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Ma Y, Ma Z, Guo J, Ma X, Lv S, Cheng S. Surgical Advances in the Treatment of Acromioclavicular Joint Injury: A Comprehensive Review. Med Sci Monit 2024; 30:e942969. [PMID: 39548667 DOI: 10.12659/msm.942969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2024] Open
Abstract
In this article, we aim to review the diagnosis, classification, and treatment of acromioclavicular joint injury by mainly describing the progress of surgical treatment for acromioclavicular joint injury, providing a reference for clinical diagnosis and treatment. Acromioclavicular joint injury is a common sports injury, which is more common in male than in female patients. The mechanism of the injury is mainly caused by direct or indirect violence, which can be clearly diagnosed by radiography. According to the time after injury, it can be divided into acute injury and chronic injury. The Rockwood classification is the most commonly used classification in research. For Rockwood types V to VI, we treat with surgery, while the treatment options for type III are controversial and no consensus has been reached. Surgical treatment can be divided into open surgery and shoulder arthroscopy. The methods of open surgery can be divided into 3 categories: direct acromioclavicular joint fixation, coracoclavicular space suspension device fixation, and coracoclavicular ligament reconstruction. The shoulder arthroscopy method involves reconstruction of the coracoclavicular ligament under arthroscopy, combined with suture-button suspension fixation. For patients with Rockwood classification III and IV-VI, who have significant movement needs, surgery is the preferred treatment for acute acromioclavicular dislocation within 3 weeks. For patients with a chronic acromioclavicular dislocation or who do not respond to nonsurgical treatment, it is recommended to use wire suspension fixation combined with ligament to repair the damage. This article aims to review advances in the management of acromioclavicular joint injury.
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Affiliation(s)
- Yingkai Ma
- Department of Orthopaedic, Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Zhenwen Ma
- Department of Orthopaedics, Chun'an County Hospital of Traditional Chinese Medicine, Hangzhou Hospital of Traditional Chinese Medicine (Chun'an Branch), Hangzhou, Zhejiang, China
| | - Jiangrong Guo
- Department of Orthopaedic, Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Xinnan Ma
- Department of Orthopaedic, Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Songcen Lv
- Department of Orthopaedic, Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Shi Cheng
- Department of Orthopaedic, Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
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Zandiyeh P, Alonso Figueroa Fernandez L, Lee EY, Gregory J. Using Dynamic Stereo X-ray Imaging for In Vivo Acromioclavicular Joint Kinematics Assessment: A Preliminary Investigation. Orthop J Sports Med 2024; 12:23259671241274707. [PMID: 39469115 PMCID: PMC11514120 DOI: 10.1177/23259671241274707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 02/26/2024] [Indexed: 10/30/2024] Open
Abstract
Background Acromioclavicular joint (ACJ) disruption occurs frequently in athletes engaged in contact sports. However, the current understanding of ACJ biomechanics during muscle-driven functional activities and the influence of different treatment approaches (eg, reconstruction surgery vs nonoperative methods) on ACJ kinematics and stability remains limited. The absence of precise in vivo biomechanical measurement modalities for scapular and clavicular kinematics contributes significantly to this lack of understanding. Purposes/Hypothesis The purposes of this study were to determine whether dynamic stereo x-ray (DSX) imaging can be used to evaluate the in vivo kinematics of the ACJ and to provide preliminary comparative data on ACJ kinematics, range of motion, and isometric strength of surgically reconstructed or nonoperatively treated ACJ shoulders and their uninjured contralateral shoulders. It was hypothesized that ACJ kinematics could be measured successfully using DSX and that surgically and nonoperatively treated shoulders would show abnormal 3-dimensional (3-D) ACJ kinematics compared with the uninjured contralateral. Study Design Controlled laboratory study. Methods In this cross-sectional study, 11 participants who had undergone unilateral ACJ reconstruction surgery and 3 patients who received nonoperative treatment were enrolled. ACJ kinematics were assessed during active forward flexion, scaption, and abduction through high-speed DSX imaging, complemented by 3-D bone models obtained via computed tomography (CT) scans. To gauge kinematic differences, a 1-dimensional statistical parametric mapping method was employed, which compared outcomes in the index limb to