislocations with a minimum 1-year follow-up. The study hypothesis was that the AA technique would provide more favourable coracoid tunnels. METHODS This retrospective study included patients who underwent surgery between 2017 and 2022. Computed tomography images taken immediately postoperatively of all the patients were analysed to group coracoid tunnels as optimal or suboptimal based on orientation and placement within the coracoid base. Residual horizontal instability was assessed using the bilateral Alexander view at the final follow-up. Shoulder functions were evaluated at the final follow-up examination. RESULTS Of the 63 patients, 39 underwent surgery using the percutaneous procedure and 24 with the AA procedure. Surgical duration was significantly longer in the AA group (AA: 61.1 ± 5.9 min; P: 34.7 ± 5.6 min) (p = 0.001; 95% confidence interval [CI]: 23.3-29.3), whereas fluoroscopy time was longer in the percutaneous group (AA: 2.0 ± 0.8 s; P: 15.7 ± 3.9 s) (p = 0.001; 95% CI: -14.9 to 12.3). Optimal coracoid tunnels were more frequently observed in the AA group (p = 0.001; 95% CI: 7.4-137.8). There was no significant difference in functional scores between the groups (n.s.). Postoperative horizontal instability was more common in the percutaneous procedure (p = 0.013; 95% CI: 8.3-39.2). CONCLUSIONS Although no difference was detected between the methods in terms of complications and functional results, the higher frequency of residual horizontal instability, the high risk of suboptimal tunnel creation and greater radiation exposure were seen to be the most important disadvantages of the percutaneous technique. During surgery, such technical problems related to the percutaneous method should be kept in mind and care should be taken about the orientation of the coracoid tunnel. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Servet İğrek
- Department of Orthopaedics and Traumatology, Dr. Lütfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - Yavuz Şahbat
- Department of Orthopaedics and Traumatology, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Okan Yiğit
- Department of Orthopaedics and Traumatology, Dr. Lütfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - Fatih Yuvacı
- Department of Orthopaedics and Traumatology, Dr. Lütfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Keskin
- Department of Orthopaedic Surgery, Metin Sabanci Baltalimani Bone Diseases Training and Research Hospital, İstanbul, Turkey
| | - Niyazi İğde
- Department of Orthopaedic Surgery, Metin Sabanci Baltalimani Bone Diseases Training and Research Hospital, İstanbul, Turkey
| | - Süleyman Semih Dedeoğlu
- Department of Orthopaedic Surgery, Metin Sabanci Baltalimani Bone Diseases Training and Research Hospital, İstanbul, Turkey
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Tingle M, Wang T, Hoenecke HR. Current trends in surgical treatment of the acromioclavicular joint injuries in 2023: a review of the literature. JSES Int 2024; 8:389-393. [PMID: 38707567 PMCID: PMC11064557 DOI: 10.1016/j.jseint.2023.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024] Open
Abstract
Background This article examines the wide range of surgical reconstruction options available for acromioclavicular (AC) joint injuries. However, the lack of consensus regarding the most suitable surgical techniques is attributed to the high and variable failure rates observed with current approaches. Methods This article presents a comprehensive overview of the current surgical principles and techniques used by renowned experts in the field of AC shoulder injury management. Results It emphasizes the significance of addressing horizontal and rotational instability in AC injuries and highlights the impact of impaired scapular biomechanics. Conclusion By exploring these emerging concepts and strategies, the article aims to lay the foundation for future studies aimed at improving treatment outcomes and patient management.
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Affiliation(s)
- Matthew Tingle
- Veterans Affairs Nebraska-Western Iowa Health Care System-Omaha, Omaha, Ne, USA
| | - Tim Wang
- Scripps Health, Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, CA, USA
| | - Heinz R. Hoenecke
- Scripps Health, Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, CA, USA
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Albishi W, AlShayhan F, Alfridy A, Alaseem A, Elmaraghy A. Acromioclavicular joint separation: Controversies and treatment algorithm. Orthop Rev (Pavia) 2024; 16:94037. [PMID: 38404928 PMCID: PMC10891146 DOI: 10.52965/001c.94037] [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: 04/02/2023] [Accepted: 02/05/2024] [Indexed: 02/27/2024] Open
Abstract
In this article, we present an uptodate outline of acromioclavicular (AC) joint separation. A clear understanding of acromioclavicular joint injury in terms of the mechanism of injury, clinical picture, diagnostic imaging, and most updated surgical techniques used for the treatment can provide the best care for those patients. This article describes updated treatment strategies for AC separation, including type III AC separation which is known most controversial. Finally, we present a proposed treatment algorithm that can aid in the treatment of AC separation from the most updated evidence.
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Affiliation(s)
- Waleed Albishi
- Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Fahad AlShayhan
- Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Afnan Alfridy
- Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulrahman Alaseem
- Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Amr Elmaraghy
- Department of Orthopedic Surgery, University of Toronto; and St Joseph's Health Centre, Toronto, ON, Canada. University of Toronto
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Yu P, Chi Z. Floating clavicle with medial clavicular fracture causing diagnostic dilemma - A case report and literature review. Int J Surg Case Rep 2023; 112:108925. [PMID: 37866016 PMCID: PMC10667778 DOI: 10.1016/j.ijscr.2023.108925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 09/30/2023] [Accepted: 09/30/2023] [Indexed: 10/24/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE A rare case of a fracture of the medial third of the clavicle on the basis of the "floating clavicle" was hereby reported. To the best of our knowledge, this complex clavicle fracture has not yet been published. This article aims to describe, for the first time, a case of the diagnosis and treatment of this special clavicle fracture. CASE PRESENTATION The 26-year-old male patient suffered from a right sternoclavicular dislocation, a fracture of the right medial third of the clavicle, and a dislocation of the right acromioclavicular joint due to a car accident. In the course of treatment, he was missed diagnosis, and after active adjustment of treatment plan, good therapeutic effect was achieved. CLINICAL DISCUSSION A special case of a floating clavicle was hereby reported. The missed diagnosis of sternoclavicular dislocation will cause great difficulties in the management of the disease. Based on the condition and clear diagnosis of the patient, surgical treatment was actively recommended for the patient. The selection of the implant for surgical treatment varied due to its specificity. A comprehensive literature review is also provided. CONCLUSION Clavicular bone fracture is common in clinical practice. At the same time, the injury of sternoclavicular joint and acromioclavicular joint should be vigilant. For the complex clavicle fracture reported in this paper, the computed tomography scan with 3D reconstruction can assist in diagnosis. In the case of definite diagnosis, the use of a contralateral distal clavicular plate in combination with the conventional clavicular hook plate is an appropriate choice.
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Affiliation(s)
- Pengkun Yu
- College of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, 1166 Liutai Avenue, Wenjiang District, Chengdu, China
| | - Zhang Chi
- College of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, 1166 Liutai Avenue, Wenjiang District, Chengdu, China.
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Koch M, Werner A, Engel G, Huth J, Mauch F. Mini-open vs. arthroscopic double tight-rope reconstruction after acute AC-joint dislocation: a comparison in functional outcome and sports activity. Arch Orthop Trauma Surg 2023; 143:5491-5500. [PMID: 36943502 DOI: 10.1007/s00402-023-04828-8] [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: 02/25/2022] [Accepted: 02/27/2023] [Indexed: 03/23/2023]
Abstract
INTRODUCTION In athletes, acromioclavicular joint disruptions account for up to 50% of all shoulder injuries. In high-grade injuries, surgery is favored to ensure a correct restoration of the joint, especially in young athletes. The aim of this study was to compare the clinical, radiological and sport related outcomes of the arthroscopic stabilization with the fixation of the AC joint in a mini-open approach. MATERIALS AND METHODS 19 patients treated arthroscopically (ASK) and 26 patients with an acute AC-joint dislocation Rockwood V who had undergone the mini-open (MO) surgery were included. Constant Murley Score (CMS), Taft Score (TS) and the Simple Shoulder Tests (SST) were evaluated. The sports activity level was determined according to Valderrabano and the athlete's recovery of their athletic activity level after surgery according to Rhee. Furthermore, all available X-ray images were analyzed. RESULTS Patients in the ASK group achieved an average score of 11.7 ± 0.6 points in the SST, 10.3 ± 1.8 points in the TS and 91.2 ± 11.8 points in the CMS. On average, patients in the MO group achieved results of 10.5 ± 1.4 points in the SST, 11.7 ± 0.7 points in the TS and 91.6 ± 9.8 points in the CMS. The ASK group showed significant difference regarding the CC distance in side comparison (Δ = 3.6 mm), whereas no significant difference was found in the MO group (Δ = 0.8 mm). In comparison of both groups, the posterior as well as the combined translation were significantly greater in the ASK group than in the MO group (posterior: ASK: 24.8 mm, MO: 19.3 mm, combined: ASK: 29.1 mm, MO: 20.9 mm). Residual horizontal instability was greater in the ASK group (43%) than in the MO group (32%). Similar results were achieved in sports activity and the recovery of athletic activity (Valderrabano: ASK: 2.8, MO: 2.6; Rhee: ASK: 1.6, MO: 1.5). CONCLUSIONS Both techniques prove to be effective for the stabilization of high-grade AC-joint disruptions in athletes and showed excellent clinical results. From a radiographic standpoint, the mini-open procedure appears superior to the arthroscopic technique. After mini-open surgery postoperative loss of correction is less common and greater horizontal stability is achieved. The results also suggest the mini-open technique is superior to the arthroscopic procedure when aiming to restore the athlete's original level of sports activity. LEVEL OF EVIDENCE: 1
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Affiliation(s)
- Moritz Koch
- Sportklinik Stuttgart GmbH, Taubenheimstr. 8, 70372, Stuttgart, Germany
| | - Annabelle Werner
- Sportklinik Stuttgart GmbH, Taubenheimstr. 8, 70372, Stuttgart, Germany
| | - Guido Engel
- Sportklinik Stuttgart GmbH, Taubenheimstr. 8, 70372, Stuttgart, Germany
| | - Jochen Huth
- Sportklinik Stuttgart GmbH, Taubenheimstr. 8, 70372, Stuttgart, Germany.
| | - Frieder Mauch
- Sportklinik Stuttgart GmbH, Taubenheimstr. 8, 70372, Stuttgart, Germany
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Vetter P, Eckl L, Bellmann F, Allemann F, Scheibel M. [Minimally Invasive Techniques for the Treatment of Acute and Chronic Acromioclavicular Joint Instabilities]. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2023; 161:219-238. [PMID: 37015240 DOI: 10.1055/a-1781-6153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
Acromioclavicular joint instabilities are one of the most common injuries of the shoulder girdle. Diagnostic measures include the vertical and horizontal components of instability. The main goals of treatment include pain reduction, joint stabilization, and return to physical activity. For operative treatment, there are numerous techniques available. Recently, minimally-invasive techniques were developed and showed equal results as with open approach. These procedures facilitate simultaneous treatment of concomitant shoulder lesions and reduce soft tissue trauma as well as the risk of infection. This article presents an overview of such minimally-invasive techniques for both acute and chronic instabilities. Both techniques address the aspect of horizontal instability, which was found to compromise clinical results. For an acute injury, we describe the use of a low-profile button system combined with an additional acromioclavicular cerclage. In the chronic setting with a bidirectional (vertical and horizontal) instability, a free tendon graft combined with a single TightRope augmentation is recommended.
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Reyniers P, DE Mulder T, Ruette P, VAN Raebroeckx A. Long-term follow-up in a single-bundle arthroscopic acromioclavicular joint reconstruction after Rockwood III to VI dislocation. Acta Orthop Belg 2023; 89:156-161. [PMID: 37295001 DOI: 10.52628/89.1.7586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This retrospective study presents the clinical and radiographic results of a single-bundle arthroscopic acromioclavicular joint reconstruction in 45 patients with a mean follow-up of 4.8 years. Patients with a Rockwood grade III or higher were included. Clinical results were based on satisfaction, pain and functional scores. These outcome scores were compared to coracoclavicular distance measurement on X-ray. Secondly, clinical outcome scores were compared between patients who had surgery in the first 6 weeks after trauma and patients treated after 6 weeks. Overall, X-ray showed a good reduction in 71.1% of the patients (less than 50% loss of reduction). These patients showed better clinical results than patients with radiographical failure in terms of satisfaction (p = .001), Constant (p = .001), DASH (p = .031) and SPADI (p = .005) scores. In total, 78% of the patient had surgery in the first 6 weeks after trauma. When treated later (mean time to surgery of 8.8 months), patients showed worse results for satisfaction (p = .003) and DASH score (p = .006), suggesting that treatment of chronic cases might warrant additional fixation techniques. As a conclusion, these results showed that, in the acute approach, single-bundle arthroscopic coracoclavicular fixation is a good treatment in acromioclavicular joint dislocation Rockwood grade III or higher.
