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Ben-Ari E, Ragland DA, Cecora AJ, Virk MS. Fixation failure and early loss of reduction with the use of suture anchors for surgical repair of acromioclavicular joint dislocation: a case series. JSES Int 2024; 8:984-989. [PMID: 39280162 PMCID: PMC11401536 DOI: 10.1016/j.jseint.2024.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2024] Open
Abstract
Background Suture anchors have been used in surgical repair of acromioclavicular joint (ACJ) dislocation. While some reports indicate favorable results, others emphasize less promising outcomes. This case series reports our experience with suture anchors for surgical treatment of ACJ dislocation. Methods Clinical and radiographic outcomes in three patients treated operatively for ACJ dislocations were reviewed. In all patients, two suture anchors were inserted in the coracoid (unicortical) and #5 nonabsorbable suture from the suture anchor was shuttled through drill holes in the clavicle and tied over two button devices. The coracoclavicular ligaments were reconstructed using a figure of eight semitendinosus allograft around the coracoid and clavicle. Postoperatively, sling immobilization was used for 6 weeks, and physical therapy was initiated at 6 weeks with contact activity allowed at 6 months. Results Three male patients underwent treatment for Rockwood type 3 (chronic; n = 1) and type 5 (n = 2) ACJ dislocations. Loss of reduction was noted within 6 weeks postoperatively. Two patients exhibited failure due to complete suture anchor pullout and the third patient had partial pull out of one of the anchors. Additionally, the third patient also suffered a coracoid fracture adjacent to the anchor's placement after sustaining direct trauma to his shoulder, one-year postoperatively. Conclusion In our case series, we found a high rate of fixation failure and early loss of reduction with the use of suture anchors for the treatment of ACJ dislocation. These findings should be taken into consideration when selecting an appropriate implant for fixation of ACJ dislocation.
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Affiliation(s)
- Erel Ben-Ari
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Dashaun A Ragland
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Andrew J Cecora
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Mandeep S Virk
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
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Satone P, Ramteke SU, Jaiswal PR. Multimodal Exercises Adjunct to Virtual Reality in Acromioclavicular Joint Sprain Rehabilitation: A Case Report. Cureus 2024; 16:e66599. [PMID: 39258074 PMCID: PMC11383641 DOI: 10.7759/cureus.66599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2024] [Accepted: 08/10/2024] [Indexed: 09/12/2024] Open
Abstract
Acromioclavicular joint (AC) sprains are common, usually resulting from a fall on the corner of the shoulder or, less often, an outstretched arm. In this report, we discussed the assessment and physiotherapy protocol along with virtual reality (VR) training of a 21-year-old male state-level kabaddi player who complained of pain in his left shoulder following a history of fall on his left shoulder while playing. This study highlights clinical assessment, diagnostic assessment, therapeutic intervention, and outcomes for patients with a grade II AC sprain. Pain, range of motion (ROM), and muscle strength were clinically assessed. The patient was managed with cryotherapy, movement with mobilization (MWM), rigid taping, ROM exercises, VR training, and muscle strengthening. The results of the study concluded that our conventional physical therapy along with MWM adjunct to VR facilitates the patient's functional recovery.
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Affiliation(s)
- Palash Satone
- Sports Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Swapnil U Ramteke
- Sports Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Pratik R Jaiswal
- Sports Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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Ranne JO, Kainonen TU, Kanto KJ, Lehtinen JT, Niemi PT, Scheinin H. Tendon graft through the coracoid tunnel versus under the coracoid for coracoclavicular/acromioclavicular reconstruction shows no difference in radiographic or patient-reported outcomes. Arch Orthop Trauma Surg 2024; 144:3491-3501. [PMID: 39025979 PMCID: PMC11417077 DOI: 10.1007/s00402-024-05461-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 07/07/2024] [Indexed: 07/20/2024]
Abstract
INTRODUCTION The purpose of this prospective study was to report the outcomes of two different methods in CC and AC reconstruction for the treatment of AC separation using a tendon graft and knot-hiding titanium clavicular implant. MATERIALS AND METHODS Twenty-seven patients with Rockwood grade III and V acromioclavicular (AC) separations were randomized into two groups. The primary outcome was whether taking the tendon graft through the coracoid risked a fracture. The following were secondary outcomes: follow-up of clavicular wound healing and Nottingham Clavicle score, Constant score, and Simple Shoulder Test results obtained preoperatively and 24 months postoperatively. The anteroposterior radiographic change between the clavicular and coracoid cortexes and the clavicular tunnel diameter was measured postoperatively and 24 months postoperatively. General patient satisfaction with the outcome (poor, fair, good, or excellent) was assessed 2 years postoperatively. RESULTS No coracoid fractures were detected. No issues in clavicular wound healing were detected. The mean Nottingham Clavicle score increased from a preoperative mean of 42.42 ± 13.42 to 95.31 ± 14.20 (P < 0.00). The Constant score increased from a preoperative mean of 50.81 ± 17.77 to 96.42 ± 11.51 (P < 0.001). The Simple Shoulder Test score increased from a preoperative mean of 7.50 ± 2.45 to 11.77 ± 1.18 (P < 0.001). The changes were significant. The coracoclavicular distance increased from 11.88 ± 4.00 to 14.19 ± 4.71 mm (P = 0.001), which was significant. The clavicular drill hole diameter increased from 5.5 to a mean of 8.00 ± 0.75 mm. General patient satisfaction was excellent. CONCLUSIONS There were no significant differences between the two groups. There were no implant related complications in the clavicular wound healing. The results support the notion that good results are achieved by reconstructing both the CC and AC ligaments with a tendon graft. STUDY REGISTRATION This clinical trial was registered on Clinicaltrials.gov.
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Affiliation(s)
- Juha O Ranne
- Hospital Mehiläinen Neo, 20520, Joukahaisenkatu 6Turku, Finland.
- Department of Physical Activity and Health, The Paavo Nurmi Centre, The University of Turku, Turku, Finland.
| | | | | | - Janne T Lehtinen
- Department of Orthopedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Pekka T Niemi
- Hospital Mehiläinen Neo, 20520, Joukahaisenkatu 6Turku, Finland
| | - Harry Scheinin
- Department of Anesthesiology and Intensive Care, University of Turku, Turku, Finland
- Division of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland
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4
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Álvarez-Álvarez L, Cela-López M, González-Rodríguez E, García-Perez A, Rodríguez-Arenas M, Castro-Menéndez M. Type III acromioclavicular dislocation: Mid term results after operative and non-operative treatment. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:315-321. [PMID: 37187342 DOI: 10.1016/j.recot.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 05/09/2023] [Accepted: 05/09/2023] [Indexed: 05/17/2023] Open
Abstract
INTRODUCTION Controversy exists in the literature about the best treatment for type III acromioclavicular dislocations. The aim of this study is to compare functional results between surgical and conservative treatment in type III acromioclavicular joint dislocations. MATERIAL AND METHOD We retrospectively evaluated the records of 30 patients from our area with acute type III acromioclavicular dislocations that were treated from January 1st, 2016 to December 31st, 2020. Fifteen patients were treated surgically and 15 conservatively. Follow up mean time was 37.93 months in operative group and 35.73 months in non-operative group. Results obtained on the Constant score was the main variable analysed and results obtained on the Oxford score and the Visual Analogue Scale for pain were the secondary variables. Epidemiological variables were analysed, as well as range of mobility in injured shoulder and subjective and radiological variables (distance between the superior border of the acromion and the superior border of the clavicle's distal end and presence of osteoarthritis in the acromioclavicular joint). RESULTS Functional evaluation scores did not show differences between the two groups (Constant: operative 82/non-operative 86.38, p 0.412; Oxford: operative 42/non-operative 44.80, p 0.126) nor did Visual Analogue Scale (operative 1/non-operative 0.20, p 0.345). Subjective evaluation of the injured shoulder was excellent or good in 80% of the patients in both groups. Measurement of the distance between the superior border of the acromion and the superior border of the clavicle's distal end were significantly higher in non-operative group (operative 8.95/non-operative 14.21, p 0.008). CONCLUSIONS Although radiographic results were better in the surgical treatment group, functional evaluation scores did not show significant differences between the two groups. These results do not support the routine use of surgical treatment for grade III acromioclavicular dislocations.
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Affiliation(s)
- L Álvarez-Álvarez
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Álvaro Cunqueiro, Vigo, España.
| | - M Cela-López
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Álvaro Cunqueiro, Vigo, España
| | - E González-Rodríguez
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Álvaro Cunqueiro, Vigo, España
| | - A García-Perez
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Álvaro Cunqueiro, Vigo, España
| | - M Rodríguez-Arenas
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Álvaro Cunqueiro, Vigo, España
| | - M Castro-Menéndez
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Álvaro Cunqueiro, Vigo, España
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Álvarez-Álvarez L, Cela-López M, González-Rodríguez E, García-Perez A, Rodríguez-Arenas M, Castro-Menéndez M. [Translated article] Type III acromioclavicular dislocation: Mid term results after operative and non-operative treatment. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:T315-T321. [PMID: 38325567 DOI: 10.1016/j.recot.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 05/09/2023] [Accepted: 05/09/2023] [Indexed: 02/09/2024] Open
Abstract
INTRODUCTION Controversy exists in the literature about the best treatment for type III acromioclavicular dislocations. The aim of this study is to compare functional results between surgical and conservative treatment in type III acromioclavicular joint dislocations. MATERIAL AND METHOD We retrospectively evaluated the records of 30 patients from our area with acute type III acromioclavicular dislocations that were treated from January 1st, 2016 to December 31st, 2020. Fifteen patients were treated surgically and 15 conservatively. Follow-up mean time was 37.93 months in operative group and 35.73 months in non-operative group. Results obtained on the Constant score was the main variable analysed and results obtained on the Oxford score and the Visual Analogue Scale for pain were the secondary variables. Epidemiological variables were analysed, as well as range of mobility in injured shoulder and subjective and radiological variables (distance between the superior border of the acromion and the superior border of the clavicle's distal end and presence of osteoarthritis in the acromioclavicular joint). RESULTS Functional evaluation scores did not show differences between the two groups (Constant: operative 82/non-operative 86.38, p 0.412; Oxford: operative 42/non-operative 44.80, p 0.126) nor did Visual Analogue Scale (operative 1/non-operative 0.20, p 0.345). Subjective evaluation of the injured shoulder was excellent or good in 80% of the patients in both groups. Measurement of the distance between the superior border of the acromion and the superior border of the clavicle's distal end were significantly higher in non-operative group (operative 8.95/non-operative 14.21, p 0.008). CONCLUSIONS Although radiographic results were better in the surgical treatment group, functional evaluation scores did not show significant differences between the two groups. These results do not support the routine use of surgical treatment for grade III acromioclavicular dislocations.
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Affiliation(s)
- L Álvarez-Álvarez
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Álvaro Cunqueiro, Vigo, Spain.
| | - M Cela-López
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Álvaro Cunqueiro, Vigo, Spain
| | - E González-Rodríguez
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Álvaro Cunqueiro, Vigo, Spain
| | - A García-Perez
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Álvaro Cunqueiro, Vigo, Spain
| | - M Rodríguez-Arenas
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Álvaro Cunqueiro, Vigo, Spain
| | - M Castro-Menéndez
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Álvaro Cunqueiro, Vigo, Spain
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Tingle M, Wang T, Hoenecke HR. Current trends in surgical treatment of the acromioclavicular joint injuries in 2023: a review of the literature. JSES Int 2024; 8:389-393. [PMID: 38707567 PMCID: PMC11064557 DOI: 10.1016/j.jseint.2023.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024] Open
Abstract
Background This article examines the wide range of surgical reconstruction options available for acromioclavicular (AC) joint injuries. However, the lack of consensus regarding the most suitable surgical techniques is attributed to the high and variable failure rates observed with current approaches. Methods This article presents a comprehensive overview of the current surgical principles and techniques used by renowned experts in the field of AC shoulder injury management. Results It emphasizes the significance of addressing horizontal and rotational instability in AC injuries and highlights the impact of impaired scapular biomechanics. Conclusion By exploring these emerging concepts and strategies, the article aims to lay the foundation for future studies aimed at improving treatment outcomes and patient management.
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Affiliation(s)
- Matthew Tingle
- Veterans Affairs Nebraska-Western Iowa Health Care System-Omaha, Omaha, Ne, USA
| | - Tim Wang
- Scripps Health, Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, CA, USA
| | - Heinz R. Hoenecke
- Scripps Health, Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, CA, USA
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Obana KK, Lind DR, Mastroianni MA, Rondon AJ, Alexander FJ, Levine WN, Ahmad CS. What are our patients asking Google about acromioclavicular joint injuries?-frequently asked online questions and the quality of online resources. JSES REVIEWS, REPORTS, AND TECHNIQUES 2024; 4:175-181. [PMID: 38706686 PMCID: PMC11065754 DOI: 10.1016/j.xrrt.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
Background Management of acromioclavicular (AC) joint injuries has been an ongoing source of debate, with over 150 variations of surgery described in the literature. Without a consensus on surgical technique, patients are seeking answers to common questions through internet resources. This study investigates the most common online patient questions pertaining to AC joint injuries and the quality of the websites providing information. Hypothesis 1) Question topics will pertain to surgical indications, pain management, and success of surgery and 2) the quality and transparency of online information are largely heterogenous. Methods Three AC joint search queries were entered into the Google Web Search. Questions under the "People also ask" tab were expanded in order and 100 results for each query were included (300 total). Questions were categorized based on Rothwell's classification. Websites were categorized by source. Website quality was evaluated by the Journal of the American Medical Association (JAMA) Benchmark Criteria. Results Most questions fell into the Rothwell Fact category (48.0%). The most common question topics were surgical indications (28.0%), timeline of recovery (13.0%), and diagnosis/evaluation (12.0%). The least common question topics were anatomy/function (3.3%), evaluation of surgery (3.3%), injury comparison (1.0%), and cost (1.0%). The most common websites were medical practice (44.0%), academic (22.3%), and single surgeon personal (12.3%). The average JAMA score for all websites was 1.0 ± 1.3. Government websites had the highest JAMA score (4.0 ± 0.0) and constituted 45.8% of all websites with a score of 4/4. PubMed articles constituted 63.6% (7/11) of government website. Comparatively, medical practice websites had the lowest JAMA score (0.3 ± 0.7, range [0-3]). Conclusion Online patient AC joint injury questions pertain to surgical indications, timeline of recovery, and diagnosis/evaluation. Government websites and PubMed articles provide the highest-quality sources of reliable, up-to-date information but constitute the smallest proportion of resources. In contrast, medical practice represents the most visited websites, however, recorded the lowest quality score. Physicians should utilize this information to answer frequently asked questions, guide patient expectations, and help provide and identify reliable online resources.
