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Marsalli M, Bistolfi G, Morán N, Cartaya M, Urquidi C. High Early-onset acromioclavicular secondary pathologies after acute arthroscopic joint reduction: a cohort study. Arch Orthop Trauma Surg 2022; 142:1623-1631. [PMID: 34415372 DOI: 10.1007/s00402-021-04123-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 08/12/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE The research aim was to determine the prevalence and risk factors of early secondary acromioclavicular (AC) joint disease in patients undergoing acute arthroscopic AC joint reduction and fixation and early complications of acute surgical treatment in patients with high-grade AC joint dislocation. METHODS Overall, 102 patients diagnosed with Rockwood type V AC joint dislocation and undergoing arthroscopic coracoclavicular fixation were included. Early clinical and radiological complications were evaluated, as well as risk factors of secondary AC joint pathology. RESULTS Twenty-nine patients (28%) presented with a secondary AC joint pathology, with 24 and 5 cases of osteolysis and osteoarthritis, respectively. The main complication was a loss of reduction of ≥ 1 mm (78%). Patients aged > 55 years were more likely to develop a secondary AC joint disease (odds ratios (OR) = 10.1, 95% confidence interval (CI): 1.42 - 72.55, p = 0.021). Patients with osteolysis (OR = 3.2, 95% CI 1.16 - 9.27, p = 0.025) or loss of reduction of > 5 mm (OR = 7.4, 95% CI 2.31 - 24.08, p = 0.001) were more likely to develop AC joint pain. Patients with an initial over-reduction were less likely to develop a subluxated AC joint (OR = 0.033, 95% CI 0.0021-0.134, p = 0.001) CONCLUSION: Age > 55 years and female sex were identified as risk factors of early-onset secondary AC joint disease. Osteolysis and a loss of reduction of > 5 mm were risk factors of AC joint pain but not of revision surgery. The main early complication was a loss of reduction of ≥ 1 mm. An initial over-reduction of the distal clavicle was a protective factor to avoid AC joint subluxation.
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Affiliation(s)
- Michael Marsalli
- Department of Shoulder Surgery, Hospital del Trabajador, Santiago, Chile.,Department of Orthopedic Surgery, Clínica Universidad de Los Andes, Santiago, Chile
| | - Gianfranco Bistolfi
- Department of Epidemiology and Health Studies, Faculty of Medicine, Universidad de Los Andes, Santiago, Chile.
| | - Nicolás Morán
- Department of Shoulder Surgery, Hospital del Trabajador, Santiago, Chile
| | - Marco Cartaya
- Department of Shoulder Surgery, Hospital del Trabajador, Santiago, Chile
| | - Cinthya Urquidi
- Department of Epidemiology and Health Studies, Faculty of Medicine, Universidad de Los Andes, Santiago, Chile
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BASILGAN S, EKEN G. Comparison of trans-articular Kirschner wire fixation and TightRope System for the treatment of acromioclavicular joint injuries. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2021. [DOI: 10.32322/jhsm.948045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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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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Short-term clinical and radiological outcomes of treatment of acromioclavicular joint dislocations with the TightRope technique. JOURNAL OF SURGERY AND MEDICINE 2021. [DOI: 10.28982/josam.893296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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The Infinity-Lock System for Chronic Grade III AC Joint Dislocation: A Novel Technique, Rehabilitation Protocol and Short Term Results. J Clin Med 2020; 9:jcm9082519. [PMID: 32764304 PMCID: PMC7464969 DOI: 10.3390/jcm9082519] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 07/27/2020] [Indexed: 12/17/2022] Open
Abstract
Background: the choice of treatment of chronic grade III acromioclavicular (AC) joint dislocation is controversial. Several surgical techniques have been described in the literature, responding differently to nonoperative treatment. The aim of this study is to describe a modified technique of stabilizing an AC joint dislocation with the new Infinity-Lock Button System, in order to demonstrate that it is effective in optimizing outcomes and decreasing complications. Methods: this is a retrospective study of 15 patients who underwent surgical stabilization of the AC joint dislocation between 2018 and 2019, through modified surgical technique using the Infinity-Lock Button System. Active range of motion (ROM), Specific Acromio Clavicular Score (SACS) and Constant Score (CS) were evaluated preoperatively and postoperatively at last 18 months follow up. Patients rated their outcomes as very good, good, satisfactory, or unsatisfactory. Results: a total of twelve patients rated their outcome as very good and three as good; no patients were dissatisfied with surgery. The mean Constant Score increased from 38 points preoperatively to 95 postoperatively, the average SACS score decreased from 52 points preoperatively to 10 postoperatively, both significantly. No complications were detected. Conclusion: the described technique is effective for treatment of chronic grade III AC joint dislocation, resulting in elevated satisfaction ratings and predictable outcomes. Nevertheless, further longer term follow-up studies are required.
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Abstract
Background The arthroscopic approach to acromioclavicular (AC) dislocation with methods such as AC TightRope fixation has reported radiographic failure rates between 18% and 50% with functional results graded as good or excellent. Our objective was to review the outcomes after arthroscopic fixation for acute AC joint dislocation using the TightRope device. Methods We reviewed the records of 52 patients, with a mean age of 31 years, who underwent arthroscopic fixation with the TightRope device for acute AC joint dislocation. Outcomes were evaluated using the Constant and University of California, Los Angeles scores. The coracoclavicular (CC) distance before and after surgery was compared by radiography. Results The mean follow-up period was 36.7 months (range, 6-65 months). Postoperatively, the mean Constant score was 97.13 and the mean University of California, Los Angeles score was 33.2. The CC distance was maintained in 73% of the patients, whereas partial loss of reduction occurred in 19.2% and failure of reduction occurred in 7.7%. Conclusion Arthroscopic fixation using the TightRope device for acute AC joint dislocation achieves satisfactory clinical outcomes. However, CC reconstruction appears to result in subluxation in cases with AC dislocation for a period of more than 10 days.
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Biomechanical Analysis of Single-, Double-, and Triple-Bundle Configurations for Coracoclavicular Ligament Reconstruction Using Cortical Fixation Buttons With Suture Tapes: A Cadaveric Study. Arthroscopy 2018; 34:2983-2991. [PMID: 30292596 DOI: 10.1016/j.arthro.2018.06.048] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 06/18/2018] [Accepted: 06/25/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the acromioclavicular (AC) joint stability of single-bundle (SB), double-bundle with an anterolateral limb (DBa), double-bundle with a posterolateral limb (DBp), and triple-bundle (TB) coracoclavicular (CC) ligament reconstructions using cortical fixation buttons with suture tapes. METHODS Eight cadaveric shoulders were used. AC joint translation and rotational stability were tested for intact and following 4 different CC reconstruction techniques: SB, DBa, DBp, and TB configurations using cortical fixation buttons with suture tapes. For each reconstruction and native AC joint as control, anteroposterior (AP) and superoinferior translations were quantified using 10- and 15-N translational loads and anterior and posterior rotations were measured using 0.16- and 0.32-Nm rotational torque. RESULTS DBp reconstruction showed significantly better AP stability compared with SB and DBa reconstruction at 10 and 15 N (DBp: 4.1 ± 0.6 mm, SB: 7.8 ± 1.1 mm, P < .001; DBa: 6.5 ± 0.7 mm, P = .02 at 10 N; DBp: 5.5 ± 0.8 mm, SB: 10.1 ± 1.0 mm, P = .003; DBa: 9.1 ± 0.7 mm, P = .02 at 15 N). The degree of total rotation showed tendency to decrease according to increasing number of bundles; however, there were no significant differences (SB: 43.1 ± 9.2°, DBa: 37.9 ± 7.3°, DBp: 33.9 ± 6.8°, TB: 32.2 ± 6.6°, P = .37 at 0.32 Nm). CONCLUSIONS An additional posterolateral clavicular hole for CC ligament reconstruction using cortical fixation buttons with suture tapes resulted in better AP stability compared with SB reconstruction, whereas use of additional anterolateral clavicular hole did not show any improvement compared with SB reconstruction. Reconstruction using both anterolateral and posterolateral clavicular holes did not guarantee better stability compared with SB reconstruction. There was an increasing tendency of rotational stability with number of bundle increases, although they did not reach statistical difference. CLINICAL RELEVANCE When surgeons consider double-bundle CC ligament reconstruction using cortical fixation buttons with suture tapes, it is better to position the lateral clavicular hole posteriorly to restore AP stability.
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Chahla J, Cinque ME. Editorial Commentary: Double Bundle the Coracoclavicular Ligaments for Success: The More the Better? Arthroscopy 2018; 34:2992-2993. [PMID: 30392683 DOI: 10.1016/j.arthro.2018.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 08/22/2018] [Accepted: 08/24/2018] [Indexed: 02/02/2023]
Abstract
Injuries to the acromioclavicular joint are common across all levels of sport and activity. Overall, a consensus exists regarding Rockwood grade I and II injuries (conservative approach) and Rockwood grades IV to VI (best treated surgically). However, grade III injuries are heterogeneous and thus respond differently to nonoperative and operative treatment. Regardless of the acromioclavicular injury grade, these are widely prevalent injuries, and there is a lack a consensus as to which operative fixation methods yield the best outcomes for patients. Although K-wires and plates were historically used to achieve rigid fixation, recent evidence supports the use of soft tissue grafts to reconstruct the coracoclavicular ligaments and restore vertical and anteroposterior and rotational stability with a more biological approach.