those in the uninjured counterpart. In addition, the range of motion and isometric strength at various abduction angles were analyzed, employing a repeated-measures analysis of variance to compare the affected and uninjured sides. Results Leveraging a combination of DSX imaging and patient-specific CT bone models, ACJ kinematics was measured successfully during movements along anatomic planes. Preliminary findings from this investigation revealed no detectable differences between the surgically reconstructed and uninjured sides in ACJ biomechanics, shoulder range of motion, and isometric strength outcomes. However, on average, the nonoperatively treated shoulders demonstrated increased internal rotation, upward rotation, and posterior tilting of the scapula relative to the clavicle (no statistical analyses were performed due to the small sample size). Conclusion DSX imaging is a promising tool for evaluating potential in vivo kinematic abnormalities in the ACJ during muscle-driven activities, laying the groundwork for further investigations in both ACJ-reconstructed and nonreconstructed patients. This study furnished essential data for conducting power analyses and designing future studies with an adequate sample size to investigate the impact of different treatment approaches on shoulder girdle mechanics. Clinical Relevance With its potential for accurately characterizing shoulder girdle kinematics post-ACJ injury, DSX imaging can offer valuable insights for future clinical studies, facilitating informed decisions regarding the short- and long-term impacts of treatment choices on shoulder health and function.
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Affiliation(s)
- Payam Zandiyeh
- University of Texas Health Sciences Center at Houston, Department of Orthopaedic Surgery, Houston, Texas, USA
| | | | - Erica Y. Lee
- University of Texas Health Sciences Center at Houston, Department of Orthopaedic Surgery, Houston, Texas, USA
| | - James Gregory
- University of Texas Health Sciences Center at Houston, Department of Orthopaedic Surgery, Houston, Texas, USA
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Lee YS, Kim DS, Jung JW, Jo YH, Lee CH, Lee BG. Risk factors of loss of reduction after acromioclavicular joint dislocation treated with a hook plate. J Orthop Traumatol 2023; 24:10. [PMID: 36961582 PMCID: PMC10039153 DOI: 10.1186/s10195-023-00685-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 01/21/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Acromioclavicular joint fixation using a hook plate is effective for the treatment of acute acromioclavicular joint dislocation. However, several studies have reported some complications including loss of reduction after surgery for acromioclavicular joint dislocation. This study aimed to identify the risk factors associated with the loss of reduction after acromioclavicular joint dislocation surgery using a hook plate. METHODS This was a retrospective study that assessed 118 patients with acromioclavicular joint dislocation, who were diagnosed between March 2013 and January 2019 and underwent surgical treatment using the hook plate (reduction loss group: n = 38; maintenance group: n = 80). The mean follow-up period was 29.9 months (range, 24-40 months). We assessed the range of motion, the American Shoulder and Elbow Surgeons score (ASES), visual analog scale score for pain, and a subjective shoulder value. Radiological assessment of coracoid clavicular distance was performed. The risk factors of reduction loss were analyzed using multivariable logistic regression analysis. RESULTS Age (p = 0.049), sex (female, p = 0.03, odds ratio OR = 4.81), Rockwood type V (p = 0.049, OR = 2.20), and time from injury to surgery > 7 days (p = 0.018, OR = 2.59) were statistically significant factors in the reduction loss group. There were no significant differences in the clinical outcomes for range of motion, ASES, subjective shoulder value, and visual analog scale scores between the two groups. In the radiological results, preoperative coracoid clavicular distance (p = 0.039) and ratio (p = 0.001), and over-reduction (p = 0.023, OR = 0.40) were significantly different between the two groups. The multivariate logistic regression analysis identified the female sex (p = 0.037, OR = 5.88), a time from injury to surgery > 7 days (p = 0.019, OR = 3.36), and the preoperative coracoid clavicular displacement ratio of the injured shoulder (p < 0.001, OR = 1.03) as risk factors associated with reduction loss following surgery using a hook plate for acromioclavicular dislocation. CONCLUSION A delayed timing of surgery > 7 days, preoperative coracoid clavicular displacement ratio of the injured shoulder, and female sex were identified as risk factors for loss of reduction after surgery using a hook plate for acromioclavicular joint dislocation. LEVEL OF EVIDENCE Level IV; retrospective comparison; treatment study.