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Ardebol J, Hwang S, Horinek JL, Parsons BO, Denard PJ. Arthroscopically Assisted Tensionable Cerclage Reconstruction of an Acromioclavicular Separation With Combined Fixation of the Coracoclavicular and Acromioclavicular Ligaments. Arthrosc Tech 2023; 12:e321-e327. [PMID: 37013023 PMCID: PMC10066044 DOI: 10.1016/j.eats.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/24/2022] [Accepted: 11/03/2022] [Indexed: 04/05/2023] Open
Abstract
A variety of surgical techniques are currently available to manage high-grade acromioclavicular (AC) separations, including hook plates/wires, nonanatomic ligament reconstruction, and anatomic cerclage with or without biological augmentation. Traditional reconstructions focused on the coracoclavicular ligaments alone and often were associated with high rates of recurrent deformity. Biomechanical and clinical data have suggested that additional fixation of the AC ligaments is beneficial. This Technical Note describes an arthroscopically assisted approach for combined reconstruction of the coracoclavicular and AC ligaments with a tensionable cerclage.
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Affiliation(s)
| | | | | | | | - Patrick J. Denard
- Oregon Shoulder Institute, Medford, Oregon
- Address correspondence to Patrick J. Denard, M.D., 2780 E. Barnett Rd., Suite 200, Medford, OR 97504
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Elkalyoby AS, Waly MR, Abdelrazek BHMZ, Mohamed AR, Shohayeb K, Seifeldin AF. No correlation exists between coracoid tunnel widening and loss of reduction after arthroscopic acromioclavicular fixation using tightrope system. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07329-8. [PMID: 36805298 DOI: 10.1007/s00167-023-07329-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 01/30/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE To detect the widening of the tunnel of the coracoid process after arthroscopic fixation of acute acromioclavicular joint (ACJ) dislocation using the TightRope system and its correlation with loss of reduction and functional scores. METHODS From 2016 to 2018, a prospective study was performed on twenty-three patients with acute grade III-V ACJ dislocation. Arthroscopic TightRope repair of the ACJ was performed. Coracoid tunnel widening was measured by CT, and the coracoclavicular distance was measured on the radiographs immediately postoperatively and at 12 months. The Constant Shoulder Score, Oxford Shoulder Score, Nottingham Clavicle Score and Visual analog scale were used as outcome measures at 12 months. RESULTS The coracoid tunnel diameter to horizontal coracoid diameter ratio increased from 22.8 ± 3.7% immediately postoperatively to 38.5 ± 5.5% at 12 months (p < 0.001). The coracoclavicular (CC) distance showed an increase from a mean of 10.8 ± 1.7 mm to a mean of 11.8 ± 2.5 at 12 months (p < 0.001). There was no correlation between the increase in the coracoclavicular distance and the patients' functional clinical scores or coracoid tunnel widening. CONCLUSION Coracoid tunnel widening and radiological loss of reduction occur after arthroscopic fixation of acute ACJ dislocation with the TightRope system. However, they do not correlate with each other or with the functional scores of the patient. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Ahmed Samir Elkalyoby
- Trauma and Orthopedics Faculty of Medicine, Cairo University, Mathaf El-Manial Street, Manial Cairo, 11553, Egypt.
| | - Mohamed Refaat Waly
- Trauma and Orthopedics Faculty of Medicine, Cairo University, Mathaf El-Manial Street, Manial Cairo, 11553, Egypt
| | | | - Ahmed Rizk Mohamed
- Trauma and Orthopedics Faculty of Medicine, Cairo University, Mathaf El-Manial Street, Manial Cairo, 11553, Egypt
| | - Khaled Shohayeb
- Trauma and Orthopedics Faculty of Medicine, Cairo University, Mathaf El-Manial Street, Manial Cairo, 11553, Egypt
| | - Ahmed Fouad Seifeldin
- Trauma and Orthopedics Faculty of Medicine, Cairo University, Mathaf El-Manial Street, Manial Cairo, 11553, Egypt
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Sonnier JH, Kemler B, Coladonato C, Paul RW, Tjoumakaris FP, Freedman KB. Surgical management of acute, high-grade acromioclavicular joint separations: a systematic review. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:10-20. [PMID: 37588062 PMCID: PMC10426581 DOI: 10.1016/j.xrrt.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background While a number of treatment options exist for repair of acute, high-grade acromioclavicular joint (ACJ) separation, none have emerged as the standard of care. The purpose of this study was to systematically review the literature on surgical treatment of acute, high-grade (Rockwood grades III-V) ACJ separations in order to compare outcomes between direct fixation and tendon graft ligament reconstruction. Methods A systematic review of the literature evaluating outcomes for acute ACJ separation treatment with direct fixation or free biologic tendon graft reconstruction was performed. The following databases were examined: the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed (1980-2021), and Embase (1980-2021). Studies were included if they reported a mean time to surgery as <6 weeks, contained >10 patients with a minimum 1-year follow-up, and reported clinical or radiographic outcomes. Results A total of 52 studies met the inclusion criteria. Seven studies reported outcomes following tendon graft ligament reconstruction (n = 128 patients). There were multiple methods of direct fixation. Thirty-three studies utilized suture button constructs (n = 1138), 16 studies used hook plates (n = 567), 2 studies used coracoclavicular screws (n = 94), 2 studies used suture fixation (n = 93), 2 studies used suture anchor (n = 55), 2 studies used suture cerclage fixation (n = 87), 1 used single multistrand titanium cable (n = 24), and 1 used K wire (n = 11). The mean follow-up Constant scores ranged from 77.5 to 97.1 in the fixation group compared to 90.3-96.6 in the tendon graft group. The mean visual analog scale scores ranged from 0 to 4.5 in the fixation group and 0.1-1 in the tendon graft group. Net CC distance ranged from 17.5 to 3.6 mm in the fixation group and 7.4-4 mm in the tendon graft group. The revision rates ranged from 0.0% to 18.18% in the direct fixation group and 5.88%-17% in the tendon graft group. Conclusion Direct fixation and tendon graft reconstruction for management of acute, high-grade ACJ separations have similar patient subjective and radiographic outcomes, as well as complication and revision rates at a minimum 1-year follow-up.
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Affiliation(s)
- John Hayden Sonnier
- Rothman Orthopaedic Institute, Division of Sports Medicine, Philadelphia, PA, USA
| | - Bryson Kemler
- Rothman Orthopaedic Institute, Division of Sports Medicine, Philadelphia, PA, USA
| | - Carlo Coladonato
- Rothman Orthopaedic Institute, Division of Sports Medicine, Philadelphia, PA, USA
| | - Ryan W. Paul
- Rothman Orthopaedic Institute, Division of Sports Medicine, Philadelphia, PA, USA
| | | | - Kevin B. Freedman
- Rothman Orthopaedic Institute, Division of Sports Medicine, Philadelphia, PA, USA
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Scheiderer B, Obmann S, Feucht MJ, Siebenlist S, Degenhardt H, Imhoff AB, Rupp MC, Pogorzelski J. The Morphology of the Acromioclavicular Joint Does Not Influence the Postoperative Outcome Following Acute Stabilization—A Case Series of 81 Patients. Arthrosc Sports Med Rehabil 2022; 4:e835-e842. [PMID: 35747655 PMCID: PMC9210376 DOI: 10.1016/j.asmr.2021.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 09/07/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose To specifically evaluate the influence of the acromioclavicular (AC)-joint morphology on the outcome after arthroscopically assisted coracoclavicular (CC) stabilization surgery with suspensory fixation systems and to investigate whether an additional open AC-joint reduction and AC cerclage improves the clinical outcome for patients with certain morphologic AC-joint subtypes. Methods Patients with an acute acromioclavicular joint injury, who underwent arthroscopically assisted CC stabilization with suspensory fixation systems with or without concomitant AC cerclage between January 2009 and June 2017 were identified and included in this retrospective cohort analysis. AC-joint morphology was assessed on preoperative radiographs and categorized as “flat” or “non-flat” (“oblique”/“curved”) subtypes. After a minimum of 2 years of follow-up, postoperative Single Assessment Numeric Evaluation (SANE), American Shoulder and Elbow Surgeons (ASES), and visual analog scale (VAS) scores for pain were collected. A subgroup analysis of clinical outcomes depending on the surgical technique and morphological subtype of the AC joint was performed. Results Eighty-one patients (95% male, mean age 35 ± 12 years) could be included at a mean follow-up of 57 ± 14 months. Radiographic assessment of AC-joint morphology showed 24 (30%) cases of flat type, 38 (47%) cases of curved type, and 19 (23%) cases of oblique morphology. Postoperatively, no clinically significant difference could be detected after the treatment of AC joint injury via CC stabilization with or without concomitant AC cerclage (VASrest: P = .067; VASmax: P = .144, ASES: P = .548; SANE: P = .045). No clinically significant differences were found between the surgical techniques for the flat morphologic subtype (VASrest: P = .820; VASmax: P = .251; SANE: P = .104; ASES: P = .343) or the non-flat subtype (VASres: P = .021; VASmax: P = .488; SANE: P = .243, ASES: P = .843). Conclusions In arthroscopically assisted AC stabilization surgery with suspensory fixation systems for acute AC-joint injury, the AC-joint morphology did not influence the postoperative outcome, independent of the surgical technique. No clinical benefit of performing an additional horizontal stabilization could be detected in our collective at mid-term follow-up. Level of Evidence Level IV, therapeutic case series.
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Jensen G, Dey Hazra RO, Al-Ibadi M, Salmoukas K, Katthagen JC, Lill H, Ellwein A. Arthroscopically assisted single tunnel reconstruction for acute high-grade acromioclavicular joint dislocation with an additional acromioclavicular joint cerclage. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2022; 33:1185-1192. [PMID: 35523973 DOI: 10.1007/s00590-022-03271-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 04/15/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Purpose of this study was to demonstrate that a single tunnel reconstruction of high-grade acromioclavicular (AC) joint instabilities with implants of the second generation is sufficient for stabilisation, especially in combination with an AC cerclage. METHODS Patients with an acute AC-joint dislocation type Rockwood III-B and V were included. Besides clinical follow-up examination, radiographs were analysed. The functional outcome measures were Constant Score (CS), Taft score (TS), ACJI score and patient's satisfaction. Horizontal instability was evaluated by clinical examination and radiological with an Alexander view. RESULTS Thirty-five patients with a mean follow-up of 29 months were included. Ninety-seven per cent were satisfied with their result, with an average Subjective Shoulder Value of 90%. The CS averaged at 90 ± 10 points, TS at 11 ± 1 points and ACJI at 78 ± 18 points. Radiologically, 3 of 29 patients (10%) showed a persisting horizontal instability. The coracoclavicular (CC) distance improved from 22 preoperative to 10 mm postoperative, which was comparable to the contralateral side (10 mm, p = 0.103). At follow-up the CC distance increased to 13 mm (p = 0.0001). CONCLUSION AC-joint stabilisation with a single tunnel reconstruction using a second-generation implant results in good to excellent clinical results with high patient satisfaction. The additional AC augmentation improves stability in horizontal instable AC-joints and is recommended in all high-grade AC joint stabilisations. Nonetheless, reduction was slightly lost over time due to an elongation or suture failure of the coraco-clavicular fixation. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Gunnar Jensen
- Department for Orthopaedic Surgery and Traumatology, DIAKOVERE Friederikenstift, Humboldtstraße 5, 30169, Hannover, Germany.