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Tiefenboeck TM, Boesmueller S, Popp D, Payr S, Joestl J, Binder H, Schurz M, Komjati M, Fialka C, Ostermann RC. The use of the LARS system in the treatment of AC joint instability - Long-term results after a mean of 7.4 years. Orthop Traumatol Surg Res 2018; 104:749-754. [PMID: 29581067 DOI: 10.1016/j.otsr.2018.02.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 02/16/2018] [Accepted: 02/27/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND The acromioclavicular (AC) joint is of great importance for shoulder stability and one of the most frequently injured regions of the shoulder. HYPOTHESIS AC joint reconstruction with the ligament augmentation & reconstruction system (LARS™) leads to a good-to-excellent outcome at long-term follow-up. PATIENTS AND METHODS This study was performed as a retrospective single-centre data analysis of a level-I trauma centre. All patients treated operatively for an acute AC dislocation with the LARS™ between 2003 and 2013 were included. RESULTS The study group consisted of three female (6%) and 44 male patients (94%) with an average age of 37 years and a minimum follow-up of two years. The overall mean clinical outcomes at latest follow-up were: Constant 93, DASH 2.64, ASES 96, SST 97, UCLA 34 and VAS 0.4-representing a good-to-excellent outcome in all patients. Overall, 45 patients (96%) reported to be very satisfied with the achieved result at latest follow-up. In five patients, (11%) complications occurred during the follow-up period, requiring surgical revision in four of the five patients (80%). CONCLUSION AC joint reconstruction with the LARS™ achieves good-to-excellent clinical and functional outcomes at long-term follow-up with a surgical revision rate of 8.5%. LEVEL OF EVIDENCE Retrospective follow-up study, case series, level IV.
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Affiliation(s)
- T M Tiefenboeck
- Medical University of Vienna, Department of Orthopedics and Trauma Surgery, Division of Trauma Surgery, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | | | - D Popp
- Medical University of Vienna, Department of Orthopedics and Trauma Surgery, Division of Trauma Surgery, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - S Payr
- Medical University of Vienna, Department of Orthopedics and Trauma Surgery, Division of Trauma Surgery, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - J Joestl
- Medical University of Vienna, Department of Orthopedics and Trauma Surgery, Division of Trauma Surgery, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - H Binder
- Medical University of Vienna, Department of Orthopedics and Trauma Surgery, Division of Trauma Surgery, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - M Schurz
- Medical University of Vienna, Department of Orthopedics and Trauma Surgery, Division of Trauma Surgery, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - M Komjati
- Department of Orthopaedics, Hospital of sacred Heart of Jesus, 1030 Vienna, Austria
| | - C Fialka
- AUVA Trauma Center Meidling, Vienna, Austria; Sigmund Freud University, 1020 Vienna, Austria
| | - R C Ostermann
- Medical University of Vienna, Department of Orthopedics and Trauma Surgery, Division of Trauma Surgery, Waehringer Guertel 18-20, 1090 Vienna, Austria
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Kay J, Memon M, Alolabi B. Return to Sport and Clinical Outcomes After Surgical Management of Acromioclavicular Joint Dislocation: A Systematic Review. Arthroscopy 2018; 34:2910-2924.e1. [PMID: 30173912 DOI: 10.1016/j.arthro.2018.04.027] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 03/18/2018] [Accepted: 04/16/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the rate at which athletes return to sport after surgical management of acute and chronic acromioclavicular (AC) joint dislocations. METHODS Three databases-PubMed, MEDLINE, and EMBASE-were searched from database inception until October 28, 2017, by 2 reviewers independently and in duplicate. The inclusion criteria were English language studies that reported return to sport outcomes in patients undergoing surgical management of AC joint dislocations. RESULTS Overall, 12 studies with a combined total of 315 patients met the inclusion criteria, with a mean age of 33.8 years (range, 18-65 years) and a mean follow-up of 34.9 months (range, 6-126 months). Of the 12 included studies, 1 was a prospective comparative study (Level II), 1 was a retrospective comparative study (Level III), 1 was a prospective case series (Level IV), and 9 were retrospective case series (Level IV). The rates of return to any level of sport ranged from 94% to 100% (I2 = 0%), whereas the rates of return to the preinjury level of sport ranged from 62% to 100% (I2 = 61%). The pooled rate of return to preinjury level of sport in type V AC joint separations was 86.2% (95% confidence interval = 68.1%-98.0%), whereas that after type III or IV AC joint injuries was 89.6% (95% confidence interval = 79.9%-96.9%). CONCLUSIONS An almost perfect rate of return to sport participation after surgical management of AC joint dislocations have been reported, with most returning to their preinjury level of sport. The rates of return to sport were comparable across the different types of injuries and surgical procedures. LEVEL OF EVIDENCE Level IV, systematic review of Level II, III, and IV investigations.
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Affiliation(s)
- Jeffrey Kay
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
| | - Muzammil Memon
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Bashar Alolabi
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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Kapil-Mani KC, Niroula A. Acromio-Clavicular Joint Dislocation Types IV to VI: Does the Outcome with the modified Weaver-Dunn Procedure Justify the Treatment? Malays Orthop J 2018; 12:31-36. [PMID: 30112126 PMCID: PMC6092530 DOI: 10.5704/moj.1807.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Introduction: The optimal surgical treatment for acromioclavicular joint (ACJ) injuries remains controversial. The modified Weaver-Dunn (WD) procedure is one of the frequently used techniques. Recently when it was compared with anatomical autogenous tendon graft reconstruction procedures, the results were inferior. However, these anatomical procedures are technically more demanding with small margin of error and they have tendency for postoperative pain because of extra donor site incision. Materials and Methods: Forty patients with type IV to VI ACJ dislocations were treated by modified WD procedure using non-absorbable synthetic suture passed through the base of coracoid process for augmentation of transferred coraco-acromial (CA) ligament. Functional outcome was assessed using the Oxford Shoulder Score, Nottingham Clavicular Score and Visual Analog Score (VAS) at the final follow-up after surgery. Results: The mean pre-operative Oxford Shoulder Score improved from 25.22±2.64 (range 20 to 30) to 44.75±1.99 (range 40 to 48) and mean pre-operative Nottingham Shoulder Score improved from 49.25±4.91 (range 39 to 58) to 87.27±4.39 (range 79 to 96) at last follow-up after surgery with p-value <0.001. Thirty-five (87.5%) patients had excellent outcomes, four (10%) patients had good outcomes and one (2.5%) patient had fair outcome. Thirty-eight (95%) patients had no pain while two (5%) had moderate pain based on VAS score. Conclusion: Modified Weaver-Dunn is a simple well established technique for grade IV to VI ACJ dislocation. We cannot consider this procedure as old and outdated on the argument that the long term functional outcomes are not suboptimal.
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Affiliation(s)
- K C Kapil-Mani
- Department of Orthopaedics, Civil Service Hospital, Kathmandu, Nepal
| | - A Niroula
- Department of Orthopaedics, Civil Service Hospital, Kathmandu, Nepal
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North AS, Wilkinson T. Surgical reconstruction of the acromioclavicular joint: Can we identify the optimal approach? Strategies Trauma Limb Reconstr 2018; 13:69-74. [PMID: 29978445 PMCID: PMC6042224 DOI: 10.1007/s11751-018-0314-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 06/30/2018] [Indexed: 11/26/2022] Open
Abstract
Injuries to the acromioclavicular (AC) joint are common, tending to occur secondary to traumatic injuries. Rockwood grade IV, V and VI injuries involve complete dislocation of the joint and require surgical reconstruction, with inconclusive literature on whether grade III injuries should be surgically or conservatively managed. There are over one hundred reported surgical techniques which reconstruct the AC joint, with little indication of which methods achieve the best results. Techniques can generally be considered as: anatomical reduction; CC ligament reconstruction; and anatomical reconstruction. Techniques which implant hardware to reduce the AC joint, such as the hook plate, are commonly implemented, but have been shown to alter the mechanics of the joint significantly, resulting in poor short-term and long-term outcomes. Methods which reconstruct both the acromioclavicular and coracoclavicular ligaments are comparatively new, and early reports suggest that they achieve biomechanical properties similar to the native joint. More focus should be placed on such techniques in the future to determine whether they offer a more suitable approach to improve patient outcomes following AC joint reconstruction.
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Zhang LF, Yin B, Hou S, Han B, Huang DF. Arthroscopic fixation of acute acromioclavicular joint disruption with TightRope™: Outcome and complications after minimum 2 (2-5) years follow-up. J Orthop Surg (Hong Kong) 2018. [PMID: 28635564 DOI: 10.1177/2309499016684493] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To evaluate the midterm results of arthroscopic reconstruction of acute acromioclavicular (AC) joint disruption using TightRope™ system. METHODS AND MATERIAL We retrospectively assess the results of 24 patients of acute AC joint dislocation who were operated using TightRope system. Constant and University of California, Los Angeles (UCLA) scores and coracoclavicular distance were calculated pre- and postoperatively. Data was entered into MS excel and analyzed using the SPSS version 17. RESULTS The mean follow-up was 39.45 months. Constant and UCLA scores were significantly increased postoperatively. Six patients had partial loss of reduction within 3-6 months and two patients had a failure of construct. Constant score was significantly lower in these patients. CONCLUSION TightRope reconstruction of the AC joint is a reproducible and safe alternative to many other techniques of AC joint reconstruction. Early subluxation remains a concern and may reflect the need for technique modification.
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Affiliation(s)
- Li-Feng Zhang
- 1 Department of Pediatric Surgery, Jining No. 1 People's Hospital, Shandong, China
| | - Bo Yin
- 2 Department of Bone Surgery, Zoucheng People's Hospital, Zoucheng, Shandong, China
| | - Su Hou
- 3 Department of Pediatric Surgery, Zoucheng People's Hospital, Zoucheng, Shandong, China
| | - Bing Han
- 2 Department of Bone Surgery, Zoucheng People's Hospital, Zoucheng, Shandong, China
| | - De-Fa Huang
- 1 Department of Pediatric Surgery, Jining No. 1 People's Hospital, Shandong, China
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Gupta R, Sood M, Malhotra A, Masih GD, Khanna T, Raghav M. Functional Outcome of Modified Weaver Dunn Technique for Acromioclavicular Joint Dislocation. Indian J Orthop 2018; 52:418-422. [PMID: 30078902 PMCID: PMC6055455 DOI: 10.4103/ortho.ijortho_469_16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The debate about the ideal surgical procedure for acromioclavicular joint (ACJ) dislocation is still unresolved and newer techniques are being evolved continuously. The present study evaluates functional outcome of ACJ reconstruction using the modified Weaver Dunn procedure. MATERIALS AND METHODS 35 patients (26 males, 9 females) with ACJ dislocation, between the age group of 18-48 years (mean age 31 years), were operated using modified Weaver Dunn procedure at our center from May 2005 to June 2010. The dominant side was involved in 25 patients (22 right, 13 left). The mean period from the time of injury to the surgery was 14 days (range 4-26 days). All the patients were assessed with Oxford shoulder score and the time required to return to preinjury level was recorded. RESULTS At the mean followup of 95 months (range 72-120 months), the mean Oxford Shoulder Score improved from 25 ± 7.2 to 43 ± 6.9. 85% (30 out of 35) patients had satisfactory results, while 15% (5 out of 35) had mild shoulder dysfunction using this scoring system. Five patients had radiological evidence of Grade 2 ACJ subluxation. Out of these five patients, two developed ossification around the coracoclavicular ligament. Three patients had intermittent mild pain without any functional disability, and one had a moderate restriction of shoulder movements. CONCLUSION ACJ reconstruction, using the modified Weaver Dunn procedure in ACJ dislocation, is a reproducible procedure and provides a good functional outcome.
