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Van Eecke E, Struelens B, Muermans S. Long-term clinical and radiographic outcomes of arthroscopic acromioclavicular stabilization for acute acromioclavicular joint dislocation. Clin Shoulder Elb 2024:cise.2023.01060. [PMID: 38738320 DOI: 10.5397/cise.2023.01060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 01/20/2024] [Indexed: 05/14/2024] Open
Abstract
Background Standard open acromioclavicular (AC) stabilization is associated with increased postoperative complications including deltoid injury, infection, tunnel complications, loss of reduction, and wound/cosmetic concerns. Arthroscopy may offer superior visualization and advantages that limit these risks. The aim of this prospective non-randomized study is to evaluate advantages and long-term reliability of arthroscopic AC stabilization. Methods Thirty-two patients with acute grade III, IV and V AC dislocations underwent arthroscopic AC reconstruction with long-term assessment by clinical AC examination, Simple Shoulder Test, American Shoulder and Elbow Surgeons scores, visual analog scale, Specific AC Score and Quick Disabilities of the Arm, Shoulder and Hand scores. Radiographs verified conservation of initial reduction and presence of coracoclavicular (CC) ossifications. Complications, revision rate and satisfaction were assessed and compared to the literature. Results Mean follow-up time was 67.6 months. All clinical outcome scores improved and differences were statistically significant (P<0.001). Initial postoperative radiographs consistently showed complete reduction. Two patients experienced relapse to grade II AC dislocation without clinical implications. In total, 71.8% showed CC ossifications without functional impairment, and in 31.3% concomitant injuries were observed. Reintervention rate was 9.4% and 96.7% of patients were satisfied with procedure outcomes. Conclusions Arthroscopic stabilization for acute AC joint dislocations offers satisfactory clinical and radiographic outcomes, and our results show that the arthroscopic technique is reliable in the long run. We report better reduction in maintenance, fewer complications and similar reoperation rates compared to other techniques.
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Affiliation(s)
- Eduard Van Eecke
- Department of Orthopedic Surgery, AZ Delta Roeselare, Roeselare, Belgium
| | | | - Stijn Muermans
- Department of Orthopedic Surgery, AZ Delta Roeselare, Roeselare, Belgium
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Huang L, Cai L, Fan M, Yu P, Tu D. Subacromial osteolysis following hook plate fixation for acromioclavicular dislocation: a systematic review and meta-analysis. J Shoulder Elbow Surg 2024:S1058-2746(24)00266-0. [PMID: 38642874 DOI: 10.1016/j.jse.2024.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/06/2024] [Accepted: 03/03/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Clavicular hook plates are extensively used in the treatment of acromioclavicular (AC) dislocation. Subacromial osteolysis is a typical complication following hook plate fixation. We performed a systematic review and meta-analysis to determine the incidence of subacromial osteolysis and analyzed the associated characteristics of subacromial osteolysis to guide surgeons. METHODS PubMed, EMBASE, and Cochrane Library databases were comprehensively searched for relevant literature. We screened the literature based on the eligibility criteria, extracted relevant data and assessed the quality of the included studies. Pooled odds ratios (ORs) or mean differences (MDs) with 95% confidence intervals were calculated by a fixed-effects or random-effects model. Heterogeneity was evaluated by the chi-squared test and I2 statistics. A meta-regression analysis was performed to explore the potential source of heterogeneity. RESULTS Thirty-two studies met the inclusion criteria. The total pooled incidence of subacromial osteolysis was 29%, and the only covariate that could influence the incidence of subacromial osteolysis was the radiological measurement method (P=0.017). Patients in the hook plate fixation with coracoclavicular (CC) ligament reconstruction group had lower odds of subacromial osteolysis (OR, 2.54, 95% CI 1.54 to 4.18; P < 0.001). There were no significant differences in the Constant-Murley scores at the final follow-up between patients with and without subacromial osteolysis (SMD, -0.17; 95% CI, -0.50 to 0.15; P= 0.294). CONCLUSIONS Subacromial osteolysis has a relatively high and variable incidence, and the primary factor influencing the reported incidence is the radiological assessment method. The current analysis suggests CC ligament reconstruction as an effective surgical approach for decreasing the incidence of subacromial osteolysis. The presence or absence of subacromial osteolysis did not significantly impact the functional outcomes observed during the final follow-up period.
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Affiliation(s)
- Ligang Huang
- Department of Orthopedic Surgery, Hangzhou Xiaoshan Traditional Chinese Medical Orthopedic Hospital, Hangzhou, China.
| | - Lijun Cai
- Department of Orthopedic Surgery, Hangzhou Xiaoshan Traditional Chinese Medical Orthopedic Hospital, Hangzhou, China
| | - Mingjun Fan
- Department of Orthopedic Surgery, Hangzhou Xiaoshan Traditional Chinese Medical Orthopedic Hospital, Hangzhou, China
| | - Pengzhen Yu
- Department of Orthopedic Surgery, Hangzhou Xiaoshan Traditional Chinese Medical Orthopedic Hospital, Hangzhou, China
| | - Dongpeng Tu
- Department of Orthopedic Surgery, Hangzhou Xiaoshan Traditional Chinese Medical Orthopedic Hospital, Hangzhou, China
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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:S1888-4415(24)00048-1. [PMID: 38325567 DOI: 10.1016/j.recot.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Renaud M, Caubrière M, Lancigu R, Hubert L, Marc C, David G, Rony L. Management of acute grade IV and greater acromioclavicular dislocations: Open acromioclavicular brace versus arthroscopic double DogBone® endobutton. Orthop Traumatol Surg Res 2024; 110:103635. [PMID: 37236392 DOI: 10.1016/j.otsr.2023.103635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 02/08/2023] [Accepted: 02/21/2023] [Indexed: 05/28/2023]
Abstract
INTRODUCTION Several surgical techniques exist to manage grade IV acute acromioclavicular dislocation (ACD). However, the conventional acromioclavicular brace technique (ACB) has never been compared to the arthroscopic DogBone® (DB) double endobutton technique. The aim of this work was to compare the functional and radiological results of DB stabilization with those of ACB. HYPOTHESIS DB stabilization provides similar functional results with a low rate of radiological recurrences compared to ACB. MATERIAL AND METHODS This is a case-control study comparing 17 cases of ACD operated by DB (DB group) between January 2016 and January 2021 with 31 cases of ACD operated by ACB (ACB group) between January 2008 and January 2016. The primary outcome was the difference in the D/A ratio (reflecting vertical displacement) measured on an anteroposterior acromioclavicular (AC) X-ray compared between the 2 groups at one-year after surgery. The secondary outcome was a clinical evaluation at one-year using the Constant score and clinical AC instability. RESULTS At revision, the mean D/A ratio in the DB and ACB groups was 0.4±0.5 [-0.4-1.6] and 1.6±0.3 [0.8-3.1] respectively (p>0.05). Two patients (11.7%) in the DB group had implant migration with radiological recurrence while 14 patients (33%) had radiological recurrence in the ACB group (p<0.05). CONCLUSION The DB technique limits the radiographic recurrence of acute ACD with an equivalent functional result at 1-year postoperatively compared to the conventional ACB technique, which implicitly requires a second operation for hardware removal. The DB technique has become the technique of choice in first-line treatment of acute grade IV ACD. LEVEL OF EVIDENCE III; retrospective case-control series.
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Affiliation(s)
- Martin Renaud
- Département de chirurgie osseuse, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France
| | - Marin Caubrière
- Département de chirurgie osseuse, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France
| | - Romain Lancigu
- Département de chirurgie osseuse, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France
| | - Laurent Hubert
- Département de chirurgie osseuse, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France
| | - Clément Marc
- Département de chirurgie osseuse, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France
| | - Guillaume David
- Département de chirurgie osseuse, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France
| | - Louis Rony
- Département de chirurgie osseuse, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France.
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Lima EBDS, Belangero PS, Lara PHS, Ribeiro LM, de Figueiredo EA, Andreoli CV, Pochini ADC, Ejnisman B, Pagura JR, Cohen M, Arliani GG. Shoulder injuries in Brazilian professional football players: epidemiological analysis of 3828 games. J ISAKOS 2024:S2059-7754(24)00012-9. [PMID: 38296185 DOI: 10.1016/j.jisako.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVES Football is a globally played sport that poses potential risks for musculoskeletal injuries. Upper-limb injuries have a lower incidence rate than lower-limb injuries but can still cause absenteeism and performance impairment in football players. This descriptive epidemiological study aimed to evaluate and compare the epidemiological data on shoulder injuries among professional football players in two major Brazilian football championships. METHODS Data were collected throughout the championships, and club physicians medically evaluated each player during official games using two online forms. The collected information included the player's age and position, injury diagnosis, laterality, location on the field where the injury occurred, playing time, imaging examinations performed, need for surgical treatment, time to return to play (TRP), and recurrence of the injury. The incidence of injuries was evaluated using the Federation Internationale de Football Association (FIFA) incidence formula. RESULTS A total of 107 shoulder injuries were recorded (4.3% of all injuries), with a FIFA incidence of 0.847. Glenohumeral dislocations (GHDs) and acromioclavicular dislocations (ACDs) accounted for 37.38% and 35.51% of all shoulder injuries, respectively. Goalkeepers and defenders presented, respectively, a 2.15 and 1.57 times increased risk of suffering shoulder injuries, while attackers presented a 0.63 times decreased risk. Injury recurrence was observed in 14.95% of cases, with GHDs and ACDs showing recurrence rates of 35.00% and 5.26%, respectively. Surgery was performed in 9.35% of cases, with GHDs representing 50% of all surgeries. The average TRP was 22.37 days, with severe and major injuries accounting for 11.21% and 10.28% of all injuries, respectively. Goalkeepers had the highest average TRP of 36.15 days. Recurring injuries had a higher average TRP of 33.44 days compared to nonrecurring injuries, which had an average TRP of 20.43 days. Surgically treated injuries had the highest average TRP of 112.5 days. CONCLUSION Shoulder injuries in the professional football scenario are of great concern due to the high recurrence rate and need for surgical treatment, which will lead to a long TRP. These findings emphasize the need to implement prevention protocols and effective treatments to reduce the consequences of such injuries, which are usually underestimated in this sport. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Ewerton Borges de Souza Lima
- Sports Traumatology Center, Discipline of Sports Medicine and Physical Activity, Department of Orthopedics and Traumatology, Federal University of São Paulo, R. Estado de Israel, 713 - Vila Clementino, São Paulo, SP 04022-002, Brazil
| | - Paulo Santoro Belangero
- Sports Traumatology Center, Discipline of Sports Medicine and Physical Activity, Department of Orthopedics and Traumatology, Federal University of São Paulo, R. Estado de Israel, 713 - Vila Clementino, São Paulo, SP 04022-002, Brazil
| | - Paulo Henrique Schmidt Lara
- Sports Traumatology Center, Discipline of Sports Medicine and Physical Activity, Department of Orthopedics and Traumatology, Federal University of São Paulo, R. Estado de Israel, 713 - Vila Clementino, São Paulo, SP 04022-002, Brazil
| | - Leandro Masini Ribeiro
- Sports Traumatology Center, Discipline of Sports Medicine and Physical Activity, Department of Orthopedics and Traumatology, Federal University of São Paulo, R. Estado de Israel, 713 - Vila Clementino, São Paulo, SP 04022-002, Brazil
| | - Eduardo Antônio de Figueiredo
- Sports Traumatology Center, Discipline of Sports Medicine and Physical Activity, Department of Orthopedics and Traumatology, Federal University of São Paulo, R. Estado de Israel, 713 - Vila Clementino, São Paulo, SP 04022-002, Brazil
| | - Carlos Vicente Andreoli
- Sports Traumatology Center, Discipline of Sports Medicine and Physical Activity, Department of Orthopedics and Traumatology, Federal University of São Paulo, R. Estado de Israel, 713 - Vila Clementino, São Paulo, SP 04022-002, Brazil
| | - Alberto de Castro Pochini
- Sports Traumatology Center, Discipline of Sports Medicine and Physical Activity, Department of Orthopedics and Traumatology, Federal University of São Paulo, R. Estado de Israel, 713 - Vila Clementino, São Paulo, SP 04022-002, Brazil
| | - Benno Ejnisman
- Sports Traumatology Center, Discipline of Sports Medicine and Physical Activity, Department of Orthopedics and Traumatology, Federal University of São Paulo, R. Estado de Israel, 713 - Vila Clementino, São Paulo, SP 04022-002, Brazil.
