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Wang Y, Ren C, Niu J, Cao L, Yang C, Bi F, Tian K. Surgical treatment of acromioclavicular joint dislocation of Rockwood III/IV: a retrospective study on clavicular hook plate versus arthroscopic TightRope loop titanium button. BMC Musculoskelet Disord 2024; 25:174. [PMID: 38409002 PMCID: PMC10895789 DOI: 10.1186/s12891-024-07269-5] [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: 09/26/2023] [Accepted: 02/08/2024] [Indexed: 02/28/2024] Open
Abstract
PURPOSE To compare the clinical efficacy of arthroscopic TightRope loop titanium button and clavicular hook plate in the treatment of acromioclavicular joint (ACJ) dislocation of Rockwood III/IV. METHODS A retrospective analysis of patients with ACJ dislocation in our hospital from January 2018 to December 2020 was conducted. The patients were assigned to be treated with arthroscopic TightRope loop titanium button (TR group) or clavicular hook plate (HP group). The preoperative, intraoperative and postoperative data and imaging findings of the two groups were compared. RESULTS A total of 58 eligible patients were enrolled in this study. Compared with HP group, TR group had shorter incision length and less blood loss during operation. Postoperative follow-up ranged from 12 to 24 months (mean 15.4 months). At 6 months and 12months postoperatively, compared with HP group, TR group had lower VAS and higher CMS, and the difference was statistically significant. At 12 months postoperatively, compared with HP group, TR group had lower ACJ gap and coracoclavicular joint(CCJ) distance, and the difference was statistically significant.In HP group, there were 3 cases of subacromial impact, 1 case of redislocation, 2 cases of traumatic arthritis and 2 cases of wound infection. There was 1 case of redislocation in TR group. CONCLUSIONS Compared with clavicular hook plate, arthroscopic TightRope loop titanium button is minimally invasive, safe and effective in the treatment of ACJ dislocation, and has a good trend in clinical application.
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Affiliation(s)
- Yafei Wang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Zhengzhou University, NO.1 Jianshe East Road, Zhengzhou, 450052, China
| | - Chengzhen Ren
- Department of Orthopedic Surgery, The First Affiliated Hospital of Zhengzhou University, NO.1 Jianshe East Road, Zhengzhou, 450052, China
| | - Junqi Niu
- Department of Orthopedic Surgery, The First Affiliated Hospital of Zhengzhou University, NO.1 Jianshe East Road, Zhengzhou, 450052, China
| | - Le Cao
- Department of Orthopedic Surgery, The First Affiliated Hospital of Zhengzhou University, NO.1 Jianshe East Road, Zhengzhou, 450052, China
| | - Can Yang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Zhengzhou University, NO.1 Jianshe East Road, Zhengzhou, 450052, China
| | - Fanggang Bi
- Department of Orthopedic Surgery, The First Affiliated Hospital of Zhengzhou University, NO.1 Jianshe East Road, Zhengzhou, 450052, China
| | - Ke Tian
- Department of Orthopedic Surgery, The First Affiliated Hospital of Zhengzhou University, NO.1 Jianshe East Road, Zhengzhou, 450052, China.
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Hess S, Bütler K, Haupt S, Grehn H, Sommer C, Michelitsch C. Clavicular hook plate versus dog-bone technique for acute high-grade acromioclavicular joint dislocation: a retrospective cohort study comparing clinical outcome scores, complications, and costs. Arch Orthop Trauma Surg 2023:10.1007/s00402-023-04856-4. [PMID: 37005933 DOI: 10.1007/s00402-023-04856-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 03/20/2023] [Indexed: 04/04/2023]
Abstract
INTRODUCTION Arthroscopically assisted coracoclavicular (CC) ligament fixation techniques have been promoted as providing superior outcomes for the treatment of acute high-grade acromioclavicular joint (ACJ) dislocations. Nevertheless, there is a lack of high-level evidence for clinically relevant benefits. At our institute, orthopaedic surgeons use an arthroscopically assisted coracoclavicular ligament fixation technique (DB), while general trauma surgeons use a clavicular hook plate (cHP) technique. The aim of the study was to compare clinical outcomes, complication rates, and costs between the two groups. MATERIALS AND METHODS The hospital database was searched for patients treated for acute traumatic high-grade (Rockwood Typ ≥ III) ACJ dislocation using either a cHP or arthroscopically assisted DB technique between 2010 and 2019. Seventy-nine patients could be included (56 patients in the cHP group and 23 in the DB group). QuickDASH scores, subjective shoulder value (SSV) scores, pain scores (numerical pain rating scale 10), and complication rates were retrospectively collected through phone interviews and by screening patient charts as well as surgical reports. Costs per patient were obtained from the hospital's accounting system. RESULTS Mean follow-up was 54 ± 33.7 and 45 ± 21.7 months in the cHP and DB group, respectively. QuickDASH and SSV scores did not differ, but patients in the cHP group reported significantly lower pain scores (p = 0.033). More patients reported hypertrophic or disturbing scars (p = 0.49) and sensibility disturbances (p = 0.007) in the cHP group. Three patients suffered from a frozen shoulder in the DB group (p = 0.023). CONCLUSION Patient-reported outcomes are excellent after long-term follow-up for both techniques. There are no clinically relevant differences in clinical outcome scores based on our results and a review of the literature. Both techniques certainly have their benefits regarding secondary outcome measures. LEVEL OF CLINICAL EVIDENCE Level 3, retrospective cohort study.