- Department for Orthopaedic Surgery, Medical School Hannover, DIAKOVERE Annastift, Anna-von-Borries-Straße 1-7, 30625, Hannover, Germany.
| | - Rony-Orijit Dey Hazra
- Department for Orthopaedic Surgery and Traumatology, DIAKOVERE Friederikenstift, Humboldtstraße 5, 30169, Hannover, Germany
| | - Mireille Al-Ibadi
- Department for Orthopaedic Surgery and Traumatology, DIAKOVERE Friederikenstift, Humboldtstraße 5, 30169, Hannover, Germany
| | - Katharina Salmoukas
- Unfallkrankenhaus Berlin, Warener Str. 7, 12683, Hannover, Lower Saxony, Germany
| | - Jan Christoph Katthagen
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus, building W1, 48149, Münster, Germany
| | - Helmut Lill
- Department for Orthopaedic Surgery and Traumatology, DIAKOVERE Friederikenstift, Humboldtstraße 5, 30169, Hannover, Germany
| | - Alexander Ellwein
- Department for Orthopaedic Surgery and Traumatology, DIAKOVERE Friederikenstift, Humboldtstraße 5, 30169, Hannover, Germany
- Department for Orthopaedic Surgery, Medical School Hannover, DIAKOVERE Annastift, Anna-von-Borries-Straße 1-7, 30625, Hannover, Germany
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Gu F, Zhang J, Sui Z, Zhang K, Xie X, Yu T. Minimally Invasive Percutaneous TightRope® System Fixation for an Unstable Posterior Pelvic Ring: Clinical Follow-up and Biomechanical Studies. Orthop Surg 2022; 14:1078-1092. [PMID: 35470582 PMCID: PMC9163799 DOI: 10.1111/os.13261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 02/10/2022] [Accepted: 02/18/2022] [Indexed: 12/23/2022] Open
Abstract
Objective To evaluate the mechanical stability and clinical efficacy of minimally invasive percutaneous TightRope® systems applied via gun‐shaped reduction forceps for unstable posterior pelvic ring fractures. Materials and methods This study consists of two parts: a clinical retrospective study and a randomized controlled biomechanical test. For the clinical study, a retrospective analysis of posterior pelvic ring fractures was performed between June 2015 and May 2020. Eighteen patients underwent surgery using two TightRope® systems to fix a broken posterior pelvic ring because of unstable AO type C1 and C2 pelvic ring fractures. The patients were followed up for at least 2 years, and all patients were evaluated using the Majeed scoring system and vertical displacement. In the biomechanical tests, six embalmed adult pelvic specimens were used. The fractures were subjected to TightRope®, IS screw, and TBP fixation in a randomized block design. The specimens were placed in a biomechanical testing machine in a standing neutral posture. A cyclic vertical load of up to 500 N was applied, and the displacement of the specimens was recorded by the testing machine. The ultimate load in each group of specimens was recorded. The displacement and ultimate load were compared and analyzed by statistical methods. Results At a mean follow‐up of 38.89 ± 8.72 months, the functional Majeed score was excellent in 14 patients and good in four patients. The final radiological examinations showed that the outcome was excellent in 14 patients and good in four patients. In these patients, no serious clinical complications were found. Weight‐bearing was delayed in four patients. In biomechanical tests, the displacement of the specimens fixed with TightRope® was significantly lower than that of the specimens fixed with TBP (P < 0.05) when the load ranged from 300 to 500 N. The displacement in the IS screw group was significantly lower than that in either the TBP or TightRope® group (P < 0.05) when the load ranged from 0 to 500 N. The ultimate load in the IS screw group (1798 ± 83.53 N) was significantly greater than that in the TBP group (1352 ± 74.41 N) (t = 9.78, P < 0.0001) and the TightRope® group (1347 ± 54.28 N) (t = 11.11, P < 0.0001). However, no significant difference was observed between the TightRope® and TBP groups (t = 0.13, P = 0.90). Conclusion Percutaneous posterior TightRope® system shows strong stability in mechanical experiments and shows good results in clinical follow‐up while this system has certain advantages in lower surgical requirements and lower risk of related nerve and vascular structural damage.
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Affiliation(s)
- Feng Gu
- Department of Orthopaedics, First Hospital of Jilin University, Changchun, China
| | - Jiting Zhang
- Department of Orthopaedics, First Hospital of Jilin University, Changchun, China
| | - Zhenjiang Sui
- Department of Orthopaedics, First Hospital of Jilin University, Changchun, China
| | - Ke Zhang
- Department of Orthopaedics, First Hospital of Jilin University, Changchun, China
| | - Xiaoping Xie
- Department of Orthopaedics, First Hospital of Jilin University, Changchun, China
| | - Tiecheng Yu
- Department of Orthopaedics, First Hospital of Jilin University, Changchun, China
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Madi S, Pandey V, Murali S, Acharya K. Clinical and radiological outcome of acute high-grade acromioclavicular joint dislocation: A retrospective cohort study on Hook plate versus arthroscopic assisted single coracoclavicular tunnel with DogBone™ button dual FiberTape® construct. J Clin Orthop Trauma 2022; 27:101825. [PMID: 35310786 PMCID: PMC8924685 DOI: 10.1016/j.jcot.2022.101825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/06/2022] [Accepted: 03/01/2022] [Indexed: 10/18/2022] Open
Abstract
Purpose Hook plate (HP) is a popular implant of choice in the management of highgrade acute acromioclavicular joint (ACJ) dislocations. Recently, suspensory loop systems have drawn significant interest with comparable results and additionally does not warrant implant removal. However, no studies have compared the outcomes of HP vis-a-vis Dog Bone TM Button with dual FiberTape® (DB). Methods 38 patients who underwent HP or Arthroscopic assisted single tunnel DB fixation to stabilize high-grade ACJ dislocations were retrospectively included in study for clinically and radiological evaluation at a minimum follow up of one year. American Shoulder and Elbow Society and Constant Murley scores were used for clinical assessment. The radiological evaluation was done by assessing quality of reduction, measuring coracoclavicular distance (CCD), and extent of subacromial erosion. Results For final follow up evaluation, both HP and DB group had 16 patients each. The mean follow-up was 55.38 ± 10.9 and 32.88 ± 14.0 months in HP and DB group, respectively. No significant difference in mean ASES (p=0.71) and CM score (p=0.62) was found between the two groups. The DB group revealed higher CCD at the final follow-up compared to the HP group (p=0.01). Although statistically insignificant, there were more subluxations and dislocations in the DB group (37.5%) compared to the HP group (25%). The subacromial erosion was noted in all cases of the HP group at time of implant removal. Conclusion Both groups revealed satisfactory functional and radiological outcome. However, the DB group showed a higher tendency of loss of reduction.
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Yu P, Zhang Y, Ye T, Liu J, Zhuang C, Wang L. Clinical and radiological outcomes of acute Rookwood type IIIB acromioclavicular joint dislocation: Mini-open tightrope technique versus hook plate. Injury 2022; 54 Suppl 2:S63-S69. [PMID: 35180996 DOI: 10.1016/j.injury.2022.02.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 01/13/2022] [Accepted: 02/06/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Treatment of acute Rookwood type III AC joint dislocation is still controversially discussed. ISAKOS suggested to subdivide type III AC joint injuries into type IIIA (stable) and type IIIB (unstable). The aim of this study was to compare clinical and radiographic outcomes between hook plate fixation and mini-open tightrope for the treatment of acute Rookwood type IIIB acromioclavicular joint dislocation. METHODS We conducted a retrospective clinical study of 112 patients with acute Rookwood type IIIB acromioclavicular joint dislocation who were treated surgically using either mini-open TightRope or hook plate from 2013 to 2019. All patients were followed up for 12 months. Clinical outcomes were evaluated using Visual Analogue Scale (VAS) and the Constant-Murley Score (CMS). Radiological results were assessed with the coracoclavicular distance (CCD), the change in clavicular elevation (ΔCE) and horizontal translation. RESULTS The length of incision was significantly shorter in the mini-open TightRope group than that in hook plate group (6.62±0.60 vs. 2.58±0.43 p <0.001). Duration of surgery was significantly shorter in the mini-open TightRope group than that in hook plate group (30.12±6.65 vs. 53.33±12.03; p < 0.001). Total blood loss volume was significantly less in the mini-open TightRope group than in the hook plate group. (23.85±7.88 vs. 70.67±24.62, p < 0.001). VAS and CMS in mini-open TightRope group were better than that in hook plate group at 2 weeks after surgery (VAS: 2.19±0.92 vs. 3.30±1.51, p = 0.002 and CMS 69.80±5.61 vs. 57.53±9.24, p<0.001) and 3 month after surgery (VAS: 1.19±0.48 vs. 3.07±1.36, p<0.001 and CMS 89.30±4.47 vs. 83.20±12.11, p = 0.205). There was no statistically significant difference between two groups at 12 months follow-up including VAS, CMS, the CC distance,ΔCE and the degree of dynamic horizontal translation. There were 2 complications in the hook plate group including 1cut out and 1 superficial wound infection. CONCLUSION The mini-open tightrope has better function and relieves pain in the early postoperative period compared to hook plate, and at the last follow up two groups have similar clinical and radiological outcomes. Mini-open TightRope fixation is a good option for the treatment of acute Rockwood types ⅢB AC joint dislocation.
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Affiliation(s)
- Pei Yu
- Department of orthopedics, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, No. 197 Ruijin 2nd Rd, Shanghai 200025, China
| | - Yin Zhang
- Department of orthopedics, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, No. 197 Ruijin 2nd Rd, Shanghai 200025, China
| | - Tingjun Ye
- Department of orthopedics, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, No. 197 Ruijin 2nd Rd, Shanghai 200025, China
| | - Jingfeng Liu
- Department of orthopedics, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, No. 197 Ruijin 2nd Rd, Shanghai 200025, China
| | - Chengyu Zhuang
- Department of orthopedics, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, No. 197 Ruijin 2nd Rd, Shanghai 200025, China.
| | - Lei Wang
- Department of orthopedics, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, No. 197 Ruijin 2nd Rd, Shanghai 200025, China.
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Oh HS, Kim S, Hyun JH, Kim MS. Effect of subacromial erosion shape on rotator cuff and clinical outcomes after hook plate fixation in type 5 acromioclavicular joint dislocations: a retrospective cohort study. BMC Musculoskelet Disord 2022; 23:42. [PMID: 35012506 PMCID: PMC8751107 DOI: 10.1186/s12891-021-04987-y] [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: 08/19/2021] [Accepted: 12/22/2021] [Indexed: 11/25/2022] Open
Abstract
Background Surgical fixation using hook plates is widely used in the treatment of acromioclavicular (AC) joint dislocations. The purpose of this study was to evaluate the incidence and shape of subacromial erosions after removal of the hook plate in type 5 AC joint dislocations. Further, we evaluated the effect of the shape of the subacromial erosion on the rotator cuff. Methods We retrospectively reviewed 30 patients who underwent hook plate fixation for type 5 AC joint dislocations at our hospital between December 2010 and December 2018. Patients with a follow-up of at least 1 year were included. Clinical outcomes were assessed using the final follow-up Constant-Murley, Korean Shoulder, and visual analog scores. To ensure that the appropriate reduction was well maintained, the coracoclavicular distances of the injured and contralateral sides were evaluated at the last follow-up. Computed tomography was performed to investigate the presence and shape of the subacromial erosion after hook plate removal at 4 months after surgery. Ultrasonography was performed to investigate the presence of rotator cuff lesions at the last follow-up. Clinical and radiological outcomes were compared between groups divided according to the presence and types of subacromial erosions. Results Subacromial erosion was observed in 60% of patients (18/30): 13, 2, and 3 simple groove, cave, and marginal protrusion types, respectively. Four patients showed reduction loss at the final follow-up. There were no significant differences in clinical and radiological outcomes between the groups with and without subacromial erosion. Moreover, there were no significant differences between groups according to the types of subacromial erosion. There were no rotator cuff lesions, such as partial tears, in the injured shoulders. Conclusions Hook plate fixation may induce subacromial erosions. However, the subacromial erosions caused by the hook plate did not affect the clinical outcomes of type 5 AC joint dislocations. Moreover, regardless of its shape, the subacromial erosion did not affect the clinical outcomes nor cause rotator cuff lesions after plate removal.
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Affiliation(s)
- Ho-Seok Oh
- Department of Orthopedic Surgery, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju, 61469, South Korea
| | - Sungmin Kim
- Department of Orthopedic Surgery, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju, 61469, South Korea
| | - Jeong-Hun Hyun
- Department of Orthopedic Surgery, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju, 61469, South Korea
| | - Myung-Sun Kim
- Department of Orthopedic Surgery, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju, 61469, South 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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20
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Ligamentous healing potential of the acromioclavicular ligament following acute anatomical reconstruction. Arch Orthop Trauma Surg 2022; 142:2225-2234. [PMID: 34013381 PMCID: PMC9381440 DOI: 10.1007/s00402-021-03936-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 05/02/2021] [Indexed: 10/27/2022]
Abstract
BACKGROUND Horizontal instability following acute acromioclavicular joint (ACJ) reconstruction still occurs with a high prevalence. Although the human acromioclavicular ligament complex (ACLC) represents the major horizontal ACJ stabilizer, experimental studies on healing characteristics are lacking. Therefore, the purpose of this histological study was to investigate the healing potential of the ACLC following acute anatomical reconstruction METHODS: In this prospective clinical-experimental study, 28 ACLC biopsies were performed in patients with complete ACJ dislocations (Rockwood type 4 or 5) during acute hook plate stabilization (IG: implantation group; n = 14) and hook plate removal (EG: explantation group; n = 14). Histological analyses included Giemsa staining, polarized light microscopy and immunostaining against CD68, αSMA and collagen type I and type III. Histomorphological evaluation entailed cell counts, collagen expression score, ligament tissue maturity index (LTMI) and descriptive analysis of specific ligamentous structures. Statistics consisted of nonparametric Mann-Whitney U tests and a level of significance of P < .05. RESULTS Total cell counts (cells/mm2 1491 ± 296 vs. 635 ± 430; P < 0.001) and collagen III expression (3.22 ± 0.22 vs. 1.78 ± 0.41; P < 0.001) were higher in EG compared to IG. Inversely αSMA + (11 ± 9 vs. 179 ± 186; P < 0.001) and CD68 + cell counts (56 ± 20 vs. 100 ± 57; P 0.009) were significantly lower in the EG. The EG revealed a comparable reorientation of ligamentous structures. Consistently, ACLC samples of the EG (21.6 ± 2.4) displayed a high total but differently composed LTMI score (IG: 24.5 ± 1.2; P < 0.001). CONCLUSIONS This experimental study proved the ligamentous healing potential of the human ACLC following acute anatomical reconstruction. Histomorphologically, the ACLC reliably showed a ligamentous state of healing at a mean of about 12 weeks after surgery. However, processes of ligamentous remodeling were still evident. These experimental findings support recent clinical data showing superior horizontal ACJ stability with additional AC stabilization in the context of acute ACJ reconstruction. Though, prospective clinical and biomechanical studies are warranted to evaluate influencing factors on ACLC healing and potential impacts of acute ACLC repair on clinical outcome. STUDY TYPE Controlled Laboratory Study.