| | - Jorge Roberto Pagura
- Brazilian Football Confederation, Avenida Luis Carlos Prestes, 130 - Barra da Tijuca, Rio de Janeiro, RJ 22775-055, Brazil
| | - Moisés Cohen
- Sports Traumatology Center, Discipline of Sports Medicine and Physical Activity, Department of Orthopedics and Traumatology, Federal University of São Paulo, R. Estado de Israel, 713 - Vila Clementino, São Paulo, SP 04022-002, Brazil
| | - Gustavo Gonçalves Arliani
- Sports Traumatology Center, Discipline of Sports Medicine and Physical Activity, Department of Orthopedics and Traumatology, Federal University of São Paulo, R. Estado de Israel, 713 - Vila Clementino, São Paulo, SP 04022-002, Brazil
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Ruiz Ibán MA, Ruiz Díaz R, de Rus Aznar I, Vaquero Comino C, Diaz Heredia J. Anatomic acromioclavicular and Coracoclavicular ligament reconstruction with allograft is effective for the management of non-acute acromioclavicular dislocations. Injury 2023; 54 Suppl 7:111047. [PMID: 38225163 DOI: 10.1016/j.injury.2023.111047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 09/08/2023] [Accepted: 09/10/2023] [Indexed: 01/17/2024]
Abstract
OBJECTIVE to analyze the short-term outcomes of an anatomical technique that reconstructs both the acromioclavicular and coracoclavicular ligaments with the help of a tendon allograft for the management of non-acute acromioclavicular dislocations. METHODS this is a prospective longitudinal study of a case series of subjects with symptomatic non-acute (>3 weeks) acromioclavicular dislocations surgically managed with an anatomical reconstruction of both the acromioclavicular and coracoclavicular ligaments using tibial tendon allografts. Outcomes were assessed with simple standardized radiographs and with the Constant-Murley, American Shoulder and Elbow Surgeons (ASES)-shoulder and Quick-DASH (Disabilities of the Arm, Shoulder and Hand) scales; also, the acromioclavicular joint stability and the scapulothoracic kinematics were assessed. RESULTS a total of 19 subjects were assessed. There were no intraoperative or early postoperative complications. After a minimum two year follow-up (mean 3.12 years, [standard deviation 1.10 years]), there were significant improvements in all three of the scales: The Constant-Murley score increased from 65.4 (13.0) preoperatively to 92.6 (11.2) at the end of follow-up (p<0.001); the Quick-DASH score improved from 21.3 (6.73) to 13.0(4.58) (p<0.001); and the ASES-shoulder score increased from 56.6 (14.6) to 91.0 (9.86) (p<0.001). The AC joint was stable in both the vertical and the horizontal plane, without residual scapulothoracic dysfunction in 18/19 subjects at the end of follow-up. Only one patient presented a poor functional outcome, with loss of reduction, instability and persistent symptoms. Another subject suffered loss of reduction, though without functional repercussions. Two subjects had asymptomatic distal clavicle osteolysis and two developed radiographic osteoarthritis and were also asymptomatic. Moderate widening of the tunnels was observed in most patients: tunnel size after surgery was 5.1 (0.3) mm versus 5.8 (1.1) mm at the end of follow-up (p = 0.001) but widening was not correlated to final function. CONCLUSIONS the anatomical reconstruction of the acromioclavicular and coracoclavicular ligament complexes with a tendon allograft yields excellent clinical outcomes when used in subjects with symptomatic non-acute acromioclavicular dislocations. Secondary tunnel widening, distal clavicle osteolysis and osteoarthritis might be of concern but do not affect clinical outcomes.
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Affiliation(s)
- Miguel Angel Ruiz Ibán
- Unidad de Hombro y Codo, Hospital Universitario Ramón y Cajal, Madrid, Spain; Universidad de Alcalá de Henares, Alcalá de Henares, Madrid, Spain; Universidad CEU San Pablo, Madrid, Spain.
| | - Raquel Ruiz Díaz
- Unidad de Hombro y Codo, Hospital Universitario Ramón y Cajal, Madrid, Spain; Universidad de Alcalá de Henares, Alcalá de Henares, Madrid, Spain
| | | | | | - Jorge Diaz Heredia
- Unidad de Hombro y Codo, Hospital Universitario Ramón y Cajal, Madrid, Spain; Universidad de Alcalá de Henares, Alcalá de Henares, Madrid, Spain
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Chen H, Fang JH, Yin GY. [Finite element analysis of different reconstruction methods of coracoclavicular ligament for acromioclavicular joint dislocation]. Zhongguo Gu Shang 2023; 36:543-9. [PMID: 37366096 DOI: 10.12200/j.issn.1003-0034.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
OBJECTIVE This study aims to examine the biomechanical effects of different reconstruction methods, including single-bundle, double-bundle anatomical reconstruction, and double-bundle truly anatomical reconstruction of the coracoclavicular ligament on the acromioclavicular joint using finite element analysis, to provide a theoretical basis for the clinical application of truly anatomical coracoclavicular ligament reconstruction. METHODS One volunteer, aged 27 years old, with a height of 178 cm and a weight of 75 kg, was selected for CT scanning of the shoulder joint. Three-dimensional finite element models of single-bundle reconstruction, double-bundle anatomical reconstruction, and double-bundle truly anatomical reconstruction of coracoclavicular ligament were established by using Mimics17.0, Geomagic studio 2012, UG NX 10.0, HyperMesh 14.0 and ABAQUS 6.14 software. The maximum displacement of the middle point of the distal clavicle in the main loading direction and the maximum equivalent stress of the reconstruction device under different loading conditions were recorded and compared. RESULTS The maximum forward displacement and the maximum backward displacement of the middle point of the distal clavicle in the double-bundle truly anatomic reconstruction were the lowest, which were 7.76 mm and 7.27 mm respectively. When an upward load was applied, the maximum displacement of the distal clavicle midpoint in the double-beam anatomic reconstruction was the lowest, which was 5.12 mm. Applying three different loads forward, backward, and upward, the maximum equivalent stress of the reconstruction devices in the double-beam reconstruction was lower than that in the single-beam reconstruction. The maximum equivalent stress of the trapezoid ligament reconstruction device in the double-bundle truly anatomical reconstruction was lower than that in the double-bundle anatomical reconstruction, which was 73.29 MPa, but the maximum equivalent stress of the conoid ligament reconstruction device was higher than that of the double-bundle anatomical reconstruction. CONCLUSION The truly anatomical reconstruction of coracoclavicular ligament can improve the horizontal stability of acromioclavicular joint and reduce the stress of the trapezoid ligament reconstruction device. It can be a good method for the treatment of acromioclavicular joint dislocation.
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Affiliation(s)
- Hao Chen
- Nanjing Medical University, Nanjing 211166, Jiangsu, China; Department of Orthopaedics, Nanjing Hospital Affiliated to Nanjing University of Chinese Medicine, Nanjing 210003, Jiangsu, China
| | - Jia-Hu Fang
- Department of Orthopaedics, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu, China
| | - Guo-Yong Yin
- Department of Orthopaedics, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu, China
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Barati H, Afzal S. Simultaneous acromioclavicular dislocation, proximal humeral fracture, and reverse Hill-Sachs lesion: a case report. J Med Case Rep 2023; 17:222. [PMID: 37248546 PMCID: PMC10228123 DOI: 10.1186/s13256-023-03966-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/02/2023] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND In cases with injuries to the shoulder region, the combination of acromioclavicular joint dislocation, reverse Hill-Sachs lesion, and proximal humeral fracture is a very rare condition. CASE PRESENTATION This study described a 38-year-old male Persian patient with simultaneous acromioclavicular joint dislocation, proximal humeral fracture, and reverse Hill-Sachs lesion due to motor vehicle crash injury who underwent arthroscopic acromioclavicular joint fixation using tight rope technique. In the 7-month follow-up period following the surgical fixation, range of motion was approximately normal. Reduction and hardware were intact, no dislocation or apprehension to dislocation was observed. Patient only had minor shoulder pain at the end of range of motion and a dull pain on the site of incision over the clavicle in deep touch. Our findings showed acceptable arthroscopic outcomes in the management of such complex case. CONCLUSION Our experience on this case showed acceptable outcomes of the arthroscopic treatment of the acromioclavicular joint dislocation in the management of such a complex case with associated injuries to the shoulder region.