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Affiliation(s)
- Ravi Gupta
- Department of Orthopaedics, Government Medical College and Hospital, Chandigarh, India
| | - Munish Sood
- Department of Orthopaedics, Government Medical College and Hospital, Chandigarh, India,Address for correspondence: Dr. Munish Sood, Department of Orthopaedics, Government Medical College and Hospital, Chandigarh - 160 030, India. E-mail:
| | - Anubhav Malhotra
- Department of Orthopaedics, Government Medical College and Hospital, Chandigarh, India
| | - Gladson David Masih
- Department of Orthopaedics, Government Medical College and Hospital, Chandigarh, India
| | - Tanu Khanna
- Department of Orthopaedics, Government Medical College and Hospital, Chandigarh, India
| | - Mukta Raghav
- Department of Orthopaedics, Government Medical College and Hospital, Chandigarh, India
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Tiefenboeck TM, Popp D, Boesmueller S, Payr S, Joestl J, Komjati M, Binder H, Schurz M, Ostermann RC. Acromioclavicular joint dislocation treated with Bosworth screw and additional K-wiring: results after 7.8 years - still an adequate procedure? BMC Musculoskelet Disord 2017; 18:339. [PMID: 28778193 PMCID: PMC5545010 DOI: 10.1186/s12891-017-1692-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 07/24/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The acromioclavicular (AC) joint dislocation is a major reason for shoulder instability. Different concepts of treatment and surgical methods are described in the literature. Thus, the purpose of this study was to present our data of long-term follow-up of patients having undergone treatment of acromioclavicular (AC) joint dislocation using the Bosworth Screw with additional K-wiring. METHODS This study was conducted as a retrospective single centre data analysis. All patients treated operatively for AC joint dislocation with a Bosworth screw and additional K-wire fixation at our Department were asked to participate in this study. RESULTS The study population consisted of 22 patients, 20 male and 2 female, with a mean age of 40 years ±15.6 years. Three grade-II lesions, 13 grade-III lesions, four grade-IV lesions and two grade-V lesions according to the Rockwood classification were found. The overall mean clinical outcome at the latest follow up was: Constant 95, DASH 6.4, ASES 94.6, SST 99.02, UCLA 33.1, ACJI 91.82 and VAS 0.29 - representing a good-to-excellent long-term outcome in all patients after at least 2 years follow-up (range; 2 - 19 years). Overall, 19 patients (86%) reported to be very satisfied with the achieved result, 15 patients (68%) reported to be able to participate in every sports activity and 16 patients (73%) reported to be able to perform their daily work without limitations. Overall, complications occurred in three patients (14%). Only one patient remained unsatisfied with the achieved result. CONCLUSION Summarizing, our reported results showed that surgical fixation of acute AC joint dislocation with a Bosworth screw and additional K-wire fixation leads to good-to-excellent functional outcome and highly satisfactory results in the majority of patients. Despite its complications, in accordance with our results, Bosworth screw fixation with additional K-wiring in AC joint dislocation represents an adequate surgical procedure. LEVEL OF EVIDENCE Level IV, retrospective study.
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Affiliation(s)
- Thomas M Tiefenboeck
- Department of Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria.
| | - Domenik Popp
- Department of Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | | | - Stephan Payr
- Department of Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Julian Joestl
- Department of Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Micha Komjati
- Department of Orthopaedics, Hospital of sacred Heart of Jesus, Vienna, Austria
| | - Harald Binder
- Department of Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Mark Schurz
- Department of Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Roman C Ostermann
- Department of Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
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Arthroscopically Assisted Coracoclavicular Fixation Using a Single Flip Button Device Technique: What Are the Main Factors Affecting the Maintenance of Reduction? BIOMED RESEARCH INTERNATIONAL 2017; 2017:4859262. [PMID: 28831394 PMCID: PMC5558640 DOI: 10.1155/2017/4859262] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 05/30/2017] [Indexed: 11/30/2022]
Abstract
Background Among coracoclavicular (CC) fixation techniques, the use of flip button device was demonstrated to have successful outcomes with the advantage of being able to accommodate an arthroscopic procedure. Purpose This study was conducted to investigate the factors associated with loss of fixation after arthroscopically assisted CC fixation using a single flip button device for acromioclavicular (AC) joint dislocations. Materials and Methods We enrolled a total of 47 patients (35 men and 12 women). Plain radiography was performed at a mean of 24 months postoperatively to evaluate the final radiological outcome. The primary outcome measure was a long-term reduction of the AC joint for at least 24 months. Results We found that 29 patients had a high quality reduction (61.7%) and 18 patients had a low quality reduction (38.3%) in initial postoperative CT findings. Our study showed that the duration (5 days) from injury to treatment and the quality of initial postoperative reduction were significantly associated with the maintenance of reduction at final follow-up. Conclusion Our study showed that maintaining stable reduction after arthroscopically assisted CC fixation using a single flip button device technique is difficult especially in patients who received delayed treatment or whose initial reduction quality was poor.
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Shin SJ, Jeon YS, Kim RG. Arthroscopic-Assisted Coracoclavicular Ligament Reconstruction for Acute Acromioclavicular Dislocation Using 2 Clavicular and 1 Coracoid Cortical Fixation Buttons With Suture Tapes. Arthroscopy 2017; 33:1458-1466. [PMID: 28427871 DOI: 10.1016/j.arthro.2017.02.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 01/31/2017] [Accepted: 02/02/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To introduce an arthroscopically assisted coracoclavicular (CC) fixation technique using a cortical fixation button device and to evaluate the clinical and radiologic outcomes in patients with acute acromioclavicular (AC) dislocation who were treated with the technique. METHODS Twenty-one consecutive patients with grade III and V acute AC dislocation who underwent arthroscopically assisted CC ligament reconstruction using a cortical fixation button device were prospectively enrolled. Our fixation technique involved using a cortical fixation button device consisting of 1 coracoid button and 2 clavicular buttons connected with 2 suture tapes to reconstruct the conoid and trapezoid ligaments, respectively. Clinical outcomes were evaluated and CC distance and horizontal displacement of the AC joint were measured. RESULTS The mean follow-up period was 27.2 months (range, 24-32 months). The average CC distance of the injured shoulder was 17.2 ± 5.2 mm preoperatively, which represented an increase of 103% ± 42% compared with the uninjured shoulder. The CC distance was significantly reduced to 8.5 ± 1.5 mm after surgery (P < .001). At the final follow-up, the CC distance was maintained in 20 patients (95%) without loss of reduction. No significant radiologic difference was found in horizontal displacement of the AC joint immediately after the operation and at the final follow-up (P = .422). The average American Shoulder and Elbow Surgeons and Constant scores were 95.7 ± 3.6 and 95.4 ± 3.4, respectively. There were 3 complications, including 1 reduction loss, 1 coracoid process fracture, and 1 CC interval ossification. CONCLUSIONS Satisfactory clinical and radiologic outcomes were obtained simultaneously by arthroscopically assisted CC reconstruction using cortical fixation buttons. This reconstruction technique provided sufficient stability of the AC joint by using 2 clavicular holes to reconstruct the conoid and trapezoid ligaments separately. Therefore, arthroscopically assisted CC ligament reconstruction using a cortical fixation button device for management of acute AC dislocation is considered a viable treatment option for restoring stability to the AC joint. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Sang-Jin Shin
- Department of Orthopaedic Surgery, Ewha Womans University, College of Medicine, Seoul, Republic of Korea.
| | - Yoon Sang Jeon
- Department of Orthopaedic Surgery, Ewha Womans University, College of Medicine, Seoul, Republic of Korea
| | - Rag Gyu Kim
- Department of Orthopaedic Surgery, Ewha Womans University, College of Medicine, Seoul, Republic of Korea
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Horst K, Garving C, Thometzki T, Lichte P, Knobe M, Dienstknecht T, Hofman M, Pape HC. Comparative study on the treatment of Rockwood type III acute acromioclavicular dislocation: Clinical results from the TightRope ® technique vs. K-wire fixation. Orthop Traumatol Surg Res 2017; 103:171-176. [PMID: 27940250 DOI: 10.1016/j.otsr.2016.11.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 10/28/2016] [Accepted: 11/11/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND HYPOTHESIS The aim of this study was to address the inconsistency regarding the operative treatment of Rockwood type III acromioclavicular joint separation. We compared results after single- and double TightRope® reduction with results after acromioclavicular transfixation via K-wires only and additional ligament augmentation in acute acromioclavicular (AC) joint separations graded Rockwood type III, and hypothesized that the TightRope® technique leads to better clinical and radiological results. MATERIALS AND METHODS We conducted a retrospective clinical cohort study and included 42 consecutive patients (mean age 43 years [24-66]) diagnosed and operatively treated between 2004 and 2012 (mean follow-up was 54.6 months [15-118]). Specific shoulder scores as well as scores reflecting the patients' overall mental and physical health status were used. Radiological evaluation was also performed. RESULTS The SF12 test revealed comparability between all subgroups. Specific shoulder tests and a visual analogue scale demonstrated comparable results. Radiographic measurements showed a significant reduction in the AC distance and CC distance after surgery in all subgroups. The early complication rate was 9.5% for all patients, while late complications occurred in 14.3% of all cases. CONCLUSIONS Compared to the established methods, the operative TightRope® procedures represent a safe alternative in Rockwood III injuries. All investigated techniques predominantly led to good and excellent clinical results in acute Rockwood type III AC joint instabilities. Avoidance of material removal and shorter hospital stays appear to speak in favour for the TightRope® technique. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- K Horst
- Department of Orthopaedic Trauma at Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany.