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Campagna V, Piccinni V, Rotundo G, Candela V, Gumina S. The Kite technique: a new all-arthroscopic technique for the treatment of acute acromioclavicular joint dislocation. Knee Surg Sports Traumatol Arthrosc 2021; 29:2055-2063. [PMID: 32335696 DOI: 10.1007/s00167-020-06013-5] [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: 08/24/2019] [Accepted: 04/17/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Although many open techniques have been developed, no all-arthroscopic technique has been introduced to reduce acute acromioclavicular joint dislocation (ACJD) and augment both coracoclavicular (CC) ligaments. The Kite technique is the first all arthroscopic technique with this aim. METHODS Forty-one consecutive patients [35M-6F; median: 29.2 years (range 23-36)] with acute type III and V acromioclavicular joint dislocation were treated with the Kite technique: it consists of positioning three titanium buttons connected by heavy sutures in an 8-strand configuration between clavicle and coracoid to restore the anatomy of CC ligaments. Patients were followed up for a median of 35 months (range 30-43 months). RESULTS Median operation time was 70.6 min (range 58-82), with no cases of intra-operative complications. At the final follow-up, the median post-operative Constant Score and SST were 94.1 (range 89-98) and 11.6 (range 10-12), respectively. At the final follow-up reduction maintenance was present in 39 patients; in one patient, signs of acromioclavicular joint dislocation recurrence were present 3 months post-op. In another patient, medial suture ruptures occurred 4 months after surgery with type II acromioclavicular joint dislocation recurrence but with scarce symptoms and full recovery to sport activity. Clavicle osteolysis was observed in four patients. Cosmetics of the arm were judged as excellent in 39/41. All patients, except two, were satisfied with the final result. CONCLUSIONS The kite technique is a safe and reproducible arthroscopic procedure to treat acute ACJD. In daily clinical practice, due to the excellent results and the low complication rate, this technique might be considered by surgeons when operative treatment of an acute acromioclavicular joint dislocation is planned. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- V Campagna
- Department of Shoulder and Elbow Surgery, Celio Military Hospital, Rome, Italy
| | - V Piccinni
- Department of Shoulder and Elbow Surgery, Celio Military Hospital, Rome, Italy
| | - G Rotundo
- Department of Shoulder and Elbow Surgery, Celio Military Hospital, Rome, Italy
| | - Vittorio Candela
- Department of Anatomy, Histology, Legal Medicine and Orthopedics, Sapienza University of Rome-Polo Pontino (ICOT), Latina, Italy.
| | - S Gumina
- Department of Anatomy, Histology, Legal Medicine and Orthopedics, Sapienza University of Rome-Polo Pontino (ICOT), Latina, Italy
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Biologic and synthetic ligament reconstructions achieve better functional scores compared to osteosynthesis in the treatment of acute acromioclavicular joint dislocation. Knee Surg Sports Traumatol Arthrosc 2021; 29:2175-2193. [PMID: 32797247 DOI: 10.1007/s00167-020-06217-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 08/06/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE To systematically review the outcomes of surgical treatments of acute acromioclavicular joint dislocation. METHODS Studies were identified by electronic databases (Ovid, PubMed). All studies reporting functional and radiological outcomes of surgical treatments of acute acromioclavicular joint dislocations were included. Following data were extracted: authors and year, study design, level of evidence, number of patients, age, classification of acromioclavicular joint dislocation, time to surgery, surgical technique, follow-up, clinical and imaging outcomes, complications, and failures. Descriptive statistics was used, when a data pooling was not possible. Comparable outcomes were pooled to generate summary outcomes reported as frequency-weighted values. Quality appraisal was assessed through the MINORS checklist. RESULTS One hundred and thirty-three studies were included for a total of 4473 shoulders. Mean age of participants was 36.9 years. Mean follow-up was 42.06 months. Arthroscopy showed better ASES (p < 0.0001) and lower VAS pain score (p = 0.0249) compared to an open approach. Biologic and synthetic reconstructions demonstrated better results over osteosynthesis techniques. Biologic techniques showed overall better Constant (p = 0.0001) and DASH (p = 0.0215) scores, while synthetic reconstruction showed better UCLA score (p = 0.0001). Among suture buttons, triple button showed overall better results in Constant (p = 0.0001) and VAS (p = 0.0001) scores, while better results in DASH score (p = 0.0003) were achieved by 2 double button techniques. Overall, the level of evidence was low. CONCLUSION Biological and synthetic reconstructions achieved better functional scores compared to osteosynthesis. Among suture buttons, the triple button showed better functional performance. LEVEL OF EVIDENCE IV.
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Yoo YS, Khil EK, Im W, Jeong JY. Comparison of Hook Plate Fixation Versus Arthroscopic Coracoclavicular Fixation Using Multiple Soft Anchor Knots for the Treatment of Acute High-Grade Acromioclavicular Joint Dislocations. Arthroscopy 2021; 37:1414-1423. [PMID: 33340675 DOI: 10.1016/j.arthro.2020.12.189] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 12/03/2020] [Accepted: 12/05/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the clinical and radiologic outcomes of arthroscopically assisted coracoclavicular (CC) fixation using multiple soft anchor knots versus hook plate fixation in patients with acute high-grade Rockwood type III and V acromioclavicular (AC) joint dislocations. METHODS This retrospective study included 22 patients with acute Rockwood type III and V AC joint dislocations who underwent arthroscopic fixation or hook plate fixation surgery between February 2016 and March 2018. Patients were categorized into 2 groups: arthroscopically assisted CC fixation using multiple soft anchor knots group (AR, n = 12) and hook plate fixation group (HO, n = 10). We measured the CC distances (CCDs) and CCD ratio at 6 months, 1 year, and last follow-up postoperatively to compare the radiologic results between the groups. Clinical outcomes were assessed at 1 year postoperatively and at the last follow-up using the Visual Analog Scale, American Shoulder and Elbow Surgeons (ASES) scores, and Shoulder Pain and Disability Index (SPADI) scores, and the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Magnetic resonance imaging after hook plate removal was used to evaluate the healing ligaments and tendon-bone interface. RESULTS The patients in the AR group had better ASES, SPADI, and Quick DASH scores than the patients in the HO group at 1 year postoperatively and at last follow-up. The CCD and CCD ratio were significantly better in the AR group than in the HO group at the last follow-up period (P = .007/0.029). Magnetic resonance imaging findings showed grade I in 60% of patients in the AR group and grade III in 60% of patients in the HO group. AC joint arthritic change was observed in 40% of the HO group. CONCLUSIONS The CC fixation method using multiple soft anchor knots showed satisfactory results and had superior CC ligament healing ability and maintenance of CCD than hook fixation. LEVEL OF EVIDENCE Level III, retrospective therapeutic comparative investigation.
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Affiliation(s)
- Yon-Sik Yoo
- Camp 9 Orthopedic Clinic, Gyeonggi-do, Republic of Korea
| | - Eun Kyung Khil
- Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, Medical College of Hallym University, Gyeonggi-do, Republic of Korea
| | - Wooyoung Im
- Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Medical College of Hallym University, Gyeonggi-do, Republic of Korea
| | - Jeung Yeol Jeong
- Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Medical College of Hallym University, Gyeonggi-do, Republic of Korea.
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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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Liu T, Bao F, Jiang T, Ji G, Li J, Jerosch J. Acromioclavicular Joint Separation: Repair Through Suture Anchors for Coracoclavicular Ligament and Nonabsorbable Suture Fixation for Acromioclavicular Joint. Orthop Surg 2020; 12:1362-1371. [PMID: 32893498 PMCID: PMC7670157 DOI: 10.1111/os.12771] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/07/2020] [Accepted: 07/09/2020] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To evaluate the clinical and radiographic outcomes of patients undergoing coracoclavicular (CC) ligament repair by two suture anchors and acromioclavicular (AC) joint (ACJ) fixation using heavy nonabsorbable sutures for the treatment of types III-V ACJ injuries with a minimum of 1-year follow-up. METHODS The clinical and radiographic outcomes of 36 consecutive patients (26 men and 10 women) who underwent anatomic reduction for acute ACJ dislocation using two suture anchors for CC ligament reconstruction and two strands of non-absorbable stitches for ACJ fixation between December 2013 and December 2018 were reviewed. Two 3.5 mm suture anchors with double-loaded sutures were separately inserted into the anterolateral and posteromedial portions of the coracoid process. The suture strands were passed through the hole created in the clavicle using 2.0 mm drill and tied over the clavicle. Additional ACJ augmentation using two strands of non-absorbable heavy sutures was performed in all patients. At 3, 6, and 12 months and last follow-up visit, the scores on the visual analog scale (VAS), the American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score, and simple shoulder test (SST) questionnaires were used to provide a final evaluation of shoulder function. Comparison between baseline and treatment results was performed. Radiographic analysis included vertical displacement and horizontal shift. RESULTS A total of 29 patients (20 men and nine women) were included in the study. A total of seven, six, and 16 patients had Rockwood type III, type IV, and type V ACJ dislocations, respectively. The mean patient age was 42.8 ± 13.5 years, with a mean follow-up of 28 months (range, 12-56 months). At the 12-month follow-up, the mean ASES score was 92.1 ± 3.5, with a mean pain score of 0.5 ± 0.7 on the VAS and mean Constant-Murley score of 93.0 ± 2.4. The new number of positive answers on the SST was 11.5 ± 0.6. Compared with the baseline, the clinical results improved significantly (P < 0.05). No significant difference could be found between the 6- and 12-month follow-up evaluations (P > 0.05). Radiographs showed two partial loss of reduction, whereas no horizontal displacement was found in all patients. One patient developed a superficial wound infection 3 weeks postoperation. The wound healed after routine wound care. No neurovascular complications were recorded. CONCLUSIONS CC ligament reconstruction using two suture anchors and ACJ augmentation using two strands of non-absorbable heavy sutures on high-grade AC dislocation is a reliable technique for restoring stability to the ACJ and can obtain good to excellent clinical results.
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Affiliation(s)
- Tao Liu
- Department of Orthopaedic SurgeryQilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong UniversityQingdaoChina
| | - Fei‐long Bao
- Department of Orthopaedic SurgeryQilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong UniversityQingdaoChina
| | - Tao Jiang
- Department of Orthopaedic SurgeryQilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong UniversityQingdaoChina
| | - Guang‐wei Ji
- Department of Orthopaedic SurgeryQilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong UniversityQingdaoChina
| | - Jian‐min Li
- Department of Orthopaedic SurgeryCheeloo College of Medicine, Shandong UniversityJinanChina
| | - Jörg Jerosch
- Clinic for Orthopaedics and Orthopaedic SurgeryJohanna‐Etienne HospitalNeussGermany
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Özcafer R, Albayrak K, Lapçin O, Çetinkaya E, Arıkan Y, Gül M. Early clinical and radiographic results of fixation with the TightRope device for Rockwood type V acromioclavicular joint dislocation: A retrospective review of 15 patients. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2020; 54:473-477. [PMID: 33155554 DOI: 10.5152/j.aott.2020.18407] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The aims of this study were, first, to assess the loss of reduction after fixation of Rockwood type V acromioclavicular joint dislocation (ACJD) with the TightRope device (Arthrex, Naples, FL, USA) and, second, to present the functional and radiological outcomes of this treatment. METHODS We retrospectively reviewed the medical records of 15 patients (12 males; mean age=39.2 years; age range=23-61) with Rockwood type V ACJD who were treated by the TightRope fixation device. The mean follow-up period was 19.3 (range=12-30) months. Functional status was assessed using the Constant-Murley score (CMS) at the final follow-up examination. To determine the reduction loss of ACJ, we measured and compared the coracoclavicular (CC) distance using radiographs with Zanca view in the early postoperative period and at the final follow-up examination. The fixation procedures were performed with an open technique using the TightRope fixation device. RESULTS The mean CMS at the final follow-up was 93.2 (range=82-100) points. All the patients experienced full recovery of the shoulder's range of motion, were able to return to the activities of daily living, and were satisfied with the treatment. ACJ reduction was successfully achieved in all the patients using the TightRope technique. Postoperative radiographs revealed no reduction loss in the ACJ, and the CC distance was well maintained. The mean CC distance was 19.95 (range=13.1-28.3) mm before surgery. The mean CC distance was 7.47 (range=4.2-11.5) mm in the early postoperative radiographic measurements. This difference was statistically significant (p=0.001). The mean CC distance at the final follow-up examination was 7.70 (range=4.5-11.7) mm. At the final follow-up visit, the shoulders of all the patients were still completely reduced, with a mean difference in the CC of 0.23 (range=0-1.3) mm compared with that in the early postoperative period. The difference in the CC between the early postoperative and final follow-up intervals was not statistically significant (p=0.055). No patient experienced recurrence or required an operation for hardware removal. CONCLUSION It seems that the TightRope device can provide anatomical restoration in patients with acute type V ACJD without subluxation at the final follow-up examination. LEVEL OF EVIDENCE Level IV, Therapeutic study.
