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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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Vetter P, Bellmann F, Eckl L, Lazaridou A, Scheibel M. Clavicular tunnel widening in chronic acromioclavicular joint instabilities after primary versus revision arthroscopically-assisted acromio- and coracoclavicular stabilization. J Exp Orthop 2024; 11:e12114. [PMID: 39291056 PMCID: PMC11405927 DOI: 10.1002/jeo2.12114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 07/02/2024] [Accepted: 07/05/2024] [Indexed: 09/19/2024] Open
Abstract
Purpose To evaluate joint reduction (loss of reduction [LOR]; dynamic posterior translation [DPT]) and clavicular tunnel widening (cTW) in patients treated with arthroscopically-assisted acromioclavicular joint (ACJ) stabilization after previously failed nonoperative versus surgical treatment. Methods Patients undergoing arthroscopically-assisted ACJ stabilization (bidirectional tendon allograft with a low-profile TightRope) after previously failed nonoperative versus surgical treatment were included retrospectively. Bilateral anteroposterior stress views served for evaluating LOR (side-comparative coracoclavicular distance [CCD]) and cTW at a 6-weeks- and 6-months-follow-up (FU) and for evaluating the filling ratio (FR, vertical device insertion depth relative to clavicle height) at the 6-weeks-FU. Postoperative DPT was assessed on Alexander's views. Results Twenty-seven patients (20 male, mean age 46.1 ± 14.8 years) were included (prior treatment: nonoperative: n = 15; surgical: n = 12). There were no differences in LOR, DPT or cTW between groups postoperatively. Initial CCD-symmetry at the 6-weeks-FU (CCD: -0.1 mm [95% confidence interval, CI, -2 to 1.4 mm]) was followed by LOR at the 6-months-FU (CCD: -3.5 mm [95% CI, -5.2 to -1.9 mm]; p < 0.001). cTW increased towards the inferior cortex, compared to the superior cortex and the intermediate level (p < 0.001, respectively). cTW at the inferior cortex was associated with more LOR (r = -0.449; p = 0.024) and DPT (r = 0.421; p = 0.036), dependent on a smaller FR (r = -0.430; p = 0.032). Conclusion Patients undergoing arthroscopically-assisted ACJ stabilization for chronic bidirectional ACJ instabilities showed comparable radiologic results after previous nonoperative versus surgical treatment. cTW increased towards the inferior cortex and was associated with recurrent vertical and horizontal instability, related to a smaller FR. More research into reduced cTW, for example, by a more filling device, should be performed. Level of Evidence Level III, retrospective comparative study.
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Affiliation(s)
- Philipp Vetter
- Department of Traumatology University Hospital Zurich Zurich Switzerland
| | - Frederik Bellmann
- Department of Shoulder and Elbow Surgery Schulthess Clinic Zurich Switzerland
| | - Larissa Eckl
- Department of Shoulder and Elbow Surgery Schulthess Clinic Zurich Switzerland
| | - Asimina Lazaridou
- Department of Shoulder and Elbow Surgery Schulthess Clinic Zurich Switzerland
| | - Markus Scheibel
- Department of Shoulder and Elbow Surgery Schulthess Clinic Zurich Switzerland
- Department of Shoulder and Elbow Surgery, Center for Muskuloskeletal Surgery Charité Universitaetsmedizin Berlin Germany
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Rojas JT, Oyarzún A, Muñoz JT, García de la Pastora D, Canals A, Viacava A, Carreño H, Águila R. Medial placement of trapezoid tunnel leads to higher reduction loss in acute acromioclavicular joint dislocation treated with anatomic coracoclavicular fixation. Shoulder Elbow 2024; 16:265-273. [PMID: 38818098 PMCID: PMC11135191 DOI: 10.1177/17585732231170322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 03/12/2023] [Accepted: 03/19/2023] [Indexed: 06/01/2024]
Abstract
Aim To analyze the association between clavicular tunnel positioning and postoperative reduction loss in patients with acute acromioclavicular (AC) joint dislocation treated with anatomic coracoclavicular (CC) fixation using double clavicular tunnels. Methods A retrospective review of patients with AC joint dislocation, treated with anatomic CC fixation using double clavicular tunnels, was conducted. Patients with pre-operative, immediate post-operative, and final follow-up Zanca-view X-rays were included. On each X-ray, the obtained measures included: distance from lateral border of clavicle to trapezoid and conoid tunnels, distance between tunnels, clavicle length, and CC distance of affected and un-affected sides. Loss of reduction was calculated as CC distance difference between immediate and final post-operative X-rays. Association between reduction loss and tunnel positioning was analyzed. Results Conoid, trapezoid and tunnel ratios were 24% ± 4, 15% ± 3, and 9% ± 2, respectively. Significant reduction loss was seen in 21(45.7%) patients. Significantly higher probabilities of reduction loss were associated with trapezoid tunnels placed medial to 24 mm (30.8% vs 65.0%, OR 4.2 (IC95%: 1.2-14.4), p: 0.024) or 15% of the clavicle length (32.1% vs 66.7%, OR 4.2 (IC 95%: 1.2-14.9), p: 0.025). Conclusions Trapezoid tunnels placed medial to 24 mm or 15% medial to clavicle length could lead to higher probabilities of significant reduction loss. These findings support the importance of clavicular tunnels' proper placement for decreasing significant reduction loss.
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Affiliation(s)
- J Tomás Rojas
- Shoulder and Elbow Team, Clínica Santa María, Santiago, Chile
- Shoulder and Elbow Team, Hospital San José, Santiago, Chile
| | - Andrés Oyarzún
- Resident of Orthopedic Surgery, Universidad de Chile, Santiago, Chile
| | - J Tomás Muñoz
- Resident of Orthopedic Surgery, Universidad de los Andes, Santiago, Chile
| | | | - Andrea Canals
- Academic unit, Clínica Santa María, Santiago, Chile
- School of Public health, Universidad de Chile, Santiago, Chile
| | | | - Hector Carreño
- Shoulder and Elbow Team, Clínica Santa María, Santiago, Chile
| | - Raúl Águila
- Shoulder and Elbow Team, Clínica Santa María, Santiago, Chile
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Bieling M, Ellwein A, Lill H, Sehmisch S, Reeh FM. Proximal humerus fracture and acromioclavicular joint dislocation. Innov Surg Sci 2024; 9:67-82. [PMID: 39100718 PMCID: PMC11294519 DOI: 10.1515/iss-2023-0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 12/12/2023] [Indexed: 08/06/2024] Open
Abstract
Proximal humerus fractures and injuries to the acromioclavicular joint are among the most common traumatic diseases of the upper extremity. Fractures of the proximal humerus occur most frequently in older people and are an indicator fracture of osteoporosis. While a large proportion of only slightly displaced fractures can be treated non-operatively, more complex fractures require surgical treatment. The choice of optimal treatment and the decision between joint-preserving surgery by means of osteosynthesis or endoprosthetic treatment is often a difficult decision in which both fracture morphology factors and individual factors should be taken into account. If endoprosthetic treatment is indicated, satisfactory long-term functional and clinical results have been achieved with a reverse shoulder arthroplasty. Injuries to the acromioclavicular joint occur primarily in young, athletic individuals. The common classification according to Rockwood divides the injury into 6 degrees of severity depending on the dislocation. This classification forms the basis for the decision on non-operative or surgical treatment. The indication for surgical treatment for higher-grade injuries is the subject of controversial debate in the latest literature. In chronic injuries, an autologous tendon transplant is also performed. Whereas in the past, treatment was often carried out using a hook plate, which was associated with complications, the gold standard today is minimally invasive treatment using Endobutton systems. This review provides an overview of the two injury patterns and discusses the various treatment options.
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Affiliation(s)
- Maren Bieling
- Klinik für Orthopädie und Unfallchirurgie, DIAKOVERE Friederikenstift, Hannover, Germany
| | - Alexander Ellwein
- Klinik für Orthopädie und Unfallchirurgie, DIAKOVERE Friederikenstift, Hannover, Germany
- Klinik für Unfallchirurgie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Helmut Lill
- Klinik für Orthopädie und Unfallchirurgie, DIAKOVERE Friederikenstift, Hannover, Germany
| | - Stephan Sehmisch
- Klinik für Unfallchirurgie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Freya Margaretha Reeh
- Klinik für Orthopädie und Unfallchirurgie, DIAKOVERE Friederikenstift, Hannover, Germany
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Van Eecke E, Struelens B, Muermans S. Long-term clinical and radiographic outcomes of arthroscopic acromioclavicular stabilization for acute acromioclavicular joint dislocation. Clin Shoulder Elb 2024; 27:219-228. [PMID: 38738320 PMCID: PMC11181058 DOI: 10.5397/cise.2023.01060] [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: 11/30/2023] [Revised: 01/16/2024] [Accepted: 01/20/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND Standard open acromioclavicular (AC) stabilization is associated with increased postoperative complications including deltoid injury, infection, tunnel complications, loss of reduction, and wound/cosmetic concerns. Arthroscopy may offer superior visualization and advantages that limit these risks. The aim of this prospective non-randomized study is to evaluate advantages and long-term reliability of arthroscopic AC stabilization. METHODS Thirty-two patients with acute grade III, IV and V AC dislocations underwent arthroscopic AC reconstruction with long-term assessment by clinical AC examination, Simple Shoulder Test, American Shoulder and Elbow Surgeons scores, visual analog scale, Specific AC Score and Quick Disabilities of the Arm, Shoulder and Hand scores. Radiographs verified conservation of initial reduction and presence of coracoclavicular (CC) ossifications. Complications, revision rate, and satisfaction were assessed and compared to the literature. RESULTS Mean follow-up time was 67.6 months. All clinical outcome scores improved and differences were statistically significant (P<0.001). Initial postoperative radiographs consistently showed complete reduction. Two patients experienced relapse to grade II AC dislocation without clinical implications. In total, 71.8% showed CC ossifications without functional impairment, and in 31.3% concomitant injuries were observed. Reintervention rate was 9.4%, and 96.9% of patients were satisfied with procedure outcomes. CONCLUSIONS Arthroscopic stabilization for acute AC joint dislocations offers satisfactory clinical and radiographic outcomes, and our results show that the arthroscopic technique is reliable in the long run. We report better reduction in maintenance, fewer complications, and similar reoperation rates compared to other techniques. Level of evidence: III.
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Affiliation(s)
- Eduard Van Eecke
- Department of Orthopedic Surgery, AZ Delta Roeselare, Roeselare, Belgium
| | | | - Stijn Muermans
- Department of Orthopedic Surgery, AZ Delta Roeselare, Roeselare, Belgium
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Yubran AP, Pesquera LC, Juan ELS, Saralegui FI, Canga AC, Camara AC, Valdivieso GM. Presurgical perspective and postsurgical evaluation of acromioclavicular joint instability. Skeletal Radiol 2024; 53:847-861. [PMID: 38008754 DOI: 10.1007/s00256-023-04526-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 11/28/2023]
Abstract
Acromioclavicular joint (ACJ) dislocations are a common cause of pain in patients of any age. Athletes who participate in contact sports, such as hockey, football, rugby, and soccer, are particularly susceptible to such injuries. The ACJ has an important role in the function of the upper limb, and its complexity of movement makes it susceptible to acute injuries and chronic dysfunction with debilitating effects that must be treated appropriately and promptly to preserve function. Recently, ACJ has received increasing attention due to the development of new surgical techniques for the restoration of normal function and stability. There is some agreement about the treatment of ACJ dislocations, but controversy remains about the treatment of Rockwood grade III dislocations, and a new approach to these injuries is suggested by ISAKOS. Overall, the paper summarizes new concepts in the anatomy of the ACJ and reviews the utility of imaging methods in ACJ dislocations as well as their treatment and complications.
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Affiliation(s)
- Alexeys Perez Yubran
- Department of Radiology, IBERORAD, 1893, Carrer Valencia 226, Principal, Primera, 08007, Barcelona, Spain.
| | | | | | | | - Alvaro Cerezal Canga
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitario La Paz, Madrid, Spain
| | - Antonio Cruz Camara
- Department of Arthroscopic Surgery, Hospital Santa Clotilde, Santander, Spain
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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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Ulusoy A, Turgut N, Cilli F, Unal AM. Reconstruction of Coracoclavicular Ligaments with Semitendinosus Autograft and Temporary Kirschner Wires is a good option for Chronic Acromioclavicular Joint Instability. Malays Orthop J 2024; 18:99-105. [PMID: 38638667 PMCID: PMC11023339 DOI: 10.5704/moj.2403.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 08/24/2023] [Indexed: 04/20/2024] Open
Abstract
Introduction This study reports the results of surgical anatomic reconstruction of torn coracoclavicular ligaments with an autogenous semitendinosus graft and temporary Kirschner wires (K-wires) in chronic acromioclavicular (AC) joint dislocations. Materials and methods Nineteen shoulders underwent surgical anatomic reconstruction of torn coracoclavicular (CC) ligaments with an autogenous semitendinosus tendon graft and temporary K-wires for Rockwood grade III, IV and V chronic AC joint dislocations. Pre-operative data included patients' demographic characteristics, injury characteristics and surgical histories. The primary outcome measures were the University of California Los Angeles (UCLA) shoulder rating scale and visual analogue pain scoring (VAS), and the complications were noted for each patient. Results Surgical anatomic reconstruction of torn CC ligaments was performed in 19 patients with a mean age of 41.6±16 years (range 21-72 years). All of the patients were satisfied and felt better after CC ligament reconstruction. The average UCLA shoulder rating scale score was good/excellent: 29.4 (range 23-34) out of 35 points. The average pre-operative VAS score was 7.7 points out of 10 and improved to 1.1 points post-operatively (p<0.05). None of the patients experienced failure during the follow-up. One patient had a mild subluxation, but the patient was satisfied with the result. Conclusions This technique is simple, reliable, and biologic without major complications. It is also a cost-effective procedure since it can be performed with Kirschner wires and autogenous grafts. It has a major advantage of leaving no implants inside the joint, which can lead to hardware complications, and it can be performed in basic operating room settings.