| | - C Garving
- Klinik für Unfall-, Schulter- und Handchirurgie, Krankenhaus Agatharied, Norbert-Kerkel-Platz, 83734 Hausham, Germany
| | - T Thometzki
- Department of Orthopaedic Trauma at Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany
| | - P Lichte
- Department of Orthopaedic Trauma at Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany
| | - M Knobe
- Department of Orthopaedic Trauma at Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany
| | - T Dienstknecht
- Department of Orthopaedic Trauma at Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany
| | - M Hofman
- Department of Orthopaedic Trauma at Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany
| | - H-C Pape
- Department of Orthopaedic Trauma at Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany
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Metzlaff S, Rosslenbroich S, Forkel PH, Schliemann B, Arshad H, Raschke M, Petersen W. Surgical treatment of acute acromioclavicular joint dislocations: hook plate versus minimally invasive reconstruction. Knee Surg Sports Traumatol Arthrosc 2016; 24:1972-8. [PMID: 25209209 DOI: 10.1007/s00167-014-3294-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 08/28/2014] [Indexed: 12/21/2022]
Abstract
PURPOSE This study was performed to compare the clinical results of a minimally invasive technique for acute acromioclavicular (AC) joint dislocation repair with the traditional hook plate fixation. METHODS Forty-four patients with an acute (within 2 weeks after trauma) complete AC joint separation (35 male, nine female; median age 36.2 years, range 18-56) underwent surgical repair with either a minimally invasive AC joint repair or a conventional hook plate. Functional outcome was evaluated using the Constant-Murley Score (CMS), the TAFT score and the AC joint instability score (ACJI). Radiographic evaluation was performed with bilateral anterior-posterior (a.p.) stress and Alexander views. RESULTS All patients were available after a median follow-up of 32 months (range 24-51). There were no significant differences in the mean CMS, Taft score and the ACJI between the two groups. The radiological assessment revealed no significant difference in the coracoclavicular distance. In both groups, a slight loss of reduction was observed. Periarticular ossification was seen in 11 patients of the minimally invasive AC joint repair and eight patients of the hook plate group but this did not affect the final outcome. Hook plates were removed after a median interval of 11.9 weeks (range 10-13). CONCLUSION Good clinical results can be achieved with both minimally invasive AC joint repair and hook plate fixation. However, in the hook plate group a second operation is mandatory for plate removal. LEVEL OF EVIDENCE III.
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Affiliation(s)
- S Metzlaff
- Department of Orthopaedic and Trauma Surgery, Martin Luther Hospital, Grunewald, Berlin, Germany.
| | - S Rosslenbroich
- Department of Orthopaedic and Trauma Surgery, University Hospital Münster, Münster, Germany
| | - P H Forkel
- Department of Orthopaedic and Trauma Surgery, Martin Luther Hospital, Grunewald, Berlin, Germany
| | - B Schliemann
- Department of Orthopaedic and Trauma Surgery, University Hospital Münster, Münster, Germany
| | - H Arshad
- Norfolk and Norwich University Hospital, Norwich, UK
| | - M Raschke
- Department of Orthopaedic and Trauma Surgery, University Hospital Münster, Münster, Germany
| | - W Petersen
- Department of Orthopaedic and Trauma Surgery, Martin Luther Hospital, Grunewald, Berlin, Germany
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Naziri Q, Williams N, Hayes W, Kapadia BH, Chatterjee D, Urban WP. Acromioclavicular joint reconstruction using a tendon graft: a biomechanical study comparing a novel "sutured throughout" tendon graft to a standard tendon graft. SICOT J 2016; 2:17. [PMID: 27163106 PMCID: PMC4849238 DOI: 10.1051/sicotj/2016013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 02/17/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND With a recurrence rate of over 30%, techniques that offer stronger acromioclavicular (AC) joint reconstruction through increased graft strength may provide longevity. The purpose of our study was to determine the biomechanical strength of a novel tendon graft sutured throughout compared to a native tendon graft in Grade 3 anatomical AC joint reconstruction. METHODS For this in vitro experiment, nine paired (n = 18) embalmed cadaveric AC joints of three males and six females (age 86 years, range 51-94 years) were harvested. Anatomic repair with fresh bovine Achilles tendon grafts without bone block was simulated. Specimens were divided into two groups; with group 1 using grafts with ultra-high molecular-weight polyethylene (UHMWPE) suture ran throughout the entire length. In group 2, reconstruction with only native allografts was performed. The distal scapula and humerus were casted in epoxy compound and mounted on the mechanical testing machine. Tensile tests were performed using a mechanical testing machine at the rate of 50 mm/min. Maximum load and displacement to failure were collected. RESULTS The average load to failure was significantly higher for group 1 compared to group 2, with mean values of 437.5 N ± 160.7 N and 94.4 N ± 43.6 N, (p = 0.001). The average displacement to failure was not significantly different, with 29.7 mm ± 10.6 mm in group 1 and 25 mm ± 9.1 mm in group 2 (p = 0.25). CONCLUSION We conclude that a UHMWPE suture reinforced graft can provide a 3.6 times stronger AC joint reconstruction compared to a native graft.
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Affiliation(s)
- Qais Naziri
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Department of Orthopaedics, SUNY Downstate Medical Center 450 Clarkson Avenue, MSC 30 Brooklyn NY
11203 USA
| | - Nadine Williams
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Department of Orthopaedics, SUNY Downstate Medical Center 450 Clarkson Avenue, MSC 30 Brooklyn NY
11203 USA
| | - Westley Hayes
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Department of Orthopaedics, SUNY Downstate Medical Center 450 Clarkson Avenue, MSC 30 Brooklyn NY
11203 USA
| | - Bhaveen H. Kapadia
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Department of Orthopaedics, SUNY Downstate Medical Center 450 Clarkson Avenue, MSC 30 Brooklyn NY
11203 USA
| | - Dipal Chatterjee
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Department of Orthopaedics, SUNY Downstate Medical Center 450 Clarkson Avenue, MSC 30 Brooklyn NY
11203 USA
| | - William P. Urban
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Department of Orthopaedics, SUNY Downstate Medical Center 450 Clarkson Avenue, MSC 30 Brooklyn NY
11203 USA
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Clavert P, Meyer A, Boyer P, Gastaud O, Barth J, Duparc F. Complication rates and types of failure after arthroscopic acute acromioclavicular dislocation fixation. Prospective multicenter study of 116 cases. Orthop Traumatol Surg Res 2015; 101:S313-6. [PMID: 26545944 DOI: 10.1016/j.otsr.2015.09.012] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 09/07/2015] [Indexed: 02/02/2023]
Abstract
AIMS To report and analyze both the surgical and radiographic complications associated with anatomic coracoclavicular (CC) ligament procedures and to evaluate the effect of these complications on patient outcomes. PATIENTS AND METHODS From July 2012 to July 2013, 116 primary anatomic CC ligament procedures (all arthroscopic endobutton fixations) were performed in 14 different centers. Demographic, surgical, subjective, and radiographic data were prospectively analyzed in 14 centers with a minimum follow-up of 12 months. RESULTS This series included 96 men and 20 women, mean age 37 years old, with a mean delay to surgery of 10 days. No intraoperative complications were reported. There were 11 complications due to hardware failure resulting in a loss of reduction, 1 coracoid fracture, 7 cases of adhesive capsulitis, 2 local infections, 5 cases of hardware pain. There were significant differences in outcomes between patients who did and did not develop complications: mean CS=71 vs. 93, (P<0.0001). All the parameters of the CS were statistically affected (P<0.0001). Forty-eight patients had persistent dislocation>150% on an AP X-ray which affected the pain and activity CS (P=0.023 and P=0.044). No preoperative predictive factors were identified. These patients could not return to the same level of sports activities due to persistent pain. DISCUSSION Anatomic procedures to treat AC joint dislocation using CC ligament reconstruction resulted in an overall complication rate of 22.4% and influenced the return to sports. Good to excellent outcomes were reported in patients without complications. CLINICAL SERIES Level of evidence 4.
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Affiliation(s)
- P Clavert
- Service de chirurgie du membre supérieur, CCOM, 10, avenue Baumann, 67400 Illkirch-Graffenstaden, France.
| | - A Meyer
- Chirurgie de l'épaule, groupe Maussins, 67, rue de Romainville, Paris, France
| | - P Boyer
- Service de chirurgie orthopédique, hôpital Bichat, AP-HP, 46, rue Henri-Huchard, 75877 Paris, France
| | - O Gastaud
- Institut universitaire de l'appareil locomoteur et du sport, CHU Nice-Pasteur 2, 30, voie Romaine, CS51069, 06001 Nice cedex 1, France
| | - J Barth
- Centre ostéo-articulaire des Cèdres, Parc Sud Galaxie, 5, rue des Tropiques, Échirolles, France
| | - F Duparc
- Service de chirurgie orthopédique et traumatologique, hôpital Charles-Nicolle, 1, rue de Germont, 76031 Rouen cedex, France
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Chaudhary D, Jain V, Joshi D, Jain JK, Goyal A, Mehta N. Arthroscopic fixation for acute acromioclavicular joint disruption using the TightRope device. J Orthop Surg (Hong Kong) 2015; 23:309-14. [PMID: 26715707 DOI: 10.1177/230949901502300310] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To review outcome after arthroscopic fixation for acute acromioclavicular (AC) joint dislocation using the TightRope device. METHODS Records of 15 men and 2 women aged 19 to 52 (mean, 35) years who underwent arthroscopic fixation using the TightRope device for acute (<3 weeks) AC joint dislocation of Rockwood type III (n=6), type IV (n=1), and type V (n=10) were reviewed. Outcome was evaluated using the Constant score. The coracoclavicular (CC) distance before and after surgery was compared. RESULTS The mean follow-up period was 22.1 (range, 12-37) months. The mean time to return to work was 4 (range, 1.5-12) months, excluding one failure. The mean postoperative Constant score was 86.4 (range, 63-96). The CC distance decreased from 21.5±5.2 mm preoperatively to 9.8±3.5 mm at 6 months and to 10±3.2 mm at one year. There was no over-correction. All patients had satisfactory outcome except for one who had rupture of the TightRope suture at 6 months. Two patients had partial loss of reduction (≥2 mm) after 3 to 6 months secondary to osteolysis at the clavicular button site. CONCLUSION Arthroscopic fixation using the TightRope device for acute AC joint dislocation achieves satisfactory outcome.