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Affiliation(s)
- Silvan Hess
- Department of Trauma Surgery, Kantonsspital Graubünden, Loëstrasse 170, 7000, Chur, Switzerland.
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Graubünden, Loëstrasse 99, 7000, Chur, Switzerland.
| | - Kerstin Bütler
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Graubünden, Loëstrasse 99, 7000, Chur, Switzerland
| | - Samuel Haupt
- Department of Trauma Surgery, Kantonsspital Graubünden, Loëstrasse 170, 7000, Chur, Switzerland
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Graubünden, Loëstrasse 99, 7000, Chur, Switzerland
| | - Holger Grehn
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Graubünden, Loëstrasse 99, 7000, Chur, Switzerland
| | - Christoph Sommer
- Department of Trauma Surgery, Kantonsspital Graubünden, Loëstrasse 170, 7000, Chur, Switzerland
| | - Christian Michelitsch
- Department of Trauma Surgery, Kantonsspital Graubünden, Loëstrasse 170, 7000, Chur, Switzerland
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Okereke I, Abdelfatah E. Surgical Management of Acute Rockwood Grade III Acromioclavicular Joint Dislocations: A Systematic Review. Cureus 2022; 14:e28657. [PMID: 36196289 PMCID: PMC9525049 DOI: 10.7759/cureus.28657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2022] [Indexed: 12/01/2022] Open
Abstract
Injuries of the acromioclavicular joint (ACJ) occur frequently in young and active people. The best management of acute grade III injuries has been a source of controversy and extensive debate. When surgery is indicated, there is still no gold standard surgical technique for treating acute grade III ACJ injuries. The methodology of this review was a comprehensive search of PubMed, Medline, Cochrane, and EMBASE databases using various combinations of the keywords “Rockwood,” “type III,” “grade III,” “treatment,” “surgery,” “acromioclavicular joint,” and “dislocation,” since the inception of the databases to December 2020. Surgical techniques were divided into two groups. In group 1 were ACJ fixation techniques using hardware such as the hook plate, Kirschner wires, and wire cerclage; group 2 included coracoclavicular (CC) ligament fixation/reconstruction techniques using double buttons, TightRope®, suture anchors, Endobuttons, the Infinity-LockTM Button System, etc. Fourteen studies were selected for the final review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. This review showed better outcome scores in group 2. Overall, complication rates were higher in group 1 compared to group 2. The results of this review show that CC fixation, using suspensory or loop devices, of Rockwood grade III injuries, has better outcomes and fewer complications than fixation of the ACJ with hardware.