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Affiliation(s)
- Young Seok Lee
- Department of Orthopedic Surgery, Hanyang University Guri Hospital, Guri, Republic of Korea
| | - Doo Sup Kim
- Department of Orthopedic Surgery, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Ji Won Jung
- Department of Orthopedic Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Young-Hoon Jo
- Department of Orthopedic Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Chang-Hun Lee
- Department of Orthopedic Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Bong Gun Lee
- Department of Orthopedic Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea.
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Kelley N, Tuttle M, Sylvia SM, Dragoo JL, Khodaee M. Acromioclavicular Joint Injuries in Sport. Curr Sports Med Rep 2023; 22:91-99. [PMID: 36866952 DOI: 10.1249/jsr.0000000000001046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
ABSTRACT Sport-related shoulder injuries, including disruptions to the acromioclavicular joint (ACJ), are common. An ACJ injury is classified by the degree and direction of the clavicle displacement. Although the diagnosis can be made clinically, standard radiographic views are important to determine the severity of the ACJ disruption and assess for concurrent injuries. The majority of ACJ injuries can be managed nonoperatively; however, surgical treatment is indicated in some cases. Long-term outcomes are generally favorable for most ACJ injuries, and athletes generally return to sport without functional limitations. This article provides an in-depth discussion regarding all aspects of ACJ injuries, including clinically relevant anatomy, biomechanics, evaluation, treatment, and complications.
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Affiliation(s)
- Naomi Kelley
- University of Colorado School of Medicine, Aurora, CO
| | - Matthew Tuttle
- Head of Soccer Medicine and Performance, New York Red Bulls, Harrison, NJ
| | - Stephen M Sylvia
- University of Colorado School of Medicine, Department of Orthopedics, Division of Sports Medicine, Englewood, CO
| | - Jason L Dragoo
- University of Colorado School of Medicine, Department of Orthopedics, Division of Sports Medicine, Englewood, CO
| | - Morteza Khodaee
- University of Colorado School of Medicine, Department of Family Medicine and Orthopedics, Division of Sports Medicine, Denver, CO
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Okereke I, Abdelfatah E. Surgical Management of Acute Rockwood Grade III Acromioclavicular Joint Dislocations: A Systematic Review. Cureus 2022; 14:e28657. [PMID: 36196289 PMCID: PMC9525049 DOI: 10.7759/cureus.28657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2022] [Indexed: 12/01/2022] Open
Abstract
Injuries of the acromioclavicular joint (ACJ) occur frequently in young and active people. The best management of acute grade III injuries has been a source of controversy and extensive debate. When surgery is indicated, there is still no gold standard surgical technique for treating acute grade III ACJ injuries. The methodology of this review was a comprehensive search of PubMed, Medline, Cochrane, and EMBASE databases using various combinations of the keywords "Rockwood," "type III," "grade III," "treatment," "surgery," "acromioclavicular joint," and "dislocation," since the inception of the databases to December 2020. Surgical techniques were divided into two groups. In group 1 were ACJ fixation techniques using hardware such as the hook plate, Kirschner wires, and wire cerclage; group 2 included coracoclavicular (CC) ligament fixation/reconstruction techniques using double buttons, TightRope®, suture anchors, Endobuttons, the Infinity-LockTM Button System, etc. Fourteen studies were selected for the final review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. This review showed better outcome scores in group 2. Overall, complication rates were higher in group 1 compared to group 2. The results of this review show that CC fixation, using suspensory or loop devices, of Rockwood grade III injuries, has better outcomes and fewer complications than fixation of the ACJ with hardware.