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Loriaut P, Casabianca L, Alkhaili J, Dallaudière B, Desportes E, Rousseau R, Massin P, Boyer P. Arthroscopic treatment of acute acromioclavicular dislocations using a double button device: Clinical and MRI results. Orthop Traumatol Surg Res 2015; 101:895-901. [PMID: 26545942 DOI: 10.1016/j.otsr.2015.09.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 08/26/2015] [Accepted: 09/08/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Arthroscopic treatment of acute grade 3 and 4 acromioclavicular dislocation is controversial, due to the risk of recurrence and of postoperative reduction defect. The purpose of the present study was to investigate whether the healing of the acromioclavicular (AC) and coracoclavicular (CC) ligaments and the accurate 3D positioning parameters of the AC joint using MRI were correlated with satisfactory functional outcome. MATERIAL Thirty-nine patients were enrolled from 2009 to 2011 and managed arthroscopically by CC lacing using a double-button device. METHODS Clinical assessment included the Shoulder and Hand (QuickDash) score, Constant-Murley score and visual analog scale (VAS) for residual pain. Time and rate to return to work and return to sport were assessed according to type of sport and work. Postoperative complications were recorded. Radiological examination consisted of anteroposterior clavicle and lateral axillary radiographs. AC ligament healing and 3D joint congruency were assessed on MRI and correlated to the clinical results. RESULTS Mean patient age was 35.7 years (range, 20-55). Mean follow-up was 42.3±10.6 months (range, 24-60). At final follow-up, mean QuickDash score, Constant score and VAS were respectively 1.7±4 (range, 0-11), 94.7±7.3 (range, 82-100) and 0.5±1.4 (range, 0-2). Thirty-five (90%) patients were able to resume work, including heavy manual labor, and sport. Radiology found accurate 3D joint congruency in 34 patients (87%) and CC and AC ligament healing in 36 (93%). Complications included reduction loss at 6 weeks in 3 patients, requiring surgical stabilization. Satisfactory functional results were associated with accurate AC joint congruency in the coronal and axial planes (P<0.05) and good AC and CC ligament healing (P<0.04). An initial 25% reduction defect in the coronal plane was not associated with poor functional results (P=0.07). CONCLUSION Arthroscopic treatment by CC lacing satisfactorily restored ligament and joint anatomy in the present series. These satisfactory anatomic results correlated with good clinical outcome encourage continuing with this technique. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- P Loriaut
- Service de chirurgie orthopédique et de traumatologie, hôpital de la Pitié-Salpêtrière, université Pierre-et-Marie-Curie, 47, boulevard de l'Hôpital, 75013 Paris, France; Institut de chirurgie orthopédique, clinique des Lilas, 41-49, avenue du Maréchal-Juin, 93260 Les Lilas, France.
| | - L Casabianca
- Service de chirurgie orthopédique et de traumatologie, hôpital de la Pitié-Salpêtrière, université Pierre-et-Marie-Curie, 47, boulevard de l'Hôpital, 75013 Paris, France
| | - J Alkhaili
- Service de chirurgie orthopédique et de traumatologie, hôpitaux universitaires Paris Nord - Val-de-Seine, 46, rue Henri-Huchard, 75877 Paris cedex 18, France
| | - B Dallaudière
- Service de radiologie, clinique du sport, Bordeaux-Mérignac, 2, rue Negrevergne, 33700 Mérignac, France; Service de radiologie, hôpital Pellegrin, Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - E Desportes
- Service de radiologie, hôpitaux universitaires Paris Nord - Val-de-Seine, 46, rue Henri-Huchard, 75877 Paris cedex 18, France
| | - R Rousseau
- Service de chirurgie orthopédique et de traumatologie, hôpital de la Pitié-Salpêtrière, université Pierre-et-Marie-Curie, 47, boulevard de l'Hôpital, 75013 Paris, France
| | - P Massin
- Service de chirurgie orthopédique et de traumatologie, hôpitaux universitaires Paris Nord - Val-de-Seine, 46, rue Henri-Huchard, 75877 Paris cedex 18, France
| | - P Boyer
- Service de chirurgie orthopédique et de traumatologie, hôpitaux universitaires Paris Nord - Val-de-Seine, 46, rue Henri-Huchard, 75877 Paris cedex 18, France
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Wright J, Osarumwense D, Ismail F, Umebuani Y, Orakwe S. Stabilisation for the disrupted acromioclavicular joint using a braided polyester prosthetic ligament. J Orthop Surg (Hong Kong) 2015; 23:223-8. [PMID: 26321556 DOI: 10.1177/230949901502300223] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To report outcomes of 21 men who underwent stabilisation for the disrupted acromioclavicular joint (ACJ) using a braided polyester prosthetic ligament. METHODS 21 men aged 23 to 76 (mean, 43) years underwent stabilisation for the disrupted ACJ of Rockwood type 3 (n=12), type 4 (n=1), and type 5 (n=8) using a braided polyester prosthetic ligament. RESULTS The mean time from injury to surgery was 6.8 (range, 0-19) months. The mean follow-up duration was 30 (range, 7-67) months. The mean Constant Score was 86.8 (range, 62-100), and the mean individualised Constant Score was 88.5 (range, 68-100). The mean Oxford Shoulder Score was 43.1 (range, 28-48). The mean abduction power of the operated side was 82% (range, 31%-97%) that of the normal side. 20 patients were satisfied with the procedure. One patient was dissatisfied who developed scapulothoracic bursitis. One patient required arthroscopic subacromial decompression for impingement. One patient sustained a redislocation following a fall at 6 weeks and declined further surgery. CONCLUSION The braided polyester prosthetic ligament achieved good outcome for patients undergoing stabilisation for the disrupted ACJ.
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Arthroscopic-Assisted Acromioclavicular Joint Reconstruction Using the TightRope Device With Allograft Augmentation: Surgical Technique. Arthrosc Tech 2015; 4:e293-7. [PMID: 26759765 PMCID: PMC4680852 DOI: 10.1016/j.eats.2015.02.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 02/19/2015] [Indexed: 02/03/2023] Open
Abstract
Surgical management of acromioclavicular (AC) joint separations remains challenging, especially in the revision setting. Most commonly, Rockwood type I and II injuries are managed nonoperatively whereas type IV, V, and VI injuries are managed with surgery. Type III separations are more controversial, with evidence supporting both nonoperative and operative treatment options. Multiple different arthroscopic techniques have been described; however, there is no current gold standard. AC joint reconstruction with the TightRope device (Arthrex, Naples, FL) with the patient in the lateral decubitus position is a method of restoring joint stability that allows for a minimally invasive, low-profile fixation construct using a single drill hole through the clavicle. Allograft augmentation of this fixation construct helps to eliminate the stress risers potentially created by this device while increasing overall repair construct stability. The purpose of this article is to describe the surgical technique for arthroscopic AC joint reconstruction using a TightRope device with allograft augmentation.
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Rosslenbroich SB, Schliemann B, Schneider KN, Metzlaff SL, Koesters CA, Weimann A, Petersen W, Raschke MJ. Minimally Invasive Coracoclavicular Ligament Reconstruction With a Flip-Button Technique (MINAR): Clinical and Radiological Midterm Results. Am J Sports Med 2015; 43:1751-7. [PMID: 25896983 DOI: 10.1177/0363546515579179] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Acromioclavicular (AC) joint dislocation is a frequent injury in sports. HYPOTHESIS A minimally invasive flip-button technique, MINAR (minimally invasive acromioclavicular joint reconstruction), will achieve good clinical and radiographic results in the surgical treatment of high-grade AC joint dislocations. STUDY DESIGN Case series; Level of evidence, 4. METHODS In this study, 96 patients with AC joint dislocation grades III through V and minimally invasive flip-button repair were identified. Radiographic assessment was performed by use of the Alexander view and by anteroposterior stress radiograph. Clinical outcomes were assessed with the Constant and Taft scores. Factors that influenced outcomes, such as age, time from trauma to surgery, and degree of dislocation, were evaluated. RESULTS Of the 96 patients, 83 (86.4%; 3 women and 80 men) were able to participate in clinical and radiographic follow-up. The average age of the participants was 39 years (range, 17-80 years). At a mean follow-up of 39 months (range, 12-78 months), clinical assessment revealed excellent results with a mean Constant score of 94.7 (range, 61-100). Clinical and radiological assessment using the Taft score also showed excellent results, with a mean score of 10.8 (range, 3-12). The mean time period from trauma to surgery was 6 days (range, 0-22 days), and mean duration of surgery was 48 minutes (range, 24-98 minutes). Nine patients (10.8%) underwent revision surgery due to recurrent dislocation (n = 8) or wound infection (n = 1). Radiological assessment showed that 18 patients had sustained a loss of reduction defined as subluxation of 50% of the clavicle shaft width in the vertical plane. However, there was no significant correlation (P = .254) with clinical outcome. Patient age was a relevant factor influencing outcome, as significantly higher outcome values were detected for younger patients (P = .024). No significant influence was shown for the time period from trauma to surgery (P = .336) or degree of dislocation after trauma (P = .987). CONCLUSION The MINAR technique is a safe procedure and achieves good to excellent clinical and radiographic results in the surgical treatment of high-grade AC joint dislocations. Despite the simplicity of this technique, the surgeon has to overcome the learning curve to minimize the risk of recurrent dislocation.