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Affiliation(s)
- A Ulusoy
- Department of Orthopaedics and Traumatology, Acibadem University, Mugla, Turkey
| | - N Turgut
- Department of Orthopaedics and Traumatology, Baskent University, Adana, Turkey
| | - F Cilli
- Department of Orthopaedics and Traumatology, Acibadem University, Mugla, Turkey
| | - A M Unal
- Department of Orthopaedics and Traumatology, Private Meddem Hospital, Isparta, Turkey
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Velasquez Garcia A, Franco Abache A, Ingala Martini L. Clavicular tunnel widening after coracoclavicular stabilization surgery: a systematic review and meta-analysis. J Shoulder Elbow Surg 2024; 33:738-755. [PMID: 37977250 DOI: 10.1016/j.jse.2023.09.037] [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: 05/10/2023] [Revised: 09/10/2023] [Accepted: 09/25/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND This systematic review and meta-analysis aimed to (1) estimate the prevalence of clavicular tunnel widening (TW) after coracoclavicular stabilization surgery and its risk factors and (2) assess whether TW is correlated with clavicle fracture or loss of reduction of the acromioclavicular joint (ACJ). METHODS In January 2023, 3 electronic databases were searched to collect data on postoperative clavicular TW, its prevalence, magnitude, and correlation with fracture and ACJ loss of reduction. Studies were classified according to the time of surgical intervention, and the clavicular tunnels were categorized by their anatomic location. Mean differences were calculated using a DerSimonian-Laird random-effects model, while binomial outcomes were pooled using the Freeman-Tukey double arcsine transformation. Univariate and multivariate meta-regression analyses were performed to determine the effect of several variables on the proportion of cases with TW. RESULTS Fifteen studies (418 shoulders) were included. At the final follow-up, evidence of clavicular TW was found in 70% (95% confidence interval [CI]: 70%-87%; I2 = 89%) of 221 shoulders. Surgeries in acute cases had a lower prevalence of TW (52%) compared to chronic cases (71%) (P < .001). Significant TW was found in the central tunnel (3.2 mm; 95% CI: 1.8-4.6 mm; P < .001; I2 = 72%) for acute injuries and in the medial (1.2 mm; 95% CI: 0.7-1.7 mm; P < .001; I2 = 77%) and lateral (1.5 mm; 95% CI: 0.7-2.3 mm; P < .001; I2 = 77%) tunnels for chronic cases. Single central-tunnel techniques were positively associated with the prevalence of TW (P = .046), while biotenodesis screw fixation was associated with a lower prevalence (P = .004) in chronic cases. Reconstruction of the ACJ ligament complex with tendon grafts or sutures was associated with a higher prevalence of TW (P < .001). Drill sizes between 2.5 and 5 mm were significantly associated with a lower prevalence of TW, regardless of injury chronicity (P = .012). No correlation was found between TW and the loss of ACJ reduction or clavicle fractures. CONCLUSIONS This systematic review and meta-analysis explored TW occurrence following coracoclavicular stabilization surgery. TW was observed in 70% of patients at final follow-up, with a higher prevalence in chronic than in acute cases. Modifiable surgical variables, such as single-tunnel tendon graft constructs for acute or chronic injuries and knotted graft procedures for chronic injuries, were significantly associated with TW. Furthermore, the prevalence of TW increased with concomitant surgical treatment of the ACJ ligament complex, and decreased with drill sizes between 2.5 and 5 mm, regardless of lesion chronicity. These surgical variables should be considered when establishing transosseous tunnels for coracoclavicular stabilization. Clavicle fractures and TW mechanisms require further investigation.
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Affiliation(s)
- Ausberto Velasquez Garcia
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Orthopaedic Surgery, Clínica Universidad de los Andes, Las Condes, Santiago, Chile.
| | - Andres Franco Abache
- Department of Orthopedic Surgery, Hospital de Especialidades Guayaquil MSP, Guayaquil, Ecuador
| | - Liborio Ingala Martini
- Department of Orthopedic Surgery, Hospital IVSS Dr. Luis Ortega, Porlamar, Venezuela; Department of Orthopedic Surgery, Hospital Clinicas del Este, Los Robles, Venezuela
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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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11
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Renaud M, Caubrière M, Lancigu R, Hubert L, Marc C, David G, Rony L. Management of acute grade IV and greater acromioclavicular dislocations: Open acromioclavicular brace versus arthroscopic double DogBone® endobutton. Orthop Traumatol Surg Res 2024; 110:103635. [PMID: 37236392 DOI: 10.1016/j.otsr.2023.103635] [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: 10/17/2022] [Revised: 02/08/2023] [Accepted: 02/21/2023] [Indexed: 05/28/2023]
Abstract
INTRODUCTION Several surgical techniques exist to manage grade IV acute acromioclavicular dislocation (ACD). However, the conventional acromioclavicular brace technique (ACB) has never been compared to the arthroscopic DogBone® (DB) double endobutton technique. The aim of this work was to compare the functional and radiological results of DB stabilization with those of ACB. HYPOTHESIS DB stabilization provides similar functional results with a low rate of radiological recurrences compared to ACB. MATERIAL AND METHODS This is a case-control study comparing 17 cases of ACD operated by DB (DB group) between January 2016 and January 2021 with 31 cases of ACD operated by ACB (ACB group) between January 2008 and January 2016. The primary outcome was the difference in the D/A ratio (reflecting vertical displacement) measured on an anteroposterior acromioclavicular (AC) X-ray compared between the 2 groups at one-year after surgery. The secondary outcome was a clinical evaluation at one-year using the Constant score and clinical AC instability. RESULTS At revision, the mean D/A ratio in the DB and ACB groups was 0.4±0.5 [-0.4-1.6] and 1.6±0.3 [0.8-3.1] respectively (p>0.05). Two patients (11.7%) in the DB group had implant migration with radiological recurrence while 14 patients (33%) had radiological recurrence in the ACB group (p<0.05). CONCLUSION The DB technique limits the radiographic recurrence of acute ACD with an equivalent functional result at 1-year postoperatively compared to the conventional ACB technique, which implicitly requires a second operation for hardware removal. The DB technique has become the technique of choice in first-line treatment of acute grade IV ACD. LEVEL OF EVIDENCE III; retrospective case-control series.
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Affiliation(s)
- Martin Renaud
- Département de chirurgie osseuse, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France
| | - Marin Caubrière
- Département de chirurgie osseuse, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France
| | - Romain Lancigu
- Département de chirurgie osseuse, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France
| | - Laurent Hubert
- Département de chirurgie osseuse, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France
| | - Clément Marc
- Département de chirurgie osseuse, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France
| | - Guillaume David
- Département de chirurgie osseuse, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France
| | - Louis Rony
- Département de chirurgie osseuse, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France.
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Behrens A, Behrendt P, Heintzen MJ, Finn J, Seekamp A, Mader K, Lippross S, Klatte TO. Mid-term clinical and sonographic outcomes of minimally invasive acromioclavicular joint reconstruction: mini-open versus arthroscopically assisted. Arch Orthop Trauma Surg 2024; 144:807-814. [PMID: 37940713 PMCID: PMC10822806 DOI: 10.1007/s00402-023-05110-7] [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: 11/13/2022] [Accepted: 10/12/2023] [Indexed: 11/10/2023]
Abstract
INTRODUCTION The current literature describes various operative stabilization strategies which achieve good clinical outcomes after acute acromioclavicular joint (ACJ) dislocation. The aim of this study was to compare the mid-term clinical and sonographic treatment outcomes after minimally invasive mini-open and arthroscopic reconstruction. MATERIALS AND METHODS We conducted a retrospective two-center study of patients with acute ACJ dislocation. Surgical treatment was performed using either a mini-open approach (MIOP) or an arthroscopic technique (AR). The primary outcome parameters of this study were the sonographically measured acromioclavicular (ACD) and coracoclavicular distances (CCD). Secondary outcome parameters included the Constant-Murley score (CS), range of motion (ROM), postoperative pain scale (VAS), return to daily routine, return to sports, complications, as well as operative revisions. RESULTS After a mean follow-up of 29 months, 30 patients were included in this study with an average age of 41.3 ± 14.8 years (MIOP) and 41.2 ± 15.4 years (AR). The sonographic ACD (MIOP 9.11 mm vs. AR 8.93 mm, p = 0.41) and CCD (MIOP 25.08 mm vs. AR 24.36 mm, p = 0.29) distances showed no statistically significant differences. Furthermore, there was no statistically significant difference when compared to the contralateral side (p = 0.42). With both techniques, patients achieved excellent clinical outcome parameters without statistically significant differences in CS (MIOP 95 vs. AR 97, p = 0.11) and VAS (MIOP 1.76 vs. AR 1.14, p = 0.18). The return to daily activity and return to sport rates did not differ. There were neither complications nor revisions in both groups. CONCLUSION Both minimally invasive techniques for acute ACJ stabilization achieved excellent clinical and sonographic outcomes without one technique being statistically superior to the other.
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Affiliation(s)
- A Behrens
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany.
| | - P Behrendt
- Asklepios Hospital St. Georg, Hamburg, Germany
- Department of Anatomy, Kiel University, Kiel, Germany
- Department of Trauma and Orthopedic Surgery, University Medical Center Schleswig-Holstein (UKSH), Kiel, Germany
| | - M J Heintzen
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany
| | - J Finn
- Orthopraxis Kiel, Kiel, Germany
- Department of Trauma and Orthopedic Surgery, University Medical Center Schleswig-Holstein (UKSH), Kiel, Germany
| | - A Seekamp
- Department of Trauma and Orthopedic Surgery, University Medical Center Schleswig-Holstein (UKSH), Kiel, Germany
| | - K Mader
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany
| | - S Lippross
- Department of Trauma and Orthopedic Surgery, University Medical Center Schleswig-Holstein (UKSH), Kiel, Germany
| | - T O Klatte
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany
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Eckl L, Vetter P, Bellmann F, Imiolczyk JP, Moroder P, Scheibel M. Management of Acute High-Grade Acromioclavicular Joint Dislocations: Comparable Clinical and Radiological Outcomes After Bidirectional Arthroscopic-Assisted Stabilization With the Single Low-Profile Suture Button Technique Versus Double-Suture Button Technique. Arthroscopy 2023; 39:2283-2290. [PMID: 37230186 DOI: 10.1016/j.arthro.2023.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 05/08/2023] [Accepted: 05/11/2023] [Indexed: 05/27/2023]
Abstract
PURPOSE To compare the 2-year clinical and radiological outcomes of an arthroscopic-assisted bidirectional stabilization procedure using a single low-profile (LPSB) or double-suture button (DSB) technique with additional percutaneous acromioclavicular (AC) cerclage fixation for patients with acute high-grade AC joint dislocation. METHODS This retrospective cohort study compared male patients aged between 18 and 56 years with acute high-grade AC joint dislocation fixed with either a LPSB or DSB technique. Patients were examined at least 24 months after surgery. Subjective Shoulder Value (SSV), Taft (TF), and Acromioclavicular Joint Instability (ACJI) scores were evaluated. Coracoclavicular difference, ossification, AC joint osteoarthritis, and dynamic posterior translation (DPT) were assessed on bilateral anteroposterior stress radiographs and modified Alexander views. The revision rate due to implant conflict and duration of surgery were reported. Group outcome differences were analyzed using standardized hypothesis tests. RESULTS 28 patients aged 39.2 (LPSB) and 36.4 years (DSB) (P = .319; CI: -2.77-8.34) were eligible per cohort. The follow-up was 30.5 (LPSB) and 37.4 months (DSB) (P = .02; CI: -12.73-1.08). LPSB patients rated a significantly higher SSV (93.2% vs 81.9% [DSB]; P = .004). TF and ACJI scores were similar between the groups. Coracoclavicular difference markedly decreased from 12 mm to 3 mm for both cohorts (P < .001). Ossification was identified in over 85% in both cohorts (P = .160; CI -0.77-0.13) and osteoarthritis in 21.4% (LPSB) and 39.3% (DSB) (P = .150). Persistent DPT was found in around 30% for both cohorts (P = .561; CI -0.26-0.48). The revision rates were 0% (LPSB) and 7% (DSB) (P = .491). LPSB surgery was shorter (59.7 vs 71.5 mins [DSB]) (P = .011). CONCLUSIONS The results of the LPSB and DSB techniques with additional percutaneous AC cerclage fixation showed comparable outcomes with excellent clinical and satisfactory radiological results. The assessment of the subjective patient satisfaction was in favor of the LPSB technique and no postoperative revision event was observed following this procedure. LEVEL OF EVIDENCE Level III, retrospective comparative therapeutic trial.
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Affiliation(s)
- Larissa Eckl
- Shoulder and Elbow Surgery, Schulthess Clinic, Zurich, Switzerland
| | - Philipp Vetter
- Department of Trauma Surgery, University Hospital, Zurich, Switzerland
| | | | - Jan-Philipp Imiolczyk
- Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin, Berlin, Germany
| | - Philipp Moroder
- Shoulder and Elbow Surgery, Schulthess Clinic, Zurich, Switzerland
| | - Markus Scheibel
- Shoulder and Elbow Surgery, Schulthess Clinic, Zurich, Switzerland; Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin, Berlin, Germany.