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Affiliation(s)
- Raşit Özcafer
- Department of Orthopaedic Surgery, Baltalimanı Bone and Joint Diseases Training and Research Hospital, İstanbul, Turkey
| | - Kutalmış Albayrak
- Department of Orthopaedic Surgery, Baltalimanı Bone and Joint Diseases Training and Research Hospital, İstanbul, Turkey
| | - Osman Lapçin
- Department of Orthopaedic Surgery, Aydın University, School of Medicine Hospital, İstanbul, Turkey
| | - Engin Çetinkaya
- Department of Orthopaedic Surgery, Baltalimanı Bone and Joint Diseases Training and Research Hospital, İstanbul, Turkey
| | - Yavuz Arıkan
- Department of Orthopaedic Surgery, Baltalimanı Bone and Joint Diseases Training and Research Hospital, İstanbul, Turkey
| | - Murat Gül
- Department of Orthopaedic Surgery, Aydın University, School of Medicine Hospital, İstanbul, Turkey
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Jeong JY, Chun YM. Treatment of acute high-grade acromioclavicular joint dislocation. Clin Shoulder Elb 2020; 23:159-165. [PMID: 33330252 PMCID: PMC7714286 DOI: 10.5397/cise.2020.00150] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/06/2020] [Indexed: 02/07/2023] Open
Abstract
Acromioclavicular (AC) joint dislocations account for about 9% of shoulder injuries. Among them, acute high-grade injury following high-energy trauma accounts for a large proportion of patients requiring surgical treatment. However, there is no gold standard procedure for operative treatment of acute high-grade AC joint injury, and several different procedures have been used for this purpose in clinical practice. This review article summarizes the most recent and relevant surgical options for acute high-grade AC joint dislocation patients and the outcomes of each treatment type.
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Affiliation(s)
- Jeung Yeol Jeong
- Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Yong-Min Chun
- Department of Orthopedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Rosslenbroich SB, Heimann K, Katthagen JC, Koesters C, Riesenbeck O, Petersen W, Raschke MJ, Schliemann B. Early clinical results of minimally invasive coracoclavicular ligament reconstruction can be maintained at a minimum of five years' follow-up. Bone Joint J 2020; 102-B:918-924. [PMID: 32600145 DOI: 10.1302/0301-620x.102b7.bjj-2020-0114.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS There is a lack of long-term data for minimally invasive acromioclavicular (AC) joint repair. Furthermore, it is not clear if good early clinical results can be maintained over time. The purpose of this study was to report long-term results of minimally invasive AC joint reconstruction (MINAR) and compare it to corresponding short-term data. METHODS We assessed patients with a follow-up of at least five years after minimally invasive flip-button repair for high-grade AC joint dislocation. The clinical outcome was evaluated using the Constant score and a questionnaire. Ultrasound determined the coracoclavicular (CC) distance. Results of the current follow-up were compared to the short-term results of the same cohort. RESULTS A total of 50 patients (three females, 47 males) were successfully followed up for a minimum of five years. The mean follow-up was 7.7 years (63 months to 132 months). The overall Constant score was 94.4 points (54 to 100) versus 97.7 points (83 to 100) for the contralateral side showing a significant difference for the operated shoulder (p = 0.013) The mean difference in the CC distance between the operated and the contralateral shoulder was 3.7 mm (0.2 to 7.8; p = 0.010). In total, 16% (n = 8) of patients showed recurrent instability. All these cases were performed within the first 16 months after introduction of this technique. A total of 84% (n = 42) of the patients were able to return to their previous occupations and sport activities. Comparison of short-term and long-term results revealed no significant difference for the Constant Score (p = 0.348) and the CC distance (p = 0.974). CONCLUSION The clinical outcome of MINAR is good to excellent after long-term follow-up and no significant differences were found compared to short-term results. We therefore suggest this is a reliable technique for surgical treatment of high-grade AC joint dislocation. Cite this article: Bone Joint J 2020;102-B(7):918-924.
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Affiliation(s)
- Steffen B Rosslenbroich
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Westfalian-Wilhelms University Muenster, Muenster, Germany
| | - Katharina Heimann
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Westfalian-Wilhelms University Muenster, Muenster, Germany
| | - Jan Christoph Katthagen
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Westfalian-Wilhelms University Muenster, Muenster, Germany
| | - Clemens Koesters
- Department of Orthopedics and Trauma Surgery, Maria and Josef Hospital, Greven, Germany
| | - Oliver Riesenbeck
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Westfalian-Wilhelms University Muenster, Muenster, Germany
| | - Wolf Petersen
- Department of Orthopedics and Trauma Surgery, Martin Luther Hospital Berlin, Greven, Germany
| | - Michael J Raschke
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Westfalian-Wilhelms University Muenster, Muenster, Germany
| | - Benedikt Schliemann
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Westfalian-Wilhelms University Muenster, Muenster, Germany
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Celik H, Chauhan A, Flores-Hernandez C, Dorthe E, Goodine T, D'Lima D, Hoenecke H. Vertical and Rotational Stiffness of Coracoclavicular Ligament Reconstruction: A Biomechanical Study of 3 Different Techniques. Arthroscopy 2020; 36:1264-1270. [PMID: 32035171 DOI: 10.1016/j.arthro.2020.01.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the biomechanical stability of 3 different coracoclavicular reconstruction techniques under rotational and vertical loading using a cadaveric model. METHODS In total, 12 cadaveric shoulders were used for testing. The native state was first tested then followed by 3 different reconstruction configurations using suture tapes and cortical buttons: coracoid loop (CL), single-bundle (SB), and double-bundle (DB). Superior displacement was measured by cycling an inferiorly directed force of 70 N to the scapula. The rotational stiffness of the scapula was determined by cycling the scapula in rotational displacement control between 15° of internal and external rotation. The rotational stiffness of the clavicle was determined by rotating the clavicle around its long axis 20° anteriorly and 30° posteriorly in rotational displacement control. All measurements were captured over 10 cycles at a rate of 200 Hz. RESULTS Both the CL and SB techniques demonstrated significantly less internal scapular rotation stiffness. (intact: 19.70 ± 9.07 cNm/deg, CL: 3.70 ± 2.63 cNm/deg, SB:4.30 ± 2.66 cNm/deg, P <.001) External scapular rotation stiffness was significantly decreased in all techniques (intact: 17.70 ± 4.43 cNm/deg, CL: 3.30 ± 1.37 cNm/deg, SB: 4.50 ± 1.56 cNm/deg, DB: 4.67 ± 1.99 cNm/deg, P < .001). The CL and SB reconstructions were significantly less stiff with regards to posterior rotation of the clavicle (intact: 5.60 ± 1.80 cNm/deg, CL: 2.90 ± 1.10 cNm/deg, SB: 1.40 ± 0.65 cNm/deg, P < .001). Anterior rotation stiffness of the clavicle was significantly lower in all of the reconstructions (intact: 6.95 ± 1.90 cNm/deg, CL: 3.08 ± 0.84 cNm/deg, SB: 3.64 ± 0.93 cNm/deg, DB: 4.48 ± 1.21 cNm/deg, P < .001). CONCLUSIONS None of the described techniques provided equivalent rotational stability in all planes compared with the native state. DB reconstruction presented stiffness characteristics closest to the native state under cyclic loading during internal scapular and posterior clavicular rotation. CLINICAL RELEVANCE Additional procedures such as tendon grafting or acromioclavicular ligament reconstruction may be required to control rotational stability.
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Affiliation(s)
- Haluk Celik
- Division of Sports Medicine, Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, California, U.S.A.; Shiley Center for Orthopaedic Research & Education (SCORE), Scripps Clinic, La Jolla, California, U.S.A..
| | - Aakash Chauhan
- Division of Sports Medicine, Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, California, U.S.A.; Shiley Center for Orthopaedic Research & Education (SCORE), Scripps Clinic, La Jolla, California, U.S.A
| | - Cesar Flores-Hernandez
- Shiley Center for Orthopaedic Research & Education (SCORE), Scripps Clinic, La Jolla, California, U.S.A
| | - Erik Dorthe
- Shiley Center for Orthopaedic Research & Education (SCORE), Scripps Clinic, La Jolla, California, U.S.A
| | - Thomas Goodine
- Division of Sports Medicine, Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, California, U.S.A.; Shiley Center for Orthopaedic Research & Education (SCORE), Scripps Clinic, La Jolla, California, U.S.A
| | - Darryl D'Lima
- Shiley Center for Orthopaedic Research & Education (SCORE), Scripps Clinic, La Jolla, California, U.S.A
| | - Heinz Hoenecke
- Division of Sports Medicine, Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, California, U.S.A.; Shiley Center for Orthopaedic Research & Education (SCORE), Scripps Clinic, La Jolla, California, U.S.A
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Wang C, Meng JH, Zhang YW, Shi MM. Suture Button Versus Hook Plate for Acute Unstable Acromioclavicular Joint Dislocation: A Meta-analysis. Am J Sports Med 2020; 48:1023-1030. [PMID: 31315003 DOI: 10.1177/0363546519858745] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND Surgical treatment is indicated for unstable acromioclavicular (AC) joint dislocation. The hook plate (HP) technique is a commonly used treatment method, but the use of the suture button (SB) technique is increasing. PURPOSE To conduct a meta-analysis of clinical studies evaluating patient outcomes between the SB and HP techniques for acute unstable AC joint dislocation. STUDY DESIGN Meta-analysis. METHODS A literature search of the Embase, PubMed, and Cochrane Library databases was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Cohort studies and case-control studies comparing the SB and HP procedures for acute unstable AC joint dislocation were included. Statistical analysis was performed with RevMan (v 5.3.5). RESULTS Eight clinical studies that met the inclusion criteria were identified and included a total of 204 patients treated with the SB technique and 195 patients with the HP technique. Patients treated with the SB technique had a higher Constant score (mean difference [MD], 3.95; 95% CI, 1.20-6.70; P = .005) and a lower visual analog scale pain score (MD, -0.75; 95% CI, -1.12 to 0.37; P < .0001) when compared with the HP technique. No significant differences in operation time (MD, -0.38; 95% CI, -7.14 to 6.37; P = .91), coracoclavicular distance (MD, -0.07; 95% CI, -0.49 to 0.35; P = .75), complications (odds ratio, 0.59; 95% CI, 0.22-1.54; P = .28), and loss of reduction (odds ratio, 2.55; 95% CI, 0.66-9.83; P = .17) were found between the SB and HP techniques. The subgroup analysis showed that the arthroscopic SB technique resulted in a higher Constant score (MD, 6.75; 95% CI, 4.21-9.29; P < .00001) as compared with the HP technique, but no differences were observed between the open SB and HP techniques (MD, 0.69; 95% CI, -0.82 to 2.20; P = .37). CONCLUSION This meta-analysis demonstrated that the SB technique resulted in better functional outcomes and a reduced visual analog scale pain score when compared with the HP technique. However, for operation time, coracoclavicular distance, complications, and loss of reduction, there were no statistically significant differences between the techniques. Compared with the open procedure, arthroscopic SB may be superior for better functional outcomes.