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Affiliation(s)
- Steffen B Rosslenbroich
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Muenster, Westphalian-Wilhelms University, Muenster, Germany
| | - Benedikt Schliemann
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Muenster, Westphalian-Wilhelms University, Muenster, Germany
| | - Kristian N Schneider
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Muenster, Westphalian-Wilhelms University, Muenster, Germany
| | - Sebastian L Metzlaff
- Department of Orthopedics and Trauma Surgery, Martin Luther Hospital, Berlin, Germany
| | - Clemens A Koesters
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Muenster, Westphalian-Wilhelms University, Muenster, Germany
| | - Andre Weimann
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Muenster, Westphalian-Wilhelms University, Muenster, Germany
| | - Wolf Petersen
- Department of Orthopedics and Trauma Surgery, Martin Luther Hospital, Berlin, Germany
| | - Michael J Raschke
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Muenster, Westphalian-Wilhelms University, Muenster, Germany
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Complications after arthroscopic coracoclavicular reconstruction using a single adjustable-loop-length suspensory fixation device in acute acromioclavicular joint dislocation. Arthroscopy 2015; 31:816-24. [PMID: 25543250 DOI: 10.1016/j.arthro.2014.11.013] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 10/22/2014] [Accepted: 11/07/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to evaluate clinical and radiological outcomes after arthroscopically assisted coracoclavicular (CC) fixation using a single adjustable-loop-length suspensory fixation device for acute acromioclavicular dislocation and to report intraoperative and postoperative complications. METHODS Eighteen consecutive patients with acute acromioclavicular dislocation underwent arthroscopically assisted CC fixation using a single TightRope (Arthrex, Naples, FL). Using the Rockwood classification, 3 patients had grade III dislocations, one patient had a grade IV dislocation, and 14 patients had grade V dislocations. RESULTS The preoperative CC distance of the injured shoulder was 16.1 ± 2.7 mm (range, 11.2 to 21.0 mm), and it increased by 99% ± 36% (range, 17% to 153%) on average compared with the contralateral shoulder. The average CC distance was 10.5 ± 2.5 mm (range, 7.7 to 15.5 mm), and it increased by 30% ± 30% (range, -9.4% to 90%) at the final follow-up. Compared with immediate postoperative radiographs, the CC distance was maintained in 12 patients, increased between 50% and 100% in 4 patients, and increased more than 100% in 2 patients at final follow-up. However, there was no statistical difference in Constant scores between 6 patients with reduction loss (95.6 ± 4.5) and 12 patients with reduction maintenance (98.4 ± 2.5; P = .17). Perioperative complications occurred in 8 patients, including one case of acromioclavicular arthritis, one case of delayed distal clavicular fracture at the clavicular hole of the device, 3 cases of clavicular or coracoid button failures, and 3 cases of clavicular bony erosion. CONCLUSIONS Satisfactory clinical outcomes were obtained after CC fixation using the single adjustable-loop-length suspensory fixation device for acute acromioclavicular joint dislocation. However, CC fixation failure of greater than 50% of the unaffected side in radiological examinations occurred in 33% of the patients within 3 months after the operation. Additionally, 8 patients (44%) had complications associated with the adjustable-loop-length suspensory fixation device and surgical technical problems. Despite acceptable shoulder function restoration, adequate care should be exercised in surgical treatment of acute acromioclavicular dislocation with a single adjustable-loop-length suspensory fixation device for optimal radiological outcomes. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Schliemann B, Roßlenbroich SB, Schneider KN, Theisen C, Petersen W, Raschke MJ, Weimann A. Why does minimally invasive coracoclavicular ligament reconstruction using a flip button repair technique fail? An analysis of risk factors and complications. Knee Surg Sports Traumatol Arthrosc 2015; 23:1419-1425. [PMID: 24170189 DOI: 10.1007/s00167-013-2737-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 10/14/2013] [Indexed: 12/23/2022]
Abstract
PURPOSE Aim of the present study was to evaluate the risk factors for the failure of coracoclavicular ligament reconstruction using a flip button repair technique and to analyse complications related to this procedure. METHODS Seventy-one patients (3 female, 68 male) underwent surgical treatment using a flip button repair technique for an acute acromioclavicular joint dislocation. The following factors and its impact on clinical and radiographic outcome were assessed: age at trauma, interval between trauma and surgery, degree of displacement (according to Rockwood's classification), coracoid button position, button migration and post-operative appearance of ossifications. RESULTS Sixty-three patients were available for follow-up. The overall Constant score was 95.2 points (range 61-100 points) compared to 97 points (range 73-100 points) for the contralateral side (p = 0.05). Nine patients (14.3 %) needed surgical revision. Inappropriate positioning of the coracoid bone tunnel with subsequent button dislocation was the most frequently observed mode of failure (6 cases, 9.5 %). Button migration into the clavicle was associated with loss of reduction (p = 0.02). The patient's age at the time of trauma had a significant impact on the clinical outcome, whereas younger patients achieved better results (p = 0.02). The interval between trauma and surgery did not significantly affect the outcome (n.s.). CONCLUSION Good to excellent clinical results can be achieved with the presented surgical technique. The age of the patient at trauma had a significant influence on the functional outcome. Furthermore, placement of the coracoid button centrally under the coracoid base is crucial to prevent failure. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Benedikt Schliemann
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Waldeyerstraße 1, 48149, Münster, Germany.
| | - Steffen B Roßlenbroich
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Waldeyerstraße 1, 48149, Münster, Germany
| | - Kristian N Schneider
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Waldeyerstraße 1, 48149, Münster, Germany
| | - Christina Theisen
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Waldeyerstraße 1, 48149, Münster, Germany
| | - Wolf Petersen
- Department of Orthopaedics and Trauma Surgery, Martin-Luther Hospital, Caspar-Theyß-Straße 27-31, 14193, Berlin, Germany
| | - Michael J Raschke
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Waldeyerstraße 1, 48149, Münster, Germany
| | - André Weimann
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Waldeyerstraße 1, 48149, Münster, Germany
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Woodmass JM, Esposito JG, Ono Y, Nelson AA, Boorman RS, Thornton GM, Lo IK. Complications following arthroscopic fixation of acromioclavicular separations: a systematic review of the literature. Open Access J Sports Med 2015; 6:97-107. [PMID: 25914562 PMCID: PMC4401206 DOI: 10.2147/oajsm.s73211] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Purpose Over the past decade, a number of arthroscopic or arthroscopically assisted reconstruction techniques have emerged for the management of acromioclavicular (AC) separations. These techniques provide the advantage of superior visualization of the base of the coracoid, less soft tissue dissection, and smaller incisions. While these techniques have been reported to provide excellent functional results with minimal complications, discrepancies exist within the literature. This systematic review aims to assess the rate of complications following these procedures. Methods Two independent reviewers completed a search of Medline, Embase, PubMed, and the Cochrane Library entries up to December 2013. The terms “Acromioclavicular Joint (MeSH)” OR “acromioclavicular* (text)” OR “coracoclavicular* (text)” AND “Arthroscopy (MeSH)” OR “Arthroscop* (text)” were used. Pooled estimates and 95% confidence intervals were calculated assuming a random-effects model. Statistical heterogeneity was quantified using the I2 statistic. Level of evidence IV Results A total of 972 abstracts met the search criteria. After removal of duplicates and assessment of inclusion/exclusion criteria, 12 articles were selected for data extraction. The rate of superficial infection was 3.8% and residual shoulder/AC pain or hardware irritation occurred at a rate of 26.7%. The rate of coracoid/clavicle fracture was 5.3% and occurred most commonly with techniques utilizing bony tunnels. Loss of AC joint reduction occurred in 26.8% of patients. Conclusion Arthroscopic AC reconstruction techniques carry a distinct complication profile. The TightRope/Endobutton techniques, when performed acutely, provide good radiographic outcomes at the expense of hardware irritation. In contrast, graft reconstructions in patients with chronic AC separations demonstrated a high risk for loss of reduction. Fractures of the coracoid/clavicle remain a significant complication occurring predominately with techniques utilizing bony tunnels.
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Affiliation(s)
- Jarret M Woodmass
- Department of Surgery, Section of Orthopaedic Surgery, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
| | - John G Esposito
- Department of Surgery, Section of Orthopaedic Surgery, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
| | - Yohei Ono
- Department of Surgery, Section of Orthopaedic Surgery, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada ; Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Atiba A Nelson
- Department of Surgery, Section of Orthopaedic Surgery, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
| | - Richard S Boorman
- Department of Surgery, Section of Orthopaedic Surgery, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
| | - Gail M Thornton
- Department of Surgery, Section of Orthopaedic Surgery, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada ; Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
| | - Ian Ky Lo
- Department of Surgery, Section of Orthopaedic Surgery, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
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Lu N, Zhu L, Ye T, Chen A, Jiang X, Zhang Z, Zhu Q, Guo Q, Yang D. Evaluation of the coracoclavicular reconstruction using LARS artificial ligament in acute acromioclavicular joint dislocation. Knee Surg Sports Traumatol Arthrosc 2014; 22:2223-7. [PMID: 23812536 DOI: 10.1007/s00167-013-2582-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Accepted: 06/10/2013] [Indexed: 02/01/2023]
Abstract
PURPOSE The most appropriate procedure for surgical treatment of severe acromioclavicular (AC) joint dislocation was still not clear. The purpose of this study is to evaluate the outcomes of coracoclavicular (CC) reconstruction with ligament augmentation and reconstruction system (LARS) artificial ligaments for the treatment of acute complete AC joint dislocation. METHODS Twenty-four patients (16 male and 8 female, ages ranged from 21 to 45) with acute complete AC joint dislocations were treated with CC reconstruction using LARS artificial ligaments. All these dislocations were unstable injuries. Clinical evaluation was used by the Constant scores and VAS. The radiographic evaluation consisted of Zanca radiographs for bilateral AC joint and axillary radiographs for the injured shoulder. RESULTS All patients had follow-up times of 36 months (range 6-60). The Constant scores rose from 62.3 ± 6.9 preoperatively to 94.5 ± 9.3 at final evaluation (P < 0.05). Preoperative VAS scores were 5.1 ± 1.7, and the VAS scores at the last review were 0.7 ± 1.4 (P < 0.05). Follow-up radiographs showed anatomical reduction in 20 patients and slight loss of reduction in 4 patients. Calcification of CC ligament in 4 patients, degenerative change around the AC joint in 2 patient and clavicular osteolysis around screws in one patient were found. CONCLUSIONS LARS artificial ligament for reconstruction of CC can provide immediate stability and allow early shoulder mobilization with good functional results and few complications. This procedure was an effective and safe method to treat grade III and more AC joint dislocations. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Nan Lu
- Department of Orthopaedic Surgery, Shanghai Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China
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Warth RJ, Lee JT, Millett PJ. Arthroscopically-Assisted Anatomic Coracoclavicular Ligament Reconstruction With Tendon Grafts: Biomechanical Rationale, Surgical Technique, and a Review of Clinical Outcomes. OPER TECHN SPORT MED 2014. [DOI: 10.1053/j.otsm.2013.10.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Wang Y, Zhang J. Acromioclavicular joint reconstruction by coracoid process transfer augmented with hook plate. Injury 2014; 45:949-54. [PMID: 24521873 DOI: 10.1016/j.injury.2013.12.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 12/25/2013] [Accepted: 12/31/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND Various techniques have been reported for the treatment of chronic acromioclavicular (AC) joint separation. The purpose of this study was to evaluate the results of surgical construction of coracoclavicular ligament using coracoid process transfer augmented with a hook plate fixation. MATERIALS AND METHODS Twenty-one patients treated with coracoid process transfer augmented with a hook plate fixation for chronic type III and V AC injuries were retrospectively analysed in 2003-2009. The age of the patients ranged from 23 to 58 years with an average age of 41.6 years. The patients were followed up clinically and radiographically, with an average of 33.0 months. Functional status and the ability to return to work were recorded during follow-up. Constant score and visual analogue scale (VAS) for pain were measured. RESULTS The mean Constant score has increased from 70.9 points preoperatively to 90.7 points at follow-up. The mean VAS score has decreased from 4.7 preoperatively to 1.2 at follow-up. The average abduction was 172°, forward flexion was 170° and external rotation was 56°. There were 10 excellent results, 10 good results and one fair result. All patients had resumed their job or returned to original sport activity at mean 3.7 months postoperatively. No reduction loss was observed after plate removal and the final follow-up. CONCLUSIONS Despite retrospective nature of the study, the outcomes of surgical construction with process transfer augmented with hook plate fixation are promising for chronic type III and V AC injuries. LEVEL OF EVIDENCE Therapeutic level IV. Retrospective case series, treatment study.