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Affiliation(s)
- Isaac Okereke
- Trauma and Orthopaedics, The Royal London Hospital, London, GBR
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Bhaskarwar AP, Dev Jaidev KP, Joshi RK, Mopagar V. Managing acute acromioclavicular joint dislocation during COVID 19 pandemic by minimally invasive technique with suture anchor and miniplate: A pilot study. Med J Armed Forces India 2022; 79:S0377-1237(22)00099-5. [PMID: 35996616 PMCID: PMC9385407 DOI: 10.1016/j.mjafi.2022.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 06/20/2022] [Indexed: 11/30/2022] Open
Abstract
Background Acromioclavicular (AC) joint dislocation is common in sportsmen and physically active population. Its management depends upon the grade of injury and functional demands of the patient. A variety of surgical procedures have been described with different limitations and advantages. The present study has assessed the clinical and radiological outcome of acute AC joint dislocation managed with a 3.5 mm Titanium suture anchor and 2 mm miniplate construct which requires lesser dissection, surgical time and thus contact with the patient as mandated by COVID-19 pandemic. Methods We enrolled 10 patients of Rockwood type-III, IV and V acute AC joint injury (<3 weeks old) reporting at this hospital from Feb 2020 to May 2021. All were tested for COVID-19 using reverse transcriptase polymer chain reaction test (RTPCR) and managed by closed/open reduction and fixation with a 3.5 mm Titanium Suture Anchor and a 2 mm Titanium miniplate construct. Follow-up was done at 3, 6 and 9 month post-operatively. Results The average age of patients was 31 yrs. RTPCR test for COVID-19 was negative in all patients. Median surgical time was 25 min (Interquartile Range[IQR] = 16-34 min) and median follow-up duration was 36 weeks (IQR = 33-39 weeks). Median visual analogue scale score and IQR at pre-operative, 3 month, 6 month and 9 month follow-up was 7(IQR = 6-8), 3.5(IQR = 2.5-4.5), 2(IQR = 0) and 1(IQR = 0), respectively. Median constant score at pre-operative, 3 month, 6 month and 9 month follow-up were 34(IQR = 25-43), 65.5(IQR = 60.5-70.5), 82.5(IQR = 77.5-87.5) and 88(IQR = 81-95). There was significant improvement in clinical status (non parametric-Friedman test p < 0.001). Radiographs showed no loss of reduction, fracture or implant failure till last follow-up. Conclusions Minimally invasive technique with a 3.5 mm Ti-suture anchor and 2 mm plate is an easy, fast and reliable construct for the management of acute AC dislocation in physically active population.
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Konservative Therapie von Verletzungen des Akromioklavikulargelenks. ARTHROSKOPIE 2022. [DOI: 10.1007/s00142-022-00545-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
ZusammenfassungNiedriggradige Verletzungen (Grad I und II nach Rockwood) des Akromioklavikulargelenks (ACG) können in den meisten Fällen mit gutem Outcome konservativ behandelt werden. Hierbei gibt es keine Methode der Immobilisation, welche sich als Überlegen herausgestellt hätte. Höhergradige Verletzungen (Grad IV und V), welche eine relevante Instabilität und konsekutiv häufig eine Dyskinesie des skapulothorakalen Rhythmus zur Folge haben, profitieren von einer chirurgischen Rekonstruktion. Kein Konsens trotz breiter akademischer Diskussion besteht bei Grad-III-Verletzungen. In Langzeitstudien und im Rahmen von Metaanalysen zeigten sich keine Vorteile eines operativen Vorgehens gegenüber der konservativen Behandlung nach 1 bis 2 Jahren, während einzelne Fallserien Vorteile in der anatomischen Rekonstruktion aufzeigten, insbesondere wenn für das ACG spezifische Outcome-Scores verwendet wurden. In Grenzfällen sollte das individuelle Arbeits- und Sportprofil, insbesondere regelmäßige Überkopfaktivität, in die therapeutische Entscheidungsfindung einfließen. Sowohl bei niedrig- wie auch hochgradigen Verletzungen des ACG kann durch eine fokussierte Therapie zur Verbesserung der skapulothorakalen Mobilität und Stabilität eine Skapuladyskinesie in vielen Fällen (gelegentlich auch ≥ Grad III nach Rockwood) vermieden oder erfolgreich behandelt werden.