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Affiliation(s)
- Cong Wang
- Department of Orthopaedic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jia-Hong Meng
- Department of Orthopaedic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yi-Wen Zhang
- Operating Room, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ming-Min Shi
- Department of Orthopaedic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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31
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Aliberti GM, Kraeutler MJ, Trojan JD, Mulcahey MK. Horizontal Instability of the Acromioclavicular Joint: A Systematic Review. Am J Sports Med 2020; 48:504-510. [PMID: 31013137 DOI: 10.1177/0363546519831013] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Injuries to the acromioclavicular (AC) joint are common and should be suspected in patients who have shoulder pain in the region of the acromion and clavicle. Injuries to the AC ligament can cause horizontal instability and are often neglected or underdiagnosed, which can lead to poor patient outcomes. PURPOSE To perform a systematic review of the literature on the diagnosis and treatment of horizontal instability of the AC joint. STUDY DESIGN Systematic review. METHODS The authors performed a systematic review using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed and EMBASE were searched for studies that investigated diagnosis, treatment, and failure of operative management of acute and chronic AC separations. Studies that did not specifically evaluate AC joint injuries, were not written in English, or were specific only to vertical instability of the AC joint were excluded. RESULTS Overall, 23 articles met the inclusion criteria and were therefore included in this systematic review. Diagnosing horizontal AC instability is difficult using plain radiographs; dynamic views were shown in some cases to better detect horizontal instability than with static views. More than 60 procedures for treating AC joint injuries have been published, but many focus on vertical rather than horizontal instability. Modifications to current surgical procedures to incorporate reconstruction of the horizontal component showed improved patient outcomes. Such modifications included additional AC joint suture cord cerclage, combined AC and coracoclavicular ligament reconstruction, and the Twin Tail TightRope triple button technique. Failure after surgical stabilization of AC joint separation has been reported to occur in 15% to 80% of cases. CONCLUSION No consensus is available regarding the best practices for diagnosis, evaluation, and treatment of acute or chronic horizontal instability of the AC joint. Moreover, horizontal instability injuries are often neglected or poorly understood, making diagnosis difficult, which may lead to high complication rates and failure after surgical stabilization.
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Affiliation(s)
| | - Matthew J Kraeutler
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, New Jersey, USA
| | - Jeffrey D Trojan
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Mary K Mulcahey
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
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Dyrna F, Berthold DP, Feucht MJ, Muench LN, Martetschläger F, Imhoff AB, Mazzocca AD, Beitzel K. The importance of biomechanical properties in revision acromioclavicular joint stabilization: a scoping review. Knee Surg Sports Traumatol Arthrosc 2019; 27:3844-3855. [PMID: 31624902 DOI: 10.1007/s00167-019-05742-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 09/30/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE Treatment of failed primary reconstruction of the unstable acromioclavicular (AC) joint remains challenging for orthopaedic surgeons. When approaching revision cases, the reason for failure has to be precisely identified. The purpose of this manuscript was to perform a critical review of the literature regarding treatment options for failed AC joint stabilization techniques and to provide a treatment algorithm for salvage procedures. METHODS A thorough search included electronic databases for articles published up to April 15th, 2019. Inclusion criteria were set as (1) studies that reported on clinical outcomes following surgical or conservative treatment of AC joint dislocation; (2) studies reporting on failure or complications of primary treatment; (3) chronic instabilities caused by delayed or secondary treatment as well as (4) revision and salvage procedures. RESULTS The search strategy identified a total of 3269 citations. The final dataset comprised 84 studies published between 1954 and 2019. A total of 5605 patients (9.63% females) were involved with a mean age of 34.5 years. Overall, complication rates varied between 5 and 88.9% in patients with AC joint instability. CONCLUSION In the current literature, evidence for treatment of revision AC joint instability is still lacking, however, surgical treatment continues to evolve. The importance of failure analysis and clinically relevant algorithms were highlighted in this review. Adequately restoring native joint biomechanics is needed for ensuring an optimal healing environment that will translate into patient satisfaction and long-term stability. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Felix Dyrna
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Daniel P Berthold
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA.,Department of Orthopaedic Sports Medicine, Technical University, Munich, Germany
| | - Matthias J Feucht
- Department of Orthopaedic Sports Medicine, Technical University, Munich, Germany
| | - Lukas N Muench
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA.,Department of Orthopaedic Sports Medicine, Technical University, Munich, Germany
| | | | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Technical University, Munich, Germany
| | - Augustus D Mazzocca
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Knut Beitzel
- Department of Orthopaedic Sports Medicine, Technical University, Munich, Germany. .,ATOS Clinic Cologne, Cologne, Germany.
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Arthroscopically assisted acromioclavicular joint stabilization leads to significant clavicular tunnel widening in the early post-operative period. Knee Surg Sports Traumatol Arthrosc 2019; 27:3821-3826. [PMID: 31410526 DOI: 10.1007/s00167-019-05662-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 08/05/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Arthroscopically assisted acromioclavicular joint (ACJ) stabilization techniques use bone tunnels in the clavicle and coracoid process. The tunnel size has been shown to have an impact on the fracture risk of clavicle and coracoid. The aim of the present study was to radiographically evaluate the alterations of the clavicular tunnel size in the early post-operative period. It was hypothesized that there would be a significant increase of tunnel size. METHODS Twenty consecutive patients with acute high-grade ACJ (Rockwood type IV-V) injury underwent arthroscopic-assisted ACJ stabilization. The median age of the patients was 40 (26-66) years. For all patients, a single tunnel button-tape construct was used along with an additional ACJ tape cerclage. Radiologic measurements were undertaken on standardized Zanca films at two separate time points, immediate post-operative examination (IPO) and at late post-operative examination (> 4 months; LPO). The LPO radiographs were taken at a median follow-up period of 4.5 (3-6) months. Clavicular tunnel width (CT) and coracoclavicular distance (CCD) were measured using digital calipers by two independent examiners and the results are presented as median, range, and percentage. RESULTS The median CCD increased significantly from 9.5 (8-13) mm at IPO to 12 (7-20) mm at LPO (p < 0.05). Median tunnel size showed significant difference from 3 (3-4) mm at IPO to 5 (4-7) mm at LPO (p < 0.05). Despite a significant increase of 2 mm (66.6%) of the initial tunnel size, there was no correlation between tunnel widening and loss of reduction. CONCLUSION Arthroscopic ACJ stabilization with the use of bone tunnels led to a significant increase of clavicular tunnel size in the early post-operative period. This phenomenon carries a higher fracture risk, especially in high-impact athletes, which needs to be considered preoperatively. LEVEL OF EVIDENCE IV.
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Clavicle and coracoid process periprosthetic fractures as late post-operative complications in arthroscopically assisted acromioclavicular joint stabilization. Knee Surg Sports Traumatol Arthrosc 2019; 27:3797-3802. [PMID: 30900030 DOI: 10.1007/s00167-019-05482-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 03/06/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Arthroscopic-assisted stabilization surgery for acute acromioclavicular joint (ACJ) disruption shows excellent and reliable clinical outcomes. However, characteristic complications such as fracture of the clavicle and coracoid have been reported to occur during the early post-operative period. The main goal of this study was to highlight the occurrence of fractures as a late post-operative complication. The secondary goals were to describe possible fracture morphologies and treatment outcomes. METHOD Patient records from a single surgery centre were searched for all patients presenting with late fracture complication following arthroscopically assisted acromioclavicular stabilization. Medical reports including the operative notes and pre- and post-operative X-rays were reviewed. A telephone interview was conducted with each patient to access the American Shoulder and Elbow Surgeons shoulder score. RESULTS A total of four patients presented with late fracture complication following arthroscopic-assisted ACJ stabilization surgery. All patients were males and presented following trauma at a median duration of 19.5 months after the index surgery. Fracture morphology differed between patients; the treatment was conservative in three patients, while one patient underwent osteosynthesis. CONCLUSION Traumatic peri-implant fractures can occur, even 2 years after arthroscopically assisted ACJ reconstruction. This needs to be considered when planning for surgical intervention in acute ACJ disruption, especially in a high-risk population. LEVEL OF EVIDENCE Therapeutic study, Level IV.
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Youn GM, Chakrabarti MO, McGahan PJ, Chen JL. Acromioclavicular Joint Repair Using a Suture Cerclage Tensioning System. Arthrosc Tech 2019; 8:e1555-e1560. [PMID: 31890537 PMCID: PMC6928360 DOI: 10.1016/j.eats.2019.08.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 08/15/2019] [Indexed: 02/03/2023] Open
Abstract
Injuries to the acromioclavicular (AC) joint are common among adults in their twenties and account for 8% of all joint dislocations. Although there are numerous operative approaches to treating AC joint separations, a gold standard does not exist because of lack of conclusive evidence supporting the use of 1 standard technique. In this Technical Note and accompanying video, we describe an anatomic AC joint repair using a suture cerclage tensioning system to accurately control the reduction and improve the precision and outcomes of the repair.
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Affiliation(s)
- Gun Min Youn
- Address correspondence to Gun Min Youn, B.A., Advanced Orthopaedics and Sports Medicine, 450 Sutter St, Ste 400, San Francisco, CA 94108, U.S.A.
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Abdelrahman AA, Ibrahim A, Abdelghaffar K, Ghandour TM, Eldib D. Open versus modified arthroscopic treatment of acute acromioclavicular dislocation using a single tight rope: randomized comparative study of clinical outcome and cost-effectiveness. J Shoulder Elbow Surg 2019; 28:2090-2097. [PMID: 31451349 DOI: 10.1016/j.jse.2019.06.007] [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: 02/28/2019] [Revised: 05/28/2019] [Accepted: 06/07/2019] [Indexed: 02/01/2023]
Abstract
PURPOSE The purpose of this study was to compare clinical outcome and cost-effectiveness between arthroscopic and open repair using TightRope in acromioclavicular joint dislocation III and IV. PATIENTS AND METHODS Fifty-two patients with acute acromioclavicular joint dislocation type III and IV were included. Patients were randomly allocated to either of 2 groups: Arthroscopic Repair Group (ARG) and Open Repair Group (ORG). Constant-Murley Score (CMS), visual analog scale (VAS) score, and coracoclavicular (CC) distance were measured preoperatively and 3 months, 6 months, 1 year, and 2 years postoperatively. RESULTS CMS increased from 40.68 for the ARG and 40.70 for the ORG preoperatively to 84.18 and 84.45 after 2 years from operation. VAS score decreased from 60.59 for the ARG and 64.50 for the ORG 1 day after surgery to 18.04 and 17.87 respectively after 6 months. CC distance decreased from 29.27 mm in the ARG and 28.16 mm in the ORG preoperatively to 9.86 mm in the ARG and 10.54 mm in the ORG on postoperative day 1. Rewidening of the CC distance occurred after 6 months (13.27 mm for the ARG and 13.62 mm for the ORG) and 1 year postoperatively (15.77 for the ARG and 15.41 for the ORG) but remained stable at final follow-up. There was a significant difference in surgical time (80.00 minutes in the ARG compared to 52.79 minutes in the ORG) and cost of consumables (US$1729.95 in the ARG compared to US$851.87 in the ORG). CONCLUSION Open and arthroscopic repair of acute acromioclavicular joint dislocation yielded good clinical results, yet the arthroscopic technique is more expensive and has a longer surgical time.
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Affiliation(s)
| | - Amr Ibrahim
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | | | - Diaa Eldib
- Faculty of Medicine, Benha University, Cairo, Egypt
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Jobmann S, Buckup J, Colcuc C, Roessler PP, Zimmermann E, Schüttler KF, Hoffmann R, Welsch F, Stein T. Anatomic ligament consolidation of the superior acromioclavicular ligament and the coracoclavicular ligament complex after acute arthroscopically assisted double coracoclavicular bundle stabilization. Knee Surg Sports Traumatol Arthrosc 2019; 27:3168-3179. [PMID: 28924949 DOI: 10.1007/s00167-017-4717-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 09/13/2017] [Indexed: 01/26/2023]
Abstract
PURPOSE The consolidation of the acromioclavicular (AC) and coracoclavicular (CC) ligament complex after arthroscopically assisted stabilization of acute acromioclavicular joint (ACJ) separation is still under consideration. METHODS Fifty-five consecutive patients after arthroscopically assisted double-CC-bundle stabilization within 14 days after acute high-grade ACJ separation were studied prospectively. All patients were clinically analysed preoperatively (FU0) and post-operatively (FU1 = 6 months; FU2 = 12 months). The structural MRI assessments were performed at FU0 (injured ACJ) and at FU2 bilateral (radiologic control group) and assessed separately the ligament thickness and length at defined regions for the conoid, trapezoid and the superior AC ligament. RESULTS Thirty-seven patients were assessed after 6.5 months and after 16.0 months. The 16-month MRI analysis revealed for all patients continuous ligament healing for the CC-complex and the superior AC ligament with in the average hypertrophic consolidation compared to the control side. Separate conoid and trapezoid strands (double-strand configuration) were detected in 27 of 37 (73%) patients, and a single-strand configuration was detected in 10 of 37 (27%) patients; both configurations showed similar CCD data. The ligament healing was not influenced by the point of surgery, age at surgery and heterotopic ossification. The clinical outcome was increased (FU0-FU2): Rowe, 47.7-97.0 pts.; TAFT, 3.9-10.6 pts.; NAS pain, 8.9-1.4 pts. (all P < 0.05). CONCLUSION The arthroscopically assisted double-CC-bundle stabilization within 14 days after acute high-grade ACJ separation showed 16 months after surgery sufficient consolidations of the AC and double-CC ligament complex in 73%. LEVEL OF EVIDENCE III, Case series.