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Hu F, Han S, Liu F, Wang Z, Jia H, Wang F, Hu L, Chen J, Wang B, Yang Y. A modified single-endobutton technique combined with nice knot for treatment of Rockwood type III or V acromioclavicular joint dislocation. BMC Musculoskelet Disord 2022; 23:15. [PMID: 34980065 PMCID: PMC8725473 DOI: 10.1186/s12891-021-04915-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 11/24/2021] [Indexed: 02/08/2023] Open
Abstract
PURPOSE Double-endobutton technique, as a widely accepted strategy for the treatment of acromioclavicular joint dislocation, is undergoing constant improvement. This study aims to assess the clinical effect of a modified single-endobutton combined with the nice knot in the fixation of Rockwood type III or V acromioclavicular joint dislocation. METHODS From January 2016 to June 2019, 16 adult patients (13 males and 3 females) with Rockwood type III or V acromioclavicular joint dislocation were treated with a modified single-endobutton technique combined with the nice knot in our department. The age ranged from 18 to 64 years old with an average of 32.8 years old. Operative time, intraoperative blood loss, post-operative clinical outcomes and radiographic results were recorded and analyzed. Preoperative and last follow-up scores in the Constant-Murley Scale, Neer score, Rating Scale of the American Shoulder and Elbow Surgeons and VAS scale and complications such as infection, re-dislocation, implant loosening, medical origin fracture and hardware pain were recorded and evaluated. RESULTS Sixteen patients were followed up for 6 to 18 months with an average of 10.3 months. The operative time was 50-90 min with an average of (62.5 ± 3.10) min. The intraoperative blood loss was 30-100 ml, with an average of (55.0 ± 4.28) ml. The complications, such as wound infection, internal fixation failure and fractures, were not found in these cases. According to Karlsson criteria, there were excellent in 14 cases, good in 2 cases at the final follow-up. The mean VAS score of the patients was 5.88 ± 0.26 preoperatively, compared with 0.19 ± 0.14 at the final follow-up evaluation. The difference was statistically significant (P < 0.05). The mean Constant score was 45.5 ± 2.0 preoperatively, compared to 94.0 ± 0.73 at the final follow-up evaluation. The difference was statistically significant (P < 0.05). Patients had statistically significant preoperative and postoperative AC (acromioclavicular distance) and CC (coracoclavicular distance) distances (P < 0.05); 6 months postoperatively the AC(P = 0.412) and CC(P = 0.324) distances were not statistically significant compared to the healthy side. CONCLUSION Nice knot provides a reliable fixation for the single-endobutton technique in the treatment of acromioclavicular dislocations. The modified single-endobutton technique combined with the nice knot can achieve good clinical outcomes in the treatment of Rockwood type III or V acromioclavicular joint dislocation.
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Affiliation(s)
- Fangning Hu
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong Province, China
| | - Shumei Han
- Department of Radiotherapy, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Fanxiao Liu
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong Province, China
| | - Zhuang Wang
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong Province, China
| | - Honglei Jia
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong Province, China
| | - Fu Wang
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong Province, China
| | - Lingfei Hu
- Department of Emergency surgery, Linyi People's Hospital, Shandong First Medical University and Shandong Academy of Medical Sciences, Linyi, Shandong Province, China
| | - Jing Chen
- Department of Emergency surgery, Linyi People's Hospital, Shandong First Medical University and Shandong Academy of Medical Sciences, Linyi, Shandong Province, China
| | - Bomin Wang
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong Province, China.
- Department of Hemodialysis, Linyi People's Hospital, Shandong First Medical University and Shandong Academy of Medical Sciences, Linyi, Shandong Province, China.
| | - Yongliang Yang
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong Province, China.
- Department of Hemodialysis, Linyi People's Hospital, Shandong First Medical University and Shandong Academy of Medical Sciences, Linyi, Shandong Province, China.
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Qi J, Fu S, Ping R, Wu K, Feng Z, Xu Y, Guo X, Lin D, Zhang L. Biomechanical testing of three coracoclavicular ligament reconstruction techniques with a 3D printing navigation template for clavicle-coracoid drilling. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1121. [PMID: 34430562 PMCID: PMC8350707 DOI: 10.21037/atm-21-737] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 06/10/2021] [Indexed: 11/07/2022]
Abstract
Background The identification and precise clavicle-coracoid drilling during coracoclavicular (CC) ligament reconstruction for acromioclavicular (AC) joint dislocation require a high level of experience and surgical skills. Furthermore, the improvement of flexible fixation, such as Endobutton techniques for CC ligament reconstructions is ongoing. We have developed a 3D printing technique navigation template for clavicle-coracoid drilling and a novel implant for the reconstruction. This study aimed to determine the efficiency of the navigation template for clavicle-coracoid drilling and to evaluate the biomechanical performance of the novel CC ligament reconstruction technique. Methods A total of 24 fresh-frozen human cadaveric shoulders were randomly assigned to 1 of 3 reconstruction groups or a control group: TightRope, Triple Endobutton, and the Adjustable Closed-Loop Double Endobutton technique. Computed tomography scans, navigation template designs, and 3D printing were performed for the shoulders. Then, AC joint dislocation was simulated in the reconstruction groups, and 3 CC ligament reconstruction techniques were operated via the 3D printing template separately. Furthermore, biomechanical protocols including the translation test (load from 5 to 70 N) and the load-to-failure test were performed to characterize the behaviors and strengths. One-way ANOVA test analyzed differences in displacement under the translation load and the load at failure. Results CC ligament reconstructions were performed successfully along with the 3D printing navigation template in the 3 reconstruction groups. During the translation test, no significant difference was found in displacements among the 4 groups. Meanwhile, the mean load of all reconstruction groups at failure (Adjustable Closed-Loop Double Endobutton, 722.1620 N; TightRope, 680.4020 N; Triple Endobutton, 868.5762 N) was significantly larger than the control group (564.6264 N, P<0.05). The Triple Endobutton group had the maximum load at failure (P<0.05), however, no significant difference was noticed between the other 2 reconstruction groups (P>0.05). Conclusions The 3D printing navigation template may become helpful and reliable for AC joint dislocation surgery. Among the 3 CC ligament reconstruction techniques, the Triple Endobutton technique has the best strength in terms of biomechanics, while the biomechanical strength of the Adjustable Closed-Loop Double Endobutton technique is reliable in comparison with the TightRope technique.