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8
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Sciascia A, Bois AJ, Kibler WB. Nonoperative Management of Traumatic Acromioclavicular Joint Injury: A Clinical Commentary with Clinical Practice Considerations. Int J Sports Phys Ther 2022; 17:519-540. [PMID: 35391875 PMCID: PMC8975563 DOI: 10.26603/001c.32545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 12/01/2021] [Indexed: 11/18/2022] Open
Abstract
Traumatic injuries of the acromioclavicular joint result in pain and potentially long-term alterations in scapulohumeral rhythm that occurs due to disruption of the clavicular strut function which is integral to scapular kinematics. Nonoperative treatment remains a valid option in most acromioclavicular joint injuries with the potential of minimizing pain and restoring scapulohumeral rhythm. However, few studies have provided nonoperative treatment details. Therefore, the purpose of this clinical commentary is to discuss the rationale, indications, and techniques of nonoperative treatment and present an organized approach for evaluating and managing such patients based on the best available evidence. Attention will be focused on identifying the treatment methods employed and the results/outcomes of such treatments. Level of Evidence 5.
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Affiliation(s)
- Aaron Sciascia
- Institute Clinical Outcomes and Research, Lexington Clinic
| | - Aaron J Bois
- Sport Medicine Centre, University of Calgary; McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary
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Barberis L, Faggiani M, Calò MJ, Marenco S, Vasario G, Castoldi F. Coracoid tunnels in open and arthroscopic treatment of acromioclavicular dislocation: an experimental cadaveric study. Musculoskelet Surg 2022; 106:15-19. [PMID: 32399677 DOI: 10.1007/s12306-020-00665-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 05/02/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE Treatment of acromioclavicular joint (ACJ) dislocation is not encoded uniquely. Type I and II injuries are usually treated conservatively, while types IV, V and VI surgically. Controversy still exists over the treatment of type III injuries. In the operative approach, there is no agreement on the best surgical technique. Our purpose is to compare the mini-open and arthroscopic approach focusing on the evaluation of the anatomical precision of the coracoid drilling. METHODS This is a controlled laboratory study. Ten fresh-frozen cadaveric shoulders were randomly assigned to the two techniques in order to compare them. We performed essential surgical gestures to drill the tunnel using MINAR® System (mini-open) and Dog-Bone® (ARTHREX, arthroscopic). The anatomical specimens were then subjected to CT-scan investigation. We statistically evaluated the precision of these two techniques analyzing DICOM files using two parameters. Parameter 1 evaluates the tunnel entry area on the superior side of the coracoid. Parameter 2 describes the orientation of the tunnel. RESULTS There are no statistically significant differences (95% confidence level) between arthroscopic and mini-open approach about the precision in the location of the coracoid hole, regarding the entry area (p = 1.00) and the orientation (p = 0.196). CONCLUSION The evidences collected enable the orthopedic surgeon to choose equally between the two techniques in the treatment of AC joint dislocation toward precision.
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Affiliation(s)
- L Barberis
- Department of Orthopaedics and Traumatology, C.T.O. Hospital, University of Turin Medical School, 29, Via Zuretti, 10126, Turin, TO, Italy
| | - M Faggiani
- Department of Orthopaedics and Traumatology, C.T.O. Hospital, University of Turin Medical School, 29, Via Zuretti, 10126, Turin, TO, Italy.