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Affiliation(s)
- Kyle K. Obana
- Department of Orthopaedic Surgery, New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Dane R.G. Lind
- Department of Orthopaedic Surgery, New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Michael A. Mastroianni
- Department of Orthopaedic Surgery, New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Alexander J. Rondon
- Department of Orthopaedic Surgery, New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Frank J. Alexander
- Department of Orthopaedic Surgery, New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - William N. Levine
- Department of Orthopaedic Surgery, New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Christopher S. Ahmad
- Department of Orthopaedic Surgery, New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
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Xiao M, Abrams GD. Editorial Commentary: Acromioclavicular Joint Reconstruction With Double-Bundle Constructs Provides Improved Maintenance of Reduction but Comparable Clinical Outcomes Versus Single-Bundle Constructs. Arthroscopy 2024:S0749-8063(24)00299-8. [PMID: 38697326 DOI: 10.1016/j.arthro.2024.04.014] [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: 04/16/2024] [Accepted: 04/16/2024] [Indexed: 05/04/2024]
Abstract
Treatment of acute acromioclavicular (AC) joint separations is dependent on a variety of factors, including severity, acuity, patient demographics, activity level, and surgeon preferences. For more severe or unstable separations (Rockwood types IIIB, IV, V, and VI), surgical intervention is typically recommended. Over 160 surgical techniques have been described, but none have emerged as a gold standard. Arthroscopic-assisted or all-arthroscopic fixation of the coracoclavicular ligaments with suture buttons has become increasingly popular due to lower complication rates compared with more rigid fixation. Configurations include single-bundle (SB) constructs and double-bundle (DB) configurations that more anatomically reconstruct the conoid and trapezoid ligaments but with longer operative times. Clinical studies with short-term follow-up have demonstrated improved maintenance of fixation for DB compared with SB constructs but no significant differences in clinical outcomes. In our experience, SB suture button-only constructs lead to unacceptable failures due to loss of reduction. We recommend either a single suture button construct augmented with allograft or DB suture button constructs for the treatment of acute AC joint separations.
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Maleki A, Dibamehr M, Bisadi A, Kouhestani E. Innovative approach to managing acromion fracture and acromioclavicular joint dislocation: A case report. Int J Surg Case Rep 2024; 117:109446. [PMID: 38458019 PMCID: PMC10937823 DOI: 10.1016/j.ijscr.2024.109446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/19/2024] [Accepted: 02/21/2024] [Indexed: 03/10/2024] Open
Abstract
INTRODUCTION This study delves into the management of acromion fractures and acromioclavicular (AC) joint dislocations-orthopedic injuries with significant implications for shoulder function. Despite their infrequency, these injuries present challenges due to potential persistent pain and functional limitations. Current treatment strategies span from conservative measures to surgical interventions, yet there exists a notable gap in comprehensive data on specific surgical approaches. PRESENTATION OF CASE We present a compelling case involving a 38-year-old male athlete who sought medical attention following a motor vehicle accident due to severe right shoulder pain. Upon admission to the emergency ward, the patient reported an inability to move the affected shoulder. Radiographic evaluations, comprising X-ray and computerized tomography scans, revealed a displaced fracture at the base of the acromion coupled with an AC dislocation. A novel surgical technique was employed, featuring coracoid fixation with mersilene thread and a 2-hole reconstruction plate-a distinctive approach in the field. DISCUSSION The systematic rehabilitation plan yielded successful healing and the restoration of normal shoulder function, offering promising insights into potential advancements in orthopedic practices. CONCLUSION This case contributes valuable knowledge to the understanding of these complex injuries, paving the way for further exploration and refinement in their management. The innovative surgical approach showcased underscores the importance of continued research and exploration to enhance the overall treatment landscape for acromion fractures and AC joint dislocations.
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Affiliation(s)
- Arash Maleki
- Department of Orthopedic Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Bone Joint and Related Tissues Research Center, Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Dibamehr
- Bone Joint and Related Tissues Research Center, Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Bisadi
- Department of Orthopedic Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Bone Joint and Related Tissues Research Center, Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Emad Kouhestani
- Department of Orthopedic Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Bone Joint and Related Tissues Research Center, Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Wang Y, Ren C, Niu J, Cao L, Yang C, Bi F, Tian K. Surgical treatment of acromioclavicular joint dislocation of Rockwood III/IV: a retrospective study on clavicular hook plate versus arthroscopic TightRope loop titanium button. BMC Musculoskelet Disord 2024; 25:174. [PMID: 38409002 PMCID: PMC10895789 DOI: 10.1186/s12891-024-07269-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 02/08/2024] [Indexed: 02/28/2024] Open
Abstract
PURPOSE To compare the clinical efficacy of arthroscopic TightRope loop titanium button and clavicular hook plate in the treatment of acromioclavicular joint (ACJ) dislocation of Rockwood III/IV. METHODS A retrospective analysis of patients with ACJ dislocation in our hospital from January 2018 to December 2020 was conducted. The patients were assigned to be treated with arthroscopic TightRope loop titanium button (TR group) or clavicular hook plate (HP group). The preoperative, intraoperative and postoperative data and imaging findings of the two groups were compared. RESULTS A total of 58 eligible patients were enrolled in this study. Compared with HP group, TR group had shorter incision length and less blood loss during operation. Postoperative follow-up ranged from 12 to 24 months (mean 15.4 months). At 6 months and 12months postoperatively, compared with HP group, TR group had lower VAS and higher CMS, and the difference was statistically significant. At 12 months postoperatively, compared with HP group, TR group had lower ACJ gap and coracoclavicular joint(CCJ) distance, and the difference was statistically significant.In HP group, there were 3 cases of subacromial impact, 1 case of redislocation, 2 cases of traumatic arthritis and 2 cases of wound infection. There was 1 case of redislocation in TR group. CONCLUSIONS Compared with clavicular hook plate, arthroscopic TightRope loop titanium button is minimally invasive, safe and effective in the treatment of ACJ dislocation, and has a good trend in clinical application.
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Affiliation(s)
- Yafei Wang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Zhengzhou University, NO.1 Jianshe East Road, Zhengzhou, 450052, China
| | - Chengzhen Ren
- Department of Orthopedic Surgery, The First Affiliated Hospital of Zhengzhou University, NO.1 Jianshe East Road, Zhengzhou, 450052, China
| | - Junqi Niu
- Department of Orthopedic Surgery, The First Affiliated Hospital of Zhengzhou University, NO.1 Jianshe East Road, Zhengzhou, 450052, China
| | - Le Cao
- Department of Orthopedic Surgery, The First Affiliated Hospital of Zhengzhou University, NO.1 Jianshe East Road, Zhengzhou, 450052, China
| | - Can Yang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Zhengzhou University, NO.1 Jianshe East Road, Zhengzhou, 450052, China
| | - Fanggang Bi
- Department of Orthopedic Surgery, The First Affiliated Hospital of Zhengzhou University, NO.1 Jianshe East Road, Zhengzhou, 450052, China
| | - Ke Tian
- Department of Orthopedic Surgery, The First Affiliated Hospital of Zhengzhou University, NO.1 Jianshe East Road, Zhengzhou, 450052, China.
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Li Y, Cai J, Li P, Pang L, Li J, Tang X. Suture Button Could Result in More Functional Outcomes Improvement and Pain Relief Than Hook Plate Technique for Treating Acute Acromioclavicular Joint Dislocation: A Systematic Review of Comparative Studies. Arthroscopy 2024; 40:553-566. [PMID: 37315745 DOI: 10.1016/j.arthro.2023.05.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 05/12/2023] [Accepted: 05/18/2023] [Indexed: 06/16/2023]
Abstract
PURPOSE To systematically review the current evidence to compare the differences in outcomes of the suture button (SB) versus hook plate (HP) fixations for treating acute acromioclavicular joint dislocation (ACD). METHODS Two independent reviewers performed the literature search based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A literature search of the Embase, PubMed, and Cochrane Library databases was performed and Level I-IV evidence studies comparing the SB and HP procedures for acute ACD were included. Studies that met the following exclusion criteria were excluded: (1) letters, comments, case reports, reviews, animal studies, cadaveric studies, biomechanical studies, and study protocols; (2) incomplete data; and (3) repeated studies and data. The Newcastle-Ottawa Scale was used to evaluate the quality of nonrandomized studies. Constant score, visual analog scale (VAS) score, operation time, coracoclavicular distance (CCD), and complications were recorded and the mean differences of VAS and Constant were compared with preset minimal clinically important difference. RESULTS Fourteen studies with 363 patients treated with SB procedures and 432 patients with the HP procedure were included. In terms of patient-reported outcomes, 5 of the 13 included studies reported significantly greater Constant score in SB group and most (4/5) used arthroscopic SB technique. Statistically significant differences in favor of SB were found in 3 of the 7 included studies in terms of VAS score whereas none of them reached the minimal clinically important difference. In terms of recurrent instability, no statistically significant difference was noted. All studies showed that the SB technique resulted in lower estimated blood loss. No difference was detected in CCD and complications. CONCLUSIONS Based on the current body of evidence, it is suggested that employment of the SB technique may confer advantageous outcomes when compared to the HP technique in acute ACD patients. These potential benefits may include higher Constant scores, lower pain levels, and no discernible increases in operation time, CCD, or complication rates. LEVEL OF EVIDENCE Level IV, systematic review of Level II-IV studies.
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Affiliation(s)
- Yinghao Li
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Jie Cai
- West China School of Medicine, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Pengcheng Li
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China; West China School of Nursing, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Long Pang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Jian Li
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
| | - Xin Tang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
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12
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Adams BG, Yow BG, Roach WB, Posner MA, Donohue MA. Arthroscopic Anatomic Knotless Coracoclavicular Ligament Repair Without Coracoid Drilling. Arthrosc Tech 2023; 12:e2359-e2367. [PMID: 38196860 PMCID: PMC10773260 DOI: 10.1016/j.eats.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/07/2023] [Indexed: 01/11/2024] Open
Abstract
Acromioclavicular joint injuries are common in young active patients. A wide variety of surgical techniques exist to address specific complications associated with surgery. Complications after surgery include loss of reduction, fracture of the clavicle or coracoid, failure of fixation, and prominent and symptomatic hardware. This technique aims to reduce these complications with an arthroscopic anatomic coracoclavicular ligament repair using knotless adjustable loop buttons with fifth-generation suture tape and no drilling of the coracoid.
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Affiliation(s)
- Bryan G. Adams
- Department of Orthopaedic Surgery, Landstuhl Regional Medical Center, Rheinland-Pfalz, Germany
| | - Bobby G. Yow
- Keller Army Community Hospital, West Point, New York, U.S.A
| | | | - Matthew A. Posner
- Geisinger Orthopaedics and Sports Medicine, Scranton, Pennsylvania, U.S.A
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13
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Olsen BA, Rollins JW, Ngo DH, Gregory JM. Tunnel-free acromioclavicular joint reconstruction is associated with improved initial reduction and higher patient satisfaction. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:519-523. [PMID: 37928985 PMCID: PMC10624993 DOI: 10.1016/j.xrrt.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Background Many surgical techniques have been described for acromioclavicular (AC) joint reconstruction. Creation of bone tunnels through the clavicle or coracoid has been shown to be a risk factor for fracture. Use of an AC reconstruction technique that does not create bone tunnels may obviate this risk. This study aims to evaluate clinical outcomes of AC joint reconstruction using a tunnel-free technique compared to reconstruction using a cortical button and clavicular drill holes. Methods Consecutive patients who underwent AC joint reconstruction by a single surgeon in a subspecialty referral practice were included. One group of patients received cortical button fixation (button group), in which sutures were passed around the coracoid, brought up through a drill hole in the clavicle, and tied over a cortical button. The other group of patients received tunnel-free fixation, in which a self-locking tape suture was passed in a cerclage fashion around the base of the coracoid and the clavicle and tensioned with a tensioning device (cerclage group). Both groups underwent reconstruction of the coracoclavicular (CC) ligament and AC joint capsule using tibialis anterior allograft. Patient-reported outcome scores and satisfaction were collected and compared between groups. Radiographs were reviewed to evaluate CC ligament distance and loss of reduction. Results Twenty-two patients were included in the study (button n = 10, cerclage n = 12). Preoperative demographics and injury characteristics were not different between groups. Average radiographic follow-up was not different between groups (button: 231 days, cerclage: 105 days). Postoperative American Shoulder and Elbow Surgeons, visual analog scale, and Single Assessment Numeric Evaluation scores were similar between groups. Two postoperative clavicle fractures were sustained in the button group. These occurred through clavicular drill holes and were preceded by tunnel widening. No fractures occurred in the cerclage group. CC distance at initial follow-up was significantly less in the cerclage group (button: 11.2 ± 4.5 mm, cerclage: 7.0 ± 2.9 mm, P =.023). Loss of reduction was similar throughout the postoperative period (button: 4.3 ± 2.6 mm, cerclage: 4.8 ± 4.1 mm, P >.05. Forty percent of patients were unsatisfied with their clavicle after button fixation (n = 4/10), compared with zero after cerclage fixation (n = 0/12, P =.03). Reasons for dissatisfaction were fracture (n = 2) and persistent cosmetic deformity (n = 2). Conclusion Tunnel-free AC joint reconstruction is associated with improved initial radiographic appearance and patient satisfaction compared to single cortical button fixation. Postoperative clavicle fracture and persistent cosmetic deformity drive patient dissatisfaction, which may be minimized by avoiding clavicular drill holes and using a tensioned self-locking cerclage suture to improve initial reduction.