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Affiliation(s)
- Yeming Wang
- Department of Orthopaedics, Tianjin Hospital, Tianjin, China.
| | - Jianguo Zhang
- Department of Orthopaedics, Tianjin Hospital, Tianjin, China
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Abstract
Acromioclavicular (AC) dislocation is a common injury especially among sportsmen. There is still a lack of consensus on whether to conserve or operate type III AC joint dislocations. Even among surgeons inclined to operate AC joint dislocations there is no unanimity on which surgical technique. There are a plethora of choices between mechanical fixation or synthetic materials or biologic anatomic reconstructions. Even among surgeons, there is a choice between open repairs and the latest-arthroscopic reconstructions. This review of AC joint dislocations intends to analyze the available surgical options, a critical analysis of existing literature, actual technique of anatomic repair, and also accompanying complications.
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Affiliation(s)
- Ashish Babhulkar
- Department of Shoulder and Sports Injuries, Deenanath Mangeshkar Hospital, Erandwane, Pune, Maharashtra, India, 411 004,
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Tavakoli Darestani R, Ghaffari A, Hosseinpour M. Acromioclavicular joint fixation using an acroplate combined with a coracoclavicular screw. ARCHIVES OF TRAUMA RESEARCH 2014; 2:36-9. [PMID: 24396788 PMCID: PMC3876507 DOI: 10.5812/atr.10338] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 02/21/2013] [Accepted: 02/24/2013] [Indexed: 11/29/2022]
Abstract
Background Appropriate treatment of acromioclavicular joint dislocation is controversial. Acroplate fixation is one of the most common treatment methods of acromioclavicular joint (ACJ) dislocation. Based on the risk of re-dislocation after Acroplate fixation, we assumed that combined fixation with an Acroplate and a coracoclavicular screw helps improve the outcome. Objectives The main purpose of the current study was to compare the outcome of ACJ dislocation treated with an Acroplate alone and in combination with coracoclavicular screw. Patients and Methods This study was carried out on 40 patients with ACJ dislocation types III to VI who were divided randomly into two equal groups: Acroplate group (P) and Acroplate in combination with coracoclavicular screw group (P + S). The screws were extracted 3-6 months postoperatively. The patients were followed for 1 year and Imatani’s score was calculated. Finally, the data were compared between the groups. Results The mean Imatani’s score was significantly higher in P + S group (83.4 ± 14.1) than P group (81.2 ± 10.3) (P < 0.001). The mean duration of surgery was the same in the two groups (59.8 ± 9.4 minutes in group P V.s 64.3 ± 10.9 minutes in group P + S; P = 0.169). There were no cases of re-dislocation, degenerative changes and ossification and all patients returned to their previous jobs or sporting activities. Conclusions Using a coracoclavicular screw combined with an Acroplate can improve the patients’ function after ACJ disruption without any significant increase in surgical duration. Authors recommend this technique in the fixation of ACJ dislocation.
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Affiliation(s)
| | - Arash Ghaffari
- Orthopedics Surgery Department, Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Mehrdad Hosseinpour
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
- Corresponding author: Mehrdad Hosseinpour, Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran. Tel.: +98-3112335547, Fax: +98-3615620634, E-mail:
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Flinkkilä TE, Ihanainen E. Results of Arthroscopy-Assisted TightRope Repair of Acromioclavicular Dislocations. Shoulder Elbow 2014; 6:18-22. [PMID: 27582904 PMCID: PMC4986652 DOI: 10.1111/sae.12040] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 07/26/2013] [Indexed: 01/16/2023]
Abstract
BACKGROUND The present study assessed results of arthroscopy-assisted TightRope (Arthrex, Naples, FL, USA) repair of acute Rockwood grade III and V acromioclavicular (AC) dislocations. METHODS We retrospectively reviewed the medical records of 57 patients with AC dislocations treated with TightRope fixation: 15 Rockwood grade III and 42 grade V. Functional results were assessed using the Constant score, and Disabilities of Arm, Shoulder and Hand (DASH) and RAND 36-ltem Health Survey scores after a mean 2.6 years of follow-up (range 1.0 years to 4.5 years). Radiographic results were assessed using the AC joint coracoclavicular (CC) distance. RESULTS Postoperative radiographs showed anatomical AC joint reduction in all patients. In nine patients, fixation failed before 6 weeks postoperatively, mainly as a result of suture breakage. For the remaining 47 patients, CC distance was well maintained at 6 weeks. At follow-up, mean (SD) CC distance was significantly increased compared to the contralateral side or postoperative radiographs [17 (4) mm versus 10 (3) mm]. Mean DASH score was 9, Constant score was 88 and the RAND 36 score showed a quality of life similar to the Finnish reference population. CONCLUSIONS Despite initial good reduction of grade III and V AC dislocations using TightRope fixation, subluxation often recurs after 6 weeks. Patients suffer minor subjective complaints that do not worsen the quality of life.
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Affiliation(s)
- Tapio E. Flinkkilä
- Division of Orthopedic and Trauma Surgery, Department of Surgery, Oulu University Hospital, Oulu, Finland,
Correspondence: Tapio Flinkkilä, Division of Orthopedic and Trauma Surgery, Department of Surgery, Oulu University Hospital, PL 21, Oulu, FIN-90029 OYS, Finland. Tel.: +358 8 3152812. Fax: +358 8 3152351. E-mail:
| | - Essi Ihanainen
- Division of Orthopedic and Trauma Surgery, Department of Surgery, Oulu University Hospital, Oulu, Finland
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Ye T, Ouyang Y, Chen A. Evaluation of coracoclavicular stabilization of acute acromioclavicular joint dislocation with multistrand titanium cables. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2013; 24:1061-6. [PMID: 24327005 DOI: 10.1007/s00590-013-1385-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 11/28/2013] [Indexed: 11/24/2022]
Abstract
PURPOSE The aim of this study was to evaluate the outcome of surgical treatment of acute acromioclavicular (AC) joint dislocation with multistrand titanium cables for coracoclavicular (CC) stabilization. METHODS Forty-two patients with acute AC joint dislocation, including Rockwood type III 14 cases, type IV 2 cases and type V 26 cases, were operated with CC stabilization using multistrand titanium cables. The cables were removed 3-12 months after surgery. The function outcome was evaluated by Constant scores and visual analog scale (VAS) scores. Radiological examination included bilateral antero-posterior and axillary radiography. RESULTS Three patients were lost to follow-up. Thirty-nine patients had an average follow-up time of 42 months (range 34-60). The Constant scores were 95.3 ± 9.3 at final evaluation. Preoperative and final follow-up VAS scores were 5.6 ± 1.5 and 0.4 ± 1.2, respectively (P < 0.05). Radiographs showed anatomical reduction in 32 patients. Cables breakage occurred in two patients. CONCLUSIONS CC stabilization with multistrand titanium cables was an effective and safe alternative to other procedures for the treatment of acute high-grade AC joint dislocations. It can provide immediate joint stabilization and allow early mobilization of limb with satisfied functional recovery.
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Affiliation(s)
- Tianwen Ye
- Department of Orthopaedic Surgery, Shanghai Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China
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Horst K, Dienstknecht T, Andruszkow H, Gradl G, Kobbe P, Pape HC. Radiographic changes in the operative treatment of acute acromioclavicular joint dislocation - tight rope technique vs. K-wire fixation. Pol J Radiol 2013; 78:15-20. [PMID: 24505220 PMCID: PMC3908503 DOI: 10.12659/pjr.889615] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 09/27/2013] [Indexed: 11/18/2022] Open
Abstract
Background Operative treatment of higher degree acromioclavicular joint luxation is common. A new option is made available by the tight rope technique. It claims to provide adequate outcome with the use of a minimally invasive technique. First clinical studies justified its medical use, but the equivalence to established surgical methods remains unclear. We therefore analyzed radiographic data from patients that were treated with the tight rope system (TR) and compared them to those treated with K-wires (KW) fixation. Material/Methods Retrospective study with inclusion criteria: surgery for acromioclavicular joint luxation between 2004 and 2011, classified as Rockwood type III, no concomitant injury, first event injury. We compared pre- and post-operative X-rays with those taken at the end of treatment. Clinical data from follow-ups and radiographic data were evaluated. The main outcome variable was the remaining distance between the acromion and clavicle (ACD), as well as the coracoid process and clavicle (CCD). Results 27 patients (TR: n=16; KW: n=11) with comparable demographics and injury severity were included. Surgery reduced ACD (TR: p=0.002; KW: p<0.001) and CCD (TR: p=0.001; KW: p=0.003). Heterotopic ossification or postoperative osteolysis was not significantly associated with either one of the procedures. Three patients (18.75%) in the TR group showed impaired wound healing, migrating K-wires were recorded in 2 patients (18.2%) and impingement syndrome occurred in 1 patient (9.1%) with K-wires. Posttraumatic arthritis was not seen. There was a loss of reduction in 2 cases within the TR-group (12.51%) and 1 in the KW-group (9.1%). At last follow up, ACD and CCD were wider in both groups compared to the healthy side. Conclusions This study shows that the Tight rope system is an effective alternative in the treatment of higher degree acromioclavicular luxation and comparable to the established methods.