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Affiliation(s)
- Ji Qi
- Department of Orthopaedics, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China.,Wang Jing Hospital of China Academy of Chinese Medical Sciences, Beijing, China.,The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China.,Postdoctoral Research Station, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Shijie Fu
- Department of Orthopaedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China.,Center for Orthopaedic Diseases Research, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, 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.,Expert Workstation in Luzhou, Luzhou, China
| | - Ruiyue Ping
- Department of Orthopaedics, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China.,The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Kai Wu
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ziyu Feng
- Southern Medical University, Guangzhou, China
| | | | - Xiaoguang Guo
- Department of Orthopaedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
| | - Dingkun Lin
- Department of Orthopaedics, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China.,The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lei Zhang
- Department of Orthopaedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China.,Center for Orthopaedic Diseases Research, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, 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.,Expert Workstation in Luzhou, Luzhou, China
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6
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Ruiz Ibán MA, Moreno Romero MS, Diaz Heredia J, Ruiz Díaz R, Muriel A, López-Alcalde J. The prevalence of intraarticular associated lesions after acute acromioclavicular joint injuries is 20%. A systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2021; 29:2024-2038. [PMID: 32179968 DOI: 10.1007/s00167-020-05917-6] [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] [Received: 09/02/2019] [Accepted: 02/24/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE To synthesise the evidence on the prevalence of associated intraarticular lesions in subjects with acute acromioclavicular joint (ACJ) dislocations. METHODS A search in two electronic databases (PUMBMED and EMBASE) was performed from 1985 to 2019. Two independent reviewers selected studies that complied with the following inclusion criteria: (1) the study included data on surgically treated ACJ dislocation grade III-V in the Rockwood classification, (2) the ACJ injuries were acute (the surgery was performed less than 6 weeks after injury), (3) an arthroscopic evaluation of the glenohumeral joint was performed during surgery. The quality of the studies included was assessed using the tool of the Joanna Briggs Institute. RESULTS A total of 47 studies with acute ACJ injuries met the initial inclusion criteria. Of these, 21 studies (9 retrospective case series, 9 prospective case series and 3 retrospective cohort studies) presented data on associated intraarticular lesions amenable for use in the meta-analysis. The meta-analysed studies included a total of 860 subjects with acute ACJ dislocations with a male/female ratio of 6.5 and a mean age of 32 years. The meta-analysis showed a prevalence of associated intraarticular lesions in subjects with acute ACJ of 19.9% (95% confidence interval [CI] 14.0-26.4%; 21 studies, 860 analysed participants; P = 0.000; I2: 74.5% random-effects model; low risk of bias). CONCLUSION One in five subjects with surgically treated acute ACJ dislocations will have an associated intraarticular lesion that requires further intervention. The case for a customary arthroscopic evaluation of the joint, even when an open procedure is performed to deal with the ACJ dislocation, is strong. Level of evidence IV Trial registry Systematic review registration number: PROSPERO CRD42018090609.