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Affiliation(s)
- Brittany A. Olsen
- Department of Orthopaedic Surgery, UTHealth Houston McGovern Medical School, Houston, TX, USA
| | - Joshua W. Rollins
- Department of Orthopaedic Surgery, UTHealth Houston McGovern Medical School, Houston, TX, USA
| | - Daniel H. Ngo
- Department of Orthopaedic Surgery, UTHealth Houston McGovern Medical School, Houston, TX, USA
| | - James M. Gregory
- Department of Orthopaedic Surgery, UTHealth Houston McGovern Medical School, Houston, TX, USA
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14
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Bellmann F, Eckl L, Vetter P, Audigé L, Scheibel M. Clavicular Tunnel Widening After Acromioclavicular Stabilization Shows Implant-Dependent Correlation With Postoperative Loss of Reduction. Arthroscopy 2023; 39:2273-2280. [PMID: 37230185 DOI: 10.1016/j.arthro.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/28/2023] [Accepted: 05/10/2023] [Indexed: 05/27/2023]
Abstract
PURPOSE To radiographically describe, quantify, and compare clavicular tunnel widening (cTW) of 2 different types of stabilization devices and investigate a possible correlation between cTW and loss of reduction. METHODS In a retrospective analysis of single-center registry data, we compared patients who were treated for an acute AC dislocation (Rockwood types III to V) with either the AC Dog Bone (DB) or low-profile AC (LP) repair systems. On 6-week and 6-month postoperative radiographs, we measured clavicle height and tunnel diameter. We calculated the button/clavicle filling (B/C) ratio to quantify how much of the clavicular tunnel height is covered by the low-profile inlet. The association between B/C ratio and the extent of cTW was defined, and we also compared cTW between treatment groups. Reduction of the AC joint was graded as either stable, partially dislocated or dislocated depending on the AC ratio. A 2-sample t-test was used for comparing cTW progression between the 2 groups. For continuous variables between more than 2 groups, the Kruskal-Wallis test was used. RESULTS Of 65 eligible patients, there were 37 and 28 included in the DB and LP groups, respectively. Overall, cTW was conically shaped with transclavicular widening noted in the DB group and cTW developing strictly inferior to the button in the LP group. For both implants, mean maximal cTW was 7.1 mm and located at the inferior cortex; the B/C ratio was not associated with increased inferior cTW (r = -0.23, P = .248). Only LP patients with complete loss of reduction had significantly increased cTW (P = .049). CONCLUSIONS Conical-shaped cTW is a common implant-independent phenomenon after AC stabilization using suture-button devices. It occurs only at the suture-bone interface and is less excessive for the LP implant. There is an association between increased cTW and loss of reduction specific to the LP implant only. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Frederik Bellmann
- Department of Shoulder and Elbow Surgery, Schulthess Clinic, Zurich, Switzerland
| | - Larissa Eckl
- Department of Shoulder and Elbow Surgery, Schulthess Clinic, Zurich, Switzerland
| | - Philipp Vetter
- Department of Trauma Surgery, University Hospital, Zurich, Switzerland
| | - Laurent Audigé
- Department of Shoulder and Elbow Surgery, Schulthess Clinic, Zurich, Switzerland
| | - Markus Scheibel
- Department of Shoulder and Elbow Surgery, Schulthess Clinic, Zurich, Switzerland; Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin, Berlin, Germany.
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15
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Hassebrock JD, Stokes DJ, Cram TR, Frank RM. Arthroscopic Repair and Reconstruction of Coracoclavicular Ligament. Clin Sports Med 2023; 42:599-611. [PMID: 37716724 DOI: 10.1016/j.csm.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
Acromioclavicular joint separations are common shoulder injuries that require prompt recognition, diagnosis, and treatment. Deciding on a treatment algorithm relies on a detailed knowledge of anatomy and a thorough understanding of the specific functional demands of the patient in question. When a repair or reconstruction is indicated, arthroscopic assistance can be a helpful tool to ensure a safe, anatomic reconstruction that minimizes morbidity and maximizes the potential return to high-level function.
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Affiliation(s)
- Jeffrey D Hassebrock
- Department of Orthopedic Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Daniel J Stokes
- Department of Orthopedic Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Tyler R Cram
- Department of Orthopedic Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Rachel M Frank
- Department of Orthopedic Surgery, University of Colorado School of Medicine, Aurora, CO, USA.
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16
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Cain EL, Parker D. Open Anatomic Coracoclavicular Ligament Reconstruction for Acromioclavicular Joint Injuries. Clin Sports Med 2023; 42:589-598. [PMID: 37716723 DOI: 10.1016/j.csm.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
Open reconstruction of the coracoclavicular (CC) and acromioclavicular (AC) ligaments results in excellent reduction of severely displaced AC dislocations, most commonly Grades III and V. Anatomic CC reconstruction through clavicular bone tunnels can prevent vertical instability, whereas the addition of an acromial limb of the graft can increase horizontal stability. Autograft tendon is preferred in the young athletic group of collision sports participants, although allograft has had acceptable results. Accessory fixation may be placed to protect the graft during healing, or for severe instability, especially for athletes involved in contact sports.
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Affiliation(s)
- E Lyle Cain
- American Sports Medicine Institute, Andrews Sports Medicine and Orthopaedic Center, 805 Saint, Vincents Drive, Suite 100, Birmingham, AL, 35205, USA.
| | - David Parker
- American Sports Medicine Institute, Andrews Sports Medicine and Orthopaedic Center, 805 Saint, Vincents Drive, Suite 100, Birmingham, AL, 35205, USA
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17
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Peebles LA, Akamefula RA, Kraeutler MJ, Mulcahey MK. Management of Acromioclavicular Joint Injuries: A Historic Account. Clin Sports Med 2023; 42:539-556. [PMID: 37716720 DOI: 10.1016/j.csm.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
There has been a rapid evolution in best practice management of acromioclavicular (AC) joint injuries. AP, Zanca, scapular Y, and dynamic axillary radiographic views provide optimal visualization of the joint and may assess for the presence of horizontal AC instability. Severity of AC joint pathology is classified according to the 6-tier Rockwood scoring system. Over 160 surgical techniques have been described for AC joint repair and reconstruction in the last decade; as a result, determining the optimal treatment algorithm has become increasingly challenging secondary to the lack of consistently excellent clinical outcomes.
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Affiliation(s)
- Liam A Peebles
- Tulane University School of Medicine, 1430 Tulane Avenue, #2070, New Orleans, LA, USA
| | - Ramesses A Akamefula
- Tulane University School of Medicine, 1430 Tulane Avenue, #2070, New Orleans, LA, USA
| | - Matthew J Kraeutler
- Department of Orthopedics & Sports Medicine, Houston Methodist Hospital, 6445 Main Street, #2300, Houston, TX, USA
| | - Mary K Mulcahey
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL, USA.
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18
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Chang PS, Murphy CP, Whalen RJ, Apostolakos JM, Provencher MT. Surgical Pearls and Pitfalls for Anatomic Acromioclavicular/Coracoclavicular Ligament Reconstruction. Clin Sports Med 2023; 42:621-632. [PMID: 37716726 DOI: 10.1016/j.csm.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
Injuries to the acromioclavicular (AC) joint are common shoulder injuries in contact/collision athletes. There are a number of different surgical options that can be used to treat these injuries. The majority of these injuries can be treated nonoperatively with an early return to play for type I and II injuries. Surgical intervention and AC/CC (coracoclavicular) ligament reconstruction have excellent postoperative outcomes if complications can be avoided. This review will focus on the pearls and pitfalls for anatomic AC and CC ligament reconstruction for high-grade AC joint injuries.
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Affiliation(s)
- Peter S Chang
- Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 400, Vail, CO 81657, USA
| | - Colin P Murphy
- University of North Dakota Orthopaedic Surgery Residency Program, 1919 Elm Street North, Fargo, ND 58102, USA
| | - Ryan J Whalen
- Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 400, Vail, CO 81657, USA
| | - John M Apostolakos
- Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 400, Vail, CO 81657, USA
| | - Matthew T Provencher
- Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 400, Vail, CO 81657, USA; The Steadman Clinic, 181 West Meadow Drive, Suite 400, Vail, CO 81657, USA.
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19
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Olsen B, Gregory B. Diagnosis and Nonoperative Treatment of Acromioclavicular Joint Injuries in Athletes and Guide for Return to Play. Clin Sports Med 2023; 42:573-587. [PMID: 37716722 DOI: 10.1016/j.csm.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
Injury to the acromioclavicular (AC) joint accounts for approximately 40% to 50% of all shoulder injuries. In contact sports, the prevalence of AC joint injury increases. This injury is frequently encountered and treated by fellowship-trained as well as general orthopedic surgeons. As such, it is important to understand the diagnostic and treatment pathways for AC joint disruption. The treatment pathways in athletes may be different from those in the general population. This article will focus on the diagnosis and nonoperative treatment of AC joint injuries in athletes. We will also comment on return-to-play guidelines after this nonoperative treatment.
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Affiliation(s)
- Brittany Olsen
- Department of Orthopaedic Surgery, University of Texas Health Science Center at Houston/McGovern Medical School, 6400 Fannin Street, Suite 1700, Houston, TX 77030, USA
| | - Bonnie Gregory
- Department of Orthopaedic Surgery, University of Texas Health Science Center at Houston/McGovern Medical School, 6400 Fannin Street, Suite 1700, Houston, TX 77030, USA.
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20
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Hohmann E, Tetsworth K. Clinical outcomes for grades III-V acromioclavicular dislocations favor double-button fixation compared to clavicle hook plate fixation: a systematic review and meta-analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:2831-2846. [PMID: 36841909 PMCID: PMC10504211 DOI: 10.1007/s00590-023-03492-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 02/05/2023] [Indexed: 02/27/2023]
Abstract
INTRODUCTION The purpose of this study was to perform a systematic review and meta-analysis of both randomized controlled and observational studies comparing double-button suture fixation to hook plate fixation for types III-IV acromioclavicular joint dislocation. METHODS Systematic review of Medline, Embase, Scopus, and Google Scholar, including all levels 1-3 studies from 2000 to 2022. Clinical outcome scores, range of motion, and complications were included. Risk of bias was assessed using the Cochrane Collaboration's ROB2 tool and ROBINs-I tool. MINORS and modified Coleman Methodology Score (CMS) were used to assess within study quality. The GRADE system was used to assess the overall quality of the body of evidence. Heterogeneity was assessed using χ2 and I2 statistics. RESULTS Fifteen studies were included. Three of the four included LOE II and eleven of the LOE III studies had a high risk of bias. Study quality was considered poor and fair for 67% by MINORS criteria and 93% for CMS criteria. The pooled estimate (SMD 0.662) for all clinical outcomes was statistically significant and in favor of button repair (p = 0.0001). The pooled estimate (SMD 0.662) for all VAS pain scores was statistically significant, again in favor of button repair (p = 0.001). CONCLUSIONS The results of this meta-analysis demonstrated significantly better outcomes of button repair for acute ACJ dislocations when compared to clavicle hook plate. Button repair is also associated with a 2.2 times lower risk for complications. However, risk of bias is high, and study quality within and between studies was low. These results, therefore, must be viewed with caution. LEVEL OF EVIDENCE Level III; systematic review and meta-analysis.
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Affiliation(s)
- Erik Hohmann
- Medical School, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
- Department of Orthopaedic Surgery and Sports Medicine, Burjeel Hospital for Advanced Surgery, Dubai, UAE.
| | - Kevin Tetsworth
- Department of Orthopaedic Surgery, Royal Brisbane Hospital, Herston, Australia
- Department of Surgery, School of Medicine, University of Queensland, Brisbane, Australia
- Limb Reconstruction Center, Macquarie University Hospital, Macquarie Park, Australia
- Orthopaedic Research Centre of Australia, Brisbane, Australia
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21
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Chen RE, Gates ST, Vaughan A, Santoro A, Reddy Y, Williams GR, Namdari S. Complications after operative treatment of high-grade acromioclavicular injuries. J Shoulder Elbow Surg 2023; 32:1972-1980. [PMID: 37075939 DOI: 10.1016/j.jse.2023.03.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 03/13/2023] [Accepted: 03/22/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Treatment of Rockwood type III-V acromioclavicular (AC) joint injuries remains controversial. Numerous reconstruction techniques have been proposed. The purpose of this study was to describe the complication profile in a large cohort of patients who underwent surgical management of AC joint separations using a variety of reconstruction strategies. METHODS All patients who underwent surgery for AC joint injuries from 2013 to 2019 at a single institution were identified. Chart review was performed to capture patient demographics, radiographic measurements, operative techniques, postoperative complications, and revision surgery. Structural failure was defined as a radiographic loss of reduction of greater than 50% when comparing immediate and final postoperative imaging. Logistic regression analysis was performed to identify risk factors for complications and revision surgery. RESULTS Of the 279 patients included in the study, 66 (24%) had type III separations, 20 (7%) type IV, and 193 (69%) type V. Fifty-three percent underwent surgery acutely (<6 weeks of injury), and 40% were chronic (>3 months). A total of 252 of the 279 surgeries (90%) were performed open and 27 (10%) were arthroscopically assisted. Allograft was used in 164 of 279 (59%) cases. Specific operative techniques (with or without allograft) included hook plating (1%), modified Weaver Dunn (16%), cortical button fixation (18%), and suture fixation (65%). At mean 28-week follow-up, 108 complications were identified in 97 patients (35%). Complications were identified at mean 20 ± 21 weeks. Sixty-nine structural failures (25%) were identified. Persistent AC joint pain requiring injection, clavicle fracture, adhesive capsulitis, and hardware complications were the other most common complications. Twenty-one patients (8%) underwent unplanned revision surgery at mean 38 ± 28 weeks after the index procedure, with the most common indication for structural failure, hardware complications, or fracture of the clavicle or coracoid. Patients who had surgery after 6 weeks from injury had a significantly greater risk of having a complication (odds ratio [OR] 3.19, 95% confidence interval [CI] 1.34-7.77, P = .009) and a significantly greater risk of having structural failure (OR 2.65, 95% CI 1.38-5.28, P = .004). Patients who had an arthroscopic technique had a greater risk of structural failure (P = .002). Complications, structural failure, and revision surgery were not significantly correlated with use of allograft or specific operative techniques. CONCLUSION Surgical management of AC joint injuries is associated with a relatively high complication profile. Loss of reduction in the postoperative period is common. However, the revision surgery rate is low. These findings are important for patient preoperative counseling.