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Affiliation(s)
- Klemens Horst
- Department of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Thomas Dienstknecht
- Department of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Hagen Andruszkow
- Department of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Gertraud Gradl
- Department of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Philipp Kobbe
- Department of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Hans-Christoph Pape
- Department of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
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Stübig T, Jähnisch T, Reichelt A, Krettek C, Citak M, Meller R. Navigated vs arthroscopic-guided drilling for reconstruction of acromioclavicular joint injuries: accuracy and feasibility. Int J Med Robot 2013; 9:359-64. [PMID: 23784857 DOI: 10.1002/rcs.1506] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2013] [Indexed: 11/05/2022]
Abstract
BACKGROUND Anatomical reconstruction of the coracoclavicular ligaments is a relatively new technique for acromioclavicular (AC) joint injuries. METHODS Eighteen procedures (nine non-navigated, nine navigated) of anatomical reconstruction were performed minimally invasively, using the Tight Rope system, on cadaveric shoulders. Two Kirschner wires were placed, freehand under fluoroscopic control (non-navigated) or 3D C-arm navigated. The insertion point on the clavicle as well as the position of the K-wire in the coracoid were measured in the axial and coronal planes; points were assigned for different zones. For statistical analysis, the significance level was set to p = 0.05. RESULTS The accuracy of the entry point in the clavicle was significantly more accurate for the conoidal (p = 0.022) and trapezoidal ( p = 0.0062) drillings. The positioning in the coronal (p = 0.037) and axial (p = 0.0416) planes also showed higher accuracy for the navigated procedures. CONCLUSION The accuracy of anatomical AC joint reconstruction can be improved using 3D C-arm flat detector navigation.
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Affiliation(s)
- Timo Stübig
- Trauma Department, Hannover Medical School, Germany
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Horst K, Dienstknecht T, Pishnamaz M, Sellei RM, Kobbe P, Pape HC. Operative treatment of acute acromioclavicular joint injuries graded Rockwood III and IV: risks and benefits in tight rope technique vs. k-wire fixation. Patient Saf Surg 2013; 7:18. [PMID: 23721404 PMCID: PMC3681720 DOI: 10.1186/1754-9493-7-18] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 05/22/2013] [Indexed: 12/17/2022] Open
Abstract
Background Operative treatment of acromioclavicular joint injuries is recommended for higher degree dislocations. Recently a new option has become available with the minimally-invasive tight rope technique. Whereas clinical studies justify the medical use, risks and benefits remain unclear. Therefore, this study analyzed these facts associated with this procedure and compared them to K-wire fixation. Material and Methods A retrospective analysis was performed of patients surgically treated either with the TightRope™-technique (TR) or K-wires (KW) for a first event isolated Rockwood type III or higher acromioclavicular joint dislocation between 2004 and 2011. Timing for surgery, surgical duration, length of hospital stay, costs, complications and outpatient visits were recorded. Results 41 patients were included (TR: n = 18; KW: n = 23) with comparable demographics and injury severity. A trend towards shorter operation time was seen in the TR group (TR: 64.3 ±19.8 min. vs. KW: 80.9 ±33.7 min., n.s.) A tendency for lower total operation theater costs was seen in the TR group (TR: 474 ±436.5€ vs. KW: 749.1 ±31.2€, n.s.). Patients from the TR group left hospital earlier (TR: 2 ±1d vs. KW: 3.6 ±1.8d, p = 0.002). Severe complications (i.e. a fracture of the clavicle or nerve damage) occurred in neither of the groups. Early loss of reduction (n = 1) and impaired wound healing (n = 2) was seen in the TR group. Migrating K-wires (n = 4), loss of reduction (n = 1) and impingement syndrome (n = 1) were recorded in the KW group. Conclusion Usage of the tight rope technique offered advantages, such as being a safe minimally-invasive technique and showed a tendency towards shorter operation time, and lower physician- and total operation and theater costs. Material costs were significantly higher for this device but patients were discharged earlier. The influence of different clinical long-term results on the financial outcome needs to be evaluated in further studies.
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Affiliation(s)
- Klemens Horst
- Department of Orthopedic Trauma Surgery, University Hospital RWTH Aachen, Paulwelsstreet 30, Aachen, 52074, Germany
| | - Thomas Dienstknecht
- Department of Orthopedic Trauma Surgery, University Hospital RWTH Aachen, Paulwelsstreet 30, Aachen, 52074, Germany
| | - Miguel Pishnamaz
- Department of Orthopedic Trauma Surgery, University Hospital RWTH Aachen, Paulwelsstreet 30, Aachen, 52074, Germany
| | - Richard Martin Sellei
- Department of Orthopedic Trauma Surgery, University Hospital RWTH Aachen, Paulwelsstreet 30, Aachen, 52074, Germany
| | - Philipp Kobbe
- Department of Orthopedic Trauma Surgery, University Hospital RWTH Aachen, Paulwelsstreet 30, Aachen, 52074, Germany
| | - Hans-Christoph Pape
- Department of Orthopedic Trauma Surgery, University Hospital RWTH Aachen, Paulwelsstreet 30, Aachen, 52074, Germany
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Abstract
Acromioclavicular (AC) joint separations are common injuries of the shoulder girdle, especially in the young and active population. Typically the mechanism of this injury is a direct force against the lateral aspect of the adducted shoulder, the magnitude of which affects injury severity. While low-grade injuries are frequently managed successfully using non-surgical measures, high-grade injuries frequently warrant surgical intervention to minimize pain and maximize shoulder function. Factors such as duration of injury and activity level should also be taken into account in an effort to individualize each patient's treatment. A number of surgical techniques have been introduced to manage symptomatic, high-grade injuries. The purpose of this article is to review the important anatomy, biomechanical background, and clinical management of this entity.
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Affiliation(s)
- Ryan J Warth
- Steadman Philippon Research Institute, 181 W. Meadow Drive, Vail, CO, 81657, USA
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Weatherall JM, Chapman CB, Shapiro SL. Postoperative second metatarsal fractures associated with suture-button implant in hallux valgus surgery. Foot Ankle Int 2013; 34:104-10. [PMID: 23386769 DOI: 10.1177/1071100712458961] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to perform a retrospective review of a nonosteotomy technique for the reduction of the intermetatarsal (IM) angle in hallux valgus (HV) surgery using a modified nonabsorbable suture-button implant previously described for ankle syndesmotic injuries and to report on the outcomes and complications associated with this technique. METHODS A retrospective review was performed of consecutive patients with a minimum follow-up of 1 year. Twenty-five patients, a total of 25 feet, were identified with a mean follow-up of 22.5 months. The mean age was 60 years. The pre- and postoperative HV and IM angles were compared. Each postoperative radiograph was assessed for loss of correction, implant failure, and second metatarsal (MT) stress fracture. The postoperative hallux American Orthopaedic Foot & Ankle Society (AOFAS) scores were obtained at the patient's final follow-up visit. Statistics were performed using the paired Student t test with the P value set at .05 to determine statistical differences. RESULTS The preoperative mean IM and HV angles were 15.1 and 30.5 degrees, respectively. The postoperative mean IM and HV angles were 8.2 and 10.2 degrees, respectively. The reductions in the IM and HV angles were statistically significant (P < .05). The average postoperative AOFAS hallux score was 85. Two patients developed hallux varus (8%). Eight patients (32%) developed second metatarsal stress fractures. One patient (4%) with a second metatarsal stress fracture had a failure of the implant that required implant removal. The remaining stress fractures healed uneventfully. CONCLUSION Suture-button fixation in hallux valgus achieved a satisfactory reduction in the first-second intermetatarsal angle compared with first metatarsal osteotomies but was associated with a high rate of second metatarsal stress fractures. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Acromioclavicular joint injuries and reconstructions: a review of expected imaging findings and potential complications. Emerg Radiol 2012; 19:399-413. [PMID: 22639336 DOI: 10.1007/s10140-012-1053-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Accepted: 05/10/2012] [Indexed: 10/28/2022]
Abstract
Shoulder injuries, including acromioclavicular (AC) joint separations, remain a common reason for presentation to the emergency room. Although the diagnosis can be made apparent through proper history and physical examination by the emergency medicine physician, ascertaining the degree of injury can be difficult on the basis of clinical evaluation alone. While there is consensus in the literature that low-grade AC joint injuries can be treated with conservative management, high-grade injuries will generally require surgical intervention. Furthermore, the treatment of grade 3 injuries remains controversial, making it incumbent upon the radiologist to become comfortable with distinguishing this diagnosis from lower or higher grade injuries. Imaging of AC joint injuries after clinical evaluation is generally initiated in the emergency room setting with plain film radiography; however, on occasion, an alternative modality may be presented to the emergency room radiologist for interpretation. As such, it remains important to be familiar with the appearance of AC joint separations on a variety of modalities. Another possible patient presentation in both the emergent and nonemergent setting includes new onset of pain or instability in the postsurgical shoulder. In this scenario, the onus is often placed on the radiologist to determine whether the pain or instability represents the sequelae of reinjury versus a complication of surgery. The purpose of this review is to present an anatomically based discussion of imaging findings associated with AC joint separations as seen on multiple modalities, as well as to describe and elucidate a variety of potential complications which may present to the emergency room radiologist.
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