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Affiliation(s)
- Miguel Angel Ruiz Ibán
- Unidad de Hombro Y Codo, Hospital Universitario Ramón Y Cajal, Cta Colmenar km 9,100, Madrid, Spain.
| | | | - Jorge Diaz Heredia
- Unidad de Hombro Y Codo, Hospital Universitario Ramón Y Cajal, Cta Colmenar km 9,100, Madrid, Spain
| | - Raquel Ruiz Díaz
- Unidad de Hombro Y Codo, Hospital Universitario Ramón Y Cajal, Cta Colmenar km 9,100, Madrid, Spain
| | - Alfonso Muriel
- Unidad de Bioestadística Clínica, Hospital Ramón Y Cajal, IRYCIS, CIBERESP, Madrid, Spain.,Departamento de Enfermería, Universidad de Alcalá, Madrid, Spain
| | - Jesus López-Alcalde
- Unidad de Bioestadística Clínica, Hospital Ramón Y Cajal, IRYCIS, CIBERESP, Madrid, Spain.,Faculty of Health Sciences, Universidad Francisco de Vitoria (UFV)-Madrid, Madrid, Spain.,Cochrane Associate Centre of Madrid, Madrid, Spain
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Franovic S, Pietroski A, Kuhlmann N, Bazzi T, Zhou Y, Muh S. Rockwood Grade-III Acromioclavicular Joint Separation: A Cost-Effectiveness Analysis of Treatment Options. JB JS Open Access 2021; 6:JBJSOA-D-20-00171. [PMID: 34056509 PMCID: PMC8154465 DOI: 10.2106/jbjs.oa.20.00171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: The treatment of Rockwood Grade-III acromioclavicular (AC) joint separation has been widely disputed since the introduction of the classification system. The present literature does not reach consensus on whether operative or nonoperative management is more advantageous, nor does it effectively distinguish between operative measures. We hypothesized that nonoperative treatment of Rockwood Grade-III AC joint separation would be more cost-effective when compared with surgical options. Methods: We created a decision-tree model outlining the treatment of Rockwood Grade-III separations using nonoperative management or hook-plate, suture-button, or allograft fixation. After nonoperative intervention, the possible outcomes predicted by the model were uneventful healing, delayed operative management, a second round of sling use and physical therapy, or no reduction and no action; and after operative intervention, the possible outcomes were uneventful healing, loss of reduction and revision, and depending on the implant, loss of reduction and no action, or removal of the implant. A systematic review was conducted, and probabilities of each model state were averaged. A cost-effectiveness analysis was conducted both through rollback analysis yielding net monetary benefit and through incremental cost-effectiveness ratios (ICERs). Thresholds of $50,000/quality-adjusted life-year (QALY) and $100,000/QALY were used for ICER analysis. Furthermore, a sensitivity analysis was utilized to determine whether differential probabilities could impact the model. Results: Forty-five papers were selected from a potential 768 papers identified through our literature review. Nonoperative treatment was used as our reference case and showed dominance over all 3 of the operative measures at both the $50,000 and $100,000 ICER thresholds. Nonoperative treatment also showed the greatest net monetary benefit. Nonoperative management yielded the lowest total cost ($6,060) and greatest utility (0.95 QALY). Sensitivity analysis showed that allograft fixation became the favored technique at a willingness-to-pay threshold of $50,000 if the rate of failure of nonoperative treatment rose to 14.6%. Similarly, at the $100,000 threshold, allograft became dominant if the probability of failure of nonoperative treatment rose to 22.8%. Conclusions: The cost-effectiveness of nonoperative treatment is fueled by its notably lower costs and overall high rates of success in Grade-III separations. It is important to note that, in our analysis, the societal cost (measured in lost productivity) of nonoperative treatment neared that of surgical treatment, but the cost from the health-care system perspective was minimal. Physicians should bear in mind the sensitivity of these conclusions and should consider cost-effectiveness analyses in their decision-making guidelines. Level of Evidence: Economic and Decision Analysis Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Sreten Franovic
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan
| | - Alex Pietroski
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan
| | - Noah Kuhlmann
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan
| | - Talal Bazzi
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan
| | - Yang Zhou
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan
| | - Stephanie Muh
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan
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8
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Lloyd AJ, Hurley ET, Davey MS, Pauzenberger L, Mullet H. Arthroscopic Suture-Button Versus Hook-Plate Fixation for Acromioclavicular Joint Injuries-A Systematic Review of Comparative Studies. Arthrosc Sports Med Rehabil 2020; 2:e671-e676. [PMID: 33135009 PMCID: PMC7588637 DOI: 10.1016/j.asmr.2020.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 07/03/2020] [Indexed: 01/16/2023] Open
Abstract
Purpose To systematically review the comparative studies in the literature to compare joint stability, clinical outcomes, and complications of acromioclavicular joint fixation using a hook plate versus arthroscopic suture-button (SB) fixation. Methods A literature search was performed in accordance with the PRISMA guidelines to identify clinical studies comparing the hook plate and arthroscopic SB techniques for acromioclavicular joint injuries. Qualitative statistical analysis was performed using SPSS, and a P value of ≤.05 was considered to be statistically significant. Results Six clinical studies including 285 patients were included in the systematic review. In 3 of the studies, there was a significant difference in favor of SB for Constant score. Patients treated with the SB technique had a lower visual analog scale score at final follow-up in 2 of the 4 studies that measured this outcome. In addition, there were no significant difference in the rate of complications, revisions, or joint malreduction in any of the included studies. Conclusions The arthroscopic SB procedure resulted in lower postoperative pain scores, and improved postoperative functional outcomes, although this was not a clinically significant difference. In addition, there were no significant differences in the rate of complications, revisions, or joint malreduction. Level of Evidence Level III, systematic review of Level I, II, and III studies.