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Affiliation(s)
- Raymond E Chen
- Rothman Orthopaedic Institute, Thomas Jefferson University Hospitals, Philadelphia, PA, USA.
| | - Stephen T Gates
- Rothman Orthopaedic Institute, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Alayna Vaughan
- Rothman Orthopaedic Institute, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Adam Santoro
- Rothman Orthopaedic Institute, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Yashas Reddy
- Rothman Orthopaedic Institute, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Gerald R Williams
- Rothman Orthopaedic Institute, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Surena Namdari
- Rothman Orthopaedic Institute, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
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22
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Yan Y, Liao M, Lai H, Xu Z, Chen H, Huang W, Yu H, Zhang Y. Comparison of Effectiveness and Safety in Treating Acute Acromioclavicular Joint Dislocation with Five Different Surgical Procedures: A Systematic Review and Network Meta-Analysis. Orthop Surg 2023; 15:1944-1958. [PMID: 37105917 PMCID: PMC10432441 DOI: 10.1111/os.13731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 03/15/2023] [Accepted: 03/16/2023] [Indexed: 04/29/2023] Open
Abstract
This network meta-analysis aims to evaluate the comparative effectiveness and safety of suture anchors (SA), tendon grafts (TG), hook plates (HP), Tight-Rope (TR), and EndoButton (EB) in the treatment of acute acromioclavicular joint (ACJ) dislocation. The Embase, PubMed, and Web of Science databases were searched from their inception date to June 3, 2022. Studies included all eligible randomized controlled trials (RCTs) and cohort studies with the comparison of five different fixation systems among SA, TG, HP, TR, and EB were identified. All studies were reviewed, performed data extraction, and assessed the risk of bias independently by two reviewers. The primary outcomes are Constant-Murley score (CMS) improvement for assessing clinical efficacy, and complications. The second outcomes are visual analog scale (VAS) for assessing pain relief and the coracoclavicular distance (CCD) for assessing postoperative joint reduction. Version 2 of the revised Cochrane risk of bias tool for randomized trials (RoB 2) and the risk of bias in nonrandomized studies of interventions (ROBINS-I) were used to assess the RCTs and non-randomized trials, respectively. The continuous outcomes were presented as mean differences (MD), and risk ratios (OR) were used for dichotomous outcomes, both with 95% confidence intervals (CI). Surface under the cumulative ranking curves (SUCRA) results were calculated to offer a ranking of each intervention. We identified 31 eligible trials, including 1687 patients in total. HP showed less CMS improvement than TR and EB in both the Network Meta-analysis (NMA) and pairwise meta-analysis. HP also showed less CMS improvement than SA in NMA. For pain relief, HP performed worse than TR both in pairwise meta-analysis and NMA. No significant differences were found for the measured value of CCD. Both TR and EB showed a lower incidence of complications than HP in pairwise meta-analysis. The rank of SUCRA for CMS improvement was as follows: SA, TR, EB, TG, and HP; for pain relief: TR, EB, TG, SA, and HP; for CCD: HP, TR, SA, EB, and TG. For complications, HP showed the highest rank, followed by TG, EB, TR, and SA. SA shows better clinical effectiveness and reliable safety in the treatment of acute ACJ dislocation. Although HP is the most widely used surgical option currently, it should be carefully taken into consideration for its high incidence of complications.
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Affiliation(s)
- Yuan Yan
- Guangdong Cardiovascular InstituteGuangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical UniversityGuangzhouChina
- Department of Orthopaedics, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences)Southern Medical UniversityGuangzhouChina
| | - Mingxin Liao
- Nanping First Hospital Affiliated to Fujian Medical UniversityNanpingChina
| | - Huahao Lai
- Department of Orthopaedics, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences)Southern Medical UniversityGuangzhouChina
| | - Ziyang Xu
- Department of Orthopaedics, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences)Southern Medical UniversityGuangzhouChina
| | - Haobin Chen
- Department of Orthopaedics, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences)Southern Medical UniversityGuangzhouChina
| | - Wenhan Huang
- Department of Orthopaedics, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences)Southern Medical UniversityGuangzhouChina
| | - Hui Yu
- Department of OrthopaedicsThe Third Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
| | - Yu Zhang
- Guangdong Cardiovascular InstituteGuangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical UniversityGuangzhouChina
- Department of Orthopaedics, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences)Southern Medical UniversityGuangzhouChina
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23
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Balke M, Wafaisade A, Hoeher J, Greshake O. Minimally invasive reconstruction of acute acromioclavicular joint injuries using the TwinBridge button system. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:1349-1355. [PMID: 35641794 PMCID: PMC10125920 DOI: 10.1007/s00590-022-03293-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 05/09/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Acute acromioclavicular joint (ACJ) injuries are among the most common shoulder injuries in active young adults. The most frequently used surgical treatments include the hook plate implantation and arthroscopic treatment using flip-button systems. The aim of this study was to evaluate the results of treating acute ACJ injuries using a new minimally invasive implant based on a flip-button system. MATERIAL AND METHODS From January 2016 to October 2019, a total of 20 patients with acute ACJ injuries (1 × Type III, 3 × Type IV, 16 × Type V) underwent surgery using the Twinbridge implant (Smith & Nephew). It is a prefabricated construct consisting of two Endobuttons connected with an UltraTape. One button is placed under the coracoid using a special aiming device and two buttons are placed on the clavicle. Preoperatively, 1 day postoperatively, 3 months and at least 1 year postoperatively, patients were clinically examined and bilateral stress view and axial radiographs were obtained. At final follow-up, the simple shoulder test (SST), Taft score, Constant score, and ACJ instability (ACJI) score were recorded and a side-to-side ratio of the coracoclavicular (CC) distance was calculated. RESULTS All 20 patients were contacted at final follow-up at a mean of 28 (min. 13, max 50) months. Six patients were not willing to come for a clinical and radiographic examination and were contacted via telephone. All six patients were free of complaints. Another two patients free of complaints refused radiographs at final follow-up. The patients presented a mean SST of 99.6% (20 patients, min. 91.7, max. 100), Taft score of 11.6/12 points (12 patients, min. 10, max. 12), ACJI of 85.5/90 points (12 patients, min. 78, max. 90), and a Constant score of 97.1 (14 patients, min. 81.0, max. 100) for the affected shoulder. Preoperative stress view images revealed a mean side-to-side difference of the CC distance with a ratio of 1:2.34 (min. 1:1.80, max. 1:3.33). At final follow-up, CC distance was calculated with a mean ratio of 1:1.12 (min. 1.1, max. 1:1.38). Axial images showed a proper position in all cases. A "perfect" radiological result was achieved in six patients (50%) with a side-to-side CC distance of less than 10% (ratio 1:1.1 or less). A Rockwood type II result was achieved in five patients (42%) with a distance of 10 to 25% (ratio 1.11-1.25). One (8%) presented with a Rockwood type III result with a difference of more than 25% (ratio 1:1.38) and was considered a radiological failure. CONCLUSIONS When used correctly, the Twinbridge implant offers good-to-excellent clinical and radiographic results using a minimally invasive surgical technique. Complication rate is comparable to other button-systems.
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Affiliation(s)
- Maurice Balke
- Sportsclinic Cologne, University of Witten/Herdecke, Ostmerheimer Str. 200, 51109, Cologne, Germany.
| | - Arasch Wafaisade
- Department of Trauma and Orthopedic Surgery, Cologne-Merheim Medical Center, University of Witten/Herdecke, Cologne, Germany
| | - Juergen Hoeher
- Sportsclinic Cologne, University of Witten/Herdecke, Ostmerheimer Str. 200, 51109, Cologne, Germany
| | - Oliver Greshake
- Sportsclinic Cologne, University of Witten/Herdecke, Ostmerheimer Str. 200, 51109, Cologne, Germany
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Kelley N, Tuttle M, Sylvia SM, Dragoo JL, Khodaee M. Acromioclavicular Joint Injuries in Sport. Curr Sports Med Rep 2023; 22:91-99. [PMID: 36866952 DOI: 10.1249/jsr.0000000000001046] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
ABSTRACT Sport-related shoulder injuries, including disruptions to the acromioclavicular joint (ACJ), are common. An ACJ injury is classified by the degree and direction of the clavicle displacement. Although the diagnosis can be made clinically, standard radiographic views are important to determine the severity of the ACJ disruption and assess for concurrent injuries. The majority of ACJ injuries can be managed nonoperatively; however, surgical treatment is indicated in some cases. Long-term outcomes are generally favorable for most ACJ injuries, and athletes generally return to sport without functional limitations. This article provides an in-depth discussion regarding all aspects of ACJ injuries, including clinically relevant anatomy, biomechanics, evaluation, treatment, and complications.
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Affiliation(s)
- Naomi Kelley
- University of Colorado School of Medicine, Aurora, CO
| | - Matthew Tuttle
- Head of Soccer Medicine and Performance, New York Red Bulls, Harrison, NJ
| | - Stephen M Sylvia
- University of Colorado School of Medicine, Department of Orthopedics, Division of Sports Medicine, Englewood, CO
| | - Jason L Dragoo
- University of Colorado School of Medicine, Department of Orthopedics, Division of Sports Medicine, Englewood, CO
| | - Morteza Khodaee
- University of Colorado School of Medicine, Department of Family Medicine and Orthopedics, Division of Sports Medicine, Denver, CO
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Ardebol J, Hwang S, Horinek JL, Parsons BO, Denard PJ. Arthroscopically Assisted Tensionable Cerclage Reconstruction of an Acromioclavicular Separation With Combined Fixation of the Coracoclavicular and Acromioclavicular Ligaments. Arthrosc Tech 2023; 12:e321-e327. [PMID: 37013023 PMCID: PMC10066044 DOI: 10.1016/j.eats.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/24/2022] [Accepted: 11/03/2022] [Indexed: 04/05/2023] Open
Abstract
A variety of surgical techniques are currently available to manage high-grade acromioclavicular (AC) separations, including hook plates/wires, nonanatomic ligament reconstruction, and anatomic cerclage with or without biological augmentation. Traditional reconstructions focused on the coracoclavicular ligaments alone and often were associated with high rates of recurrent deformity. Biomechanical and clinical data have suggested that additional fixation of the AC ligaments is beneficial. This Technical Note describes an arthroscopically assisted approach for combined reconstruction of the coracoclavicular and AC ligaments with a tensionable cerclage.
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Affiliation(s)
| | | | | | | | - Patrick J. Denard
- Oregon Shoulder Institute, Medford, Oregon
- Address correspondence to Patrick J. Denard, M.D., 2780 E. Barnett Rd., Suite 200, Medford, OR 97504
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Sonnier JH, Kemler B, Coladonato C, Paul RW, Tjoumakaris FP, Freedman KB. Surgical management of acute, high-grade acromioclavicular joint separations: a systematic review. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:10-20. [PMID: 37588062 PMCID: PMC10426581 DOI: 10.1016/j.xrrt.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background While a number of treatment options exist for repair of acute, high-grade acromioclavicular joint (ACJ) separation, none have emerged as the standard of care. The purpose of this study was to systematically review the literature on surgical treatment of acute, high-grade (Rockwood grades III-V) ACJ separations in order to compare outcomes between direct fixation and tendon graft ligament reconstruction. Methods A systematic review of the literature evaluating outcomes for acute ACJ separation treatment with direct fixation or free biologic tendon graft reconstruction was performed. The following databases were examined: the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed (1980-2021), and Embase (1980-2021). Studies were included if they reported a mean time to surgery as <6 weeks, contained >10 patients with a minimum 1-year follow-up, and reported clinical or radiographic outcomes. Results A total of 52 studies met the inclusion criteria. Seven studies reported outcomes following tendon graft ligament reconstruction (n = 128 patients). There were multiple methods of direct fixation. Thirty-three studies utilized suture button constructs (n = 1138), 16 studies used hook plates (n = 567), 2 studies used coracoclavicular screws (n = 94), 2 studies used suture fixation (n = 93), 2 studies used suture anchor (n = 55), 2 studies used suture cerclage fixation (n = 87), 1 used single multistrand titanium cable (n = 24), and 1 used K wire (n = 11). The mean follow-up Constant scores ranged from 77.5 to 97.1 in the fixation group compared to 90.3-96.6 in the tendon graft group. The mean visual analog scale scores ranged from 0 to 4.5 in the fixation group and 0.1-1 in the tendon graft group. Net CC distance ranged from 17.5 to 3.6 mm in the fixation group and 7.4-4 mm in the tendon graft group. The revision rates ranged from 0.0% to 18.18% in the direct fixation group and 5.88%-17% in the tendon graft group. Conclusion Direct fixation and tendon graft reconstruction for management of acute, high-grade ACJ separations have similar patient subjective and radiographic outcomes, as well as complication and revision rates at a minimum 1-year follow-up.