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14
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Bellmann F, Eckl L, Vetter P, Audigé L, Scheibel M. Clavicular Tunnel Widening After Acromioclavicular Stabilization Shows Implant-Dependent Correlation With Postoperative Loss of Reduction. Arthroscopy 2023; 39:2273-2280. [PMID: 37230185 DOI: 10.1016/j.arthro.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/28/2023] [Accepted: 05/10/2023] [Indexed: 05/27/2023]
Abstract
PURPOSE To radiographically describe, quantify, and compare clavicular tunnel widening (cTW) of 2 different types of stabilization devices and investigate a possible correlation between cTW and loss of reduction. METHODS In a retrospective analysis of single-center registry data, we compared patients who were treated for an acute AC dislocation (Rockwood types III to V) with either the AC Dog Bone (DB) or low-profile AC (LP) repair systems. On 6-week and 6-month postoperative radiographs, we measured clavicle height and tunnel diameter. We calculated the button/clavicle filling (B/C) ratio to quantify how much of the clavicular tunnel height is covered by the low-profile inlet. The association between B/C ratio and the extent of cTW was defined, and we also compared cTW between treatment groups. Reduction of the AC joint was graded as either stable, partially dislocated or dislocated depending on the AC ratio. A 2-sample t-test was used for comparing cTW progression between the 2 groups. For continuous variables between more than 2 groups, the Kruskal-Wallis test was used. RESULTS Of 65 eligible patients, there were 37 and 28 included in the DB and LP groups, respectively. Overall, cTW was conically shaped with transclavicular widening noted in the DB group and cTW developing strictly inferior to the button in the LP group. For both implants, mean maximal cTW was 7.1 mm and located at the inferior cortex; the B/C ratio was not associated with increased inferior cTW (r = -0.23, P = .248). Only LP patients with complete loss of reduction had significantly increased cTW (P = .049). CONCLUSIONS Conical-shaped cTW is a common implant-independent phenomenon after AC stabilization using suture-button devices. It occurs only at the suture-bone interface and is less excessive for the LP implant. There is an association between increased cTW and loss of reduction specific to the LP implant only. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Frederik Bellmann
- Department of Shoulder and Elbow Surgery, Schulthess Clinic, Zurich, Switzerland
| | - Larissa Eckl
- Department of Shoulder and Elbow Surgery, Schulthess Clinic, Zurich, Switzerland
| | - Philipp Vetter
- Department of Trauma Surgery, University Hospital, Zurich, Switzerland
| | - Laurent Audigé
- Department of Shoulder and Elbow Surgery, Schulthess Clinic, Zurich, Switzerland
| | - Markus Scheibel
- Department of Shoulder and Elbow Surgery, Schulthess Clinic, Zurich, Switzerland; Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin, Berlin, Germany.
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15
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Sachinis NP, Beitzel K. Risk for Fracture with Acromioclavicular Joint Reconstruction and Strategies for Mitigation. Clin Sports Med 2023; 42:613-619. [PMID: 37716725 DOI: 10.1016/j.csm.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
Acromioclavicular (AC) joint injuries are a common cause of shoulder pain, especially among athletes. Surgical reconstruction of the AC joint can lead to complications such as fracture of the coracoid process, clavicle or acromion, which can negatively affect the patient's outcome. The purpose of this review is to discuss the risk factors for fractures associated with AC joint reconstruction, as well as the strategies that can be used to mitigate this risk. Risk factors for fractures include low mineral density, coracoid/clavicle drilling, larger holes in the coracoid, and the number of tunnels used for reconstruction.
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Affiliation(s)
- Nikolaos Platon Sachinis
- First Orthopaedic Department of Aristotle University of Thessaloniki, "Georgios Papanikolaou" Hospital, Exohi, 57010, Thessaloniki, Greece.
| | - Knut Beitzel
- Orthoparc Klinik, Aachener Street, 1021B, 50858, Cologne, Germany
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Peebles LA, Akamefula RA, Kraeutler MJ, Mulcahey MK. Management of Acromioclavicular Joint Injuries: A Historic Account. Clin Sports Med 2023; 42:539-556. [PMID: 37716720 DOI: 10.1016/j.csm.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
There has been a rapid evolution in best practice management of acromioclavicular (AC) joint injuries. AP, Zanca, scapular Y, and dynamic axillary radiographic views provide optimal visualization of the joint and may assess for the presence of horizontal AC instability. Severity of AC joint pathology is classified according to the 6-tier Rockwood scoring system. Over 160 surgical techniques have been described for AC joint repair and reconstruction in the last decade; as a result, determining the optimal treatment algorithm has become increasingly challenging secondary to the lack of consistently excellent clinical outcomes.
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Affiliation(s)
- Liam A Peebles
- Tulane University School of Medicine, 1430 Tulane Avenue, #2070, New Orleans, LA, USA
| | - Ramesses A Akamefula
- Tulane University School of Medicine, 1430 Tulane Avenue, #2070, New Orleans, LA, USA
| | - Matthew J Kraeutler
- Department of Orthopedics & Sports Medicine, Houston Methodist Hospital, 6445 Main Street, #2300, Houston, TX, USA
| | - Mary K Mulcahey
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL, USA.
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17
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Sheth MM, Shybut TB. Operative Management for Displaced Distal Clavicle Fractures. Clin Sports Med 2023; 42:695-711. [PMID: 37716732 DOI: 10.1016/j.csm.2023.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
This article reviews techniques and outcomes of surgical fixation for distal clavicle fractures. Near 100% union has been reported for several techniques. The most common are locked plating, coracoclavicular fixation and a combination of plating with CC fixation. Hook plates are useful for particular fracture patterns, but there can be complications specific to this implant. Low-profile constructs are favored due to the high rates of symptomatic hardware. Fixation of subacute and chronic injuries can provide reliable functional improvements, but is inferior to acute fixation. Surgery is generally the treatment of choice for displaced fractures in athletes.
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Affiliation(s)
- Mihir M Sheth
- Baylor College of Medicine, 7200 Cambridge Street, Suite 10A, Houston, TX 77030, USA
| | - Theodore B Shybut
- Southern California Orthopedic Institute, 6815 Noble Avenue, Van Nuys, CA 91405, USA.
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18
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Yan Y, Liao M, Lai H, Xu Z, Chen H, Huang W, Yu H, Zhang Y. Comparison of Effectiveness and Safety in Treating Acute Acromioclavicular Joint Dislocation with Five Different Surgical Procedures: A Systematic Review and Network Meta-Analysis. Orthop Surg 2023; 15:1944-1958. [PMID: 37105917 PMCID: PMC10432441 DOI: 10.1111/os.13731] [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: 09/04/2022] [Revised: 03/15/2023] [Accepted: 03/16/2023] [Indexed: 04/29/2023] Open
Abstract
This network meta-analysis aims to evaluate the comparative effectiveness and safety of suture anchors (SA), tendon grafts (TG), hook plates (HP), Tight-Rope (TR), and EndoButton (EB) in the treatment of acute acromioclavicular joint (ACJ) dislocation. The Embase, PubMed, and Web of Science databases were searched from their inception date to June 3, 2022. Studies included all eligible randomized controlled trials (RCTs) and cohort studies with the comparison of five different fixation systems among SA, TG, HP, TR, and EB were identified. All studies were reviewed, performed data extraction, and assessed the risk of bias independently by two reviewers. The primary outcomes are Constant-Murley score (CMS) improvement for assessing clinical efficacy, and complications. The second outcomes are visual analog scale (VAS) for assessing pain relief and the coracoclavicular distance (CCD) for assessing postoperative joint reduction. Version 2 of the revised Cochrane risk of bias tool for randomized trials (RoB 2) and the risk of bias in nonrandomized studies of interventions (ROBINS-I) were used to assess the RCTs and non-randomized trials, respectively. The continuous outcomes were presented as mean differences (MD), and risk ratios (OR) were used for dichotomous outcomes, both with 95% confidence intervals (CI). Surface under the cumulative ranking curves (SUCRA) results were calculated to offer a ranking of each intervention. We identified 31 eligible trials, including 1687 patients in total. HP showed less CMS improvement than TR and EB in both the Network Meta-analysis (NMA) and pairwise meta-analysis. HP also showed less CMS improvement than SA in NMA. For pain relief, HP performed worse than TR both in pairwise meta-analysis and NMA. No significant differences were found for the measured value of CCD. Both TR and EB showed a lower incidence of complications than HP in pairwise meta-analysis. The rank of SUCRA for CMS improvement was as follows: SA, TR, EB, TG, and HP; for pain relief: TR, EB, TG, SA, and HP; for CCD: HP, TR, SA, EB, and TG. For complications, HP showed the highest rank, followed by TG, EB, TR, and SA. SA shows better clinical effectiveness and reliable safety in the treatment of acute ACJ dislocation. Although HP is the most widely used surgical option currently, it should be carefully taken into consideration for its high incidence of complications.
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Affiliation(s)
- Yuan Yan
- Guangdong Cardiovascular InstituteGuangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical UniversityGuangzhouChina
- Department of Orthopaedics, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences)Southern Medical UniversityGuangzhouChina
| | - Mingxin Liao
- Nanping First Hospital Affiliated to Fujian Medical UniversityNanpingChina
| | - Huahao Lai
- Department of Orthopaedics, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences)Southern Medical UniversityGuangzhouChina
| | - Ziyang Xu
- Department of Orthopaedics, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences)Southern Medical UniversityGuangzhouChina
| | - Haobin Chen
- Department of Orthopaedics, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences)Southern Medical UniversityGuangzhouChina
| | - Wenhan Huang
- Department of Orthopaedics, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences)Southern Medical UniversityGuangzhouChina
| | - Hui Yu
- Department of OrthopaedicsThe Third Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
| | - Yu Zhang
- Guangdong Cardiovascular InstituteGuangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical UniversityGuangzhouChina
- Department of Orthopaedics, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences)Southern Medical UniversityGuangzhouChina
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19
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Vogt W, Borchert GH, Ahmed N, Brune JC. Anatomical acromioclavicular joint stabilization with chemically sterilized tendon allografts: A retrospective study. Shoulder Elbow 2023; 15:411-423. [PMID: 37538518 PMCID: PMC10395406 DOI: 10.1177/17585732221136863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 08/16/2022] [Accepted: 10/14/2022] [Indexed: 08/05/2023]
Abstract
Background The purpose of this retrospective study was to analyze whether chemically sterilized tendon allografts perform as well as other non-sterilized allografts and autografts as described in the literature for anatomical acromioclavicular joint stabilization for the treatment of Rockwood III-V. Allografts are still described as a factor for higher re-rupture rates. Methods Retrospective data were collected from 21 acromioclavicular joint stabilizations performed by a single surgeon and performed between 2011 and 2014 using sterilized semitendinosus allografts. The primary endpoints were re-rupture and complication rates. Secondary endpoints were AC-joint stability, pain level, return to work and sport and the range of motion. Results No re-ruptures occurred during the mean follow-up time of 33 months. Zero complications occurred directly after surgery, but three complications later than three weeks after surgery. All cases resolved without further surgery. After surgery, stability significantly improved for all patients. Post-surgery, 19 patients had stable acromioclavicular joints and only two patients showed minor instabilities. Range of motion returned to the range of the healthy shoulders for all patients. Conclusion Chemically sterilized semitendinosus allograft use for anatomic AC-joint stabilization is equivalent to the use of other allografts or autografts and required no hardware removal. No donor age or graft size dependence was observed, due to zero re-ruptures.
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Affiliation(s)
- Wolfgang Vogt
- VOGT-ORTHO Consulting & Development, Gramisch-Partenkirchen Germany
| | - Gudrun H Borchert
- German Institute for Cell and Tissue Replacement (DIZG, gemeinnützige GmbH), Berlin, Germany
| | - Norus Ahmed
- German Institute for Cell and Tissue Replacement (DIZG, gemeinnützige GmbH), Berlin, Germany
| | - Jan C Brune
- German Institute for Cell and Tissue Replacement (DIZG, gemeinnützige GmbH), Berlin, Germany
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20
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Duffett RW, Duralde XA, Marcus RE. CORR Synthesis: What Is the Most Effective Treatment for Rockwood Type III Acromioclavicular Joint Dislocations? Clin Orthop Relat Res 2023; 481:1008-1013. [PMID: 36728233 PMCID: PMC10097529 DOI: 10.1097/corr.0000000000002545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 12/08/2022] [Indexed: 02/03/2023]
Affiliation(s)
- Ross W. Duffett
- Department of Orthopaedic Surgery, Case Western University, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | | | - Randall E. Marcus
- Department of Orthopaedic Surgery, Case Western University, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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21
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Geyer S, Achtnich AE, Voss A, Berthold DP, Lutz PM, Imhoff AB, Martetschläger F. Iatrogenic instability of the acromioclavicular joint leads to ongoing impairment of shoulder function even following secondary surgical stabilization. Arch Orthop Trauma Surg 2023; 143:1877-1886. [PMID: 35220484 PMCID: PMC10030407 DOI: 10.1007/s00402-022-04387-4] [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: 04/07/2021] [Accepted: 02/05/2022] [Indexed: 02/09/2023]
Abstract
PURPOSE Iatrogenic instability of the acromioclavicular joint (ACJ) following distal clavicle excision (DCE) represents an infrequent pathology. Revision surgery to restore ACJ stability and alleviate concomitant pain is challenging due to altered anatomic relationships. The purpose of this study was to evaluate the used salvage techniques and postoperative functional and radiological outcomes in retrospectively identify patients with a painful ACJ following DCE. We hypothesized that iatrogenic instability leads to ongoing impairment of shoulder function despite secondary surgical stabilization. METHODS 9 patients with a painful ACJ after DCE (6 men, 3 women, 43.3 ± 9.4 years) were followed up at a minimum of 36 months after revision surgery. Besides range of motion (ROM), strength and function were evaluated with validated evaluation tools including the Constant score and the DASH score (Disability of the Arm, Shoulder and Hand questionnaire), specific AC Score (SACS), Nottingham Clavicle Score (NCS), Taft score and Acromioclavicular Joint Instability Score (AJI). Additionally, postoperative X-rays were compared to the unaffected side, measuring the coracoclavicular (CC) and acromioclavicular (AC) distance. RESULTS At follow-up survey (55.8 ± 18.8 months) all patients but one demonstrated clinical ACJ stability after arthroscopically assisted anatomical ACJ reconstruction with an autologous hamstring graft. Reconstruction techniques were dependent on the direction of instability. The functional results demonstrated moderate shoulder and ACJ scores with a Constant Score of 77.3 ± 15.4, DASH-score of 51.2 ± 23.4, SACS 32.6 ± 23.8, NCS 77.8 ± 14.2, AJI 75 ± 14.7 points and Taft Score 7.6 ± 3.4 points. All patients stated they would undergo the revision surgery again. Mean postoperative CC-distance (8.3 ± 2.8 mm) did not differ significantly from the contralateral side (8.5 ± 1.6 mm) (p > 0,05). However, the mean AC distance was significantly greater with 16.5 ± 5.8 mm compared to the contralateral side (3.5 ± 1.9 mm) (p = 0.012). CONCLUSION Symptomatic iatrogenic ACJ instability following DCE is rare. Arthroscopically assisted revision surgery with an autologous hamstring graft improved ACJ stability in eight out of nine cases (88.9%). However, the functional scores showed ongoing impairment of shoulder function and a relatively high overall complication rate (33.3%). Therefore, this study underlines the importance of precise preoperative indication and planning and, especially, the preservation of ACJ stability when performing AC joint resection procedures. LEVEL OF EVIDENCE Case series, LEVEL IV.
