Comparison of the Radiological and Functional Results of Tight Rope and Clavicular Hook Plate Technique in the Treatment of Acute Acromioclavicular Joint Dislocation

PURPOSE/AIM

Options for surgery for acromioclavicular (AC) joint dislocation vary considerably. This study aimed to examine the functional and radiological results of patients who were operated on using the tightrope (TR) or clavicular hook plate (CHP) technique in the treatment for AC joint dislocation. Materials and methods: The data gathered from 35 consecutive patients who were operated on for AC joint dislocation were analyzed retrospectively in terms of their radiological and functional outcomes. Results: Thirty-two (91.4%) of the 35 patients were male and 3 (8.6%) were female. Thirty (85.7%) patients were classified as Rockwood type 3 and 5 (14.3%) as type 5. Twenty-one patients operated on using the TR technique were categorized as group 1, and 14 patients treated with the CHP technique formed group 2. Functional results were evaluated using the Constant-Murley shoulder scoring system; no statistically significant difference was observed between type 3 and 5 AC separation (p = 0.337). The mean Constant scores of type 3 and 5 injuries were 82.96 and 88.6, respectively. A significant relationship was noted between reduction quality and functional scores (p = 0.006). Postoperative osteoarthritis was seen in 12 (57.14%) patients in group 1 and 7 (50.00%) patients in group 2. In terms of surgery duration, 50.57 minutes in group 1 and 35.71 minutes in group 2 were noted. A statistically significant difference was found between the two groups in terms of surgery duration (p < 0.05). Conclusions: TR and CHP techniques, which do not differ significantly in terms of their clinical results, can be used safely in the treatment of AC separation.

Acromioclavicular joint injuries: Imaging and management

Acromioclavicular joint injuries are commonly encountered in the setting of shoulder trauma. Knowledge of the anatomy and biomechanics of the joint, grading of joint injuries, and understanding the capabilities and limitations of different radiological modalities will help in selecting the best management option and outcomes for affected patients.

The suprascapular nerve and its articular branch to the acromioclavicular joint: an anatomic study

HYPOTHESIS

The suprascapular nerve and its articular branch innervate the acromioclavicular (AC) joint. Documenting the detailed anatomy of this innervation in the AC joint, including the pertinent surgical and anatomic relationships of the suprascapular nerve and its branches to the AC joint, will aid in the prevention of injury and the reduction of risk of denervation during shoulder surgery.

MATERIALS AND METHODS

Twelve shoulders from 6 embalmed human cadavers were bilaterally dissected to study the course of the suprascapular nerve and its motor and sensory branches.

RESULTS

The sensory branch runs superiorly to the supraspinatus muscle towards the AC joint. The average distance from the supraglenoid tubercle to the nerve at the coracoid base was 15 mm. The average distance from the coracoclavicular ligaments to the nerve at the coracoid base was 6 mm. The average distance from the spinoglenoid notch to the sensory branch at the suprascapular notch was 22 mm. The average length of the sensory branch was 30 mm. In half of the specimen shoulders, the suprascapular artery accompanied the nerve at the suprascapular notch under the transverse scapular ligament.

DISCUSSION

The innervation of the AC joint by the suprascapular nerve has been described, along with pertinent distances to anatomic landmarks. The sensory branch of the suprascapular nerve, which passed through the scapular notch inferior to the transverse scapular ligament, was found in 100% of the study specimens.

CONCLUSION

The sensory branch of the suprascapular nerve runs superiorly to the supraspinatus muscle towards the AC joint. The detailed information can be used to help decrease the risk of nerve injury during shoulder surgery and to aid in effectively diagnosing and treating AC joint-related disorders.

Biomechanical comparison of acromioclavicular joint reconstructions using coracoclavicular tendon grafts with and without coracoacromial ligament transfer

PURPOSE

The purpose of this study was to compare the initial strength of acromioclavicular joint reconstructions using coracoclavicular (CC) tendon grafts with and without coracoacromial (CA) ligament transfers.

METHODS

Two different acromioclavicular joint reconstructions were performed in 7 matched pairs of cadaveric shoulders. Paired shoulders were repaired with either a hamstring allograft CC reconstruction (group 1) or a hamstring allograft CC reconstruction plus a CA ligament transfer (group 2). Intact specimens and then reconstructions were cycled from 0 to 100 N at 1 Hz for 100 cycles in a superior direction, and displacements were recorded. Finally, the stiffness of the reconstructions and the ultimate load to failure were recorded.

RESULTS

Superior displacement of the reconstructions after cyclic loading was 4.43 ± 1.82 mm in group 1 and 3.75 ± 1.56 mm in group 2 (P = .38). Ultimate load after load to failure was 970.3 ± 361.03 N in group 1 and 952.7 ± 296.89 N in group 2 (P = .94). Finally, stiffness of the reconstructions was 50.6 ± 6.14 N/mm in group 1 and 65.6 ± 18.45 N/mm in group 2 (P = .12).

CONCLUSIONS

The addition of a transfer of the CA ligament to an acromioclavicular joint reconstruction with a CC hamstring graft does not appear to significantly improve its overall initial biomechanical strength.

CLINICAL RELEVANCE

These data suggest that a CA ligament transfer may add very little to a CC tendon graft reconstruction augmented with high-strength suture with regard to initial, time zero displacement and strength.