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Affiliation(s)
- John Hayden Sonnier
- Rothman Orthopaedic Institute, Division of Sports Medicine, Philadelphia, PA, USA
| | - Bryson Kemler
- Rothman Orthopaedic Institute, Division of Sports Medicine, Philadelphia, PA, USA
| | - Carlo Coladonato
- Rothman Orthopaedic Institute, Division of Sports Medicine, Philadelphia, PA, USA
| | - Ryan W. Paul
- Rothman Orthopaedic Institute, Division of Sports Medicine, Philadelphia, PA, USA
| | | | - Kevin B. Freedman
- Rothman Orthopaedic Institute, Division of Sports Medicine, Philadelphia, PA, USA
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Abstract
BACKGROUND Acromioclavicular joint (ACJ) injuries are among the most common injuries in contact and non-contact sports. As winter sports become more popular, there has been an increase in shoulder injuries among recreational skiers and snowboarders. METHODS This was a retrospective analysis of all patients who presented to the Denver Health Winter Park Medical Center with ACJ injury from 2012 to 2017. We examined the incidence of ACJ injuries, the injury mechanism, demographics, and type of ACJ injuries among skiers and snowboarders treated at the clinic. RESULTS A total of 341 ACJ injuries (6.7% of total visits) were encountered during the study period. The majority of ACJ injures were type I (41.3%) and mainly occurred in men (86.5%). Most (96.8%) of the cases were primary ACJ injuries on the right shoulder (56.9%). The average age of patients with ACJ injuries was 30.0 years (range 10-72). More than half (62.2%) of ACJ injuries occurred while snowboarding. The most common mechanism of injury (93.5%) was fall to the snow while skiing/snowboarding. Women were more likely to have a type I ACJ injury than men (80.4% vs 35.4%; P < 0.001). Women with ACJ injuries were more likely to suffer the injury while skiing than snowboarding (71.7% vs 28.3%; P < 0.001), compared to men who were more likely to suffer the injury while snowboarding than skiing (67.5% vs 32.5%; P < 0.001). CONCLUSIONS Most of the ACJ injuries were type I and occurred mostly in men. Snowboarders were more likely to have an ACJ injury than skiers. LEVEL OF EVIDENCE Level IV, Epidemeiology Study.
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Affiliation(s)
- Naomi Kelley
- University of Colorado School of Medicine, Denver, CO
| | - Lauren Pierpoint
- Center for Outcomes-Based Orthopedic Research, Steadman Philippon Research Institute, Vail, Co
| | - Jack Spittler
- Department of Family Medicine and Orthopedics, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Morteza Khodaee
- Department of Family Medicine and Orthopedics, University of Colorado School of Medicine, Denver, Colorado, USA
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Hawthorne BC, Mancini MR, Wellington IJ, DiCosmo MB, Shuman ME, Trudeau MT, Dorsey CG, Obopilwe E, Cote MP, Mazzocca AD. Deltotrapezial Stabilization of Acromioclavicular Joint Rotational Stability: A Biomechanical Evaluation. Orthop J Sports Med 2023; 11:23259671221119542. [PMID: 36743723 PMCID: PMC9893372 DOI: 10.1177/23259671221119542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 06/06/2022] [Indexed: 01/27/2023] Open
Abstract
Background Despite advances in surgical management of acromioclavicular (AC) joint reconstruction, many patients fail to maintain sustained anatomic reduction postoperatively. Purpose To determine the biomechanical support of the deltoid and trapezius on AC joint stability, focusing on the rotational stability provided by the muscles to posterior and anterior clavicular rotation. A novel technique was attempted to repair the deltoid and trapezius anatomically. Study Design Controlled laboratory study. Methods Twelve human cadaveric shoulders (mean ± SD age, 60.25 ± 10.25 years) underwent servohydraulic testing. Shoulders were randomly assigned to undergo serial defects to either the deltoid or trapezius surrounding the AC joint capsule, followed by a combined deltotrapezial muscle defect. Deltotrapezial defects were repaired with an all-suture anchor using an anatomic technique. The torque (N·m) required to rotate the clavicle 20° anterior and 20° posterior was recorded for the following conditions: intact (native), deltoid defect, trapezius defect, combined deltotrapezial defect, and repair. Results When compared with the native condition, the deltoid defect decreased the torque required to rotate the clavicle 20° posteriorly by 7.1% (P = .206) and 20° anteriorly by 6.1% (P = .002); the trapezial defect decreased the amount of rotational torque posteriorly by 5.3% (P = .079) and anteriorly by 4.9% (P = .032); and the combined deltotrapezial defect decreased the amount of rotational torque posteriorly by 9.9% (P = .002) and anteriorly by 9.4% (P < .001). Anatomic deltotrapezial repair increased posterior rotational torque by 5.3% posteriorly as compared with the combined deltotrapezial defect (P = .001) but failed to increase anterior rotational torque (P > .999). The rotational torque of the repair was significantly lower than the native joint in the posterior (P = .017) and anterior (P < .001) directions. Conclusion This study demonstrated that the deltoid and trapezius play a role in clavicular rotational stabilization. The proposed anatomic repair improved posterior rotational stability but did not improve anterior rotational stability as compared with the combined deltotrapezial defect; however, neither was restored to native stability. Clinical Relevance Traumatic or iatrogenic damage to the deltotrapezial fascia and the inability to restore anatomic deltotrapezial attachments to the acromioclavicular joint may contribute to rotational instability. Limiting damage and improving the repair of these muscles should be a consideration during AC reconstruction.
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Affiliation(s)
- Benjamin C. Hawthorne
- Department of Orthopaedic Surgery, University of Connecticut Health
Center, Farmington, Connecticut, USA.,Benjamin C. Hawthorne, BS, Department of Orthopaedic Surgery,
School of Medicine, University of Connecticut, 263 Farmington Ave, Farmington,
CT 06030, USA () (Twitter: @bchawth27)
| | - Michael R. Mancini
- Department of Orthopaedic Surgery, University of Connecticut Health
Center, Farmington, Connecticut, USA
| | - Ian J. Wellington
- Department of Orthopaedic Surgery, University of Connecticut Health
Center, Farmington, Connecticut, USA
| | - Michael B. DiCosmo
- Department of Orthopaedic Surgery, University of Connecticut Health
Center, Farmington, Connecticut, USA
| | - Matthew E. Shuman
- Department of Orthopaedic Surgery, University of Connecticut Health
Center, Farmington, Connecticut, USA
| | - Maxwell T. Trudeau
- Department of Orthopaedic Surgery, University of Connecticut Health
Center, Farmington, Connecticut, USA
| | - Caitlin G. Dorsey
- Department of Orthopaedic Surgery, University of Connecticut Health
Center, Farmington, Connecticut, USA
| | - Elifho Obopilwe
- Department of Orthopaedic Surgery, University of Connecticut Health
Center, Farmington, Connecticut, USA
| | - Mark P. Cote
- Department of Orthopaedic Surgery, University of Connecticut Health
Center, Farmington, Connecticut, USA
| | - Augustus D. Mazzocca
- Department of Orthopaedic Surgery, Massachusetts General Hospital,
Harvard Medical School, Boston, Massachusetts, USA
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Chaichana T, Apivatgaroon A, Rujiraphum P, Sanguanjit P, Chernchujit B. Reliability of Upright Chest Radiography as a Diagnostic Screening Tool for Acromioclavicular Joint Dislocations. Orthop J Sports Med 2023; 11:23259671221143767. [PMID: 36644777 PMCID: PMC9837291 DOI: 10.1177/23259671221143767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 09/26/2022] [Indexed: 01/12/2023] Open
Abstract
Background The standard radiographic view for diagnosing acromioclavicular joint (ACJ) dislocations is the Zanca view of both shoulders to assess superior displacement of the distal clavicle by measuring the coracoclavicular distance (CCD) and comparing it with the uninjured shoulder; however, there is no consensus on a gold standard for diagnostic measures to classify acute ACJ injuries. Purpose To compare the CCD from an upright chest radiograph with a standard Zanca view of both shoulders in patients with an ACJ dislocation. Study Design Cohort study (diagnosis); Level of evidence, 3. Methods We reviewed the records of 70 patients with an ACJ dislocation between 2010 and 2021 who had both an upright chest radiograph and a Zanca view. An ACJ dislocation was classified as low grade (Rockwood types 1-3) or high grade (Rockwood type 5). The CCD was measured on the upright chest radiograph and the Zanca view by 2 independent reviewers, and the percentage of the CCD difference compared with the unaffected side (ΔCCD) was calculated and compared between the upright chest radiograph and the Zanca view. Interrater and intrarater reliability were determined using the intraclass correlation coefficient. Results Included were 70 patients (55 male and 15 female; mean age, 46 years). There were 29 patients (41.43%) with a low-grade injury and 41 patients (58.57%) with a high-grade injury. In the overall analysis, the ΔCCD on the upright chest radiograph and Zanca view was significantly different (130.25% ± 88.42% vs 152.69% ± 106.56%, respectively; mean difference, 22.44% [95% CI, 2.40% to 42.48%]; P = .029). The subgroup analysis revealed that the ΔCCD on the upright chest radiograph and Zanca view was significantly different for patients with a low-grade injury (60.71% ± 25.79% vs 91.46% ± 68.54%, respectively; mean difference, 30.76% [95% CI, 7.18% to 54.33%]; P = .012) but not different for patients with a high-grade injury (179.45% ± 83.87% vs 196.00% ± 107.97%, respectively; mean difference, 16.56% [95% CI, -14.06% to 47.18%]; P = .281). The intraclass correlation coefficients for the ΔCCD measurements indicated good to excellent interrater and intrarater reliability. Conclusion The study findings indicated that upright chest radiography can be used as a diagnostic screening tool for high-grade ACJ dislocations, but not for low-grade ACJ injuries, compared with the Zanca view.
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Affiliation(s)
- Tanakorn Chaichana
- Department of Orthopaedics, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Adinun Apivatgaroon
- Department of Orthopaedics, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand.,Adinun Apivatgaroon, MD, Department of Orthopaedics, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand ()
| | - Possawat Rujiraphum
- Department of Orthopaedics, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Prakasit Sanguanjit
- Department of Orthopaedics, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Bancha Chernchujit
- Department of Orthopaedics, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
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30
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Sußiek J, Wermers J, Raschke MJ, Herbst E, Dyrna F, Riesenbeck O, Katthagen JC. Acromioclavicular and coracoclavicular ligamentous insertion distances depend on the scapular tilt and decrease with anterior direction of the inferior scapula angle. Knee Surg Sports Traumatol Arthrosc 2023; 31:656-661. [PMID: 36053292 PMCID: PMC9898319 DOI: 10.1007/s00167-022-07126-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 08/17/2022] [Indexed: 02/06/2023]
Abstract
PURPOSE A variety of reconstruction techniques exist for the operative treatment of a ruptured acromioclavicular and coracoclavicular ligamentous complex. However, the complication rate remains high; between 5 and 89%. The intraoperative distance between the clavicle, acromion and coracoid is important for the refixation quality. In this study, the influence of scapular deflection on coracoclavicular and acromioclavicular distances was analysed. METHODS The ligamentous insertions of 24 fresh-frozen human scapulae were exposed. The coracoclavicular and acromioclavicular ligaments were referenced and captured in a rigid body system using a three-dimensional (3D) measurement arm. The inferior angle of the scapula was manually pulled into maximum anterior and posterior deflection, simulating a patient positioning with or without dorsal scapular support, respectively. Based on the rigid body system, the distances between the ligamentous insertions were calculated. Statistical evaluation was performed by setting the distances in anterior deflection to 100% and considering the other distances relative to this position. RESULTS The scapular deflection had a considerable impact on the distance between the ligamentous insertions. Concerning the conoid ligament, the mean distance was almost doubled when the inferior angle pointed posteriorly compared to anterior deflection (195.3 vs 100.0%; p = 0.028). The insertion of the acromioclavicular capsule also showed a significant association with the direction of deflection (posterior = 116.1% vs. anterior = 100%; p = 0.008). CONCLUSION Dorsal support shifting the inferior angle of the scapula anteriorly reduces the distance between the ligamentous insertions. Therefore, a patient position on a shoulder table with posterior support of the scapula is recommended to reliability reduce the acromioclavicular joint.
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Affiliation(s)
- Julia Sußiek
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Münster, Waldeyerstr. 1, 48149, Münster, Germany
| | - Jens Wermers
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Münster, Waldeyerstr. 1, 48149, Münster, Germany
| | - Michael J Raschke
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Münster, Waldeyerstr. 1, 48149, Münster, Germany
| | - Elmar Herbst
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Münster, Waldeyerstr. 1, 48149, Münster, Germany
| | - Felix Dyrna
- Gelenkzentrum Rose, Richard-Lehmann-Str.21, 04275, Leipzig, Germany
| | - Oliver Riesenbeck
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Münster, Waldeyerstr. 1, 48149, Münster, Germany
| | - J Christoph Katthagen
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Münster, Waldeyerstr. 1, 48149, Münster, Germany.