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Affiliation(s)
- Hasan Barati
- Department of Orthopedic, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sina Afzal
- Department of Orthopedic, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Álvarez LÁ, López MC, Rodríguez EG, Pérez ÁG, Arenas MR, Menéndez MC. Type III acromioclavicular dislocation. Mid term results after operative and non operative treatment. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023:S1888-4415(23)00121-2. [PMID: 37187342 DOI: 10.1016/j.recot.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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)
- Lucía Álvarez Álvarez
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, (España), Estrada de Clara Campoamor, 341, 36213 Vigo, Pontevedra, España.
| | - Miguel Cela López
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, (España), Estrada de Clara Campoamor, 341, 36213 Vigo, Pontevedra, España.
| | - Elena González Rodríguez
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, (España), Estrada de Clara Campoamor, 341, 36213 Vigo, Pontevedra, España.
| | - Ángela García Pérez
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, (España), Estrada de Clara Campoamor, 341, 36213 Vigo, Pontevedra, España.
| | - Mónica Rodríguez Arenas
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, (España), Estrada de Clara Campoamor, 341, 36213 Vigo, Pontevedra, España.
| | - Manuel Castro Menéndez
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, (España), Estrada de Clara Campoamor, 341, 36213 Vigo, Pontevedra, España.
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Wahal N, Alabbasi A, Martetschläger F. [Injuries of the shoulder in winter sports]. Orthopadie (Heidelb) 2022; 51:896-902. [PMID: 36315290 DOI: 10.1007/s00132-022-04322-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/28/2022] [Indexed: 06/16/2023]
Abstract
Skiing as a sport has come a long way from the first competitive event in Norway in 1767 to about 200 million skiers today worldwide. With Germany alone recording around 8000 injuries annually, there is an increased need for awareness for winter-sport-related injuries and their management. According to the latest report by "Auswertungsstelle für Skiunfälle" (ASU, evaluation center for ski accidents), shoulder injuries alone account for more than 20% of injuries to all body regions (men 26.1% and women 13%). The most common injuries affecting the shoulder girdle are rotator cuff strains, glenohumeral dislocations, acromioclavicular dislocations and clavicle fractures. These injuries are primarily the result of four mechanisms: direct impact, axial load on an extended arm, resisted forced abduction of the arm, and external rotation forces resulting from a firmly planted ski pole in the grasp of a skier during a fall. In this article, we describe the three most common shoulder girdle injuries in winter sports along with their management and answer the most important questions for the athlete.
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Affiliation(s)
- N Wahal
- Deutsches Schulterzentrum in der ATOS Klinik München, Effnerstraße 38, 81925, München, Deutschland
| | - A Alabbasi
- Deutsches Schulterzentrum in der ATOS Klinik München, Effnerstraße 38, 81925, München, Deutschland
| | - F Martetschläger
- Deutsches Schulterzentrum in der ATOS Klinik München, Effnerstraße 38, 81925, München, Deutschland.
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Tuxun A, Keremu A, Aila P, Abulikemu M, Xie Z, Ababokeli P. Combination of Clavicular Hook Plate with Coracoacromial Ligament Transposition in Treatment of Acromioclavicular Joint Dislocation. Orthop Surg 2022; 14:613-620. [PMID: 35142059 PMCID: PMC8926994 DOI: 10.1111/os.13197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/18/2021] [Accepted: 11/22/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To evaluate the clinical efficacy of Arbeitsgemeinschaft für Osteosynthesefragen (AO) clavicular hook plate (CHP) combined with coracoacromial ligament transposition for Rockwood III-V dislocation of AC joint, providing an alternative choice for AC joint dislocation treatment. METHODS Twenty-five patients diagnosed with Rockwood III-V dislocation of acromioclavicular (AC) joint, including 18 males and seven females, aged 43.5 ± 2.4 years old on average, who had undergone open reduction and AO CHP in combination with coracoacromial (CC) ligament transposition between January 2010 and December 2015, were retrospectively analyzed. Among them, 17 cases were diagnosed as type III, five cases were type IV, and three cases were type V. The surgery mainly included three main steps: bone flap incision, drilling in the clavicle, and hook plate fixation and AC joint reposition. The treatment efficacy was evaluated through clinical examinations and imaging studies for the shoulder joint, including gross observation and measuring coracoid clavicle distance (CC-Dist) using orthophoria X-ray before and 1 year after the surgery, and University of California (UCLA) shoulder rating scale. RESULTS All the patients were followed up three to four times in 18 months (12-24 months) on average, and the UCLA rating results showed that there were 17 excellent cases (68%), five good cases (20%), and three fair cases (12%). The CC-Dist values after the surgery reduced to 9.7 ± 0.7 mm, which was significantly (P < 0.05) lower compared to that before the surgery (15.8 ± 1.6 mm). Most (88%) of the cases showed almost normal joint function and good anatomical arrangement of the acromioclavicular joint, without any secondary dislocation, and for them, 12 ± 2 weeks on average were needed to regain the normal function of shoulder joint movement. CONCLUSION Due to the stable fixation, fewer complications, and satisfactory therapeutic effect with great clinical value, the combination of AO CHP and CC ligament transposition is expected to be used for treating Rockwood III-V dislocation of AC joint.
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Affiliation(s)
- Aikebaier Tuxun
- Department of Orthopedics, The First People's Hospital of Kashgar Prefecture, Kashgar, China
| | - Ajimu Keremu
- Department of Orthopedics, The First People's Hospital of Kashgar Prefecture, Kashgar, China
| | - Pazila Aila
- Department of Orthopedics, The First People's Hospital of Kashgar Prefecture, Kashgar, China
| | - Maimaitiaili Abulikemu
- Department of Orthopedics, The First People's Hospital of Kashgar Prefecture, Kashgar, China
| | - Zengru Xie
- Department of Orthopedic Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Palati Ababokeli
- Department of Orthopedic Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
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Abstract
INTRODUCTION Although the coracoid process seems to play an important anatomical role, there are few reports concerning fracture nonunion of the coracoid process (CN) and its disorders. Therefore, there is no widely accepted standard for the treatment of CN. MATERIALS AND METHODS PubMed and Scopus were searched using "scapular fracture" and "coracoid fracture" as search terms. The inclusion criteria were English full-text articles concerning coracoid fracture, and articles that described patient characteristics and presented appropriate images. The exclusion criteria were descriptive cases, and cases without appropriate images. Citation tracking was conducted to find additional articles and notable full-text articles written in other languages. Fractures were classified using Ogawa's functional classification, with Eyres' anatomical classification used as a supplement when necessary. RESULTS Twenty-nine patients (26 men, 3 women) with 30 CN were identified. Nine CN had a predisposing factor such as seizure disorder and renal osteodystrophy. The fracture types were 12 Ogawa type I and 18 type II. Concurrent shoulder girdle injuries at the time of initial trauma/accident were varied. There were six cases of double disruption and two of triple disruption of the superior shoulder suspensory complex (SSSC), all of which had Ogawa type I fracture. Only six CN were isolated. The most frequent cause of CN was oversight by the previous physician (n = 11), followed by conservative treatment (n = 7). Although 12 patients with 13 CN had symptoms attributable to CN, most of these symptoms were insignificant. Although the acromioclavicular dislocation or CN persisted in eight patients, these residual abnormalities did not significantly affect the outcomes. CONCLUSIONS Physicians treating CN should recognize that CN itself is frequently asymptomatic, and a satisfactory outcome is achieved solely by treating the concurrent injuries, even if CN remains. When CN is suspected to produce symptoms, the physician must then determine the mechanism by which the symptoms are produced, and select a treatment strategy. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Kiyohisa Ogawa
- Department of Orthopedic Surgery, Eiju General Hospital, 2-23-16 Higashi-Ueno, Taito-ku, Tokyo, 110-8645, Japan.
| | - Noboru Matsumura
- Department of Orthopedic Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Atsushi Yoshida
- Department of Orthopedic Surgery, National Hospital Organization Saitama Hospital, 2-1 Suwa, Wako, Saitama, 351-0102, Japan
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13
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Abstract
Background Although fracture of the coracoid process (CF) used to be considered rare, it is now more commonly encountered due to increased awareness and advances in imaging methods. This review aimed to analyze reported cases of CF to determine its mechanism and appropriate treatment. Methods PubMed and Scopus were searched using the terms "scapula fracture" and "coracoid fracture." The inclusion criteria were English full-text articles concerning CF that described patient characteristics with appropriate images. The exclusion criteria included cases without appropriate images and those with physeal injury or nonunion. Citation tracking was conducted to find additional articles and notable full-text articles in other languages. Fractures were mainly classified using Ogawa's classification. Results Ninety-seven studies were identified, including 197 patients (131 men, 33 women; average age 37.0±16.9 years). CF was classified as type I in 77%, type II in 19%, and avulsion fracture at the angle in 5%. Concurrent shoulder girdle injuries included acromioclavicular injury in 33%, clavicular fracture in 17%, acromion or lateral scapular spine fracture in 15%, and anterior shoulder instability in 11%. Among patients with type I CF, 69% had multiple disruptions of the superior shoulder suspensory complex. Conservative treatment was applied in 71% of isolated type I CF, while surgical treatment was applied in 76% of type I CF with multiple disruptions. Although the evaluation methods varied, 60% of patients were followed up for more than 6 months, and the outcomes were generally satisfactory for both conservative and surgical treatments. Conclusion CF occurred commonly in the age group with higher social activity. The most common fracture type was type I. The possible mechanism of CF is violent traction of the attached muscles, except for avulsion fracture at the angle. Type I CF with multiple disruptions of the superior shoulder suspensory complex requires surgical treatment, whereas conservative care is recommended for isolated type I and type II CFs.