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Affiliation(s)
- Stephanie Geyer
- Department for Orthopaedic Sports Medicine, Technical University Munich, Klinikum Rechts Der Isar, Munich, Germany
| | - Andrea E Achtnich
- Department for Orthopaedic Sports Medicine, Technical University Munich, Klinikum Rechts Der Isar, Munich, Germany
| | - Andreas Voss
- Department of Trauma Surgery, University Medical Center, Regensburg, Germany
- Sporthopaedicum, Regensburg, Germany
| | - Daniel P Berthold
- Department for Orthopaedic Sports Medicine, Technical University Munich, Klinikum Rechts Der Isar, Munich, Germany
| | - Patricia M Lutz
- Department for Orthopaedic Sports Medicine, Technical University Munich, Klinikum Rechts Der Isar, Munich, Germany
| | - Andreas B Imhoff
- Department for Orthopaedic Sports Medicine, Technical University Munich, Klinikum Rechts Der Isar, Munich, Germany
| | - Frank Martetschläger
- Department for Orthopaedic Sports Medicine, Technical University Munich, Klinikum Rechts Der Isar, Munich, Germany.
- Deutsches Schulterzentrum, ATOS Klinik München, Effnerstr. 38, 81925, Munich, Germany.
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22
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Hohmann E, Oduoye S, Myburgh J, van Zyl R, Keough N. Transcoracoid Drilling for Coracoclavicular Ligament Reconstructions in Patients With Acromioclavicular Joint Dislocations Result in Eccentric Tunnels. Arthrosc Sports Med Rehabil 2023; 5:e489-e494. [PMID: 37101879 PMCID: PMC10123499 DOI: 10.1016/j.asmr.2023.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/31/2023] [Indexed: 03/19/2023] Open
Abstract
Purpose To determine the location of coracoid inferior tunnel exit with superior-based tunnel drilling and coracoid superior tunnel exit with inferior-based tunnel drilling. Methods Fifty-two cadaveric embalmed shoulders (mean age 79 years, range 58-96 years) were used. A transcoracoid tunnel was drilled at the center of the base. Twenty-six shoulders were used for the superior-to-inferior tunnel drilling approach and 26 shoulders for the inferior-to-superior tunnel drilling approach. The distances to the margins of the coracoid process, from both the entry and exit points of the tunnel, were measured. Paired Student t-tests were used to compare the distance from the center of the tunnel and the medial and lateral coracoid border and the apex. Results The mean difference for the distances between superior entry and inferior exit from the apex was 3.65 ± 3.51 mm (P = .002); 1.57 ± 2.27 mm for the lateral border (P = .40) and 5.53 ± 3.45 mm for the medial border (P = .001). The mean difference for the distances between inferior entry and superior exit from the apex was 16.95 ± 3.11 mm (P = .0001); 6.51 ± 3.2 mm for the lateral border (P = .40) and 1.03 ± 2.32 mm for the medial border (P = .045). Inferior-to-superior drilling resulted in 4 (15%) cortical breaks. Conclusions Both superior-to-inferior and inferior-to-superior tunnel drilling directed the tunnel from a more anterior and medial entry to a posterior-lateral exit. Superior-to-inferior drilling resulted in a more posteriorly angled tunnel. When using a 5-mm reamer and inferior-to-superior tunnel drilling, cortical breaks were observed at the inferior and medial margin of the tunnel exit. Clinical Relevance Arthroscopic-assisted acromioclavicular joint reconstruction using conventional jigs may result in an eccentric coracoid tunnel, possibly introducing stress risers and fractures. To avoid cortical breaks and eccentric tunnel placement, open drilling from superior-to-inferior with a superiorly centered guide pin and arthroscopic visualization of a centered inferior exit should be considered.
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Kelley N, Tuttle M, Sylvia SM, Dragoo JL, Khodaee M. Acromioclavicular Joint Injuries in Sport. Curr Sports Med Rep 2023; 22:91-99. [PMID: 36866952 DOI: 10.1249/jsr.0000000000001046] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
ABSTRACT Sport-related shoulder injuries, including disruptions to the acromioclavicular joint (ACJ), are common. An ACJ injury is classified by the degree and direction of the clavicle displacement. Although the diagnosis can be made clinically, standard radiographic views are important to determine the severity of the ACJ disruption and assess for concurrent injuries. The majority of ACJ injuries can be managed nonoperatively; however, surgical treatment is indicated in some cases. Long-term outcomes are generally favorable for most ACJ injuries, and athletes generally return to sport without functional limitations. This article provides an in-depth discussion regarding all aspects of ACJ injuries, including clinically relevant anatomy, biomechanics, evaluation, treatment, and complications.
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Affiliation(s)
- Naomi Kelley
- University of Colorado School of Medicine, Aurora, CO
| | - Matthew Tuttle
- Head of Soccer Medicine and Performance, New York Red Bulls, Harrison, NJ
| | - Stephen M Sylvia
- University of Colorado School of Medicine, Department of Orthopedics, Division of Sports Medicine, Englewood, CO
| | - Jason L Dragoo
- University of Colorado School of Medicine, Department of Orthopedics, Division of Sports Medicine, Englewood, CO
| | - Morteza Khodaee
- University of Colorado School of Medicine, Department of Family Medicine and Orthopedics, Division of Sports Medicine, Denver, CO
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Gao R, Zhang W, Yang Y, Zhang Y, Hu Y, Wu H, Liu M, Fei W, Wang J. Evaluation of the coracoid bone tunnel placement on Dog Bone™ button fixation for acromioclavicular joint dislocation: a cadaver study combined with finite element analysis. BMC Musculoskelet Disord 2023; 24:18. [PMID: 36624428 PMCID: PMC9827623 DOI: 10.1186/s12891-022-06119-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 12/26/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Dog Bone™ button fixation is frequently used to treat acromioclavicular joint (ACJ) dislocation. However, various studies have reported complications after fixation. OBJECTIVE To investigate the effect of the coracoid bone tunnel location on the treatment of ACJ dislocation through single-tunnel coracoclavicular (CC) ligament fixation with the Dog Bone™ button. METHODS Six cadaveric shoulders were used. Each specimen was subjected to five testing conditions in the following order: (1) normal ACJ (Gn); (2) acromioclavicular and CC ligaments were removed (G0); (3) CC ligament reconstruction was performed using the Dog Bone™ technique, and the coracoid bone tunnel was at the center of the coracoid base (G1); (4) reconstruction was performed at 5 mm distal from the G1 site, along the axis of the coracoid (G2); (5) reconstruction was performed at 10 mm distal from the G1 site, along the axis of the coracoid (G3). The angles of pronation and supination of the clavicle under the same load (30 N) were measured. Next, a finite element (FE) model was created using computed tomography (CT) images of the normal shoulder. Model 1 (M1), model 2 (M2), and model 3 (M3) correspond to G1, G2, and G3, respectively. A force of 70 N was applied as a vertical upward load to the distal clavicle. Subsequently, the von Mises stress, the strain LE along the FiberWire, and the displacement nephogram of the three models were obtained. RESULTS After single-tunnel CC ligament fixation using the Dog Bone™ technique, the clavicle in the G2 group (20.50 (19.50, 21.25) °, 20.00 (18.75, 21.25) °) had the best rotational stability. The peak von Mises stress, the strain LE along the FiberWire, and the maximum displacement were smaller in M2 than in M1 and M3. CONCLUSIONS When the coracoid bone tunnel was located 5 mm anterior to the center of the coracoid base (along the axis of the coracoid), the clavicle showed greater rotational stability.
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Affiliation(s)
- Rangshan Gao
- grid.411971.b0000 0000 9558 1426Dalian Medical University, Dalian, 116044 People’s Republic of China ,grid.268415.cSports Medicine Department, Northern Jiangsu People’s Hospital, Clinical Medical College, Yangzhou University, Yangzhou, 225001 People’s Republic of China
| | - Wendong Zhang
- grid.268415.cSports Medicine Department, Northern Jiangsu People’s Hospital, Clinical Medical College, Yangzhou University, Yangzhou, 225001 People’s Republic of China
| | - Yuxia Yang
- grid.411971.b0000 0000 9558 1426Dalian Medical University, Dalian, 116044 People’s Republic of China ,grid.268415.cSports Medicine Department, Northern Jiangsu People’s Hospital, Clinical Medical College, Yangzhou University, Yangzhou, 225001 People’s Republic of China
| | - Yucheng Zhang
- grid.411971.b0000 0000 9558 1426Dalian Medical University, Dalian, 116044 People’s Republic of China ,grid.268415.cSports Medicine Department, Northern Jiangsu People’s Hospital, Clinical Medical College, Yangzhou University, Yangzhou, 225001 People’s Republic of China
| | - Yangyang Hu
- grid.268415.cSports Medicine Department, Northern Jiangsu People’s Hospital, Clinical Medical College, Yangzhou University, Yangzhou, 225001 People’s Republic of China
| | - Honghai Wu
- grid.268415.cSports Medicine Department, Northern Jiangsu People’s Hospital, Clinical Medical College, Yangzhou University, Yangzhou, 225001 People’s Republic of China
| | - Mingsheng Liu
- grid.411971.b0000 0000 9558 1426Dalian Medical University, Dalian, 116044 People’s Republic of China ,grid.268415.cSports Medicine Department, Northern Jiangsu People’s Hospital, Clinical Medical College, Yangzhou University, Yangzhou, 225001 People’s Republic of China
| | - Wenyong Fei
- grid.268415.cSports Medicine Department, Northern Jiangsu People’s Hospital, Clinical Medical College, Yangzhou University, Yangzhou, 225001 People’s Republic of China
| | - Jingcheng Wang
- grid.268415.cSports Medicine Department, Northern Jiangsu People’s Hospital, Clinical Medical College, Yangzhou University, Yangzhou, 225001 People’s Republic of China
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Dey Hazra RO, El Bajjati H, Hanhoff M, Warnhoff M, Ellwein A, Fossum BW, Lill H, Jensen G. Implant-dependent behavior of tunnel widening and clavicular button migration after arthroscopic-assisted treatment of acromioclavicular joint instabilities. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023:10.1007/s00590-022-03466-x. [PMID: 36596884 DOI: 10.1007/s00590-022-03466-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 12/20/2022] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Despite ongoing discussions for the previous few decades, there is still no consensus regarding the optimal surgical technique for acromioclavicular joint instabilities. The purpose of this study was to determine the impact of various implant materials following arthroscopically assisted stabilization of acromioclavicular joint instabilities on tunnel widening and implant migration. We hypothesized an implant-dependent behavior for tunnel widening and implant migration with differences when comparing acute and chronic acromioclavicular joint instabilities. METHODS This study compared 105 patients with acromioclavicular joint instabilities that were managed operatively with coracoclavicular double button constructs. Two of the groups containing acute cases were treated with either a double button construct with a wire (TR) or a tape (D) as a central pillar. The two groups with chronic cases were either treated with a wire (T+) or tape D+ as a central pillar and additional hamstring tendon augmentation (+). One central transclavicular-transcoracoidal drill channel was made in the acute cases, while additional medial and lateral drill channels to augment the central pillar with the hamstring tendon were made. The central drill channel in all cases and the medial/lateral drill channels in chronic cases were subsequently radiologically analyzed immediately postoperatively and at follow-up. Following this, additional radiological analysis of the implant migration of the clavicular button took place. RESULTS All groups showed significant tunnel widening of the central drill channel at follow-up (p ≤ 0.001). The TR+ technique demonstrated significant widening in both the medial (p ≤ 0.001) and lateral (p ≤ 0.001) drill channels. The D and D+ group displayed significant higher rates of clavicular button migration to a cortical and intraosseous level (p ≤ 0.002). CONCLUSION Tunnel widening and implant migration following arthroscopically assisted management of acromioclavicular joint instabilities are dependent on the chosen implant. The stable tape showed a significantly increased degree of tunnel widening with respect to the central drill channel in comparison with the wire. In contrast, a higher degree of load capacity of the tape ultimately favors a protected intraosseous graft healing for chronic cases, which leads to less tunnel widening of the medial and lateral drill channel. Finally, the D/D+ implant groups showed higher rates of implant migration due to lower contact surface area of the implant at the upper clavicular cortex. LEVEL OF EVIDENCE IV
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Affiliation(s)
- Rony-Orijit Dey Hazra
- Department of Orthopedic and Trauma Surgery, Diakovere Friederikenstift, Humboldtstr. 5, 30169, Hannover, Germany.