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Affiliation(s)
- Angus J. Lloyd
- Sports Surgery Clinic, Santry, Dublin, Ireland
- Department of Trauma & Orthopaedic Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Eoghan T. Hurley
- Sports Surgery Clinic, Santry, Dublin, Ireland
- Department of Trauma & Orthopaedic Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
- Address correspondence to Eoghan T. Hurley, M.B., B.Ch., M.Ch., Sports Surgery Clinic, Santry, Dublin, Ireland.
| | - Martin S. Davey
- Sports Surgery Clinic, Santry, Dublin, Ireland
- Department of Trauma & Orthopaedic Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
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9
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Taleb H, Afshar A, Shariyate MJ, Tabrizi A. Comparison of Short-Term Clinical Outcomes of Hook Plate and Continuous Loop Double Endobutton Fixations in Acute Acromioclavicular Joint Dislocation. THE ARCHIVES OF BONE AND JOINT SURGERY 2019; 7:545-550. [PMID: 31970260 PMCID: PMC6935518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 01/28/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND This study was conducted to evaluate the clinical outcomes of the acromioclavicular joint (ACJ) fixation with hook plate (HP) and continuous loop double endobutton fixation (CLDE) in the treatment of acute ACJ dislocation. METHODS This retrospective study was conducted on eight patients with HP and nine patients with CLDE fixations for acute ACJ dislocations. The subjects were evaluated by various criteria, including disabilities of the Arm, Shoulder, and Hand (DASH), American Shoulder and Elbow Surgeons Standardized Shoulder Assessment (ASES), University of California, Los Angeles (UCLA) shoulder rating scale, Shoulder Constant score, Simple Shoulder Test (SST), and coracoclavicular (CC) distance. RESULTS The differences between the mean scores of the visual analog scale for pain, DASH, ASES, UCLA shoulder rating scale, and Shoulder Constant, and SST were statistically significant in favor of the CLDE group. Mean difference of CC distance was 8.6±0.9 mm in the HP group; however, it was 11.6±1.2 mm in the CLDE group. The operation time was shorter in the HP fixation, compared to that in the CLDE fixation (51±13.3 versus 105±9.7 min; P<0.001 and P=0.008). There were six concomitant subacromial erosions and osteoarthritis in the ACJ of the HP group. CONCLUSION The CLDE fixation was reported with better clinical outcomes than HP fixation; however, it was a technically demanding procedure. The HP maintained the CC distance better than CLDE with a technically easy application. The HP requires a second surgery for the removal and development of subacromial erosion and osteoarthritis of the ACJ that can be regarded as major concerns.
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Affiliation(s)
- Hasan Taleb
- Department of Orthopedics, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran
- Clinical Research Development Unit of Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran
- Department of Orthopedics, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran
- Research performed at Department of Orthopedics, Urmia University f Medical Sciences, Urmia, Iran
| | - Ahmadreza Afshar
- Department of Orthopedics, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran
- Clinical Research Development Unit of Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran
- Department of Orthopedics, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran
- Research performed at Department of Orthopedics, Urmia University f Medical Sciences, Urmia, Iran
| | - Mohammad J Shariyate
- Department of Orthopedics, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran
- Clinical Research Development Unit of Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran
- Department of Orthopedics, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran
- Research performed at Department of Orthopedics, Urmia University f Medical Sciences, Urmia, Iran
| | - Ali Tabrizi
- Department of Orthopedics, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran
- Clinical Research Development Unit of Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran
- Department of Orthopedics, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran
- Research performed at Department of Orthopedics, Urmia University f Medical Sciences, Urmia, Iran
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