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Affiliation(s)
- Kiyohisa Ogawa
- Department of Orthopedic Surgery, Eiju General Hospital, Taito-ku, Tokyo, Japan
| | - Noboru Matsumura
- Department of Orthopedic Surgery, School of Medicine, Keio University, Shinjuku-ku, Tokyo, Japan
| | - Atsushi Yoshida
- Department of Orthopedic Surgery, National Hospital Organization Saitama Hospital, Wako City, Saitama, Japan
| | - Wataru Inokuchi
- Department of Orthopedic Surgery, Eiju General Hospital, Taito-ku, Tokyo, Japan
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Campagna V, Piccinni V, Rotundo G, Candela V, Gumina S. The Kite technique: a new all-arthroscopic technique for the treatment of acute acromioclavicular joint dislocation. Knee Surg Sports Traumatol Arthrosc 2021; 29:2055-2063. [PMID: 32335696 DOI: 10.1007/s00167-020-06013-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 04/17/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Although many open techniques have been developed, no all-arthroscopic technique has been introduced to reduce acute acromioclavicular joint dislocation (ACJD) and augment both coracoclavicular (CC) ligaments. The Kite technique is the first all arthroscopic technique with this aim. METHODS Forty-one consecutive patients [35M-6F; median: 29.2 years (range 23-36)] with acute type III and V acromioclavicular joint dislocation were treated with the Kite technique: it consists of positioning three titanium buttons connected by heavy sutures in an 8-strand configuration between clavicle and coracoid to restore the anatomy of CC ligaments. Patients were followed up for a median of 35 months (range 30-43 months). RESULTS Median operation time was 70.6 min (range 58-82), with no cases of intra-operative complications. At the final follow-up, the median post-operative Constant Score and SST were 94.1 (range 89-98) and 11.6 (range 10-12), respectively. At the final follow-up reduction maintenance was present in 39 patients; in one patient, signs of acromioclavicular joint dislocation recurrence were present 3 months post-op. In another patient, medial suture ruptures occurred 4 months after surgery with type II acromioclavicular joint dislocation recurrence but with scarce symptoms and full recovery to sport activity. Clavicle osteolysis was observed in four patients. Cosmetics of the arm were judged as excellent in 39/41. All patients, except two, were satisfied with the final result. CONCLUSIONS The kite technique is a safe and reproducible arthroscopic procedure to treat acute ACJD. In daily clinical practice, due to the excellent results and the low complication rate, this technique might be considered by surgeons when operative treatment of an acute acromioclavicular joint dislocation is planned. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- V Campagna
- Department of Shoulder and Elbow Surgery, Celio Military Hospital, Rome, Italy
| | - V Piccinni
- Department of Shoulder and Elbow Surgery, Celio Military Hospital, Rome, Italy
| | - G Rotundo
- Department of Shoulder and Elbow Surgery, Celio Military Hospital, Rome, Italy
| | - Vittorio Candela
- Department of Anatomy, Histology, Legal Medicine and Orthopedics, Sapienza University of Rome-Polo Pontino (ICOT), Latina, Italy.
| | - S Gumina
- Department of Anatomy, Histology, Legal Medicine and Orthopedics, Sapienza University of Rome-Polo Pontino (ICOT), Latina, Italy
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Klass P. "A Sick Child is Always the Mother's Property": The Jane Austen Pediatric Trauma Management Protocol. J Med Humanit 2021; 42:121-129. [PMID: 32918683 DOI: 10.1007/s10912-020-09664-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Two pediatric accidents in Jane Austen's Persuasion (1818) and one in Margaret Oliphant's The Doctor's Family (1863) are examined from the point of view of trauma management with analysis of contributing risk factors, medical management, concerns of parents and bystanders, and course of recovery. Risk factors for injury are impulsivity, poor supervision, and parents who are unable to set limits. Medical attention is swift and competent, but no heroic measures are used; the management of the injuries, concussion with loss of consciousness and dislocation of the collar bone, is consistent with the way these conditions are, for the most part, still managed today, and successful recovery depends on careful nursing and rest. Louisa Musgrove, who suffers a severe head injury, requires ten weeks of convalescence and undergoes a marked personality change, which we might today attribute in part to post-concussion syndrome but which may reflect contemporary debate about the biological basis of personality and behavior. A sudden traumatic injury to a child or adolescent changes the narrative abruptly, in fiction or in life, dividing a story into before and after, introducing grief and anxiety, and requiring that plans be rethought and personal relationships reshuffled with decisions about caretaking and nursing.
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Liu T, Bao F, Jiang T, Ji G, Li J, Jerosch J. Acromioclavicular Joint Separation: Repair Through Suture Anchors for Coracoclavicular Ligament and Nonabsorbable Suture Fixation for Acromioclavicular Joint. Orthop Surg 2020; 12:1362-1371. [PMID: 32893498 PMCID: PMC7670157 DOI: 10.1111/os.12771] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/07/2020] [Accepted: 07/09/2020] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To evaluate the clinical and radiographic outcomes of patients undergoing coracoclavicular (CC) ligament repair by two suture anchors and acromioclavicular (AC) joint (ACJ) fixation using heavy nonabsorbable sutures for the treatment of types III-V ACJ injuries with a minimum of 1-year follow-up. METHODS The clinical and radiographic outcomes of 36 consecutive patients (26 men and 10 women) who underwent anatomic reduction for acute ACJ dislocation using two suture anchors for CC ligament reconstruction and two strands of non-absorbable stitches for ACJ fixation between December 2013 and December 2018 were reviewed. Two 3.5 mm suture anchors with double-loaded sutures were separately inserted into the anterolateral and posteromedial portions of the coracoid process. The suture strands were passed through the hole created in the clavicle using 2.0 mm drill and tied over the clavicle. Additional ACJ augmentation using two strands of non-absorbable heavy sutures was performed in all patients. At 3, 6, and 12 months and last follow-up visit, the scores on the visual analog scale (VAS), the American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score, and simple shoulder test (SST) questionnaires were used to provide a final evaluation of shoulder function. Comparison between baseline and treatment results was performed. Radiographic analysis included vertical displacement and horizontal shift. RESULTS A total of 29 patients (20 men and nine women) were included in the study. A total of seven, six, and 16 patients had Rockwood type III, type IV, and type V ACJ dislocations, respectively. The mean patient age was 42.8 ± 13.5 years, with a mean follow-up of 28 months (range, 12-56 months). At the 12-month follow-up, the mean ASES score was 92.1 ± 3.5, with a mean pain score of 0.5 ± 0.7 on the VAS and mean Constant-Murley score of 93.0 ± 2.4. The new number of positive answers on the SST was 11.5 ± 0.6. Compared with the baseline, the clinical results improved significantly (P < 0.05). No significant difference could be found between the 6- and 12-month follow-up evaluations (P > 0.05). Radiographs showed two partial loss of reduction, whereas no horizontal displacement was found in all patients. One patient developed a superficial wound infection 3 weeks postoperation. The wound healed after routine wound care. No neurovascular complications were recorded. CONCLUSIONS CC ligament reconstruction using two suture anchors and ACJ augmentation using two strands of non-absorbable heavy sutures on high-grade AC dislocation is a reliable technique for restoring stability to the ACJ and can obtain good to excellent clinical results.
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Affiliation(s)
- Tao Liu
- Department of Orthopaedic SurgeryQilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong UniversityQingdaoChina
| | - Fei‐long Bao
- Department of Orthopaedic SurgeryQilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong UniversityQingdaoChina
| | - Tao Jiang
- Department of Orthopaedic SurgeryQilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong UniversityQingdaoChina
| | - Guang‐wei Ji
- Department of Orthopaedic SurgeryQilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong UniversityQingdaoChina
| | - Jian‐min Li
- Department of Orthopaedic SurgeryCheeloo College of Medicine, Shandong UniversityJinanChina
| | - Jörg Jerosch
- Clinic for Orthopaedics and Orthopaedic SurgeryJohanna‐Etienne HospitalNeussGermany
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Menegaz GL, Gomide LC, Araújo CA. Biomechanical evaluation of acromioclavicular joint reconstructions using a 3-dimensional model based on the finite element method. Clin Biomech (Bristol, Avon) 2019; 70:170-6. [PMID: 31525658 DOI: 10.1016/j.clinbiomech.2019.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 08/26/2019] [Accepted: 09/04/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study aims to evaluate the influence of stabilization of acromioclavicular (AC) joint dislocation through the modified Weaver-Dunn technique and coracoclavicular (CC) ligaments using the finite element method. The goal is to determine which surgical technique allows behavior that is most similar to the joint, guaranteeing the necessary stability without restricting joint movements for the considered conditions. METHODS The analysis is based on the three-dimensional finite element models. The control group of this study is represented by a three-dimensional model of the whole structure based on finite element methods. FINDINGS The finite element models showed the stress and displacement values found in the intact acromioclavicular joint and surgical procedures. It was concluded that transferring the coracoacromial ligament to stabilize the acromioclavicular joint did not have a positive impact on the outcome. INTERPRETATION The finite element analysis on the treatment of acromioclavicular dislocation presented here provides medical teams with new parameters for choosing a suitable surgical procedure in the occurrence of acromioclavicular dislocation. The development and validation of the finite element models allow the variation of the conditions and enables different surgical configurations to be simulated.
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Chang HM, Hong CK, Su WR, Wang TH, Chang CW, Tai TW. Comparison of clavicular hook plate with and without coracoclavicular suture fixation for acute acromioclavicular joint dislocation. Acta Orthop Traumatol Turc 2019; 53:408-413. [PMID: 31582200 PMCID: PMC6939001 DOI: 10.1016/j.aott.2019.08.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 04/23/2019] [Accepted: 08/22/2019] [Indexed: 12/14/2022]
Abstract
Objective The aim of this study was to compare the clinical and radiographic outcomes of clavicular hook plate fixation with and without coracoclavicular (CC) tape augmentation for the treatment of acute unstable AC dislocation. Methods We treated 47 patients (31 men and 16 women; mean age: 47 years (range, 21–81)) with unstable acute AC dislocations (Rockwood III–V) and divided them into two groups according to the treatment modality, with hook plate fixation (hook plate group) or hook plate plus CC tape augmentation (combined group). We assessed radiologic findings, such as subacromial osteolysis and AC osteoarthritis. We also evaluated the clinical outcomes using a visual analogue scale (VAS) for pain, as well as the University of California at Los Angeles (UCLA) Shoulder Rating Scale and the American Shoulder and Elbow Surgeons (ASES) Shoulder Score. Results We found that the combined group had less subacromial osteolysis upon radiography, although the CC distance was similar in both groups (119 ± 29.7% of contralateral side CC distance in hook plate group versus 119 ± 34.8% in the combined group, p = 0.77). Compared with the hook plate group, the combined group had a lower VAS score (4.5 ± 2.3 in hook plate group versus 2.3 ± 1.4 in the combined group, p < 0.001), better UCLA scores (19.9 ± 4.9 in hook plate group versus 27.2 ± 4.0 in the combined group, p < 0.001) as well as better ASES scores (51.9 ± 17.8 in hook plate group versus 73.8 ± 13.1 in the combined group, p < 0.001) at 3 and 6 months after surgery. Conclusion Hook plate fixation plus CC tape augmentation may prevent subacromial osteolysis and yield better short-term functional outcomes. Level of Evidence Level III, Therapeutic Study.