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Dey Hazra RO, Hanhoff M, Kühnapfel A, Rutledge JC, Warnhoff M, Ellwein A, Lill H, Jensen G. Superior clinical results for early arthroscopic treatment of grade IIIb and V acromioclavicular joint instability compared to delayed operative treatment. J Shoulder Elbow Surg 2022; 32:1185-1195. [PMID: 36584871 DOI: 10.1016/j.jse.2022.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 11/16/2022] [Accepted: 11/20/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Arthroscopy-assisted cortical fixation devices have been increasingly used in the operative management of both acute and chronic cases of acromioclavicular joint instability (ACJI). It has been hypothesized that delayed surgical management leads to inferior clinical and radiologic outcomes compared to acute treatment. The purpose of this study is to compare clinical and radiologic outcomes, scapula dyskinesia, and failure or revision rates of arthroscopically treated acute and chronic ACJI. METHODS This retrospective study of prospectively collected data included all surgically treated patients with grade IIIb and V chronic ACJI between 2013 and 2017, matched 1:1 to a group of acute grade IIIb and V ACJI patients treated during the same time period. Chronic ACJI was defined as delayed surgical treatment >21 days after injury. Chronic cases received an additional hamstring autograft next to the suture pulley systems. Follow-up was obtained at an average of 3.2 years (range: 1.4-6.2). Clinical outcome scores included the Constant-Murley Score (CMS), Taft Score (TF), Nottingham Clavicle Score (NCS), ACJI Score, Sick Scapula Score (SSS), Subjective Shoulder Value (SSV), Subjective Shoulder Test (SST), American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score, and the visual analog scale pain score. Radiologic follow-up was obtained pre- and postoperatively and at final follow-up. The 2-year results were compared to the results of a 1:1 matched-pair group comprising patients who were treated with an acute ACJI during the same period. RESULTS Thirty-three (80.5%) of 41 chronic ACJI cases were available for follow-up and were compared with 33 matched-pair cases of acute ACJI (of 41). The clinical scores were significantly better in the acute cohort for the CMS (92 ± 8 vs. 88 ± 8, P = .030), ASES (91 ± 13 vs. 85 ± 13, P = .002), SSS (1.4 ± 1.6 vs. 3.4 ± 2.5, P = .0004), NCS (86 ± 13 vs. 81 ± 13, P = .049), TF (9.9 ± 1.9 vs. 9.0 ± 2.1, P = .030), and ACJI (83 ± 13 vs. 75 ± 1, P = .003). In contrast to the chronic cohort, the acute cohort illustrated a significant loss of reduction at follow-up (P = .020). CONCLUSION Based on the results of this study, early arthroscopy-assisted operative treatment of grade IIIb and V ACJIs seems superior to delayed surgical intervention of grade IIIb and V ACJIs. Furthermore, an additional autograft loop leads to less loss of reduction compared with suture pulley/suspensory loop fixation standalones.
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Affiliation(s)
- Rony-Orijit Dey Hazra
- Department of Orthopedic and Trauma Surgery, Diakovere Friederikenstift and Henriettensift, Hannover, Germany.
| | - Marek Hanhoff
- Department of Orthopedic and Trauma Surgery, Diakovere Friederikenstift and Henriettensift, Hannover, Germany
| | - Andreas Kühnapfel
- Medical Faculty, Institute for Medical Informatics, Statistics and Epidemiology (IMSE), Leipzig University, Leipzig, Germany
| | | | - Mara Warnhoff
- Department of Orthopedic and Trauma Surgery, Diakovere Friederikenstift and Henriettensift, Hannover, Germany
| | - Alexander Ellwein
- Department of Orthopedic and Trauma Surgery, Diakovere Friederikenstift and Henriettensift, Hannover, Germany
| | - Helmut Lill
- Department of Orthopedic and Trauma Surgery, Diakovere Friederikenstift and Henriettensift, Hannover, Germany
| | - Gunnar Jensen
- Department of Orthopedic and Trauma Surgery, Diakovere Friederikenstift and Henriettensift, Hannover, Germany
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Velasquez Garcia A, Abdo G. Reliability of the ISAKOS Modification to Subclassify Rockwood Type III Acromioclavicular Joint Injuries. Orthop J Sports Med 2022; 10:23259671221133379. [PMID: 36570359 PMCID: PMC9772956 DOI: 10.1177/23259671221133379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 08/10/2022] [Indexed: 12/23/2022] Open
Abstract
Background To improve clinical management, the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) developed a specific subclassification of Rockwood type III acromioclavicular (AC) injuries: IIIA (no overriding distal clavicle) and IIIB (overriding distal clavicle). Purpose/Hypothesis The study aimed to determine the inter- and intraobserver reliability of the radiographic classification proposed by ISAKOS for AC injuries. It was hypothesized that the strength of agreement for the ISAKOS modification will be substantial to almost perfect. Study Design Cohort study (diagnosis); Level of evidence, 3. Methods We evaluated 40 radiographs of all types of AC joint injuries from patients at a single institution. The images were distributed to 6 shoulder and elbow fellowship-trained orthopaedic surgeons, along with standardized assessment questionnaires. The evaluators measured the bilateral coracoclavicular distance and the coracoclavicular ratio and classified the severity of the injuries according to the modified ISAKOS Rockwood classification. Four of the surgeons repeated the evaluation 6 weeks later to calculate intraobserver agreement. The kappa (κ) statistic was calculated for categorical inter- and intraobserver reliability. Intraclass correlation coefficient (ICC) estimates were calculated for the reliability of the coracoclavicular distance measurement. A 2-tailed test was performed to assess statistical significance. Results Overall interobserver agreement was substantial (κ = 0.637; 95% CI, 0.595-0.680) among the 6 evaluators, and intraobserver agreement was also substantial among the 4 evaluators (κ = 0.616; 95% CI, 0.549-0.638). The interobserver agreement for evaluating types IIIA and IIIB was fair (κ = 0.215; 95% CI, 0.135-0.295) and moderate (κ = 0.473; 95% CI, 0.393-0.553), respectively. The agreement on the coracoclavicular distance measurements was excellent among the 6 evaluators on both the affected side (ICC, 0.982; 95% CI, 0.970-0.990) and the unaffected side (ICC, 0.930; 95% CI, 0.894-0.958). Conclusion Substantial agreement was found when categorizing AC joint injuries using the ISAKOS modification of the Rockwood classification, with excellent reliability demonstrated for the quantitative assessment of vertical displacement of the clavicle. Visual examination was unreliable in differentiating type IIIA injuries from type IIIB injuries.
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Affiliation(s)
- Ausberto Velasquez Garcia
- Department of Orthopedic Surgery, Clinica Universidad de los Andes, Santiago, Chile.,Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Ausberto Velasquez Garcia, MD, Clinica Universidad de los Andes, Av Plaza 2501, Las Condes, Santiago, Chile, 7620157 ()
| | - Glen Abdo
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Basic Sciences, Touro College of Osteopathic Medicine, New York, New York, USA
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Liu G, Hu Y, Ye F, Huang F, Yu T. Clavicular hook plate for acute high-grade acromioclavicular dislocation involving Rockwood type V: clinical and radiological outcomes and complications evaluation. INTERNATIONAL ORTHOPAEDICS 2022; 46:2405-2411. [PMID: 35854054 PMCID: PMC9492605 DOI: 10.1007/s00264-022-05498-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 06/22/2022] [Indexed: 11/28/2022]
Abstract
Background The surgical treatment of high-grade acromioclavicular joint dislocation remains a matter of debate. Clavicular hook plate internal fixation was widely used in the treatment of acromioclavicular dislocation because of its easy-to-master surgical technique. This study aimed to evaluate outcomes using hook plate fixation for acromioclavicular dislocation. Methods A consecutive series of 57 patients with acute acromioclavicular joint dislocation involving Rockwood type V were treated between November 2013 and September 2019 using hook plate fixation. The functional outcomes (using the visual analogue score, Constant-Murley score, and University of California Los Angeles score), the quality of surgical reduction (using the coracoclavicular distance), and post-operative complications were assessed with about 46 months of follow-up. Results The mean Constant-Murley score increased from 72.6 before surgery to 87.6 at final follow-up. The mean University of California Los Angeles score was 14.1 pre-operatively and 31.6 at final follow-up. Meanwhile, the visual analogue scores were significantly reduced from 3.4 pre-operatively to 1.3 post-operatively. The coracoclavicular distance decreased from 19.4 mm pre-operatively to 10.9 mm at the last follow-up. Post-operative functional and radiological outcomes were significantly improved compared with pre-operative outcomes (P < 0.01). The overall excellent and good result was 35.1% (20/57) and 54.1% (31/57), respectively. At follow-up, the overall complication rate was 15.8% (9/57) including subacromial impingement (three patients), acromial osteolysis (three patients), reduction loss (one patient), acromioclavicular joint osteoarthritis (one patient), and calcification (one patient). Conclusion Hook plate fixation was a viable treatment approach, and achieved good clinical outcomes in the treatment of acute acromioclavicular dislocation involving V. But some complications of hook plate fixation should not be ignored.
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Affiliation(s)
- Guoming Liu
- Department of Orthopedics, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, Shandong 266003 People’s Republic of China
| | - Yanling Hu
- Department of Orthopedics, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, Shandong 266003 People’s Republic of China
| | - Fagang Ye
- Department of Orthopedics, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, Shandong 266003 People’s Republic of China
| | - Fuguo Huang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041 People’s Republic of China
| | - Tengbo Yu
- Department of Orthopedics, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, Shandong 266003 People’s Republic of China
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Baren JP, Rowbotham E, Robinson P. Acromioclavicular Joint Injury and Repair. Semin Musculoskelet Radiol 2022; 26:597-610. [DOI: 10.1055/s-0042-1750726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
AbstractThe acromioclavicular (AC) joint is commonly injured in athletes participating in contact and overhead throwing sports. Injuries range from simple sprains to complete ligamentous disruption, and they are classified by the established Rockwood grading system. High-grade injuries are associated with fractures around the AC joint and disruption of the superior shoulder suspensory complex, a ring of osseous and ligamentous structures at the superior aspect of the shoulder. Radiographs are the mainstay of imaging of the AC joint, with magnetic resonance imaging reserved for high-grade injuries to aid classification and plan surgical management. Low-grade AC joint injuries tend to be managed conservatively, but a wide range of surgical procedures have been described for higher grade injuries and fractures around the AC joint. This review illustrates the anatomy of the AC joint and surrounding structures, the imaging features of AC joint injury, and the most commonly performed methods of reconstruction and their complications.
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Affiliation(s)
- James P. Baren
- Department of Musculoskeletal Radiology, Leeds Teaching Hospitals, Leeds, United Kingdom
| | - Emma Rowbotham
- Department of Musculoskeletal Radiology, Leeds Teaching Hospitals, Leeds, United Kingdom
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, University of Leeds, Leeds, United Kingdom
| | - Philip Robinson
- Department of Musculoskeletal Radiology, Leeds Teaching Hospitals, Leeds, United Kingdom
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, University of Leeds, Leeds, United Kingdom
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Peebles LA, Aman ZS, Kraeutler MJ, Mulcahey MK. Qualitative and Quantitative Anatomic Descriptions of the Coracoclavicular and Acromioclavicular Ligaments: A Systematic Review. Arthrosc Sports Med Rehabil 2022; 4:e1545-e1555. [PMID: 36033198 PMCID: PMC9402469 DOI: 10.1016/j.asmr.2022.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 04/28/2022] [Indexed: 11/28/2022] Open
Abstract
Purpose Methods Results Conclusions Clinical Relevance
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Affiliation(s)
- Liam A. Peebles
- Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Zachary S. Aman
- Sidney Kimmel Medical College, Philadelphia, Pennsylvania, U.S.A
| | - Matthew J. Kraeutler
- Department of Orthopaedic Surgery, St. Joseph’s University Medical Center, Paterson, New Jersey, U.S.A
| | - Mary K. Mulcahey
- Department of Orthopaedic Surgery, New Orleans, Louisiana, U.S.A
- Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
- Address correspondence to Mary K. Mulcahey, M.D., 1430 Tulane Ave., #8632, New Orleans, LA 70112.
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Park PSU, McDonald E, Singh SB, Raynor WY, Werner TJ, Høilund-Carlsen PF, Alavi A. The effects of limb laterality and age on the inflammation and bone turnover of the acromioclavicular shoulder joint: 18 F-fluorodeoxyglucose and 18 F-sodium-fluoride-PET/computed tomography study. Nucl Med Commun 2022; 43:922-927. [PMID: 35634806 DOI: 10.1097/mnm.0000000000001588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The acromioclavicular (AC) joint is a common site of injury and degenerative changes such as osteoarthritis (OA) of the shoulder. Physical manifestations of OA are preceded by molecular changes, detection of which may enhance early prophylaxis and monitoring of disease progression. In this study, we investigate the use of 18 F-FDG and 18 F-NaF-PET/CT to assess the effects of limb laterality and age on the inflammation and bone turnover of the AC shoulder joint. METHODS We analyzed FDG and NaF-PET/CT scans of 41 females (mean age of 43.9 ± 14.2 years) and 45 males (mean age of 44.5 ± 13.8 years) using a semiquantitative technique based on predefined ROI. RESULTS There was a greater NaF uptake in the right side of the AC joint compared with the left in both females (left: 2.22 ± 1.00; right: 3.08 ± 1.18; P < 0.0001) and males (left: 2.57 ± 1.49; right: 2.99 ± 1.40; P = 0.003). No consistent correlation between age and NaF or FDG uptakes were found in both females and males. There was also a positive correlation between FDG and NaF uptakes in both left ( P = 0.01; r = 0.37) and right ( P = 0.0006; r = 0.53) AC joints of male subjects. CONCLUSION Our study is the first to reveal the varying effect of right-left limb laterality and aging on FDG and NaF uptake at the AC joint. Future studies correlating the history of shoulder trauma, pain, and degenerative change with FDG and NaF-PET/CT findings will be critical in the adoption of molecular imaging in the clinical setting.
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Affiliation(s)
- Peter Sang Uk Park
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Elysia McDonald
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Shashi Bhushan Singh
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - William Y Raynor
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Thomas J Werner
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Poul Flemming Høilund-Carlsen
- Department of Nuclear Medicine, Odense University Hospital
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Abass Alavi
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Paul RW, Aman ZS, Kemler BR, Osman A, Doran JP, Brutico J, Tjoumakaris FP, Freedman KB. Clinical and Patient-Reported Outcomes for Acute Acromioclavicular Joint Fixation are Similar With or Without Allograft Augmentation. Arthrosc Sports Med Rehabil 2022; 4:e1481-e1487. [PMID: 36033197 PMCID: PMC9402475 DOI: 10.1016/j.asmr.2022.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/29/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose Methods Results Conclusion Level of Evidence
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Affiliation(s)
- Ryan W. Paul
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
| | | | | | - Alim Osman
- Eastern Virginia Medical School, Norfolk, Virginia
| | - James P. Doran
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
| | - Joseph Brutico
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
| | | | - Kevin B. Freedman
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
- Address correspondence to Kevin B. Freedman, M.D., Rothman Orthopaedic Institute at Thomas Jefferson University, 825 Old Lancaster Rd., Suite 200, Bryn Mawr, PA 19010.