| | - M J Calò
- Department of Orthopaedics and Traumatology, C.T.O. Hospital, University of Turin Medical School, 29, Via Zuretti, 10126, Turin, TO, Italy
| | - S Marenco
- Department of Orthopaedics and Traumatology, C.T.O. Hospital, University of Turin Medical School, 29, Via Zuretti, 10126, Turin, TO, Italy
| | - G Vasario
- Department of Orthopaedics and Traumatology, C.T.O. Hospital, University of Turin Medical School, 29, Via Zuretti, 10126, Turin, TO, Italy
| | - F Castoldi
- Department of Orthopaedics and Traumatology, C.T.O. Hospital, University of Turin Medical School, 29, Via Zuretti, 10126, Turin, TO, Italy
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Maia Dias C, Leite MJ, Ribeiro da Silva M, Granate P, Manuel Teixeira J. Arthroscopic Anatomical Acromioclavicular Joint Reconstruction using a Button Device and a Semitendinosus Graft. Orthop Surg 2022; 14:605-612. [PMID: 35142045 PMCID: PMC8927023 DOI: 10.1111/os.13202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 12/10/2021] [Accepted: 12/20/2021] [Indexed: 11/29/2022] Open
Abstract
Objective To report a new technique for anatomical acromioclavicular (AC) joint reconstruction. Methods In order to minimize such complications, the authors describe a new anatomical and biological AC joint repair. This technique aims to provide greater stability by using two anatomically placed clavicular tunnels and a combined construct with a double endobutton cortical fixation for primary stabilization, and to be biologically advantageous by using an autologous semitendinosus (ST) tendon graft. Additionally, the coracoclavicular ligament reconstruction is complemented with an AC joint cerclage and capsular reinforcement, which will protect the biological construction in its initial stage of healing. Results This technique provides adequate primary and secondary biomechanical stability by passing both a semitendinosus autogenous graft and a double endobutton device, through anatomically placed and small diameter clavicle holes, without the need for coracoid drilling. Our technique showed encouraging results regarding pain resolution, range of motion, and function. At final follow‐up we experienced excellent results with average pain score of 1.6, and average ROM of 159° of forward flexion, 160° of abduction, 68° of external rotation, and internal rotation level at T11. Postoperative function also showed great improvements with average ASES of 85 points, an average Constant Score of 87 and a Subjective Shoulder Value of 89 points. This technique also achieved perfectly acceptable radiographic results, with an average coracoclavicular distance increase of 0.8 mm. Regarding complications, our sample showed one case of AC join subluxation, two cases of internal saphenous nerve injury, and two partial graft tears at the suture‐button interface, with none of these requiring surgical revision. Conclusion This technique is advantageous in treatment of acromioclavicular joint dislocation and can be performed in both the subacute and chronic setting.
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Affiliation(s)
- Carlos Maia Dias
- Hospital da Luz Lisboa, Lisbon, Portugal.,Unidade Cuidados Médicos de Acidentes Fidelidade Lisboa, Lisbon, Portugal.,Hospital CUF Santarém, Santarém, Portugal
| | | | - Manuel Ribeiro da Silva
- Centro Hospitalar Universitário São João, Porto, Portugal.,Hospital CUF Porto, Porto, Portugal
| | - Pedro Granate
- Hospital da Luz Lisboa, Lisbon, Portugal.,Unidade Cuidados Médicos de Acidentes Fidelidade Lisboa, Lisbon, Portugal
| | - José Manuel Teixeira
- Hospital da Luz Arrábida, Vila Nova de Gaia, Portugal.,Unidade Cuidados Médicos de Acidentes Fidelidade Porto, Porto, Portugal
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Oh HS, Kim S, Hyun JH, Kim MS. Effect of subacromial erosion shape on rotator cuff and clinical outcomes after hook plate fixation in type 5 acromioclavicular joint dislocations: a retrospective cohort study. BMC Musculoskelet Disord 2022; 23:42. [PMID: 35012506 PMCID: PMC8751107 DOI: 10.1186/s12891-021-04987-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 12/22/2021] [Indexed: 11/25/2022] Open
Abstract