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Affiliation(s)
- Hao-Ming Chang
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chih-Kai Hong
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Ren Su
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | | | - Chih-Wei Chang
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ta-Wei Tai
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Taleb H, Afshar A, Shariyate MJ, Tabrizi A. Comparison of Short-Term Clinical Outcomes of Hook Plate and Continuous Loop Double Endobutton Fixations in Acute Acromioclavicular Joint Dislocation. Arch Bone Jt Surg 2019; 7:545-550. [PMID: 31970260 PMCID: PMC6935518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 01/28/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND This study was conducted to evaluate the clinical outcomes of the acromioclavicular joint (ACJ) fixation with hook plate (HP) and continuous loop double endobutton fixation (CLDE) in the treatment of acute ACJ dislocation. METHODS This retrospective study was conducted on eight patients with HP and nine patients with CLDE fixations for acute ACJ dislocations. The subjects were evaluated by various criteria, including disabilities of the Arm, Shoulder, and Hand (DASH), American Shoulder and Elbow Surgeons Standardized Shoulder Assessment (ASES), University of California, Los Angeles (UCLA) shoulder rating scale, Shoulder Constant score, Simple Shoulder Test (SST), and coracoclavicular (CC) distance. RESULTS The differences between the mean scores of the visual analog scale for pain, DASH, ASES, UCLA shoulder rating scale, and Shoulder Constant, and SST were statistically significant in favor of the CLDE group. Mean difference of CC distance was 8.6±0.9 mm in the HP group; however, it was 11.6±1.2 mm in the CLDE group. The operation time was shorter in the HP fixation, compared to that in the CLDE fixation (51±13.3 versus 105±9.7 min; P<0.001 and P=0.008). There were six concomitant subacromial erosions and osteoarthritis in the ACJ of the HP group. CONCLUSION The CLDE fixation was reported with better clinical outcomes than HP fixation; however, it was a technically demanding procedure. The HP maintained the CC distance better than CLDE with a technically easy application. The HP requires a second surgery for the removal and development of subacromial erosion and osteoarthritis of the ACJ that can be regarded as major concerns.
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Affiliation(s)
- Hasan Taleb
- Department of Orthopedics, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran
- Clinical Research Development Unit of Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran
- Department of Orthopedics, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran
- Research performed at Department of Orthopedics, Urmia University f Medical Sciences, Urmia, Iran
| | - Ahmadreza Afshar
- Department of Orthopedics, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran
- Clinical Research Development Unit of Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran
- Department of Orthopedics, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran
- Research performed at Department of Orthopedics, Urmia University f Medical Sciences, Urmia, Iran
| | - Mohammad J Shariyate
- Department of Orthopedics, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran
- Clinical Research Development Unit of Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran
- Department of Orthopedics, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran
- Research performed at Department of Orthopedics, Urmia University f Medical Sciences, Urmia, Iran
| | - Ali Tabrizi
- Department of Orthopedics, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran
- Clinical Research Development Unit of Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran
- Department of Orthopedics, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran
- Research performed at Department of Orthopedics, Urmia University f Medical Sciences, Urmia, Iran
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Kapicioglu M, Cetin H, Bilsel K. Late diagnosis of subcoracoid type 6 AC dislocation: A case report. SICOT J 2019; 5:37. [PMID: 31651396 PMCID: PMC6813848 DOI: 10.1051/sicotj/2019036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 10/05/2019] [Indexed: 11/14/2022] Open
Abstract
Acromioclavicular (AC) dislocation is a common type of shoulder injury. Although the incidence of acromioclavicular dislocation is frequent, there are different opinions regarding the treatment. Many different techniques have been proposed for the surgical treatment of AC dislocations, but all these methods have been questioned from different angles, and the gold standard in terms of treatment has not yet been determined. There are six types described by Rockwood et al. and type 6 has two types: subacromial and subcoracoid. Subcoracoid AC Type 6 dislocations are seen very rarely and difficult to diagnose in initial clinical findings or can be simply overlooked due to associated more serious injuries which take more attention. The mechanism of injury of a type 6 AC dislocation is hyperabduction and external rotation of the shoulder. A small number of type 6 subcoracoid AC dislocations have formerly been reported and apart from one case all of them were acutely diagnosed and treated with open reduction and internal fixation. In this paper, we report a case of late diagnosis of subcoracoid type 6 AC dislocation, along with its rare and previously unreported surgical management.
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Affiliation(s)
- Mehmet Kapicioglu
- Bezmialem Vakif University, School of Medicine, Department of Orthopaedics and Traumatology, Vatan Cd, Fatih 34093, İstanbul, Turkey
| | - Huzeyfe Cetin
- Bezmialem Vakif University, School of Medicine, Department of Orthopaedics and Traumatology, Vatan Cd, Fatih 34093, İstanbul, Turkey
| | - Kerem Bilsel
- Bezmialem Vakif University, School of Medicine, Department of Orthopaedics and Traumatology, Vatan Cd, Fatih 34093, İstanbul, Turkey
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Wang C, Zhang J, Chen H, Zhao D, Zhang Y, Wu Z. [Arthroscopic Twin Tail TightRope combined with distal joint capsule repair technique for acute acromioclavicular dislocation]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2019; 33:970-975. [PMID: 31407555 PMCID: PMC8337892 DOI: 10.7507/1002-1892.201903019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 06/28/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate arthroscopic treatment for acute acromioclavicular dislocation by using Twin Tail TightRope combined with distal joint capsular repair. METHODS The clinical data of 40 patients with acromioclavicular dislocation treated between February 2016 and December 2017 were retrospectively analyzed. The patients were divided into arthroscopic group (20 cases, using arthroscopic Twin Tail TightRope combined with distal joint capsular repair for anatomical repair of stable structure of acromioclavicular joint) and control group (20 cases, treated with clavicular hook plate internal fixation) according to different surgical methods. There was no significant difference in gender, age, cause of injury, Rockwood classification, time from injury to operation, preoperative visual analogue scale (VAS) score and Constant score between the two groups ( P>0.05), which were comparable. Postoperative VAS score and Constant score were used to assess shoulder function and re-dislocation was also observed. RESULTS The incisions of the two groups healed by first intention, and no early postoperative complications occurred. All patients were followed up 12-18 months (mean, 13.5 months). Postoperative X-ray films showed good anatomical reduction in both groups, but the clavicular hook had a presense in the subacromial space in control group. All patients in arthroscopic group achieved satisfactory shoulder function and returned to work after operation; there was no obvious pain, no complications such as exposure of implant after operation, and no need to remove the implant. In the control group, 4 patients had obvious subacromial impingement pain after operation, and 1 patient had re-dislocation after removal of internal fixator at 1 year after operation; the rest had no complications related to internal fixation, and the internal fixators were removed at 1.0-1.5 years after operation, without re-dislocation. The VAS score and Constant score at 3 months and 1 year after operation in both groups significantly improved when compared with those before operation, and further improved at 1 year after operation ( P<0.05). The VAS score and Constant score at 3 months and 1 year after operation in arthroscopic group were significantly better than those in control group ( P<0.05). CONCLUSION Arthroscopic treatment for acute acromioclavicular joint dislocation by using Twin Tail TightRope combined with distal capsular repair is more effective than traditional incision surgery and can obtain more satisfactory results in patient compliance and function recovery because of minimally invasive surgery.
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Affiliation(s)
- Chaoran Wang
- Department of Orthopedics, the Second Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650101, P.R.China
| | - Jun Zhang
- Department of Orthopedics, the Second Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650101,
| | - Hong Chen
- Department of Sports Medicine, Calmette International Hospital of Kunming First People's Hospital, Kunming Yunnan, 650051, P.R.China
| | - Daohong Zhao
- Department of Orthopedics, the Second Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650101, P.R.China
| | - Yuhao Zhang
- Department of Orthopedics, the Second Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650101, P.R.China
| | - Zhidan Wu
- Department of Orthopedics, the Second Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650101, P.R.China
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Nordin JS, Olsson O, Lunsjö K. The gracilis tendon autograft is a safe choice for orthopedic reconstructive procedures: a consecutive case series studying the effects of tendon harvesting. BMC Musculoskelet Disord 2019; 20:138. [PMID: 30927929 PMCID: PMC6441161 DOI: 10.1186/s12891-019-2520-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 03/21/2019] [Indexed: 01/31/2023] Open
Abstract
Background The gracilis tendon is commonly used as an autograft to reconstruct torn tendons or ligaments in many parts of the body. Little is known about the subjective and functional outcome after gracilis tendon harvest. The aim of this study was to evaluate the outcome of the donor leg in patients undergoing such surgery. Methods Patients with chronic acromioclavicular joint dislocations undergoing coracoclavicular ligament reconstructions using autogenous gracilis tendon grafts were eligible for this study. The graft harvesting procedure was carried out in a standard fashion using a tendon stripper. Knee injury and Osteoarthritis Outcome Score (KOOS) were collected preoperatively and after 12 months. The first 5 patients were included retrospectively and lacked preoperative data, for these patients age- and gender matched normative KOOS scores were used as baseline values. Isometric knee flexor strength in 60° and 90° degrees of flexion was measured at final follow up at a median of 26 (14–56) months postoperatively with the non-operated leg used as reference. Results Twenty four patients were eligible for the study and 2 were excluded. The 22 patients available for analysis had a mean age of 44 (22–62) years at the time of surgery and 4 were women. There was no statistically significant change in KOOS 12 months postoperatively compared to baseline values but the patients were weaker in knee flexion in the operated leg compared to the non-operated one. Conclusions Gracilis tendon harvesting results in a weakness of knee flexion but does not impair subjective knee function and is a procedure that can be recommended when an autogenous tendon graft is needed.