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Jildeh TR, Peebles AM, Brown JR, Mologne MS, Provencher MT. Treatment of Failed Coracoclavicular Ligament Reconstructions: Primary Acromioclavicular Ligament and Capsular Reconstruction and Revision Coracoclavicular Ligament Reconstruction. Arthrosc Tech 2022; 11:e1387-e1393. [PMID: 36061467 PMCID: PMC9437465 DOI: 10.1016/j.eats.2022.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 03/12/2022] [Indexed: 02/03/2023] Open
Abstract
Acromioclavicular (AC) joint dislocations are a common injury affecting 2 of every 10,000 people in the general population and comprise 9% to 12% of all injuries to the shoulder. Most injuries occur through contact activity, which drives the acromion inferiorly with the clavicle remaining in its anatomic position, initiating a cascade of injury propagating from the AC ligament followed by failure of the coracoclavicular ligaments. Many techniques have been described for AC joint injuries, without a consensus gold standard. The revision setting offers even less consensus on treatment options and countless difficulties for surgeons. There have been more than 60 described procedures regarding AC and coracoclavicular ligament reconstructions, with significant controversy regarding the optimal intervention for each injury. When these techniques fail, it is important to pinpoint the mechanism of failure to construct a successful plan for revision. The purpose of this Technical Note is to describe our preferred method of primary AC and revision coracoclavicular reconstruction using a combination of autograft and allograft semitendinosus as well as TightRope fixation.
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Affiliation(s)
| | | | - Justin R. Brown
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | | | - Matthew T. Provencher
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A,Steadman Clinic, Vail, Colorado, U.S.A,Address correspondence to CAPT Matthew T. Provencher, M.D., M.B.A., M.C., U.S.N.R. (ret.), Steadman Philippon Research Institute, The Steadman Clinic, 181 W Meadow Dr., Ste 400, Vail, CO 81657.
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Cerciello S, Corona K, Morris BJ, Proietti L, Mercurio M, Cattaneo S, Milano G. Hybrid coracoclavicular and acromioclavicular reconstruction in chronic acromioclavicular joint dislocations yields good functional and radiographic results. Knee Surg Sports Traumatol Arthrosc 2022; 30:2084-2091. [PMID: 34841469 DOI: 10.1007/s00167-021-06790-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 10/25/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Optimal treatment of chronic unstable acromioclavicular (AC) joint dislocations (stage 3-5 according the Rockwood classification) is still debated. Anatomic coracoclavicular (CC) reconstruction is a reliable option in terms of two-dimensional radiographic reduction, clinical outcomes, and return to sports, but there remain concerns regarding anterior-posterior stability of the AC joint with CC ligament reconstruction alone. The aim of the present study was to describe the mid-term results of a new hybrid technique with CC and AC ligament reconstruction for chronic AC joint dislocations. METHODS Twenty-two patients surgically treated for chronic AC joint dislocations (grade 3 to 5) were retrospectively reviewed. All patients were assessed before surgery and at final follow-up with the Constant-Murley score (CMS) and the American Shoulder and Elbow Surgeons (ASES) score. The CC vertical distance (CCD) and the CCD ratio (affected side compared to unaffected side) were measured on Zanca radiographs preoperatively, at 6 months postop and at final follow-up. The same surgical technique consisting in a primary fixation with a suspensory system, coracoclavicular ligaments reconstruction with a double loop of autologous gracilis and acromioclavicular ligaments reconstruction with autologous coracoacromial ligament was performed in all cases. RESULTS Twenty-two shoulders in 22 patients (19 males and 3 females) were evaluated with a mean age of 34.4 ± 9 years at the time of surgery. The mean interval between the injury and surgery was 53.4 ± 36.7 days. The mean duration of postoperative follow-up was 49.9 ± 11.8 months. According to the Rockwood classification, there were 5 (22.6%) type-III and 17 (77.2%) type-V dislocations. Mean preoperative ASES and CMS were 54.4 ± 7.6 and 64.6 ± 7.2, respectively. They improved to 91.8 ± 2.3 (p = 0.0001) and 95.2 ± 3.1 (p = 0.0001), respectively at final FU. The mean preoperative CCD was 22.4 ± 3.2 mm while the mean CCD ratio was 2.1 ± 0.1. At final FU, the mean CCD was 11.9 ± 1.4 mm (p = 0.002) and the mean CCD ratio was 1.1 ± 0.1 (p = 0.009). No recurrence of instability was observed. One patient developed a local infection and four patients referred some shoulder discomfort. Heterotopic ossifications were observed in three patients. CONCLUSIONS The optimal treatment of chronic high-grade AC joint dislocations requires superior-inferior and anterior-posterior stability to ensure good clinical outcomes and return to overhead activities or sports. The present hybrid technique of AC and CC ligaments reconstruction showed good clinical and radiographic results and is a reliable an alternative to other reported techniques. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Simone Cerciello
- A. Gemelli University Hospital Foundation IRCCS, Catholic University, Rome, Italy
- Marrelli Hospital, Crotone, Italy
- Casa Di Cura Villa Betania, Rome, Italy
| | - Katia Corona
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Campobasso, Italy.
| | - Brent Joseph Morris
- Baptist Health Medical Group Orthopedics and Sports Medicine, Lexington, KY, USA
| | | | - Michele Mercurio
- Department of Orthopaedic and Trauma Surgery, Magna Græcia" University, Mater Domini" University Hospital, Catanzaro, Italy
| | - Stefano Cattaneo
- Department of Bone and Joint Surgery, Spedali Civili, Brescia, Italy
| | - Giuseppe Milano
- Department of Bone and Joint Surgery, Spedali Civili, Brescia, Italy
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Ertogrul R, Sahin K, Celik H, Kapicioglu M, Ersen A, Bilsel K. Is coracoclavicular ossification a complication or a good prognostic factor after surgical treatment of acromioclavicular joint injury? JSES Int 2022; 6:769-774. [PMID: 36081692 PMCID: PMC9445996 DOI: 10.1016/j.jseint.2022.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background The purpose of this study was to investigate whether heterotopic ossification (HO) in the coracoclavicular (CC) space after surgical treatment of acromioclavicular joint (ACJ) injury is a complication or a sign of good prognosis. Methods Fifty-nine consecutive patients who underwent CC reconstruction with or without augmentation of the ACJ for acute ACJ injuries were analyzed. Postoperative American Shoulder and Elbow Surgeons (ASES) score, Constant score (CS), subjective shoulder value (SSV), and visual analog scale (VAS) results were evaluated. For radiological evaluation, HO was evaluated, and CC distances were measured. Results Fifty-one patients (11 women and 40 men; mean age, 36 years [range, 17-68 years]) were evaluated after a mean follow-up of 3 years (range, 2-8 years). The mean ASES score at the follow-up was 82.73 (range, 51.6-100), mean CS was 85 (range, 50-100), mean SSV was 80 (range, 40-100), and mean VAS was 1.9 (range, 0-5). It was observed that the clinical outcomes (ASES, CS, SSV, VAS) of patients who developed ossification in the CC space were better than those who did not although it was not statistically significant. No statistically significant differences were found in the clinical outcomes (ASES, CS, SSV, VAS) between patients who underwent CC reconstruction without augmentation of the ACJ and those who were combined (P > .05). Conclusion HO in the CC space is a common finding following AC joint fixation injury. We suggest that HO is not a complication and might possibly have positive effects on clinical outcomes.
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Affiliation(s)
- Rodi Ertogrul
- Sisli Hamidiye Etfal Training and Research Hospital, Orthopaedics Department, Istanbul, Turkey
| | - Koray Sahin
- Mus State Hospital, Department of Orthopaedics and Traumatology, Muş, Turkey
| | - Haluk Celik
- Hisar Intercontinental Private Hospital, Department of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Mehmet Kapicioglu
- Bezmialem Vakif University, Department of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Ali Ersen
- Istanbul University, Istanbul Medical School, Department of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Kerem Bilsel
- Bezmialem Vakif University, Department of Orthopaedics and Traumatology, Istanbul, Turkey
- Corresponding author: Kerem Bilsel, MD, Bezmialem Vakif Universitesi Tip Fakultesi Hastanesi, vatan street, Fatih, istanbul 34093, Turkey.
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Gosselin MM, Denney BS, Gregory JM. Treatment of Acromioclavicular Joint Instability With a Tunnel-Free Reconstruction Technique. Arthrosc Tech 2022; 11:e895-e901. [PMID: 35646574 PMCID: PMC9134482 DOI: 10.1016/j.eats.2022.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/08/2022] [Indexed: 02/03/2023] Open
Abstract
Acromioclavicular joint injuries are a common shoulder injury encountered by orthopaedic surgeons. Many different surgical techniques have been described for the operative treatment of these injuries with no single, clear gold standard technique on which surgeons agree. Among the most common complications after surgical management of acromioclavicular injuries are loss of reduction, infection, fracture of clavicle or coracoid, and need for reoperation. We propose an arthroscopic-assisted, tunnel-free surgical technique using a tibialis anterior allograft combined with a FiberTape Cerclage (Arthrex, Naples, FL) to manage both acute and chronic acromioclavicular joint injuries. No bony tunnels are drilled and no hardware is implanted, which should obviate the risk for subsequent bony failure through a fracture, nor require subsequent hardware removal. In addition, the combination of suspensory and allograft fixation should impart sufficient stability to maintain an adequate reduction even in the face of failure of one of the fixation methods.
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Affiliation(s)
- Michelle M. Gosselin
- Department of Orthopaedic Surgery, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Brandon S. Denney
- Department of Orthopaedic Surgery, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - James M. Gregory
- McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA,Address correspondence to James M. Gregory, M.D., McGovern Medical School, University of Texas Health Science Center at Houston, 10125 Katy Freeway, Suite 100, Houston, TX 77024.
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Sciascia A, Bois AJ, Kibler WB. Nonoperative Management of Traumatic Acromioclavicular Joint Injury: A Clinical Commentary with Clinical Practice Considerations. Int J Sports Phys Ther 2022; 17:519-540. [PMID: 35391875 PMCID: PMC8975563 DOI: 10.26603/001c.32545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 12/01/2021] [Indexed: 11/18/2022] Open
Abstract
Traumatic injuries of the acromioclavicular joint result in pain and potentially long-term alterations in scapulohumeral rhythm that occurs due to disruption of the clavicular strut function which is integral to scapular kinematics. Nonoperative treatment remains a valid option in most acromioclavicular joint injuries with the potential of minimizing pain and restoring scapulohumeral rhythm. However, few studies have provided nonoperative treatment details. Therefore, the purpose of this clinical commentary is to discuss the rationale, indications, and techniques of nonoperative treatment and present an organized approach for evaluating and managing such patients based on the best available evidence. Attention will be focused on identifying the treatment methods employed and the results/outcomes of such treatments. Level of Evidence 5.
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Affiliation(s)
- Aaron Sciascia
- Institute Clinical Outcomes and Research, Lexington Clinic
| | - Aaron J Bois
- Sport Medicine Centre, University of Calgary; McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary
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Evaluation and Management of the Contact Athlete's Shoulder. J Am Acad Orthop Surg 2022; 30:e584-e594. [PMID: 35171860 DOI: 10.5435/jaaos-d-20-01374] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 12/10/2021] [Indexed: 02/01/2023] Open
Abstract
Shoulder injuries are common in contact athletes and vary in severity because of the required complex interplay of shoulder stability and range of motion for proper function. Pathology varies based on sport but most commonly includes shoulder instability, acromioclavicular injuries, traumatic rotator cuff tears, and brachial plexus injuries. Acute management ranges from reduction of shoulder dislocations to physical examination to determine the severity of injury. Appropriate radiographs should be obtained to evaluate for alignment and fracture, with magnetic resonance imaging commonly being necessary for accurate diagnosis and management. Treatments range from surgical stabilization in shoulder instability to repeat examinations and physical therapy. Return-to-play decision making can be complex with avoidance of reinjury and player safety being of utmost concern. Appropriate evaluation and treatment are vital because repeat injury can lead to long-term effects due to the relatively high effectsometimes seen in contact sports.
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Ostermann RC, Moen TC, Siegert P, Bukowsky C, Lang S, Heuberer PR, Pauzenberger L. Acromioclavicular Disk as a Potential Source of Pain in AC Joint Injuries. Am J Sports Med 2022; 50:1039-1043. [PMID: 35099332 DOI: 10.1177/03635465211070276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Injuries of the acromioclavicular joint (ACJ) are common shoulder injuries that often lead to pain and dysfunction of the affected shoulder. Regardless of operative or nonoperative treatment, a relatively large number of patients remain symptomatic and experience pain. However, the specific source of persistent pain in the ACJ remains ambiguous. PURPOSE To investigate the presence of sensory nerve fibers or pain-generating neurotransmitters within the intra-articular disk of the ACJ to determine its potential role as an independent pain generator in ACJ disorders. STUDY DESIGN Descriptive laboratory study. METHODS Twelve paired ACJs from 6 fresh human cadavers (mean age, 56 years; range, 41-82 years) were harvested and freed from surrounding soft tissues, leaving only the ACJ capsule intact. The specimens were placed in 4.5% formaldehyde fixative for a minimum of 48 hours. Coronal plane sections were obtained and demineralized in EDTA for a week, embedded in paraffin for 12 hours, and dehydrated overnight. With a rotation microtome, 2-μm sections were cut and stained with hematoxylin and eosin to investigate tissue architecture and confirm the presence of a fibrocartilaginous intra-articular disk. The sections were immunohistochemically stained with antisera against S100, neuropeptide Y (NPY), and substance P (SP) to detect for neural tissue. Additionally, a nerve fiber count per 10 high-power fields representing an area of 0.2 mm2 was conducted for S100 stains. All sections were examined for the presence of positive immunoreactivity to S100, NPY, and SP. RESULTS The presence of a fibrocartilaginous intra-articular disk could be observed in all 12 examined ACJs. In all specimens, an immunoreactivity to S100, NPY, and SP could be observed within the superior peripheral region of the intra-articular disk. High-power field nerve counts of the S100 stains revealed a mean ± SD of 7.9 ± 2.28 nerves per 10 high-power fields (range, 4-12). CONCLUSION The documented immunoreactivity to S100, NPY, and SP indicates the presence of somatic and autonomic nerve fibers within the intra-articular disk of the ACJ. CLINICAL RELEVANCE Confirming the presence of nerve fibers within the intra-articular disk of the ACJ suggests that the disk itself could be an independent source of pain after injury and thus a possible explanation for recalcitrant pain after treatment.