| | - Hassan El Bajjati
- Department of Orthopedic and Trauma Surgery, Diakovere Friederikenstift, Humboldtstr. 5, 30169, Hannover, Germany
| | - Marek Hanhoff
- Department of Orthopedic and Trauma Surgery, Diakovere Friederikenstift, Humboldtstr. 5, 30169, Hannover, Germany
| | - Mara Warnhoff
- Department of Orthopedic and Trauma Surgery, Diakovere Friederikenstift, Humboldtstr. 5, 30169, Hannover, Germany
| | - Alexander Ellwein
- Department of Orthopedic and Trauma Surgery, Diakovere Friederikenstift, Humboldtstr. 5, 30169, Hannover, Germany
| | | | - Helmut Lill
- Department of Orthopedic and Trauma Surgery, Diakovere Friederikenstift, Humboldtstr. 5, 30169, Hannover, Germany
| | - Gunnar Jensen
- Department of Orthopedic and Trauma Surgery, Diakovere Friederikenstift, Humboldtstr. 5, 30169, Hannover, Germany.,Department for Orthopaedic Surgery, Medical School Hannover, DIAKOVERE Annastift, Anna-von-Borries-Straße 1-7, Hannover, 30625, Germany
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26
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Berthold DP, Muench LN, Dyrna F, Mazzocca AD, Garvin P, Voss A, Scheiderer B, Siebenlist S, Imhoff AB, Beitzel K. Current concepts in acromioclavicular joint (AC) instability - a proposed treatment algorithm for acute and chronic AC-joint surgery. BMC Musculoskelet Disord 2022; 23:1078. [PMID: 36494652 PMCID: PMC9733089 DOI: 10.1186/s12891-022-05935-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 10/30/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND There exists a vast number of surgical treatment options for acromioclavicular (AC) joint injuries, and the current literature has yet to determine an equivocally superior treatment. AC joint repair has a long history and dates back to the beginning of the twentieth century. MAIN BODY Since then, over 150 different techniques have been described, covering open and closed techniques. Low grade injuries such as Type I-II according to the modified Rockwood classification should be treated conservatively, while high-grade injuries (types IV-VI) may be indicated for operative treatment. However, controversy exists if operative treatment is superior to nonoperative treatment, especially in grade III injuries, as functional impairment due to scapular dyskinesia or chronic pain remains concerning following non-operative treatment. Patients with a stable AC joint without overriding of the clavicle and without significant scapular dysfunction (Type IIIA) may benefit from non-interventional approaches, in contrast to patients with overriding of the clavicle and therapy-resistant scapular dysfunction (Type IIIB). If these patients are considered non-responders to a conservative approach, an anatomic AC joint reconstruction using a hybrid technique should be considered. In chronic AC joint injuries, surgery is indicated after failed nonoperative treatment of 3 to 6 months. Anatomic AC joint reconstruction techniques along with biologic augmentation (e.g. Hybrid techniques, suture fixation) should be considered for chronic high-grade instabilities, accounting for the lack of intrinsic healing and scar-forming potential of the ligamentous tissue in the chronic setting. However, complication and clinical failure rates remain high, which may be a result of technical failures or persistent horizontal and rotational instability. CONCLUSION Future research should focus on addressing horizontal and rotational instability, to restore native physiological and biomechanical properties of the AC joint.
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Affiliation(s)
- Daniel P. Berthold
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany ,grid.411095.80000 0004 0477 2585Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - Lukas N. Muench
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Felix Dyrna
- Department of Trauma, Hand and Reconstructive Surgery University Hospital Münster, Munich, Germany
| | - Augustus D. Mazzocca
- grid.32224.350000 0004 0386 9924Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 USA
| | - Patrick Garvin
- grid.32224.350000 0004 0386 9924Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 USA
| | - Andreas Voss
- grid.7727.50000 0001 2190 5763Department of Trauma Surgery, University Regensburg, Regensburg, Germany
| | - Bastian Scheiderer
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Sebastian Siebenlist
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Andreas B. Imhoff
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Knut Beitzel
- Arthroscopy and Orthopedic Sportsmedicine, ATOS Orthoparc Clinic, Cologne, Germany
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Saraglis G, Prinja A, To K, Khan W, Singh J. Surgical treatments for acute unstable acromioclavicular joint dislocations. SICOT J 2022; 8:38. [PMID: 36069502 PMCID: PMC9450493 DOI: 10.1051/sicotj/2022038] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 08/21/2022] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Surgical treatment is usually recommended for acute, high-grade acromioclavicular joint (ACJ) injuries. A wide variety of surgical techniques exist, and the literature does not strongly support one over the other. In this literature review, we describe and compare the results of different surgical treatments for the management of acute unstable ACJ dislocation and aim to guide surgeons on optimal treatment. MATERIALS AND METHODS A literature review was performed by searching PubMed, Medline, Cochrane, and Embase databases. Seventeen studies met the inclusion criteria and were analyzed. Only studies with comparative data were included. The clinical and radiological outcomes of these studies were reviewed. RESULTS Seventeen studies were included in this literature review. We found no difference in outcomes between open and arthroscopic procedures. Coracoclavicular ligament (CCL) reconstruction techniques provide better results than the more rigid hook plate fixation. There is no evidence that biologic repair with tendon graft is superior to synthetic grafts. Furthermore, an autograft is not shown to be better than an allograft. Rigid fixation between the clavicle and coracoid and the non-anatomic Weaver-Dunn technique appears less popular in recent literature. The hook plate is associated with subacromial osteolysis, acromial erosion, and the morbidity of a secondary procedure. DISCUSSION There is a recent increase in publications on the reconstruction of the ACJ after injury, with new techniques focusing on the anatomic reconstruction of the CCLs aiming to restore both vertical and horizontal plane stability of the ACJ using synthetic/biological grafts. Despite the plethora of new techniques introduced, meaningful comparisons are difficult to draw due to the heterogeneity of the treatments used and the outcome measure used to assess the results.
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Affiliation(s)
- Georgios Saraglis
- Department of Trauma and Orthopaedics, Lewisham and Greenwich NHS Trust, London SE13 6LH, UK
| | - Aditya Prinja
- Upper Limb Unit, Wrightington Hospital, Lancashire, UK
| | - Kendrick To
- Division of Trauma and Orthopaedic Surgery, Department of Surgery, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Wasim Khan
- Division of Trauma and Orthopaedic Surgery, Department of Surgery, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Jagwant Singh
- Department of Trauma and Orthopaedics, Lewisham and Greenwich NHS Trust, London SE13 6LH, UK
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Instabilitäten des Akromioklavikulargelenks – Komplikationen und Lehren. ARTHROSKOPIE 2022. [DOI: 10.1007/s00142-022-00552-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Paul RW, Aman ZS, Kemler BR, Osman A, Doran JP, Brutico J, Tjoumakaris FP, Freedman KB. Clinical and Patient-Reported Outcomes for Acute Acromioclavicular Joint Fixation are Similar With or Without Allograft Augmentation. Arthrosc Sports Med Rehabil 2022; 4:e1481-e1487. [PMID: 36033197 PMCID: PMC9402475 DOI: 10.1016/j.asmr.2022.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/29/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose Methods Results Conclusion Level of Evidence
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Affiliation(s)
- Ryan W. Paul
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
| | | | | | - Alim Osman
- Eastern Virginia Medical School, Norfolk, Virginia
| | - James P. Doran
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
| | - Joseph Brutico
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
| | | | - Kevin B. Freedman
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
- Address correspondence to Kevin B. Freedman, M.D., Rothman Orthopaedic Institute at Thomas Jefferson University, 825 Old Lancaster Rd., Suite 200, Bryn Mawr, PA 19010.
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Ahmed AF, Salameh M, Kayali H, Hantouly A, Darwiche A. Open reduction and tunneled suspensory fixation for lateral end of clavicle fractures: surgical technique. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:345-349. [PMID: 37588858 PMCID: PMC10426559 DOI: 10.1016/j.xrrt.2022.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Unstable distal end clavicle fractures are associated with significant rates of nonunion and poor functional outcomes. Surgical treatment is paramount for unstable fracture patterns; however, treatment options are various, with each having its advantages and drawbacks. Recently, suture-based coracoclavicular fixation techniques using suture buttons have been implemented with high union rates, satisfactory shoulder function, and low rates of complications. In this report, we demonstrate a modified fixation of unstable lateral clavicle fractures. Our technique entails open reduction and suspensory coracoclavicular fixation using suture anchors and suture button devices with supplemental acromioclavicular suspensory fixation.
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Affiliation(s)
- Abdulaziz F. Ahmed
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Orthopaedic Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Motasem Salameh
- Department of Orthopaedic Surgery, Hamad Medical Corporation, Doha, Qatar
- Department of Orthopaedic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Hammam Kayali
- Department of Orthopaedic Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Ashraf Hantouly
- Department of Orthopaedic Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Ali Darwiche
- Department of Orthopaedic Surgery, Hamad Medical Corporation, Doha, Qatar
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31
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Salazar DH, Bialek SE, Garbis NG. Acromiohumeral cerclage in reverse total shoulder arthroplasty for recurrent instability. J Shoulder Elbow Surg 2022; 31:e376-e385. [PMID: 35202831 DOI: 10.1016/j.jse.2022.01.136] [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: 11/17/2021] [Revised: 01/10/2022] [Accepted: 01/16/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Recurrent shoulder instability after reverse total shoulder arthroplasty (rTSA) presents a challenging clinical problem. A handful of cases have been reported describing stability achieved only after revision rTSA with cerclage augmentation. We describe an acromiohumeral cerclage technique, where the humeral component is fixed with a nonabsorbable, high-tensile suture tape looped through transosseous acromial drill tunnels as an augment to salvage shoulder stability. METHODS All patients treated with acromiohumeral cerclage in rTSA for instability between November 1, 2015, and February 1, 2020, with minimum 1-year follow-up were included. Demographic information, baseline preoperative and postoperative range of motion at most recent follow-up, American Shoulder and Elbow Surgeons (ASES) shoulder scores, and visual analog scale (VAS) scores were recorded and compared. RESULTS Ten patients, 4 female and 6 male, aged 64.3 ± 7.4 years (range, 53-77 years) with the mean postoperative follow-up of 23 months were included; 90% underwent surgery on the dominant side. Patients underwent an average of 2.1 ± 1.9 prior revisions (range, 0-7), over an average of 10.4 months (range, 0-72 months), before revision with suture cerclage augmentation was performed. All patients either had significant past shoulder history at other institutions and/or comorbidities that added significant complexity to their cases, with an average of 0.6 ± 0.9 (range, 0-3) prior other shoulder operations performed before their initial rTSA. The average decrease in VAS score among the 10 patients was 4.3 ± 2.7 (P < .05), ranging from 0 to 8 points. The average increase in ASES score was 51.3 ± 21 (P < .05), ranging from 13.3 to 69.9 points. The average increase in active forward elevation for 8 patients was 79° ± 39° (P = .0008), ranging from 40° to 160°. All patients have remained stable with well-positioned prostheses since their final operations with no recurrent dislocations or acromial complications. Two patients unable to travel for an office visit were contacted via phone and answered questions to obtain postoperative ASES and VAS scores. CONCLUSION Acromiohumeral cerclage suture augmentation in revision rTSA may be a useful, simple surgical strategy to employ with other revision and augmentation techniques to treat cases of recurrent, chronic instability, particularly in the setting of multiple revisions.
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Affiliation(s)
- Dane H Salazar
- Department of Orthopaedic Surgery & Rehabilitation, Loyola University Medical Center, Maywood, IL, USA.
| | - Samantha E Bialek
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Nickolas G Garbis
- Department of Orthopaedic Surgery & Rehabilitation, Loyola University Medical Center, Maywood, IL, USA
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32
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Ângelo AC, Maia Dias C, de Campos Azevedo C. Combined Vertical, Horizontal, and Rotational Acromioclavicular Joint Stabilization: "Closing the Circle" Technique. Arthrosc Tech 2022; 11:e1479-e1486. [PMID: 36061468 PMCID: PMC9437616 DOI: 10.1016/j.eats.2022.03.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 03/29/2022] [Indexed: 02/03/2023] Open
Abstract
The biomechanical and anatomical complexity of the acromioclavicular joint makes its repair techniques particularly challenging. High rates of reduction subsidence and construction failures transversally affect both anatomic and nonanatomic repair techniques. The importance of addressing both vertical and horizontal instability has been highlighted in recent years. The authors aim to describe a surgical technique that combines vertical, horizontal, and rotational stabilization, in an attempt to restore the coracoacromioclavicular circle of stability.
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Affiliation(s)
- Ana Catarina Ângelo
- Hospital CUF Tejo, Lisbon, Portugal,Hospital dos SAMS de Lisboa, Lisbon,Address correspondence to Ana Catarina Ângelo, M.D., Avenida de Roma 56 3Dto PC 1700-348 Lisboa, Portugal.
| | - Carlos Maia Dias
- Hospital dos SAMS de Lisboa, Lisbon,Hospital CUF Santarém, Santarém, Portugal,UCMA Fidelidade, Lisbon, Portugal,iBB Institute for Bioengineering and Biosciences, Instituto Superior Técnico, Lisbon, Portugal
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33
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Lee YM, Yeo JD, Hwang ZO, Song SW, Sur YJ. Reconstruction of the coracoclavicular ligament with palmaris longus tendon and Mersilene tape for acromioclavicular dislocations. BMC Musculoskelet Disord 2022; 23:648. [PMID: 35794545 PMCID: PMC9258156 DOI: 10.1186/s12891-022-05589-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 06/27/2022] [Indexed: 12/01/2022] Open
Abstract
Background Acromioclavicular (AC) joint dislocation is common among shoulder injuries, and various surgical methods have been introduced for effective ligament reconstruction. Reconstruction of the coracoclavicular (CC) ligament in the anatomical position using autologous tendons is a recent surgical trend. This study is to report clinical and radiologic results of reconstruction of the CC ligament using an autologous palmaris longus tendon interweaved with Mersilene tape (PLMT) with a minimum 2-year follow-up. Methods This retrospective study analyzed 76 patients (mean age, 43.4 ± 11.2 years) with AC joint dislocation treated by reconstruction of the CC ligament with PLMT, from March 2004 to February 2017. The mean follow-up period was 28 ± 6.7 months (range, 24–66 months). The Visual Analog Scale (VAS) for pain assessment, American Shoulder and Elbow Surgeons rating scale (ASES), and Constant Score (CS) were used to evaluate clinical outcomes at the preoperative and the final follow-ups. CC and AC distances were measured using anteroposterior (AP) X-ray preoperatively and at the final follow-up for radiologic outcomes. Complications were also assessed. Results The mean preoperative VAS for pain, ASES, CS were 5.7 ± 0.7, 77.1 ± 6.2, and 61.5 ± 5.2, respectively. These scores at the final follow-up improved to 2.1 ± 0.5, 90.9 ± 4.3, and 94 ± 7.0, respectively (p = 0.043, p < 0.001, p < 0.001). The mean preoperative CC and AC distances were 16.49 ± 3.73 mm and 13.84 ± 3.98 mm, respectively. The final follow-up CC and AC distances were 9.29 ± 2.72 mm and 5.30 ± 2.09 mm, respectively (p < 0.001, p < 0.001). Although a slight re-widening of the CC distance occurred in 10 patients (13.1%), most patients regained full range of motion of the affected shoulder at the final follow-up. Conclusion The CC ligament reconstruction with PLMT for the treatment of AC joint dislocation showed good clinical and radiological results. This technique could be a good alternative treatment for AC dislocations.