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Affiliation(s)
- Jonas S Nordin
- Department of Orthopedics, Helsingborg Hospital, Helsingborg, Sweden. .,Faculty of Medicine, Lund University, Lund, Sweden.
| | - Ola Olsson
- Department of Orthopedics, Helsingborg Hospital, Helsingborg, Sweden.,Faculty of Medicine, Lund University, Lund, Sweden
| | - Karl Lunsjö
- Department of Orthopedics, Helsingborg Hospital, Helsingborg, Sweden.,Faculty of Medicine, Lund University, Lund, Sweden
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Verstift DE, Welsink CL, Spaans AJ, van den Bekerom MPJ. Return to sport after surgical treatment for high-grade (Rockwood III-VI) acromioclavicular dislocation. Knee Surg Sports Traumatol Arthrosc 2019; 27:3803-12. [PMID: 31089792 DOI: 10.1007/s00167-019-05528-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 04/29/2019] [Indexed: 12/23/2022]
Abstract
PURPOSE Acromioclavicular (AC) joint dislocations are common in a young and active population, especially in people performing contact sports. Full recovery with a fast and high rate of return to sport is desirable. This systematic review aims to combine patient outcomes in order to help surgeons in addressing patient expectations regarding the return to sport after surgical intervention for AC dislocations. METHODS To conduct this systematic review, the PRISMA guidelines were followed. Articles were included if written in English or Dutch and evaluated return to sport after any type of surgical intervention for Rockwood types III to VI AC dislocations in patients practicing sports. Outcome parameters were return to sport, time to return to sport, level of sport, functional outcome scores and complications. RESULTS Twelve studies involving 498 patients were included, of which 462 patients practiced sports. 432 (94%) patients returned to sport. The weighted mean time to return to sport was 4.0 months. 338 out of 401 patients (84%) returned to the same level of pre-injury sport and 35 patients (9%) lowered their level of sport. The weighted mean Constant score was 92 out of 100. CONCLUSION The rate of return to sport after surgical intervention for Rockwood (RW) III-VI AC dislocations is high. However, the level of evidence was low and due to the methodological heterogeneity between studies, subgroup analyses of return to sport outcomes were not feasible. LEVEL OF EVIDENCE Systematic review of level I-IV studies, level IV.
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Phadke A, Bakti N, Bawale R, Singh B. Current concepts in management of ACJ injuries. J Clin Orthop Trauma 2019; 10:480-485. [PMID: 31061573 PMCID: PMC6491924 DOI: 10.1016/j.jcot.2019.03.020] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 03/24/2019] [Accepted: 03/26/2019] [Indexed: 01/15/2023] Open
Abstract
Acromioclavicular joint injury is common in young individuals who suffer direct trauma to the shoulder. Treatment of acromioclavicular dislocation is controversial with regards to the indication of operative management, timing of surgery, whether to perform open or arthroscopic surgery, method of stabilisation (rigid or non-rigid) and type of graft used for repair or reconstruction. Current evidence supports conservative management for Rockwood types I and II, while types IV, V and VI benefit from surgery. The optimal management of type III injuries in high demand patients remains contentious. Surgical options include acromioclavicular fixation, coracoclavicular fixation and coracoclavicular ligament reconstruction. Few studies with a low level of evidence suggest arthroscopic techniques and anatomical ligament reconstruction have better outcomes when compared to older techniques of rigid coracoclavicular fixation. The aim of this article is to look at the current evidence and address these controversial issues.
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25
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Kim E, Lee S, Jeong HJ, Park JH, Park SJ, Lee J, Kim W, Park HJ, Lee SY, Murase T, Sugamoto K, Ikemoto S. Three-dimensional scapular dyskinesis in hook-plated acromioclavicular dislocation including hook motion. J Shoulder Elbow Surg 2018; 27:1117-1124. [PMID: 29449083 DOI: 10.1016/j.jse.2017.12.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 12/08/2017] [Accepted: 12/12/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study is to analyze the 3-dimensional scapular dyskinesis and the kinematics of a hook plate relative to the acromion after hook-plated acromioclavicular dislocation in vivo. Reported complications of acromioclavicular reduction using a hook plate include subacromial erosion and impingement. However, there are few reports of the 3-dimensional kinematics of the hook and scapula after the aforementioned surgical procedure. METHODS We studied 15 cases of acromioclavicular dislocation treated with a hook plate and 15 contralateral normal shoulders using computed tomography in the neutral and full forward flexion positions. Three-dimensional motion of the scapula relative to the thorax during arm elevation was analyzed using a computer simulation program. We also measured the distance from the tip of the hook plate to the greater tuberosity, as well as the angular motion of the plate tip in the subacromial space. RESULTS Decreased posterior tilting (22° ± 10° vs 31° ± 8°) in the sagittal plane and increased external rotation (19° ± 9° vs 7° ± 5°) in the axial plane were evident in the affected shoulders. The mean values of translation of the hook plate and angular motion against the acromion were 4.0 ± 1.6 mm and 15° ± 8°, respectively. The minimum value of the distance from the hook plate to the humeral head tuberosity was 6.9 mm during arm elevation. CONCLUSIONS Acromioclavicular reduction using a hook plate may cause scapular dyskinesis. Translational and angular motion of the hook plate against the acromion could lead to subacromial erosion. However, the hook does not seem to impinge directly on the humeral head.
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Affiliation(s)
- Eugene Kim
- Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seunghee Lee
- Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Hwa-Jae Jeong
- Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jai Hyung Park
- Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Se-Jin Park
- Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jaewook Lee
- Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Woosub Kim
- Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hee Jin Park
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - So Yeon Lee
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Tsuyoshi Murase
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kazuomi Sugamoto
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Sumika Ikemoto
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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Huang YC, Yang SW, Chen CY, Lin KC, Renn JH. Single coracoclavicular suture fixation with Mersilene tape versus hook plate in the treatment of acute type V acromioclavicular dislocation: a retrospective analysis. J Orthop Surg Res 2018; 13:110. [PMID: 29769141 PMCID: PMC5956760 DOI: 10.1186/s13018-018-0831-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 05/08/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Here, we compared the clinical and radiographic outcomes between coracoclavicular (CC) fixation with Mersilene tape and hook plate for acute unstable acromioclavicular (AC) joint dislocation treatment. METHODS We enrolled 49 patients with unstable acute AC dislocation who, between January 2010 and January 2014, underwent surgery with single CC suture fixation with Mersilene tape (M group, 25 cases) or clavicle hook plate (H group, 24 cases). In M and H groups, the average age was 43.7 (range 18-72) and 42.0 (range 17-84) years, the male to female ratio of each group was 15:20 and 19:5, and the injured side left to right ratio was 12:13 and 11:13, respectively. All patients were right-handed. We retrospectively compared the operation time, complication rate, visual analog scale (VAS), University of California at Los Angeles (UCLA) shoulder rating scale, Oxford shoulder scores, and the radiographic outcomes based on reduction loss of CC distance on postoperative follow-up. RESULTS No significant difference in patient demographics between the two groups in age (p = 0.709), gender (p = 0.217), time from injury to surgery (p = 0.863), and injured side (p = 1.000). The mean follow-up was 26.2 months (range 24-35 months). Nine cases of reduction loss (36%) and one of distal clavicle osteolysis (4%) were noted in the M group. CC distance improvement in the H group was significantly superior to that in the M group at 3 months (before hook plate removal, p < 0.001) and 12 months postoperatively (after hook plate removal, p = 0.004), while subacromial erosions were revealed in nine cases (37.5%) in the H group. No significant difference in operative time (p = 0.846), complication rate (p = 1.000), VAS (p = 0.199), mean UCLA shoulder rating scale (p = 0.353), and Oxford shoulder (p = 0.224) scores between the two groups. CONCLUSIONS Both hook plate and Mersilene tape fixations provided temporary stabilization of acute type V AC dislocation and yielded comparable clinical outcomes. The hook plate provided better maintenance of reduction of radiographic outcomes. CC suture fixation with Mersilene tape may serve as an alternative method of stabilization which provides acceptable outcome without the need of implant removal.
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Affiliation(s)
- Ying-Cheng Huang
- Department of Orthopedics, Kaohsiung Veterans General Hospital, No. 386, Ta-Chung 1st Rd, Kaohsiung, 81346, Taiwan, Republic of China
| | - Shan-Wei Yang
- Department of Orthopedics, Kaohsiung Veterans General Hospital, No. 386, Ta-Chung 1st Rd, Kaohsiung, 81346, Taiwan, Republic of China
| | - Chun-Yu Chen
- Department of Orthopedics, Kaohsiung Veterans General Hospital, No. 386, Ta-Chung 1st Rd, Kaohsiung, 81346, Taiwan, Republic of China
| | - Kai-Cheng Lin
- Department of Orthopedics, Kaohsiung Veterans General Hospital, No. 386, Ta-Chung 1st Rd, Kaohsiung, 81346, Taiwan, Republic of China
| | - Jenn-Huei Renn
- Department of Orthopedics, Kaohsiung Veterans General Hospital, No. 386, Ta-Chung 1st Rd, Kaohsiung, 81346, Taiwan, Republic of China.
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Abstract
Acromioclavicular dislocation is a frequent pathology commonly encountered in traumatology. Therefore, its management is generally standardized, guided by clinical and radiological evaluation. This can range from conservative treatment by limb immobilization and functional rehabilitation, to surgical treatment by using minimally invasive techniques. We present the particular case of a 74-year-old patient with an acromioclavicular dislocation associated with a non-displaced fracture of the coracoid process as well as of the spine of the scapula. This article aims to describe the diagnostic traps as well as discuss the treatment options for this complex presentation.