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Affiliation(s)
- Roman C Ostermann
- St Vincent Shoulder and Sports Clinic, Hospital of the Sacred Heart of Jesus, Second Orthopedic Department, Vienna, Austria.,Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria.,AURROM-Austrian Research Group for Regenerative and Orthopedic Medicine, Vienna, Austria
| | | | - Paul Siegert
- Department of Trauma Surgery, University Hospital of St Poelten, Karl Landsteiner University of Health Sciences, Krems an der Donau, Austria
| | - Claus Bukowsky
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Susanna Lang
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Philipp R Heuberer
- AURROM-Austrian Research Group for Regenerative and Orthopedic Medicine, Vienna, Austria.,Schulterzentrum Wien, Vienna, Austria
| | - Leo Pauzenberger
- St Vincent Shoulder and Sports Clinic, Hospital of the Sacred Heart of Jesus, Second Orthopedic Department, Vienna, Austria
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Modified Weaver-Dunn Technique Using Transosseous Bone Tunnels and Coracoid Suture Augmentation. J Am Acad Orthop Surg 2022; 30:111-118. [PMID: 34958640 DOI: 10.5435/jaaos-d-21-00732] [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: 07/12/2021] [Accepted: 11/13/2021] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION A modified Weaver-Dunn procedure for the management of acromioclavicular joint injuries that uses transosseous bone tunnels and coracoid suture augmentation is described with associated clinical results. METHODS A retrospective review of 39 consecutive patients who underwent a primary mWD procedure by a single surgeon from January 2013 to July 2019 was conducted. Patient charts and radiographs were reviewed for clinical course, complications and management, and radiographic evaluation. Satisfaction, American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation, and Simple Shoulder Test scores were obtained. RESULTS A total of 28 patients (72%) with a mean follow-up of 37.5 (12 to 84 months) and a mean age of 44.3 ± 15.1 years were included. Postoperative ASES, Simple Shoulder Test, Single Assessment Numeric Evaluation, and satisfaction scores were 90.6 ± 14.2, 11.1 ± 1.5, 87.3 ± 10.2, and 4.4 ± 1.2 (out of 5), respectively, with a significant improvement in ASES of 42.2 ± 21.8 points (P < 0.001). All patients had significant decrease in coracoclavicular distance (P < 0.001). Three patients (10.7%) had complications, with two (7.1%) requiring additional surgery. CONCLUSION Excellent functional and radiographic outcomes can be achieved with this modified Weaver-Dunn technique. Complication and revision rates are comparable with those that are found in the literature. LEVEL OF EVIDENCE Level IV, Retrospective cohort study.
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Rupp MC, Kadantsev PM, Siebenlist S, Hinz M, Feucht MJ, Pogorzelski J, Scheiderer B, Imhoff AB, Muench LN, Berthold DP. Low rate of substantial loss of reduction immediately after hardware removal following acromioclavicular joint stabilization using a suspensory fixation system. Knee Surg Sports Traumatol Arthrosc 2022; 30:3842-3850. [PMID: 35451639 PMCID: PMC9568474 DOI: 10.1007/s00167-022-06978-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 04/01/2022] [Indexed: 11/10/2022]
Abstract
PURPOSE To evaluate immediate loss of reduction in patients undergoing hardware removal after arthroscopically assisted acromioclavicular (AC) joint stabilization using a high-tensile suture tape suspensory fixation system and to identify risk factors associated with immediate loss of reduction. MATERIALS AND METHODS Twenty-two consecutive patients with a mean age of 36.4 ± 12.6 years (19-56), who underwent hardware removal 18.2 ± 15.0 months following arthroscopically assisted stabilization surgery using a suspensory fixation system for AC joint injury between 01/2012 and 01/2021 were enrolled in this retrospective monocentric study. The coracoclavicular distance (CCD) as well as the clavicular dislocation/acromial thickness (D/A) ratio were measured on anterior-posterior radiographs prior to hardware removal and immediately postoperatively by two independent raters. Loss of reduction, defined as 10% increase in the CCD, was deemed substantial if the CCD increased 6 mm compared to preoperatively. Constitutional and surgical characteristics were assessed in a subgroup analysis to detect risk factors associated with loss of reduction. RESULTS Postoperatively, the CCD significantly increased from 12.6 ± 3.7 mm (4.8-19.0) to 14.5 ± 3.3 mm (8.7-20.6 mm) (p < 0.001) while the D/A ratio increased from 0.4 ± 0.3 (- 0.4-0.9) to 0.6 ± 0.3 (1.1-0.1) (p = 0.034) compared to preoperatively. In 10 cases (45%), loss of reduction was identified, while a substantial loss of reduction (> 6 mm) was only observed in one patient (4.5%). A shorter time interval between index stabilization surgery and hardware removal significantly corresponded to immediate loss of reduction (11.0 ± 5.6 vs. 30.0 ± 20.8 months; p = 0.007), as hardware removal within one year following index stabilization was significantly associated with immediate loss of reduction (p = 0.027; relative risk 3.4; odds ratio 11.67). CONCLUSIONS Substantial loss of reduction after hardware removal of a high-tensile suture tape suspensory fixation system was rare, indicating that the postoperative result of AC stabilization is not categorically at risk when performing this procedure. Even though radiological assessment of the patients showed a statistically significant immediate superior clavicular displacement after this rarely required procedure, with an increased incidence in the first year following stabilization, this may not negatively influence the results of ACJ stabilization in a clinically relevant way. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Marco-Christopher Rupp
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Pavel M. Kadantsev
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany ,European Clinic of Sports Traumatology and Orthopaedics (ECSTO), Moscow, Russian Federation ,grid.77642.300000 0004 0645 517XPeoples Friendship University of Russia, Moscow, Russian Federation
| | - Sebastian Siebenlist
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Maximilian Hinz
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Matthias J. Feucht
- Orthopaedic Clinic Paulinenhilfe, Diakonie-Hospital, Stuttgart, Germany ,grid.5963.9Department of Orthopaedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Jonas Pogorzelski
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Bastian Scheiderer
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Andreas B. Imhoff
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Lukas N. Muench
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Daniel P. Berthold
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
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Kumar CY, S. Kambhampati S, Rahul P, Chirag NR. Functional Results following Acromioclavicular Joint Reconstruction Using Gracilis Tendon Augmented with Fibertape: A Prospective Study. ARCHIVES OF TRAUMA RESEARCH 2022. [DOI: 10.4103/atr.atr_24_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Zhang L, Wen Y, Zhang MY, Zhou X, Fu SJ, Wang GY. Efficacy of Transosseous Tunnel Placement for Triple Endobutton Plate in Acromioclavicular Joint Reconstruction: A Three-Dimensional Printing Guide Design Technology. Orthop Surg 2021; 14:422-426. [PMID: 34904392 PMCID: PMC8867420 DOI: 10.1111/os.13091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/11/2021] [Accepted: 05/11/2021] [Indexed: 11/30/2022] Open
Abstract
Objective Explore an accurate transosseous tunnel drilling method based on three‐dimensional (3D) printing technology for acromioclavicular joint reconstruction (ACD), design a guide design, and evaluate its accuracy. Methods Using Mimics software to reconstruct 100 cases of acromioclavicular joint computed tomography (CT) data. In design 2, the non‐collinear tunnel is superimposed on the 3D model, and a virtual drilling is performed between the clavicle and the coracoid using a triple inner gusset. Then, in the Geomagic Studio software model, an elliptical plane is calculated and extracted as a guide design for precise drilling. Then put the design and the 3D shoulder model together for 3D printing. Ten lengths were measured, and the effects of the virtual model, the actual model, and the guide rail design were compared. Results We successfully compared 10 parameters of 3D virtual model and actual model. There was no significant difference between actual and virtual bone tunnels in 10 measurements (P > 0.05). Conclusions The accuracy of ACD combined with 3D printing guidance design technology in the transosseous tunnel of adult shoulder is reliable.
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Affiliation(s)
- Lei Zhang
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China.,Center for Orthopedic Diseases Research, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China.,Expert Workstation in Luzhou, Luzhou, China.,Clinical Base of Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Luzhou, China
| | - Youliang Wen
- School of Rehabilitation Medicine GanNan Medical University, Ganzhou, China
| | - Meng-Yao Zhang
- School of Clinical Medicine, Southwest Medical University, Luzhou, China
| | - Xin Zhou
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China.,Center for Orthopedic Diseases Research, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China.,Expert Workstation in Luzhou, Luzhou, China.,Clinical Base of Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Luzhou, China
| | - Shi-Jie Fu
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China.,Center for Orthopedic Diseases Research, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China.,Expert Workstation in Luzhou, Luzhou, China.,Clinical Base of Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Luzhou, China
| | - Guo-You Wang
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China.,Center for Orthopedic Diseases Research, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China.,Expert Workstation in Luzhou, Luzhou, China.,Clinical Base of Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Luzhou, China
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Ranne JO, Salonen SO, Kainonen TU, Kosola JA, Lempainen LL, Siitonen MT, Niemi PT. Arthroscopic Coracoclavicular Reconstruction Combined with Open Acromioclavicular Reconstruction Using Knot Hiding Clavicular Implants Is a Stable Solution. Arthrosc Sports Med Rehabil 2021; 3:e1745-e1753. [PMID: 34977629 PMCID: PMC8689262 DOI: 10.1016/j.asmr.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 08/04/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose The purpose of this noninterventional, register-based study was to report the outcomes and wound healing of surgically treated chronic acromioclavicular (AC) dislocations using a tendon graft and knot-hiding titanium implants. Methods Thirty-two cases with chronic AC separation underwent an arthroscopic coracoclavicular (CC) ligament reconstruction and an open AC ligament reconstruction using knot-hiding titanium implants. The wound healing was assessed 2 months after the operation. The Nottingham Clavicle score, Constant score, and Simple Shoulder Test were obtained postoperatively and at a minimum of one-year postsurgery. The radiographic change in distance between the clavicular and coracoid cortices and clavicular tunnel diameter was measured. General patient satisfaction with the outcome (poor, fair, good, or excellent) was also assessed 1 year postoperatively. Results The mean Nottingham Clavicle score increased from a preoperative mean of 41.66 ± 9.86 to 96.831 ± 5.86 (P ≤ .05). The Constant score increased from a preoperative mean of 44.66 ± 12.54 to 93.59 ± 7.01 (P ≤ .05). The Simple Shoulder Test score increased from a preoperative mean of 7.00 ± 2.14 to 11.84 ± .63 (P ≤ .05). The coracoclavicular distance increased from 11.32 ± 3.71 to 13.48 ± 3.79 mm (P ≤ .05). The clavicular drill hole diameter increased from 6 mm to a mean of 6 to a mean of 8.13 ± 1.12 mm. Twenty-three (71.9%) patients reported an excellent outcome, and nine (28.1%) reported a good outcome. One clavicular fracture occurred but no coracoid fractures. There was one reconstruction failure leading to a reoperation. Conclusions In this series, combining the arthroscopic CC ligament reconstruction to an open reconstruction of the AC joint with a tendon graft proved to be a stable solution. The knot-hiding titanium implant effectively eliminated the problems related to the clavicular wound healing. Level of Evidence Level IV, therapeutic case series.
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Affiliation(s)
- Juha O. Ranne
- Hospital Mehilainen Neo, Turku, Finland, Turku, Finland
- Address correspondence to Juha O. Ranne, M.D., Ph.D., Hospital Mehiläinen Neo, Joukahaisenkatu 6, 20520 Turku, Finland.
| | - Severi O. Salonen
- The Paavo Nurmi Centre, Department of Physical Activity and Health, the University of Turku, Turku, Finland
| | | | - Jussi A. Kosola
- Department of Orthopaedics and Traumatology, Helsinki University Hospital, Helsinki, Finland
| | - Lasse L. Lempainen
- Hospital Mehilainen Neo, Turku, Finland, Turku, Finland
- The Paavo Nurmi Centre, Department of Physical Activity and Health, the University of Turku, Turku, Finland
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Buckley PJ, Jildeh TR, Abbas MJ, Okoroha KR. Acromioclavicular Joint Reconstruction with Recessed Clavicular Implant Technique Guide. Arthrosc Tech 2021; 10:e2577-e2582. [PMID: 34868864 PMCID: PMC8626818 DOI: 10.1016/j.eats.2021.07.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 07/29/2021] [Indexed: 02/03/2023] Open
Abstract
Acromioclavicular (AC) joint injuries are common and often require operative intervention. Although there are many described surgical techniques, there remains a lack of consensus on the optimal technique. The purpose of this Technical Note is to provide our preferred method of AC reconstruction with a recessed clavicular implant and semitendinosus allograft, which mitigates hardware pain associated with arthroscopic techniques.
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Affiliation(s)
- Patrick J. Buckley
- Henry Ford Hospital, Department of Orthopaedic Surgery, Detroit, Michigan,Address correspondence to Patrick J. Buckley, B.S., Henry Ford Hospital, Department of Orthopaedic Surgery, 2799 W. Grand Blvd, Detroit, MI 48202, U.S.A.
| | - Toufic R. Jildeh
- Henry Ford Hospital, Department of Orthopaedic Surgery, Detroit, Michigan
| | - Muhammad J. Abbas
- Henry Ford Hospital, Department of Orthopaedic Surgery, Detroit, Michigan
| | - Kelechi R. Okoroha
- Mayo Clinic Department of Orthopedic Surgery, Minneapolis, Minnesota, U.S.A
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