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34
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Degeorge B, Ravoyard S, Lazerges C, Toffoli A, Chammas M, Coulet B. Clinical Impact of Malunion After All-Arthroscopic Coracoclavicular Stabilization for Displaced and Unstable Lateral Clavicle Fractures. J Orthop Trauma 2022; 36:e271-e277. [PMID: 34941602 DOI: 10.1097/bot.0000000000002330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the clinical outcome of lateral clavicle malunion treated with all-arthroscopic coracoclavicular (CC) stabilization. DESIGN Retrospective, case series. SETTING Department of hand and upper extremity surgery, university hospital center. PATIENTS Forty-five patients with unstable and displaced lateral clavicle fracture treated between January 2015 and August 2019 were included in the study. INTERVENTION Closed reduction and arthroscopic CC stabilization using cortical buttons. MAIN OUTCOME MEASUREMENTS Shoulder pain and active motion. Patient-reported outcome measures included the Constant score, the Subjective Shoulder Value, the AcromioClavicular Joint Instability score, and the Specific AcromioClavicular Score. Radiographic evaluation assessed bony union and malunion. RESULTS Mean duration of follow-up was 25 months (12-60 months). Five patients (11%) had lateral clavicle nonunion and 7 (16%) had lateral clavicle malunion (5 in the coronal plane and 2 in the axial plane). Lateral clavicle malunion did not significantly affect clinical or functional outcomes (P > 0.05). Mean active shoulder motion was forward flexion 163 degrees (SD 28), abduction 162 degrees (SD 26), and external rotation 63 degrees (SD 21). On average, the patients scored 88.3 (SD 17.7) in the Constant score, 90% (SD 12) in the Subjective Shoulder Value, 88.8 (SD 9.4) in the AcromioClavicular Joint Instability score, and 11.4 (SD 8.5) for SACS. The overall complication rate was 38% (including 7 malunions, 5 nonunions, 2 adhesive capsulitis, and 3 button malpositions). CONCLUSIONS Closed reduction and internal fixation of lateral clavicle fracture with all-arthroscopic CC stabilization using cortical button potentiates bony union but may generate lateral clavicle malunion, which does not affect the clinical or functional outcome. This result can be attributed to CC ligament healing and acromioclavicular joint congruence. All-arthroscopic CC stabilization is a minimally invasive but demanding surgical alternative for managing unstable and displaced lateral clavicle fracture. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Benjamin Degeorge
- Service de Chirurgie Orthopédique et Traumatologique du Membre Supérieur, Chirurgie de la Main et des Nerfs Périphériques, CHU Lapeyronie, Montpellier, France ; and
- Clinique Saint-Jean Sud de France, Groupe OrthoSud, Saint Jean de Védas, France
| | - Salomé Ravoyard
- Service de Chirurgie Orthopédique et Traumatologique du Membre Supérieur, Chirurgie de la Main et des Nerfs Périphériques, CHU Lapeyronie, Montpellier, France ; and
| | - Cyril Lazerges
- Service de Chirurgie Orthopédique et Traumatologique du Membre Supérieur, Chirurgie de la Main et des Nerfs Périphériques, CHU Lapeyronie, Montpellier, France ; and
| | - Adriano Toffoli
- Service de Chirurgie Orthopédique et Traumatologique du Membre Supérieur, Chirurgie de la Main et des Nerfs Périphériques, CHU Lapeyronie, Montpellier, France ; and
- Clinique Saint-Jean Sud de France, Groupe OrthoSud, Saint Jean de Védas, France
| | - Michel Chammas
- Service de Chirurgie Orthopédique et Traumatologique du Membre Supérieur, Chirurgie de la Main et des Nerfs Périphériques, CHU Lapeyronie, Montpellier, France ; and
| | - Bertrand Coulet
- Service de Chirurgie Orthopédique et Traumatologique du Membre Supérieur, Chirurgie de la Main et des Nerfs Périphériques, CHU Lapeyronie, Montpellier, France ; and
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Berthold DP, Muench LN, Imhoff AB, Lacheta L. Stabilisierung des Akromioklavikulargelenks. ARTHROSKOPIE 2022. [DOI: 10.1007/s00142-022-00546-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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36
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Otto A, Friedman JL, Szolomayer LK, Baldino JB, Obopilwe E, Cote MP, Mazzocca AD, Arciero RA. Semitendinosus vs Gracilis Grafts With 1- vs 2-Tunnel Techniques for Coracoclavicular Ligament Reconstruction: A Biomechanical Study. Am J Sports Med 2022; 50:1983-1989. [PMID: 35482448 DOI: 10.1177/03635465221092131] [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: 01/31/2023]
Abstract
BACKGROUND Despite the evolution of acromioclavicular joint surgery to a more anatomic coracoclavicular (CC) ligament reconstruction, no definitive guidance regarding the number and position of bone tunnels in the clavicle, as well as the ideal graft choice, is established. PURPOSE/HYPOTHESIS The purpose of this study was to biomechanically compare the reconstruction of the CC ligament complex between gracilis- and semitendinosus-tendon grafts in 1- and 2-tunnel techniques. It was hypothesized that the gracilis tendon graft will provide comparable primary stability in both tunnel techniques while utilizing a smaller tunnel diameter. STUDY DESIGN Controlled laboratory study. METHODS A total of 24 cadaveric shoulders (13 men, 11 women; 66 ± 7.5 years) were randomly allocated to 4 repair groups: gracilis with 1 tunnel (GT-1), gracilis with 2 tunnels (GT-2), semitendinosus with 1 tunnel (ST-1), and semitendinosus with 2 tunnels (ST-2). First, specimens were tested for native anterior, posterior, and superior translations. Then, specimens were randomly assigned to 1 of the 4 CC reconstruction groups before undergoing the same testing, followed by cyclic loading and load to failure (LTF). RESULTS The GT-2 reconstruction demonstrated significantly less translation when compared with ST-2 in anterior (P = .024) and posterior (P = .048) directions. GT-1 and ST-2 both showed significantly less translation than ST-1 in anterior and superior directions (P < .001). All reconstructions demonstrated less superior translation compared with native testing, with GT-1 and ST-2 significantly less than ST-1 (P < .001). There were no significant differences for peak displacement and LTF between groups. CONCLUSION Gracilis tendon grafts using a 1- or 2-tunnel technique for CC ligament reconstruction provided comparable translation, displacement, and LTF as corresponding semitendinosus grafts. Therefore, the gracilis tendon should be considered as a biomechanical equivalent graft choice for the reconstruction of the CC ligament complex. CLINICAL RELEVANCE In a cadaveric model, the gracilis tendon demonstrated adequate fixation with minimal translation in CC ligament reconstruction while utilizing smaller diameter bone tunnels, which may help minimize the risk of complications such as loss of reduction and fracture.
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Affiliation(s)
- Alexander Otto
- Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut Health Center, Farmington, Connecticut, USA.,Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Trauma, Orthopaedic, Plastic and Hand Surgery, University Hospital of Augsburg, Augsburg, Germany
| | - Jamie L Friedman
- Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut Health Center, Farmington, Connecticut, USA.,Colorado Springs Orthopaedic Group, Colorado Springs, Colorado, USA
| | - Lauren K Szolomayer
- Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut Health Center, Farmington, Connecticut, USA.,Excel Orthopaedic Specialists, Woburn, Massachusetts, USA
| | - Joshua B Baldino
- Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Elifho Obopilwe
- Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Mark P Cote
- Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Augustus D Mazzocca
- Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Robert A Arciero
- Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut Health Center, Farmington, Connecticut, USA
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Cerciello S, Corona K, Morris BJ, Proietti L, Mercurio M, Cattaneo S, Milano G. Hybrid coracoclavicular and acromioclavicular reconstruction in chronic acromioclavicular joint dislocations yields good functional and radiographic results. Knee Surg Sports Traumatol Arthrosc 2022; 30:2084-2091. [PMID: 34841469 DOI: 10.1007/s00167-021-06790-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 10/25/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Optimal treatment of chronic unstable acromioclavicular (AC) joint dislocations (stage 3-5 according the Rockwood classification) is still debated. Anatomic coracoclavicular (CC) reconstruction is a reliable option in terms of two-dimensional radiographic reduction, clinical outcomes, and return to sports, but there remain concerns regarding anterior-posterior stability of the AC joint with CC ligament reconstruction alone. The aim of the present study was to describe the mid-term results of a new hybrid technique with CC and AC ligament reconstruction for chronic AC joint dislocations. METHODS Twenty-two patients surgically treated for chronic AC joint dislocations (grade 3 to 5) were retrospectively reviewed. All patients were assessed before surgery and at final follow-up with the Constant-Murley score (CMS) and the American Shoulder and Elbow Surgeons (ASES) score. The CC vertical distance (CCD) and the CCD ratio (affected side compared to unaffected side) were measured on Zanca radiographs preoperatively, at 6 months postop and at final follow-up. The same surgical technique consisting in a primary fixation with a suspensory system, coracoclavicular ligaments reconstruction with a double loop of autologous gracilis and acromioclavicular ligaments reconstruction with autologous coracoacromial ligament was performed in all cases. RESULTS Twenty-two shoulders in 22 patients (19 males and 3 females) were evaluated with a mean age of 34.4 ± 9 years at the time of surgery. The mean interval between the injury and surgery was 53.4 ± 36.7 days. The mean duration of postoperative follow-up was 49.9 ± 11.8 months. According to the Rockwood classification, there were 5 (22.6%) type-III and 17 (77.2%) type-V dislocations. Mean preoperative ASES and CMS were 54.4 ± 7.6 and 64.6 ± 7.2, respectively. They improved to 91.8 ± 2.3 (p = 0.0001) and 95.2 ± 3.1 (p = 0.0001), respectively at final FU. The mean preoperative CCD was 22.4 ± 3.2 mm while the mean CCD ratio was 2.1 ± 0.1. At final FU, the mean CCD was 11.9 ± 1.4 mm (p = 0.002) and the mean CCD ratio was 1.1 ± 0.1 (p = 0.009). No recurrence of instability was observed. One patient developed a local infection and four patients referred some shoulder discomfort. Heterotopic ossifications were observed in three patients. CONCLUSIONS The optimal treatment of chronic high-grade AC joint dislocations requires superior-inferior and anterior-posterior stability to ensure good clinical outcomes and return to overhead activities or sports. The present hybrid technique of AC and CC ligaments reconstruction showed good clinical and radiographic results and is a reliable an alternative to other reported techniques. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Simone Cerciello
- A. Gemelli University Hospital Foundation IRCCS, Catholic University, Rome, Italy
- Marrelli Hospital, Crotone, Italy
- Casa Di Cura Villa Betania, Rome, Italy
| | - Katia Corona
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Campobasso, Italy.
| | - Brent Joseph Morris
- Baptist Health Medical Group Orthopedics and Sports Medicine, Lexington, KY, USA
| | | | - Michele Mercurio
- Department of Orthopaedic and Trauma Surgery, Magna Græcia" University, Mater Domini" University Hospital, Catanzaro, Italy
| | - Stefano Cattaneo
- Department of Bone and Joint Surgery, Spedali Civili, Brescia, Italy
| | - Giuseppe Milano
- Department of Bone and Joint Surgery, Spedali Civili, Brescia, Italy
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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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Zhang L, Xiong L, He S, Liu J, Zhou X, Tang X, Fu S, Wang G. Classification and morphological parameters of the coracoid process in Chinese population. J Orthop Surg (Hong Kong) 2022; 30:23094990211069694. [PMID: 35041540 DOI: 10.1177/23094990211069694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION The coracoid process is an important anatomical structure of the scapula, which can be used as a landmark in the diagnosis and treatment of scapula related diseases, such as acromioclavicular joint dislocation, anterior shoulder instability, and coracoid fractures. The aim of this study was to classify the coracoid process according to morphology and to measure the morphological parameters of the coracoid process. MATERIALS AND METHODS A total of 377 dry and intact scapulae were collected and classified in terms of the connection between the shape of coracoid process and common things in life. The anatomical morphology and the position related to acromion and glenoid socket of the coracoid process were measured in each type by three independent researchers with a digital caliper. The measurements were averaged and recorded. RESULTS Based on obvious morphological features, five specific types of the coracoid process were described: Type I, Vertical 8-shape; Type II, Long stick shape; Type III, Short stick shape; Type IV, Water drop shape, and Type V, Wedge shape. Type I (30%) and Type III (29%) were more prevalent in China. The tip width of the coracoid process of Type IV was the shortest and significantly different compared to the other types (p <.05), contrary to the longest in Type V. The tip thickness of the coracoid process of Type I was the shortest and significantly different from the other types (p <.05). CONCLUSIONS The coracoid process was classified into five types based on obvious morphological features. Knowing of morphological classification and anatomical parameters of different types of the coracoid process, to some extent, may be helpful to diagnose and treat the shoulder joint disease, such as acromioclavicular joint dislocation, anterior shoulder instability, and coracoid fractures, and to theoretically reduce postoperative complications.