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Affiliation(s)
- J Juanos Cabanas
- Service de Chirurgie orthopédique et Traumatologie, C.H.U. Tivoli, La Louvière
| | - H Jennart
- Service de Chirurgie orthopédique et Traumatologie, C.H.U. Tivoli, La Louvière
| | - G Leclercq
- Service de Chirurgie orthopédique et Traumatologie, C.H.U. Tivoli, La Louvière
| | - D Zorman
- Service de Chirurgie orthopédique et Traumatologie, C.H.U. Tivoli, La Louvière
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Gumustas SA, Saglam F, Komur B, Batmaz AG, Yukunc I, Tosun HB, Bekler HI. Surgical treatment of type III acromioclavicular dislocation: Bosworth technique versus hook plating. North Clin Istanb 2018; 5:334-40. [PMID: 30859165 DOI: 10.14744/nci.2017.65037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 12/29/2017] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE: In this study, it was compared the clinical results of the Bosworth technique and hook plating in acromioclavicular (AC) dislocations. METHODS: 44 patients are retrospectively evaluated in this study whom diagnosed as type III AC dislocations and treated by two different surgical methods in two different clinics. The patients were 30 males and 14 females with a mean age of 44 years (range, 18–80 years). The patients were divided into 2 groups according to the applied surgical technique. Group I comprised 25 patients to whom coracoclavicular fixation was applied by using the Bosworth technique. Group II comprised 19 patients to whom acromioclavicular fixation was applied by using hook plate. All patients are evaulated by The University of California at Los Angeles Shoulder Score (UCLA) and The disabilities of the arm, shoulder and hand (DASH) scoring system. RESULTS: The mean follow-up period was 23 months (range, 12–42 months). A statistically significant diffference was determined between the surgical groups in respect of the modified UCLA scale (p=0.012) and Quick DASH score (p=0.008). Hook plating group had better clinical results according to Bosworth group in terms of both UCLA and DASH score. A statistically highly significant negative correlation was determined between the UCLA and DASH scores (r=0.677, p=0.000). CONCLUSION: Although hook plating had better clinic outcomes compared to Bosworth technique, there is not seen difference between two groups in terms of the time of return to work. Treatment of the AC dislocation should perform early reconstruction for better reduction, fewer complications and higher levels of patient satisfaction.
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van Bergen CJA, van Bemmel AF, Alta TDW, van Noort A. New insights in the treatment of acromioclavicular separation. World J Orthop 2017; 8:861-873. [PMID: 29312844 PMCID: PMC5745428 DOI: 10.5312/wjo.v8.i12.861] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 11/17/2017] [Accepted: 12/06/2017] [Indexed: 02/06/2023] Open
Abstract
A direct force on the superior aspect of the shoulder may cause acromioclavicular (AC) dislocation or separation. Severe dislocations can lead to chronic impairment, especially in the athlete and high-demand manual laborer. The dislocation is classified according to Rockwood. Types I and II are treated nonoperatively, while types IV, V and VI are generally treated operatively. Controversy exists regarding the optimal treatment of type III dislocations in the high-demand patient. Recent evidence suggests that these should be treated nonoperatively initially. Classic surgical techniques were associated with high complication rates, including recurrent dislocations and hardware breakage. In recent years, many new techniques have been introduced in order to improve the outcomes. Arthroscopic reconstruction or repair techniques have promising short-term results. This article aims to provide a current concepts review on the treatment of AC dislocations with emphasis on recent developments.
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Affiliation(s)
| | - Annelies F van Bemmel
- Department of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp 2134 TM, The Netherlands
| | - Tjarco D W Alta
- Department of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp 2134 TM, The Netherlands
| | - Arthur van Noort
- Department of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp 2134 TM, The Netherlands
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Hu JT, Lu JW, Fu LF. [Case control study on the treatment of acromioclavicular dislocation with Endobutton plates combined with an anchor]. Zhongguo Gu Shang 2016; 29:841-846. [PMID: 29282956 DOI: 10.3969/j.issn.1003-0034.2016.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To compare the clinical effect of Endobutton plates combined with an anchor and clavicle hook plate in the treatment of acromioclavicular dislocation. METHODS From January 2012 to August 2014, 83 patients with Rockwood type III acromioclavicular dislocation underwent surgical treatments. Among them, 34 patients were treated with Endobutton plate and anchor repair(Endobutton group), including 23 males and 11 females, and the mean age was(39.0±6.3) years old (26 to 51 years old); the average time from injury to operation was(4.1±1.3) days(3 to 7 days);the injured side:14 left, 20 right; the dislocation in 28 patients dues to fall, 6 patients dues traffic accident. There were 49 patients treated with clavicular hook plate(hook plate group), including 33 males and 16 females;the mean age was(37.9±6.3) years old (27 to 53 years old); the average time from injury to operation was(4.1±1.1) days (2 to 7 days);the injured side: 18 left, 31 right;the dislication in 36 patients dues to fall, 13 patients dues traffic accidents. The indexes such as intraoperative bleeding volume, operation time, incision size, postoperative complication and postoperative coracoclavicular space, shoulder joint function, and life quality were compared between two groups. RESULTS In the hook plate group with 49 patients, the plates in 43 patients were removed at the secondary operation, and 32 patients had shoulder pain or limited active range. Thirty four patients in the Endobutton group had no pain symptoms and limited active range. All the patients did not suffer acromioclavicular dislocation again. There was no significant difference between the two groups in operation time, and intraoperative bleeding volume(P>0.05). The incision length in the hook plate group was longer than that in Endobutton group(P<0.05). The coracoclavicular space of the uninjured and injured side in two groups respectively had no significant differences, and the coracoclavicular space in the injured side between two group had no significant difference(P>0.05). There were no significant differences of Constant score and SF-36 between two groups 2 months after operation(P>0.05). Sixteen months after operation, the Constant score in the injured side of both groups was higher than that in 2 months postoperative. But the Constant score in the injured side of hook plate group was higher than that in Endobutton group(P<0.05). The Constant score in the uninjured side had no significant differences between two group(P>0.05). In hook plate group, the Constant score in the uninjured side was higher than that in the injured side. In Endobutton group, there were no significant differences of Constant score between two sides. The 16 month postoperative SF-36 in the injured side of both groups was higher than the 2 month postoperative one, but 16 month postoperative SF-36 in hook plate group was lower than that in Endobutton group (P<0.05). CONCLUSIONS Endobutton plate combined with an anchor can effectively fix Rockwood type III or more acute acromioclavicular dislocation. The method has less complications, avoiding secondary removal of internal fixation.
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Affiliation(s)
| | - Jian-Wei Lu
- Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang, China;
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Xiong C, Lu Y, Wang Q, Chen G, Hu H, Lu Z. Anatomical principles for minimally invasive reconstruction of the acromioclavicular joint with anchors. Int Orthop 2016; 40:2317-2324. [PMID: 27590201 DOI: 10.1007/s00264-016-3283-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 08/23/2016] [Indexed: 12/17/2022]
Abstract
PURPOSE The aim of this study was to evaluate the outcome of a minimally invasive surgical technique for the treatment of patients with acromioclavicular joint dislocation. METHODS Sixteen patients with complete acromioclavicular joint dislocation were enrolled in this study. All patients were asked to follow the less active rehabilitation protocol post-operatively. Computed tomography with 3-D reconstruction of the injured shoulder was performed on each patient post operatively for the assessment of the accuracy of the suture anchor placement in the coracoid process and the reduction of the acromioclavicular joint. Radiographs of Zanca view and axillary view of both shoulders were taken for evaluating the maintenance of the acromioclavicular joint reduction at each follow-up visit. The Constant shoulder score was used for function assessment at the final follow-up. RESULTS Twenty seven of the 32 anchors implanted in the coracoid process met the criteria of good position. One patient developed complete loss of reduction and another had partial loss of reduction in the anteroposterior plane. For the other 14 patients, the mean Constant score was 90 (range, 82-95). For the patients with partial and complete loss of reduction, the Constant score were 92 and 76 respectively. All of them got nearly normal range of motion of the shoulders and restored to pre-operative life and works. CONCLUSION With this minimally invasive approach and limited exposure of the coracoid, a surgeon can place the suture anchors at the anatomical insertions of the coracoclavicular ligament and allow the dislocated joint reduced and maintained well. LEVEL OF EVIDENCE Level IV, Case series; therapeutic study.
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Affiliation(s)
- Chuanzhi Xiong
- The Orthopedic Department, Northern Jiangsu People's Hospital, Yangzhou University, NO. 98 Nantong West Road, Yangzhou, Jiangsu Province, 225001, China.
| | - Yaojia Lu
- The Orthopedic Department, Northern Jiangsu People's Hospital, Yangzhou University, NO. 98 Nantong West Road, Yangzhou, Jiangsu Province, 225001, China
| | - Qiang Wang
- The Orthopedic Department, Northern Jiangsu People's Hospital, Yangzhou University, NO. 98 Nantong West Road, Yangzhou, Jiangsu Province, 225001, China
| | - Gang Chen
- The Orthopedic Department, Northern Jiangsu People's Hospital, Yangzhou University, NO. 98 Nantong West Road, Yangzhou, Jiangsu Province, 225001, China
| | - Hansheng Hu
- The Orthopedic Department, Northern Jiangsu People's Hospital, Yangzhou University, NO. 98 Nantong West Road, Yangzhou, Jiangsu Province, 225001, China
| | - Zhihua Lu
- The Orthopedic Department, Northern Jiangsu People's Hospital, Yangzhou University, NO. 98 Nantong West Road, Yangzhou, Jiangsu Province, 225001, China
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Vrgoč G, Japjec M, Jurina P, Gulan G, Janković S, Šebečić B, Starešinić M. Operative treatment of acute acromioclavicular dislocations Rockwood III and V-Comparative study between K-wires combined with FiberTape(®) vs. TightRope System(®). Injury 2015; 46 Suppl 6:S107-12. [PMID: 26584732 DOI: 10.1016/j.injury.2015.10.053] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Acromioclavicular (AC) joint dislocations usually occur in a young active population as a result of a fall on the shoulder. Rockwood divided these dislocations into six types. Optimal treatment is still a matter of discussion. Many operative techniques have been developed, but the main choice is between open and minimally-invasive arthroscopic procedures. The aim of this study was to compare two different surgical methods on two groups of patients to find out which method is superior in terms of benefit to the patient. The methods were evaluated through objective and subjective scores, with a focus on complications and material costs. MATERIAL AND METHODS A retrospective two-centre study was conducted in patients with acute AC joint dislocation Rockwood types III and V. The two methods conducted were an open procedure using K-wires combined with FiberTape(®) (Arthrex, Naples, USA) (Group 1) and an arthroscopic procedure using the TightRope System(®) (Arthrex, Naples, USA) (Group 2). Groups underwent procedures during a two-year period. Diagnosis was based on the clinical and radiographic examination of both AC joints. Surgical treatment and rehabilitation were performed. RESULTS Sixteen patients were included in this study: Group 1 comprised 10 patients, all male, average age 41.6 years (range 17-64 years), Rockwood type III (eight patients) and Rockwood type V (two patients); Group 2 had six patients, one female and five male, average age 37.8 years (range 18-58 years), Rockwood type III (two patients) and Rockwood type V (four patients). Time from injury to surgery was shorter and patients needed less time to return to daily activities in Group 1. Duration of the surgical procedure was shorter in Group 2 compared with Group 1. Complications of each method were noted. According to the measured scores and operative outcome between dislocation Rockwood type III and V, no significant difference was found. Implant material used in Group 2 was 4.7 times more expensive than that used in Group 1. CONCLUSION Both methods offer many advantages with satisfying evaluated scores. K-wires with FiberTape(®) offer a shorter period for complete recovery and a significantly more cost-effective outcome, whereas the TightRope System(®) offers shorter operative procedure, better cosmetic result and avoidance of intraoperative fluoroscopy.