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Affiliation(s)
- S Jobmann
- Department of Sporttraumatology - Knee- and Shoulder-Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstraße 430, 60389, Frankfurt am Main, Germany
| | - J Buckup
- Department of Sporttraumatology - Knee- and Shoulder-Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstraße 430, 60389, Frankfurt am Main, Germany
| | - C Colcuc
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - P P Roessler
- Department of Orthopaedics and Rheumatology, University Hospital Marburg, Marburg, Germany
| | - E Zimmermann
- Department of Sports medicine, University of Bielefeld, Bielefeld, Germany
| | - K F Schüttler
- Department of Orthopaedics and Rheumatology, University Hospital Marburg, Marburg, Germany
| | - R Hoffmann
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - F Welsch
- Department of Sporttraumatology - Knee- and Shoulder-Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstraße 430, 60389, Frankfurt am Main, Germany
| | - T Stein
- Department of Sporttraumatology - Knee- and Shoulder-Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstraße 430, 60389, Frankfurt am Main, Germany. .,Department of Sports medicine, University of Bielefeld, Bielefeld, Germany.
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Abstract
HYPOTHESIS The purpose of the present study was described as the arthroscopically assisted procedure that uses a synthetic conoid ligament reconstruction using Zip Tight (Zimmer biomet, Warsaw, USA) and fracture-site fixation with K-wire. Our hypothesis was that this technique provided a satisfactory functional outcome with minimum complication. METHODS 45 patients underwent operation to treat fractures of the distal clavicle between January 2014 and May 2017. The inclusion criteria were as follows: (1) there is an episode of trauma and it is the first fracture (2) distal clavicle fracture of Neer type IIb with dislocation in image findings. The exclusion criteria were as follows: (1) Neer type I, IIa and III of distal clavicle fracture (2) existing injury of rotator cuff, biceps tendon and labral during the arthroscopic procedure. Based on these criteria, 23 patients were included in this study. Clinical outcome assessments were performed using 1-year postoperative Quick DASH score, Constant-Murley score, ASES score. Radiological outcome consisted of antero-posterior and axillary radiographs. RESULTS Mean clinical outcomes were as follows: Quick DASH score was 3.8 ± 2.8, ASES score was 92.3 ± 3.2 and Constant-Murley score was 94.1 ± 3.0. It was a highly satisfactory result in all of the score at 1-year follow-up. All patients had achieved radiographic union at a minimum 1-year follow-up. There were no cases of nonunion or osteolysis. CONCLUSIONS This study demonstrated that the arthroscopy-assisted treatment using Zip Tight and K-wire provided a satisfactory functional outcome with minimum complication with Neer type IIb fractures of the distal clavicle. LEVEL OF EVIDENCE IV, Case series, Treatment study.
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Abstract
Injuries to the acromioclavicular (AC) joint are common in the athletic patient population. Most AC joint injuries occur in young males, typically from a direct fall onto the superior aspect of the shoulder when the arm is adducted. Numerous publications describing joint anatomy and biomechanics, surgical techniques for reconstruction, and rehabilitation protocols are available to guide treatment strategies for injuries to the AC joint. Treatment is typically nonsurgical for type I and II injuries and surgical for type IV and VI injuries. Controversy surrounds the indications for nonsurgical versus surgical treatment of type III and V injuries. Multiple surgical techniques have been described, including coracoclavicular (CC) screw fixation, coracoacromial ligament transfer, and numerous methods of CC ligament reconstruction. Anatomic CC ligament reconstruction can be performed either open or arthroscopically, with and without graft augmentation. This article will discuss clinically relevant anatomy and biomechanical properties of the AC joint and will review decision-making principles and treatment options for common AC joint injuries. An updated summary of clinical outcomes after AC joint treatment will also be presented.
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40
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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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Martetschläger F, Tauber M, Habermeyer P, Selim HA. Arthroscopic Coracoclavicular and Acromioclavicular Stabilization of Acute Acromioclavicular Joint Dislocation By Suspensory Fixation System. Arthrosc Tech 2019; 8:e611-e615. [PMID: 31334018 PMCID: PMC6624195 DOI: 10.1016/j.eats.2019.02.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 02/03/2019] [Indexed: 02/03/2023] Open
Abstract
Arthroscopic stabilization of acute acromioclavicular joint dislocations using coracoclavicular suspension techniques has become more popular, but lack of horizontal stability is a major concern that furthermore affects the final outcome. We present an arthroscopic technique to stabilize acute acromioclavicular joint dislocations in both the vertical and horizontal planes, with better results than conventional coracoclavicular suspension techniques.
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Affiliation(s)
- Frank Martetschläger
- Department of Shoulder and Elbow Surgery, ATOS Clinic Munich, Munich, Germany.,Department of Orthopedics Sports Medicine, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Mark Tauber
- Department of Shoulder and Elbow Surgery, ATOS Clinic Munich, Munich, Germany.,Department of Traumatology and Sports Injuries, Paracelsus Medical University, Salzburg, Austria
| | - Peter Habermeyer
- Department of Shoulder and Elbow Surgery, ATOS Clinic Munich, Munich, Germany
| | - Hisham Anis Selim
- Shoulder Arthroscopy and Sports Medicine Unit, Orthopedics Department, Zagazig University Hospital, Zagazig, Egypt
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Porschke F, Schnetzke M, Studier-Fischer S, Gruetzner PA, Guehring T. Return to work after acromioclavicular joint stabilization: a retrospective case control study. J Orthop Surg Res 2019; 14:45. [PMID: 30755238 PMCID: PMC6373092 DOI: 10.1186/s13018-019-1071-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 01/15/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Considering the epidemiology of acromioclavicular (AC) dislocation related to young and active patients, the impact on working capacity is highly relevant. The purpose of this study was to determine the capacity of work and time to return to work (RTW) after AC joint stabilization. We hypothesized that manual working patients show more restrictions returning to work. METHODS In this retrospective case series, pre- and posttraumatic working capacity of 54 patients (FU-rate 80.1%, FU time 23, range 18-45 month) stabilized in single TightRope technique was analyzed. Clinical outcome (DASH, Constant-Murley score) and complications were evaluated in addition. RESULTS Fifty one of 54 patients (94.5%) were returned to work at final follow-up. The median time to return was 13 (5-143) weeks. Manual working patients showed lower RTW-rates (91.2% vs. 100%; p = .151), longer RTW-time (15.5 vs. 6 weeks; p = .008), and more often persistent shoulder symptoms at work (55.9% vs. 5%; p < .001). CONCLUSION After stabilization of AC joint dislocation, the majority of patients returned to work, needing substantial time to return. Manual working patients required more time and often suffer under persistent symptoms at work.
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Affiliation(s)
- Felix Porschke
- BG Trauma Center Ludwigshafen, Heidelberg University Hospital, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen, Germany
| | - Marc Schnetzke
- BG Trauma Center Ludwigshafen, Heidelberg University Hospital, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen, Germany
| | - Stefan Studier-Fischer
- BG Trauma Center Ludwigshafen, Heidelberg University Hospital, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen, Germany
| | - Paul Alfred Gruetzner
- BG Trauma Center Ludwigshafen, Heidelberg University Hospital, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen, Germany
| | - Thorsten Guehring
- BG Trauma Center Ludwigshafen, Heidelberg University Hospital, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen, Germany.
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Lee SJ, Yoo YS, Kim YS, Jang SW, Kim J, Kim SJ, Kim BS, Jung KH, Varshney A. Arthroscopic Coracoclavicular Fixation Using Multiple Low-Profile Devices in Acute Acromioclavicular Joint Dislocation. Arthroscopy 2019; 35:14-21. [PMID: 30455087 DOI: 10.1016/j.arthro.2018.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 06/27/2018] [Accepted: 07/05/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To introduce an arthroscopically assisted coracoclavicular (CC) fixation technique using multiple low-profile devices to evaluate the clinical and radiologic outcomes in patients with acute high-grade acromioclavicular (AC) joint dislocation. METHODS Between July 2014 and September 2015, cases of AC joint dislocation that were treated with arthroscopic CC fixation using multiple low-profile devices with a minimum follow-up of 24 months were included. We measured the vertical coracoclavicular distance (CCD) on the anteroposterior view and the horizontal acromioclavicular distance on 3-dimensional computed tomography images to evaluate the changes in radiologic outcomes before and after surgery. We compared final radiologic outcomes between initial AC reduction groups based on hierarchical clustering. Clinical outcomes were evaluated using the Constant-Murley score. RESULTS We enrolled 27 patients in total, and the mean follow-up period was 27.2 months. The mean CCD of the injured shoulder was 13.68 ± 3.98 mm preoperatively and decreased to 5.72 ± 1.68 mm immediately postoperatively but increased to 7.32 ± 2.29 mm at last follow-up (P = .07). Horizontal displacement of the distal clavicle was 1.1 ± 1.0 mm immediately postoperatively but decreased to 0.9 ± 0.6 mm at last follow-up (P < .05). In particular, in the 2 groups that were determined using the hierarchical cluster analysis, patients with excellent recovery of the initial CCD (20 patients) showed less of an increase in the CCD at last follow-up than did those in the other group (7 patients) (P < .001). The Constant-Murley score was 93.5 ± 2.7 points on the injured side at last follow-up (P = .074). CONCLUSIONS Our CC fixation technique with multiple low-profile devices exhibited satisfactory clinical and radiologic outcomes. In particular, ensuring good initial recovery of the CCD and the precise placement and location of the AC joints was important in maintaining the proper AC position at the final follow-up. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Seung-Jin Lee
- Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Medical College of Hallym University, Hwaseong, Republic of Korea
| | - Yon-Sik Yoo
- Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Medical College of Hallym University, Hwaseong, Republic of Korea.
| | - Yoon-Sang Kim
- School of Computer Science and Engineering, Korea University of Technology and Education, Cheonan, Republic of Korea
| | - Seong-Wook Jang
- School of Computer Science and Engineering, Korea University of Technology and Education, Cheonan, Republic of Korea
| | - Jeehyoung Kim
- Department of Orthopedic Surgery, Seoul Sacred Heart General Hospital, Seoul, Republic of Korea
| | - Sung-Jae Kim
- Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Medical College of Hallym University, Hwaseong, Republic of Korea
| | - Byung-Su Kim
- Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Medical College of Hallym University, Hwaseong, Republic of Korea
| | - Koo-Hyun Jung
- Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Medical College of Hallym University, Hwaseong, Republic of Korea
| | - Ankit Varshney
- Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Medical College of Hallym University, Hwaseong, Republic of Korea
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Park TS, Park HB. A Modified Weaver-Dunn Procedure with or without Chip Bone Graft for the Treatment of Acromioclavicular Joint Separation. Indian J Orthop 2019; 53:111-116. [PMID: 30905990 PMCID: PMC6394188 DOI: 10.4103/ortho.ijortho_394_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND In spite of frequent injuries to the acromioclavicular (AC) joint, there is no consensus regarding optimal technique to be used. This cohort study evaluated the clinical results of a modified Weaver-Dunn procedure with or without chip bone graft for the treatment of AC joint separation retrospectively. MATERIALS AND METHODS 60 consecutive patients with AC joint separation, between the age of 19-76 years (mean age 43 years), were enrolled between January 2005 and September 2011. Forty patients (35 men, 5 women) were treated with a modified Weaver-Dunn procedure, and did not receive bone graft during the procedure (Group 1), whereas twenty patients (19 men, 1 woman) received autogenous chip bone graft (Group 2). Stability of the AC joint was evaluated clinically and radiographically, and the clinical results were assessed by the Imatani evaluation system. RESULTS The mean duration of followup was 2 years and 2 months. The results were excellent in all patients except one. At final followup, roentgenographic measurement revealed that the mean coracoclavicular interval was 8.2 mm on the affected side, and 8.9 mm on the unaffected side in Group 1, and 9.5 mm on the affected side and 10.1 mm on the unaffected side in Group 2. For Group 1, there were significant differences between augmentation of the grafted coracoacromial (CA) ligament antero-posteriorly and laterally (Option B) and repair of the torn AC ligament with augmentation of the grafted CA ligament antero-inferiorly (option A; P = 0.0351). CONCLUSIONS The modified Weaver-Dunn procedure (Group 1 and 2) provides a stable and strong reconstruction for the treatment of AC joint separation. In addition, this modified Weaver-Dunn procedure with chip bone graft (Group 2) may lead to same or more secure healing of the grafted CA ligament-bone than the same procedure without chip bone graft (P = 0.9737).