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Affiliation(s)
- Lei Zhang
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China.,Center for Orthopedic Diseases Research, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China.,Expert Workstation in Luzhou, Sichuan Luzhou, China.,Clinical Base of Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Luzhou, China
| | - Lujing Xiong
- School of Clinical Medicine, Southwest Medical University, Luzhou, China
| | - Siyuan He
- School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Jiaju Liu
- Market Supervision Administration of Luzhou City of Sichuan Province, Luzhou, China
| | - Xin Zhou
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China.,Center for Orthopedic Diseases Research, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China.,Expert Workstation in Luzhou, Sichuan Luzhou, China
| | - Xiaogao Tang
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China.,Center for Orthopedic Diseases Research, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China.,Expert Workstation in Luzhou, Sichuan Luzhou, China
| | - Shijie Fu
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China.,Center for Orthopedic Diseases Research, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China.,Expert Workstation in Luzhou, Sichuan Luzhou, China
| | - Guoyou Wang
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China.,Center for Orthopedic Diseases Research, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China.,Expert Workstation in Luzhou, Sichuan Luzhou, China
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Heilmann LF, Sussiek J, Raschke MJ, Langer MF, Frank A, Wermers J, Michel PA, Dyrna F, Schliemann B, Katthagen JC. Biomechanical Analysis of Coracoid Stability After Coracoplasty: How Low Can You Go? Orthop J Sports Med 2022; 10:23259671221077947. [PMID: 35340899 PMCID: PMC8951046 DOI: 10.1177/23259671221077947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 10/22/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Arthroscopic coracoplasty is a procedure for patients affected by subcoracoid
impingement. To date, there is no consensus on how much of the coracoid can
be resected with an arthroscopic burr without compromising its
stability. Purpose: To determine the maximum amount of the coracoid that can be resected during
arthroscopic coracoplasty without leading to coracoid fracture or avulsion
of the conjoint tendon during simulated activities of daily living
(ADLs). Study Design: Controlled laboratory study. Methods: A biomechanical cadaveric study was performed with 24 shoulders (15 male, 9
female; mean age, 81 ± 7.9 years). Specimens were randomized into 3
treatment groups: group A (native coracoid), group B (3-mm coracoplasty),
and group C (5-mm coracoplasty). Coracoid anatomic measurements were
documented before and after coracoplasty. The scapula was potted, and a
traction force was applied through the conjoint tendon. The stiffness and
load to failure (LTF) were determined for each specimen. Results: The mean coracoid thicknesses in groups A through C were 7.2, 7.7, and 7.8
mm, respectively, and the mean LTFs were 428 ± 127, 284 ± 77, and 159 ± 87
N, respectively. Compared with specimens in group A, a significantly lower
LTF was seen in specimens in group B (P = .022) and group C
(P < .001). Postoperatively, coracoids with a
thickness ≥4 mm were able to withstand ADLs. Conclusion: While even a 3-mm coracoplasty caused significant weakening of the coracoid,
the individual failure loads were higher than those of the predicted ADLs. A
critical value of 4 mm of coracoid thickness should be preserved to ensure
the stability of the coracoid process. Clinical Relevance: In correspondence with the findings of this study, careful preoperative
planning should be used to measure the maximum reasonable amount of
coracoplasty to be performed. A postoperative coracoid thickness of 4 mm
should remain.
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Affiliation(s)
| | - Julia Sussiek
- University Hospital Muenster (WWU), Muenster, Germany
| | | | | | - Andre Frank
- University Hospital Muenster (WWU), Muenster, Germany
| | - Jens Wermers
- University Hospital Muenster (WWU), Muenster, Germany
| | | | - Felix Dyrna
- University Hospital Muenster (WWU), Muenster, Germany
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Chang HM, Wang CH, Hsu KL, Kuan FC, Chen Y, Su WR, Hong CK. Does Weaver-Dunn procedure have a role in chronic acromioclavicular dislocations? A meta-analysis. J Orthop Surg Res 2022; 17:95. [PMID: 35168632 PMCID: PMC8848947 DOI: 10.1186/s13018-022-02995-9] [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: 11/18/2021] [Accepted: 02/04/2022] [Indexed: 12/15/2022] Open
Abstract
Background In treatment of chronic acromioclavicular (AC) joint dislocations, both the Weaver–Dunn procedure (WD) and CC ligament reconstruction (CCR) are recommended options due to the low possibility of healing of the coracoclavicular (CC) ligaments. The aim of this review was to determine whether CCR will yield favorable clinical and radiographic outcomes in the treatment of chronic AC dislocations. Method The Cochrane Library, EMBASE, and PubMed databases were searched for literature on chronic AC dislocations from data inception to June 30, 2021. Patient data were pooled using standard meta-analytic approaches. The Cochrane-Mantel–Haenszel method and variance-weighted means were used to analyze the outcomes. The Review Manager version 5.3 software (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark) was used to calculate the heterogenicity, mean difference, and relative risk (RR) for all outcomes in the meta-analysis. Results The current analysis included four trials on this topic, and all AC joint dislocations were classified as Rockwood types III to VI. The pooled data showed that the CCR group had significantly better post-operative American Shoulder and Elbow Surgeons Shoulder (ASES) scores, Oxford Shoulder Scores (OSSs), and Nottingham Clavicle Scores (NCSs) than the WD group, with a significant difference (p < 0.001, p = 0.020, and p < 0.001, respectively). In terms of the post-operative Constant-Murley Scores (CMSs), there were no significant differences between the CCR group and the WD group (p = 0.100). The CCR group had significantly better post-operative abduction and flexion of the index shoulder than the WD group (p < 0.001 and p < 0.001, respectively). In terms of radiological outcomes, the post-operative coracoclavicular distance (CCD) with a 10 kg load was smaller in the CCR group compared to that in the WD group (p < 0.001). The overall surgical wound infection rate was 11.6% in the WD group and 12.9% in the CCR, respectively (p = 0.82). Conclusion The CCR group had better clinical outcome scores in the ASES, OOS, NCS, abduction, flexion, and external rotation than the WD group. In terms of radiological outcomes, the CCR group showed less displacement in weight-loaded post-CCD than the WD group, which indicated that the CCR provided more stability and resistance to deformation forces.
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Affiliation(s)
- Hao-Ming Chang
- Department of Orthopaedics, Tainan Municipal Hospital (Managed By Show Chwan Medical Care Corporation), Tainan, Taiwan
| | - Chi-Hsiu Wang
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Kai-Lan Hsu
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng-Li Road, Tainan City, 70428, Taiwan.,Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Fa-Chuan Kuan
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng-Li Road, Tainan City, 70428, Taiwan
| | - Yueh Chen
- Department of Orthopaedic Surgery, Sin Lau Hospital, Tainan, Taiwan
| | - Wei-Ren Su
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng-Li Road, Tainan City, 70428, Taiwan.,Skeleton Materials and Bio-Compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Musculoskeletal Research Center, Innovation Headquarter, National Cheng Kung University, Tainan, Taiwan
| | - Chih-Kai Hong
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng-Li Road, Tainan City, 70428, Taiwan.
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Maia Dias C, Leite MJ, Ribeiro da Silva M, Granate P, Manuel Teixeira J. Arthroscopic Anatomical Acromioclavicular Joint Reconstruction using a Button Device and a Semitendinosus Graft. Orthop Surg 2022; 14:605-612. [PMID: 35142045 PMCID: PMC8927023 DOI: 10.1111/os.13202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 12/10/2021] [Accepted: 12/20/2021] [Indexed: 11/29/2022] Open
Abstract
Objective To report a new technique for anatomical acromioclavicular (AC) joint reconstruction. Methods In order to minimize such complications, the authors describe a new anatomical and biological AC joint repair. This technique aims to provide greater stability by using two anatomically placed clavicular tunnels and a combined construct with a double endobutton cortical fixation for primary stabilization, and to be biologically advantageous by using an autologous semitendinosus (ST) tendon graft. Additionally, the coracoclavicular ligament reconstruction is complemented with an AC joint cerclage and capsular reinforcement, which will protect the biological construction in its initial stage of healing. Results This technique provides adequate primary and secondary biomechanical stability by passing both a semitendinosus autogenous graft and a double endobutton device, through anatomically placed and small diameter clavicle holes, without the need for coracoid drilling. Our technique showed encouraging results regarding pain resolution, range of motion, and function. At final follow‐up we experienced excellent results with average pain score of 1.6, and average ROM of 159° of forward flexion, 160° of abduction, 68° of external rotation, and internal rotation level at T11. Postoperative function also showed great improvements with average ASES of 85 points, an average Constant Score of 87 and a Subjective Shoulder Value of 89 points. This technique also achieved perfectly acceptable radiographic results, with an average coracoclavicular distance increase of 0.8 mm. Regarding complications, our sample showed one case of AC join subluxation, two cases of internal saphenous nerve injury, and two partial graft tears at the suture‐button interface, with none of these requiring surgical revision. Conclusion This technique is advantageous in treatment of acromioclavicular joint dislocation and can be performed in both the subacute and chronic setting.
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Affiliation(s)
- Carlos Maia Dias
- Hospital da Luz Lisboa, Lisbon, Portugal.,Unidade Cuidados Médicos de Acidentes Fidelidade Lisboa, Lisbon, Portugal.,Hospital CUF Santarém, Santarém, Portugal
| | | | - Manuel Ribeiro da Silva
- Centro Hospitalar Universitário São João, Porto, Portugal.,Hospital CUF Porto, Porto, Portugal
| | - Pedro Granate
- Hospital da Luz Lisboa, Lisbon, Portugal.,Unidade Cuidados Médicos de Acidentes Fidelidade Lisboa, Lisbon, Portugal
| | - José Manuel Teixeira
- Hospital da Luz Arrábida, Vila Nova de Gaia, Portugal.,Unidade Cuidados Médicos de Acidentes Fidelidade Porto, Porto, Portugal
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Jeon N, Choi NH, Ha JH, Kim M, Lim TK. Clavicular Tunnel Complications after Coracoclavicular Reconstruction in Acute Acromioclavicular Dislocation: Coracoid Loop versus Coracoid Tunnel Fixation. Clin Orthop Surg 2022; 14:128-135. [PMID: 35251550 PMCID: PMC8858902 DOI: 10.4055/cios21094] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/26/2021] [Accepted: 09/22/2021] [Indexed: 11/23/2022] Open
Abstract
Background The purpose of this study was to compare clavicular tunnel complications after coracoclavicular (CC) reconstruction between a coracoid loop fixation group and a coracoid tunnel fixation group. We hypothesized that clavicular tunnel complications would be more common in the coracoid loop group. Methods This retrospective study evaluated 24 patients who underwent CC reconstruction using coracoid tunnel fixation (n = 14) and coracoid loop fixation (n = 10). Radiographic measurements included the CC distance and clavicular tunnel diameter. Clavicular tunnel complications such as tunnel widening and clavicular tunnel fractures were investigated. Clinical outcomes were assessed using the American Shoulder and Elbow Surgeons Shoulder score and the University of California at Los Angeles Shoulder score. Results The mean follow-up period was 17.5 months (range, 11–38 months). The final clavicular tunnel diameter and the increase in the clavicular tunnel diameter in millimeter and percentage were significantly greater in the coracoid loop group than in the coracoid tunnel group (all p < 0.05). Clavicular tunnel widening more than 100% was found in 5 patients, all belonging to the coracoid loop group. Clavicular tunnel fractures occurred in 3 patients (all in the coracoid loop group). Fracture was associated with severe tunnel widening (more than 100% increase). The mean value of the final clavicular tunnel diameter in patients with fractures was significantly larger than that in patients without (12.7 ± 3.3 mm vs. 8.4 ± 1.5 mm, p = 0.016). Conclusions Clavicular tunnel complications such as significant tunnel widening and fractures after CC reconstructions in acromioclavicular dislocations were common with the coracoid loop fixation technique. A greater clavicular tunnel widening and resultantly enlarged tunnel diameter might increase the risk of fracture through the clavicular tunnel.
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Affiliation(s)
- Neunghan Jeon
- Department of Orthopaedic Surgery, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Nam Hong Choi
- Department of Orthopaedic Surgery, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Joo Hyung Ha
- Department of Orthopedic Surgery, Gumdan Top General Hospital, Incheon, Korea
| | - Myonghwhan Kim
- Department of Orthopaedic Surgery, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Tae Kang Lim
- Department of Orthopaedic Surgery, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
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Del Sol SR, Dela Rueda T, Perinovic S, Chakrabarti MO, Bryant S, Gardner B, McGahan PJ, Chen JL. Anchorless Acromioclavicular and Coracoclavicular Ligament Repair Using a Graft-Passing Instrument to Pass Suture Under the Coracoid. Arthrosc Tech 2021; 11:e53-e60. [PMID: 35127429 PMCID: PMC8807716 DOI: 10.1016/j.eats.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/03/2021] [Indexed: 02/03/2023] Open
Abstract
Acromioclavicular joint separation is a common shoulder injury. Grade I and II separation may be treated nonoperatively, whereas higher grades tend to require surgical intervention. Various repair techniques have been described in the literature, with no consensus on the gold standard. This Technical Note describes our use of a graft-passing instrument to pass suture under the coracoid during an anatomic reconstruction of both the acromioclavicular and coracoclavicular ligaments. Although this approach is technically challenging, it avoids coracoid drilling and requires smaller-diameter clavicle and acromion drilling. Furthermore, using suture instead of graft material increases the cost-effectiveness of the procedure.
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Affiliation(s)
- Shane Rayos Del Sol
- Address correspondence to Shane Rayos Del Sol, M.S., Advanced Orthopaedics and Sports Medicine, 450 Sutter St, Ste 400, San Francisco, CA 94108, U.S.A.