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Affiliation(s)
- G Vrgoč
- Department of Orthopaedic Surgery, University Hospital "Sveti Duh", Sveti Duh 64, Zagreb, Croatia.
| | - M Japjec
- Clinic for Surgery, Department of General and Sports Traumatology, University Hospital "Merkur", Zagreb, Croatia
| | - P Jurina
- Clinic for Traumatology, Department of University Clinical Hospital Centre "Sestre Milosrdnice", Zagreb, Croatia
| | - G Gulan
- Clinic for Orthopaedic Surgery "Lovran", School of Medicine, University of Rijeka, Rijeka, Croatia
| | - S Janković
- Department of Orthopaedic Surgery, University Hospital "Sveti Duh", Sveti Duh 64, Zagreb, Croatia
| | - B Šebečić
- Clinic for Surgery, Department of General and Sports Traumatology, University Hospital "Merkur", Zagreb, Croatia
| | - M Starešinić
- Clinic for Surgery, Department of General and Sports Traumatology, University Hospital "Merkur", Zagreb, Croatia
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Kumar N, Sharma V. Hook plate fixation for acute acromioclavicular dislocations without coracoclavicular ligament reconstruction: a functional outcome study in military personnel. Strategies Trauma Limb Reconstr 2015. [PMID: 26216233 PMCID: PMC4570887 DOI: 10.1007/s11751-015-0228-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The aim of our study was to evaluate the shoulder function after clavicular hook plate fixation of acute acromioclavicular dislocations (Rockwood type III) in a population group consisting exclusively of high-demand military personnel. This prospective study was carried out at a tertiary care military orthopaedic centre during 2012–2013 using clavicular hook plate for management of acromioclavicular injuries without coracoclavicular ligament reconstruction in 33 patients. All patients underwent routine implant removal after 16 weeks. The functional outcome was assessed at 3, 6 and 12 months after hook plate removal and 2 years from the initial surgery using the Constant Murley and UCLA Scores. All the patients were male serving soldiers and had sustained acromioclavicular joint dislocation (Rockwood type III). Mean age of the patient group was 34.24 years (21–55 years). The mean follow-up period in this study was 23.5 months (20–26 months) after hook plate fixation and an average of 19.9 months (17–22 months) after hook plate removal. The average Constant Score at 3 months after hook plate removal was 60.3 as compared to 83.7 and 90.3 at 6 months and 1 year, respectively, and an average of 91.8 at the last follow-up that was approximately 2 years after initial surgery which was statistically significant (p value <0.05). The UCLA Score was an average of 15.27, 25.9 and 30.1 at 3, 6 months and 1 year, respectively, after removal of hook plate which improved further an average of 32.3 at the last follow-up, which was also statistically significant (p value <0.05). Clavicular hook plate fixation without coracoclavicular ligament reconstruction is a good option for acute acromioclavicular dislocations producing excellent medium-term functional results in high-demand soldiers.
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Affiliation(s)
- Narinder Kumar
- Military Hospital, Kirkee, Pune, Maharashtra, 411020, India.
| | - Vyom Sharma
- Military Hospital, Kirkee, Pune, Maharashtra, 411020, India.
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Wang Y, Zhang J. Acromioclavicular joint reconstruction by coracoid process transfer augmented with hook plate. Injury 2014; 45:949-54. [PMID: 24521873 DOI: 10.1016/j.injury.2013.12.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 12/25/2013] [Accepted: 12/31/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND Various techniques have been reported for the treatment of chronic acromioclavicular (AC) joint separation. The purpose of this study was to evaluate the results of surgical construction of coracoclavicular ligament using coracoid process transfer augmented with a hook plate fixation. MATERIALS AND METHODS Twenty-one patients treated with coracoid process transfer augmented with a hook plate fixation for chronic type III and V AC injuries were retrospectively analysed in 2003-2009. The age of the patients ranged from 23 to 58 years with an average age of 41.6 years. The patients were followed up clinically and radiographically, with an average of 33.0 months. Functional status and the ability to return to work were recorded during follow-up. Constant score and visual analogue scale (VAS) for pain were measured. RESULTS The mean Constant score has increased from 70.9 points preoperatively to 90.7 points at follow-up. The mean VAS score has decreased from 4.7 preoperatively to 1.2 at follow-up. The average abduction was 172°, forward flexion was 170° and external rotation was 56°. There were 10 excellent results, 10 good results and one fair result. All patients had resumed their job or returned to original sport activity at mean 3.7 months postoperatively. No reduction loss was observed after plate removal and the final follow-up. CONCLUSIONS Despite retrospective nature of the study, the outcomes of surgical construction with process transfer augmented with hook plate fixation are promising for chronic type III and V AC injuries. LEVEL OF EVIDENCE Therapeutic level IV. Retrospective case series, treatment study.
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Affiliation(s)
- Yeming Wang
- Department of Orthopaedics, Tianjin Hospital, Tianjin, China.
| | - Jianguo Zhang
- Department of Orthopaedics, Tianjin Hospital, Tianjin, China
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Wang Y, Zhang J. Surgical treatment of fresh complete acromioclavicular dislocation by coracoid process transfer and k-wire transfixation. Indian J Surg 2013; 75:436-9. [PMID: 24465098 DOI: 10.1007/s12262-012-0605-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 06/05/2012] [Indexed: 10/28/2022] Open
Abstract
Acromioclavicular dislocations are very common shoulder injuries. The optimal treatment for acute high-grade acromioclavicular joint injury remains a matter of debate. The purpose of this study was to evaluate the results of surgical treatment of complete acromioclavicular dislocation using coracoid process transfer and temporary K-wire transfixation. Twenty-one patients with complete acromioclavicular dislocation underwent coracoid process transfer and temporary K-wire transfixation. Patients were assessed at the follow-up based on visual analog scores (VAS), the Constant-Murley scoring system and the UCLA shoulder rating system. Radiographs were taken to check up vertical instability. The mean follow-up was 32.1 months (25-47 months). The mean Constant and Murley score and UCLA shoulder rating score was 89.9 ± 8.4 and 30.1 ± 4.4. There were fourteen excellent functional results and six results and one poor result. The overall rate of satisfaction, which means an excellent or good result, was 95.2 %. Nineteen patients (90.4 %) maintained their previous jobs or resume their daily activities. The mean final pain score, as measured from 1 to 10 on the visual analog scale, was 1.91 ± 1.09. The radiographic analysis revealed twenty patients had maintained reduction at the final follow-up. The coracoid process transfer and temporary K-wire transfixation is a reliable treatment for a complete acromioclavicular dislocation.
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Flinkkilä TE, Ihanainen E. Results of Arthroscopy-Assisted TightRope Repair of Acromioclavicular Dislocations. Shoulder Elbow 2014; 6:18-22. [PMID: 27582904 PMCID: PMC4986652 DOI: 10.1111/sae.12040] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 07/26/2013] [Indexed: 01/16/2023]
Abstract
BACKGROUND The present study assessed results of arthroscopy-assisted TightRope (Arthrex, Naples, FL, USA) repair of acute Rockwood grade III and V acromioclavicular (AC) dislocations. METHODS We retrospectively reviewed the medical records of 57 patients with AC dislocations treated with TightRope fixation: 15 Rockwood grade III and 42 grade V. Functional results were assessed using the Constant score, and Disabilities of Arm, Shoulder and Hand (DASH) and RAND 36-ltem Health Survey scores after a mean 2.6 years of follow-up (range 1.0 years to 4.5 years). Radiographic results were assessed using the AC joint coracoclavicular (CC) distance. RESULTS Postoperative radiographs showed anatomical AC joint reduction in all patients. In nine patients, fixation failed before 6 weeks postoperatively, mainly as a result of suture breakage. For the remaining 47 patients, CC distance was well maintained at 6 weeks. At follow-up, mean (SD) CC distance was significantly increased compared to the contralateral side or postoperative radiographs [17 (4) mm versus 10 (3) mm]. Mean DASH score was 9, Constant score was 88 and the RAND 36 score showed a quality of life similar to the Finnish reference population. CONCLUSIONS Despite initial good reduction of grade III and V AC dislocations using TightRope fixation, subluxation often recurs after 6 weeks. Patients suffer minor subjective complaints that do not worsen the quality of life.
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Affiliation(s)
- Tapio E. Flinkkilä
- Division of Orthopedic and Trauma Surgery, Department of Surgery, Oulu University Hospital, Oulu, Finland,
Correspondence: Tapio Flinkkilä, Division of Orthopedic and Trauma Surgery, Department of Surgery, Oulu University Hospital, PL 21, Oulu, FIN-90029 OYS, Finland. Tel.: +358 8 3152812. Fax: +358 8 3152351. E-mail:
| | - Essi Ihanainen
- Division of Orthopedic and Trauma Surgery, Department of Surgery, Oulu University Hospital, Oulu, Finland
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