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Affiliation(s)
- Tae-Soo Park
- Department of Orthopaedic Surgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Hyung Bin Park
- Department of Orthopaedic Surgery, School of Medicine, Gyeongsang National University, Jinju, Korea,Address for correspondence: Prof. Hyung Bin Park, Department of Orthopaedic Surgery, Gyeongsang National University School of Medicine, Gyeongsang National University Changwon Hospital, 11 Samjeongja-ro Seongsan-gu, Changwon, Korea. E-mail:
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45
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Müller D, Reinig Y, Hoffmann R, Blank M, Welsch F, Schweigkofler U, Stein T. Return to sport after acute acromioclavicular stabilization: a randomized control of double-suture-button system versus clavicular hook plate compared to uninjured shoulder sport athletes. Knee Surg Sports Traumatol Arthrosc 2018; 26:3832-3847. [PMID: 29980805 DOI: 10.1007/s00167-018-5044-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 06/27/2018] [Indexed: 12/27/2022]
Abstract
PURPOSE Traumatic high-grade acromioclavicular joint (ACJ) separations can be surgically stabilized by numerous anatomic and non-anatomic procedures. The return to sport (Maffe et al. in Am J Sports Med 23:93-98, 1995] and remaining sport-associated impairments after acute ACJ stabilization has not yet been investigated. METHODS 73 consecutive athletes with acute high-grade ACJ separation were prospectively assigned into two groups (64.4% randomized, 35.6% intention-to-treat): open clavicular hook plate (cHP) implantation (GI) or arthroscopically assisted double double-suture-button (dDSB) implantation (GII). Patients were analyzed using shoulder sport-specific measurement tools for sport ability (ASOSS), sport activity (SSAS), and numerical analog scales: NASpain during sport, NASshoulder function in sport, and NASre-achievement of sport level. Four points of examination were established: preoperative evaluation (FU0) and first postoperative follow-up (FU1) at 6 months; FU2 at 12 months; and FU3 at 24 months after surgery. The control group (GIII) consisted of 140 healthy athletes without anamnesis of prior macro-injury or surgery. RESULTS After surgical stabilization, 29 of 35 athletes in GI (82.9%; 38.6 ± 9.9 years) and 32 of 38 in GII (82.9%; 38.6 ± 9.9 years) were followed up for 24 months (FU3) (loss 17.8%). All operated athletes showed significantly increased scores compared to FU0 (p < 0.05). Compared to GI, GII showed significantly superior outcome data for sporting ability as well as for NASre-achievement of sport level (p < 0.05). While GII re-achieved GIII-comparable SSAS and ASOSS levels, GI remained at a significantly inferior level. Athletes after ACJ injury of Rockwood grade IV/V and overhead athletes benefited significantly from the dDSB procedure. CONCLUSION The dDSB procedure enabled significantly superior sport-specific outcomes compared to the cHP procedure. Athletes after dDSB surgeries re-achieved the sporting ability and the sport activity levels of healthy athletes, whereas athletes after cHP implantation remained at significantly inferior levels. The more extensive dDSB procedure and the more restrictive rehabilitation are recommended for treatment of acute high-grade ACJ separations of functionally high-demanding athletes. LEVEL OF EVIDENCE I.
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Affiliation(s)
- D Müller
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt, Germany.,Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt am Main, Frankfurt, Germany
| | - Y Reinig
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt, Germany
| | - R Hoffmann
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt, Germany
| | - M Blank
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt, Germany
| | - F Welsch
- Department of Sporttraumatology-Knee- and Shoulder-Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstraße 430, 60389, Frankfurt, Germany
| | - U Schweigkofler
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt, Germany
| | - T Stein
- Department of Sporttraumatology-Knee- and Shoulder-Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstraße 430, 60389, Frankfurt, Germany. .,Department of Sports Science, University of Bielefeld, Bielefeld, Germany.
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46
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Dyrna F, Imhoff FB, Haller B, Braun S, Obopilwe E, Apostolakos JM, Morikawa D, Imhoff AB, Mazzocca AD, Beitzel K. Primary Stability of an Acromioclavicular Joint Repair Is Affected by the Type of Additional Reconstruction of the Acromioclavicular Capsule. Am J Sports Med 2018; 46:3471-3479. [PMID: 30419178 DOI: 10.1177/0363546518807908] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The synergistic effect of the acromioclavicular (AC) capsule and coracoclavicular (CC) ligaments on AC joint stability has gained recent recognition for its importance. Biomechanical and clinical studies have shown the benefit of combined reconstruction with multiple variations of surgical techniques for AC capsule augmentation. The ideal configuration remains unknown for such capsular repair aimed at achieving optimal stability with anatomic reconstruction. HYPOTHESIS Primary AC joint stability can be restored by AC capsule augmentation, while position of the additional suture construct is critical. It was hypothesized that techniques that reconstruct the anterior capsular structures would restore native stability against rotations and translations. STUDY DESIGN Controlled laboratory study. METHODS Thirty fresh-frozen human cadaveric shoulders were used. Each sample was tested in the native state and served as its own control. After complete capsulotomy, 1 of 5 AC capsular repair configurations was performed: anterior, superior, posterior, O-frame, and X-frame. After testing of the AC capsular repair configurations, the tests were repeated after dissection of the CC ligaments and after CC ligament reconstruction with a suture button system. AC joint stability was immediately tested after each step under rotation and horizontal translation. To accomplish this, the AC joints were anatomically positioned on a custom fixture linked to a servohydraulic testing system. A 3-dimensional optical measuring system was used to evaluate the 3-dimensional joint motion. Clavicle posterior translation in relation to the acromion, rotation around the long axis of the clavicle, and displacement of the lateral clavicle in relation to the center of rotation were measured. The torques and forces required to rotate and translate the clavicle were recorded. RESULTS In terms of translational testing, after the complete capsulotomy, a significant reduction of resistance force was found across all groups, with a mean 13% to 20% remaining ( P < .05). All AC suture augmentations were able to significantly increase the average resistance force as compared with the native ( P = .01) against posterior translation. Subsequent cutting of the CC ligaments did not result in a significant change in any of the groups ( P = .23). The synergistic effect of AC capsule augmentation and CC ligament reconstruction could be demonstrated without exception. In terms of rotational testing, the complete capsulotomy resulted in a significant reduction of resistance torque in all groups ( P < .05), with a remaining torque ranging between 2% and 11% across the groups. However, all AC suture constructs significantly increased the resistance torque as compared with the capsulotomy ( P = .01). The subsequent cutting of the CC ligaments resulted in a significant change in 2 of the 5 groups (O-frame, P = .01; X-frame, P = .02) and an overall remaining torque reduction ranging from 3% and 42%. The combined reconstruction of the AC capsule and CC ligaments achieved the highest percentage of regained resistance torque but remained significantly weaker than the native specimen ( P = .01). CONCLUSION Native translational stability could be restored by the addition of AC capsule augmentation, while partial rotational instability remained. The tested constructs revealed no significant individual differences. CLINICAL RELEVANCE Combined stabilization of the AC capsule and CC ligaments demonstrated the greatest capacity to restore the native stability against translational and rotational loads, with the specific configuration of the AC capsule repair to be chosen according to the personal preferences of the surgeon.
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Affiliation(s)
- Felix Dyrna
- Department of Orthopaedic Sportsmedicine, Technical University, Munich, Germany.,Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Florian B Imhoff
- Department of Orthopaedic Sportsmedicine, Technical University, Munich, Germany.,Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - B Haller
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA.,Institute of Medical Statistics and Epidemiology, Technical University, Munich, Germany
| | - Sepp Braun
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Elifho Obopilwe
- Department of Orthopaedic Sportsmedicine, Technical University, Munich, Germany
| | - John M Apostolakos
- Department of Orthopaedic Sportsmedicine, Technical University, Munich, Germany
| | - Daichi Morikawa
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA.,Department of Orthopaedic Surgery, Juntendo University, Tokyo, Japan
| | - Andreas B Imhoff
- Department of Orthopaedic Sportsmedicine, Technical University, Munich, Germany
| | - Augustus D Mazzocca
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Knut Beitzel
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
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47
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Clinical effectiveness of surgical treatment with polyester tapes and temporary K-wires on complete acromioclavicular dislocation. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 29:567-573. [DOI: 10.1007/s00590-018-2321-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 10/06/2018] [Indexed: 12/26/2022]
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48
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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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49
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Stein T, Müller D, Blank M, Reinig Y, Saier T, Hoffmann R, Welsch F, Schweigkofler U. Stabilization of Acute High-Grade Acromioclavicular Joint Separation: A Prospective Assessment of the Clavicular Hook Plate Versus the Double Double-Button Suture Procedure. Am J Sports Med 2018; 46:2725-2734. [PMID: 30106600 DOI: 10.1177/0363546518788355] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The stabilization strategy for acute high-grade acromioclavicular (AC) joint separations with AC-stabilizing clavicular hook plate (cHP) or coracoclavicular (CC)-stabilizing double double-button suture (dDBS) is still under consideration. HYPOTHESIS The CC-stabilizing dDBS is superior to the cHP according to an AC-specific radiologic assessment and score system. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Seventy-three consecutive patients with acute high-grade AC joint separation were prospectively followed in 2 treatment groups (64.4% randomized, 35.6% patient-selected treatment): open reduction and cHP (cHP group) or arthroscopically assisted dDBS (dDBS group) performed within 14 days of injury. Patients were prospectively analyzed by clinical scores (Taft, Constant score [CS], numeric analog scale for pain) and AC-specific radiographs (AC distance, CC distance [CCD], relative CCD [rCCD; 100 / AC distance × CCD]) at points of examination (preoperative and 6, 12, and 24 months). The minimal clinically important differences (MCIDs) were assessed by the anchor-based method. RESULTS Twenty-seven of 35 patients (mean age ± SD: 37.7 ± 9.7 years) after cHP implantation and 29 of 38 patients (34.2 ± 9.7 years) after dDBS implantation were continuously followed until the 24-month follow-up. All patients showed significantly increased scores after surgery as compared with preoperative status (all P < .05). As compared with GI, GII had significantly better outcomes at 24 months (Taft: cHP = 9.4 ± 1.7 vs dDBS = 10.9 ± 1.1, P < .05, MCID = 2.9; CS: cHP = 90.2 ± 7.8 vs dDBS = 95.3 ± 4.4, P < .02, MCID = 16.6) and at 24 months for Rockwood IV/V (Taft: cHP = 9.4 ± 1.7 vs dDBS = 11.1 ± 0.8, P < .0005; CS: cHP = 90.1 ± 7.7 vs dDBS = 95.5 ± 3.1, P < .04). Clinically assessed horizontal instability persisted in 18.52% (GI) and 6.89% (GII; P = .24). The rCCD showed equal loss of reduction at 24 months (GII = 130.7% [control = 111%] vs GI = 141.8% [control = 115%], MCID = 11.1%). CONCLUSION This prospective study showed significantly superior outcomes in all clinical scores between GII and GI. The subanalysis of the high-grade injury type (Rockwood IV/V) revealed that these patients showed significant benefits from the dDBS procedure in the clinical assessments. The cHP procedure resulted in good to excellent clinical outcome data and displayed an alternative procedure for patients needing less restrictive rehabilitation protocols.
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Affiliation(s)
- Thomas Stein
- Department of Sporttraumatology, Knee, and Shoulder Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany.,Department of Sports Science, University of Bielefeld, Bielefeld, Germany
| | - Daniel Müller
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany.,Department of Trauma, Hand, and Reconstructive Surgery, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - Marc Blank
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - Yana Reinig
- Department of Sporttraumatology, Knee, and Shoulder Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany.,Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - Tim Saier
- Department of Reconstructive Joint Surgery, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau am Staffelsee, Germany
| | - Reinhard Hoffmann
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - Frederic Welsch
- Department of Sporttraumatology, Knee, and Shoulder Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - Uwe Schweigkofler
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
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50
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Wylie JD, Johnson JD, DiVenere J, Mazzocca AD. Shoulder Acromioclavicular and Coracoclavicular Ligament Injuries: Common Problems and Solutions. Clin Sports Med 2018. [PMID: 29525023 DOI: 10.1016/j.csm.2017.12.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Injuries to the acromioclavicular joint and coracoclavicular ligaments are common. Many of these injuries heal with nonoperative management. However, more severe injuries may lead to continued pain and shoulder dysfunction. In these patients, surgical techniques have been described to reconstruct the function of the coracoclavicular ligaments to provide stable relationship between the clavicle and scapula. These surgeries have been fraught with high complication rates including clavicle and coracoid fractures, infection, loss of reduction and fixation, hardware migration, and osteolysis. This article reviews common acromioclavicular and coracoclavicular repair and reconstruction techniques and associated complications, and provides recommendations for prevention and management.
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Affiliation(s)
- James D Wylie
- Department of Orthopedic Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Jeremiah D Johnson
- Department of Orthopedic Surgery, University of Connecticut, 263 Farmington Avenue, Farmington, CT 06030, USA
| | - Jessica DiVenere
- Department of Orthopedic Surgery, University of Connecticut, 263 Farmington Avenue, Farmington, CT 06030, USA
| | - Augustus D Mazzocca
- Department of Orthopedic Surgery, University of Connecticut, 263 Farmington Avenue, Farmington, CT 06030, USA.
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