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Yu XB, Li T, Hu W, Chen H, Wu YS, Sun LJ. Position of Coracoid Button Predicts Loss of Reduction in Acromioclavicular Joint Dislocation Patients Treated With the Suture-Button. J INVEST SURG 2021; 34:1256-1261. [PMID: 30922136 DOI: 10.1080/08941939.2019.1593557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 03/07/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Loss of reduction is the most common complication after acromioclavicular (AC) joint dislocation treated with the suture-button. Some predictors of it are known, but finding new predictors is an ongoing process. In this study, we evaluate the importance of the position of the coracoid button. MATERIALS AND METHODS Between April 2010 and February 2017, 186 patients with AC joint dislocation were identified. All patients were managed with the same surgical technique and postoperative protocol. The position of the coracoid button was determined immediately after surgery by anterior-posterior views of the operated shoulder and was classified as medial (Group A, 42 cases), central (Group B, 85 cases) and lateral (Group C, 59 cases) positions. The main outcome measurement was loss of reduction. The main analysis was the association between the coracoid button position and loss of reduction. RESULTS No significant difference was found in the baseline characteristics among 3 groups. During follow-up, there were 15 cases (35.7%) developing loss of reduction in Group A, 5 cases (5.9%) in Group B and 26 cases (44.1%) in Group C. The rate of loss of reduction in Groups A and C were higher than that in Group B (p < .05). Moreover, there was no significant difference in the rate of reduction loss between lateral and medial positions of the coracoid buttons (p > .05). CONCLUSION Our results indicated that both lateral and medial positions of the coracoid buttons could predict loss of reduction in AC joint dislocation patients treated with the suture-button.
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Affiliation(s)
- Xian-Bin Yu
- Department of Orthopaedic Surgery, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, and Zhejiang Provincial Key Laboratory of Orthopaedics, Wenzhou, Zhejiang, China
| | - Tong Li
- Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Wei Hu
- Department of Orthopaedic Surgery, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, and Zhejiang Provincial Key Laboratory of Orthopaedics, Wenzhou, Zhejiang, China
| | - Hua Chen
- Department of Orthopaedic Surgery, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, and Zhejiang Provincial Key Laboratory of Orthopaedics, Wenzhou, Zhejiang, China
| | - Yao-Sen Wu
- Department of Orthopaedic Surgery, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, and Zhejiang Provincial Key Laboratory of Orthopaedics, Wenzhou, Zhejiang, China
| | - Liao-Jun Sun
- Department of Orthopaedic Surgery, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, and Zhejiang Provincial Key Laboratory of Orthopaedics, Wenzhou, Zhejiang, China
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Ruzbarsky JJ, Elrick BP, Nolte PC, Arner JW, Millett PJ. Grade III Acromioclavicular Separations Treated With Suspensory Fixation Techniques: A Systematic Review of Level I Through IV Studies. Arthrosc Sports Med Rehabil 2021; 3:e1535-e1545. [PMID: 34712991 PMCID: PMC8527265 DOI: 10.1016/j.asmr.2021.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 04/24/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose To perform a systematic review comparing clinical outcomes, radiographic outcomes, and complication rates after acute (surgery ≤6 weeks from injury) versus chronic (surgery >6 weeks from injury) acromioclavicular joint reconstructions for grade III injuries using modern suspensory fixation techniques. Methods We performed a systematic review of the literature examining acute versus chronic surgical treatment of Rockwood grade III acromioclavicular joint separations using the Cochrane registry, MEDLINE database, and Embase database over the past 10 years according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. The inclusion criteria included techniques using suspensory fixation, a minimum study size of 3 patients, a minimum follow-up period of 6 months, human studies, and English-language studies. The methodology of each study was evaluated using the Methodological Index for Non-randomized Studies (MINORS) tool for nonrandomized studies and the revised Cochrane risk-of-bias (RoB 2) tool for randomized controlled trials. Results The systematic review search yielded 20 studies with a total of 253 patients. There were 2 prospective randomized controlled trials, but most of the included studies were retrospective. On comparison of acute surgery (≤6 weeks) and chronic surgery (>6 weeks), individual studies reported a range of Constant scores of 84.4 to 98.2 and 80.8 to 94.1, respectively. The ranges of radiographic coracoclavicular distances reported at final follow-up also favored acute reconstructions, which showed improved reduction (9.2-15.7 mm and 11.7-18.6 mm, respectively). The reported complication rates ranged from 7% to 67% for acute reconstructions and from 0% to 30% for chronic reconstructions. Conclusions The ranges in the Constant score may favor acute reconstructions, but because of the heterogeneity in the surgical techniques in the literature, no definitive recommendations can be made regarding optimal timing. Level of Evidence Level IV, systematic review of Level I through IV studies.
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Affiliation(s)
| | | | - Philip-C. Nolte
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
- Department of Trauma and Orthopedic Surgery, BG Trauma Center Ludwigshafen, Ludwigshafen, Germany
| | | | - Peter J. Millett
- The Steadman Clinic, Vail, Colorado, U.S.A
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
- Address correspondence to Peter J. Millett, M.D., M.Sc., Steadman Philippon Research Institute, The Steadman Clinic, 181 W Meadow Dr, Ste 400, Vail, CO 81657, U.S.A.
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Mid-Term Outcomes of Arthroscopically-Assisted Anatomic Coracoclavicular Ligament Reconstruction Using Tendon Allograft for High-Grade Acromioclavicular Joint Dislocations. Arthroscopy 2021; 37:3025-3035. [PMID: 33940129 DOI: 10.1016/j.arthro.2021.04.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 04/07/2021] [Accepted: 04/15/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE The purposes of this study were to assess clinical and radiographic outcomes of arthroscopically-assisted, anatomic coracoclavicular ligament reconstruction using tendon allograft (AA-ACCR) for the treatment of Rockwood type III-V injuries at minimum 2-year follow-up and to perform subgroup analyses of clinical and radiographic outcomes for acute versus chronic and type III versus type IV-V injuries. METHODS In this retrospective study of prospectively collected data, patients who underwent primary AA-ACCR for the treatment of type III-V dislocations and had minimum 2-year follow-up were included. Preoperative and postoperative patient-reported outcome scores (PROs) were collected, including American Shoulder and Elbow Surgeons score, Single Numeric Assessment Evaluation score, Short Form-12 Physical Component Summary, Quick Disabilities of the Arm Shoulder and Hand score, and patient satisfaction. Preoperative and postoperative coracoclavicular distance (CCD) was obtained. PROs and CCD were reported for the total cohort and for the subgroups. Complication and revision rates were demonstrated. RESULTS In total, 102 patients (10 women, 92 men) with a mean age of 45.0 years (range, 18-73 years) were included. There were 13 complications (12.7%) resulting in revision surgery. After exclusion of revised patients, PROs were available for 69 (77.5%). At mean follow-up of 4.7 years (range, 2.0-12.8 years), all PROs improved significantly (P < .001). Median patient satisfaction was 9.0 (interquartile range, 8.0-10.0). Median preoperative to postoperative CCD decreased significantly (P < .001). Subgroup analyses revealed significant improvements in all PROs and CCD from preoperative to postoperative for both acute and chronic, and type III and type IV-V dislocations (P < .05) with no significant differences in postoperative PROs and satisfaction between (P > .05). CONCLUSION AA-ACCR for high-grade acromioclavicular joint injuries resulted in high postoperative PROs and patient satisfaction with significant improvements from before to after surgery in those who did not undergo revision surgery. Furthermore, subgroup analyses revealed that acute and chronic, and type III and type IV-V injuries benefitted similarly from AA-ACCR. LEVEL OF EVIDENCE Level IV; therapeutic case series.
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Panarello NM, Colantonio DF, Harrington CJ, Feeley SM, Bandarra TD, Dickens JF, Kilcoyne KG. Coracoid or Clavicle Fractures Associated With Coracoclavicular Ligament Reconstruction. Am J Sports Med 2021; 49:3218-3225. [PMID: 34494899 DOI: 10.1177/03635465211036713] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Coracoclavicular (CC) ligament reconstruction is a commonly performed procedure for high-grade acromioclavicular (AC) joint separations. Although distal clavicle and coracoid process fractures represent potential complications, they have been described in only case reports and small case series. PURPOSE To identify the incidence and characteristics of clavicle and coracoid fractures after CC ligament reconstruction. STUDY DESIGN Case series; Level of evidence, 4. METHODS The US Military Health System Data Repository was queried for patients with a Current Procedural Terminology code for CC ligament repair or reconstruction between October 2013 and March 2020. The electronic health records, including patient characteristics, radiographs, operative reports, and clinical notes, were evaluated for intraoperative or postoperative clavicle or coracoid fractures. Initial operative technique, fracture management, and subsequent clinical outcomes were reviewed for these patients. RESULTS A total of 896 primary CC ligament repairs or reconstructions were performed during the study period. There were 21 postoperative fractures and 1 intraoperative fracture in 20 patients. Of these fractures, 12 involved the coracoid and 10 involved the clavicle. The overall incidence of fracture was 3.81 fractures per 1000 person-years. In 5 patients who sustained a fracture, bone tunnels were not drilled in the fractured bone during the index procedure. A total of 17 fractures were ultimately treated operatively, whereas 5 fractures had nonoperative management. Of the 16 active-duty servicemembers who sustained intraoperative or postoperative fractures, 11 were unable to return to full military duty after their fracture care. CONCLUSION Fracture of the distal clavicle or coracoid process after CC ligament repair or reconstruction is a rare but serious complication that can occur independent of bone tunnels created during the index procedure. Fractures associated with CC ligament procedures occurred at a rate of 2.46 per 100 cases. Most patients were ultimately treated surgically with open reduction and internal fixation or revision CC ligament reconstruction. Although the majority of patients with intraoperative or postoperative fractures regained full range of motion, complications such as anterior shoulder pain, AC joint asymmetry, and activity-related weakness were common sequelae resulting in physical limitations and separation from military service.
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Affiliation(s)
- Nicholas M Panarello
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Donald F Colantonio
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Colin J Harrington
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Scott M Feeley
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Tahler D Bandarra
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Jonathan F Dickens
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Kelly G Kilcoyne
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
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Furuhata R, Matsumura N, Udagawa K, Oki S, Morioka H. Residual coracoclavicular separation after plate fixation for distal clavicle fractures: comparison between fracture patterns. JSES Int 2021; 5:840-845. [PMID: 34505093 PMCID: PMC8411066 DOI: 10.1016/j.jseint.2021.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Plate fixation is an established treatment for Neer type II and V distal clavicle fractures; however, residual coracoclavicular (C-C) separation after osteosynthesis for unstable distal clavicle fractures has rarely been discussed. This study aimed to reveal the extent of postoperative C-C separation after plate fixation for distal clavicle fractures and to evaluate the relationship between residual C-C separation and the risk of postoperative complications. Methods We retrospectively reviewed 60 patients with a displaced distal clavicle fracture that was treated with a Scorpion plate without C-C reconstruction and successfully united. Distal clavicle fractures were divided as per the Neer classification into type IIA (12 patients), IIB (36 patients), and V (12 patients) groups. The modified C-C distance ratio at the time of injury and after bone union, and the postoperative complications (plate-related pain, delayed union, infection, and contracture) were compared among the three groups. Results The mean postoperative modified C-C distance ratio was 115.0% ± 12.0%; this ratio was significantly larger in the type IIB and V groups than in the type IIA group (P = .021 and P = .006, respectively). However, there was no significant difference in the frequency of postoperative complications among the three groups. Conclusions Our study demonstrated that a certain degree of C-C separation remained after plate fixation for Neer type II and V distal clavicle fractures, even when bone union was achieved. The postoperative residual C-C separation was greater for the type IIB and V groups than for the type IIA group; however, this difference may not affect postoperative complications.
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Affiliation(s)
- Ryogo Furuhata
- Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Centre, Meguro-ku, Tokyo, Japan.,Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Noboru Matsumura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Kazuhiko Udagawa
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan.,Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Satoshi Oki
- Department of Orthopaedic Surgery, Saiseikai Utsunomiya Hospital, Utsunomiya-shi, Tochigi, Japan
| | - Hideo Morioka
- Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Centre, Meguro-ku, Tokyo, Japan
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Nie S, Lan M. Comparison of clinical efficacy between arthroscopically assisted Tight-Rope technique and clavicular hook plate fixation in treating acute high-grade acromioclavicular joint separations. J Orthop Surg (Hong Kong) 2021; 29:23094990211010562. [PMID: 33896269 DOI: 10.1177/23094990211010562] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION The purpose of this study was to compare the results of arthroscopically assisted reduction of acute acromioclavicular (AC) joint separations with the Tight-Rope technique with results of clavicular hook plate fixation. MATERIALS AND METHODS The 28 patients with acute high-grade AC joint dislocation were treated with arthroscopic assisted fixation using the Tight-Rope system, the arthroscopic evaluation and treatment of glenohumeral lesions were performed before AC ligament reconstruction. Each Tight-Rope technique group patient was matched with three controls that underwent clavicular hook plate fixation, and preoperation and postoperative visual analogue scale (VAS) and functional recovery (Constant Score) of the shoulder joint was assessed,. Furthermore, the demographics and clinical characteristics were compared between the two groups. RESULTS All patients had clinical and radiological results available at 2 years or greater (mean: 34; range: 24-72 months), they were statistically significant improvement in the constant score and VAS score at the end of follow-up respectively (P < 0.001). Compared with the clavicular hook plate group, Tight-Rope system group patients were incurred significant statistically lower skin incision, hospitalization time and estimated blood loss (P < 0.001), and the constant score and VAS score at the end of follow-up was significantly higher in the Tight-Rope group (P < 0.001). Patients who underwent clavicular hook plate had a higher incidence of fixation failure [10 cases (11.9%) versus 2 cases (7.1%)] than those of the Tight-Rope system group. CONCLUSIONS The Tight-Rope technique is advantageous for treating these patients because it is a minimally invasive procedure with low complications and superior clinical outcomes.
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Affiliation(s)
- Si Nie
- Department of Radiology, 159384Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, People's Republic of China
| | - Min Lan
- Department of Orthopedics, 159384Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, People's Republic of China
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