Background Surgical fixation using hook plates is widely used in the treatment of acromioclavicular (AC) joint dislocations. The purpose of this study was to evaluate the incidence and shape of subacromial erosions after removal of the hook plate in type 5 AC joint dislocations. Further, we evaluated the effect of the shape of the subacromial erosion on the rotator cuff. Methods We retrospectively reviewed 30 patients who underwent hook plate fixation for type 5 AC joint dislocations at our hospital between December 2010 and December 2018. Patients with a follow-up of at least 1 year were included. Clinical outcomes were assessed using the final follow-up Constant-Murley, Korean Shoulder, and visual analog scores. To ensure that the appropriate reduction was well maintained, the coracoclavicular distances of the injured and contralateral sides were evaluated at the last follow-up. Computed tomography was performed to investigate the presence and shape of the subacromial erosion after hook plate removal at 4 months after surgery. Ultrasonography was performed to investigate the presence of rotator cuff lesions at the last follow-up. Clinical and radiological outcomes were compared between groups divided according to the presence and types of subacromial erosions. Results Subacromial erosion was observed in 60% of patients (18/30): 13, 2, and 3 simple groove, cave, and marginal protrusion types, respectively. Four patients showed reduction loss at the final follow-up. There were no significant differences in clinical and radiological outcomes between the groups with and without subacromial erosion. Moreover, there were no significant differences between groups according to the types of subacromial erosion. There were no rotator cuff lesions, such as partial tears, in the injured shoulders. Conclusions Hook plate fixation may induce subacromial erosions. However, the subacromial erosions caused by the hook plate did not affect the clinical outcomes of type 5 AC joint dislocations. Moreover, regardless of its shape, the subacromial erosion did not affect the clinical outcomes nor cause rotator cuff lesions after plate removal.
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Affiliation(s)
- Ho-Seok Oh
- Department of Orthopedic Surgery, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju, 61469, South Korea
| | - Sungmin Kim
- Department of Orthopedic Surgery, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju, 61469, South Korea
| | - Jeong-Hun Hyun
- Department of Orthopedic Surgery, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju, 61469, South Korea
| | - Myung-Sun Kim
- Department of Orthopedic Surgery, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju, 61469, South Korea.
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Ruzbarsky JJ, Elrick BP, Nolte PC, Arner JW, Millett PJ. Grade III Acromioclavicular Separations Treated With Suspensory Fixation Techniques: A Systematic Review of Level I Through IV Studies. Arthrosc Sports Med Rehabil 2021; 3:e1535-e1545. [PMID: 34712991 PMCID: PMC8527265 DOI: 10.1016/j.asmr.2021.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 04/24/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose To perform a systematic review comparing clinical outcomes, radiographic outcomes, and complication rates after acute (surgery ≤6 weeks from injury) versus chronic (surgery >6 weeks from injury) acromioclavicular joint reconstructions for grade III injuries using modern suspensory fixation techniques. Methods We performed a systematic review of the literature examining acute versus chronic surgical treatment of Rockwood grade III acromioclavicular joint separations using the Cochrane registry, MEDLINE database, and Embase database over the past 10 years according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. The inclusion criteria included techniques using suspensory fixation, a minimum study size of 3 patients, a minimum follow-up period of 6 months, human studies, and English-language studies. The methodology of each study was evaluated using the Methodological Index for Non-randomized Studies (MINORS) tool for nonrandomized studies and the revised Cochrane risk-of-bias (RoB 2) tool for randomized controlled trials. Results The systematic review search yielded 20 studies with a total of 253 patients. There were 2 prospective randomized controlled trials, but most of the included studies were retrospective. On comparison of acute surgery (≤6 weeks) and chronic surgery (>6 weeks), individual studies reported a range of Constant scores of 84.4 to 98.2 and 80.8 to 94.1, respectively. The ranges of radiographic coracoclavicular distances reported at final follow-up also favored acute reconstructions, which showed improved reduction (9.2-15.7 mm and 11.7-18.6 mm, respectively). The reported complication rates ranged from 7% to 67% for acute reconstructions and from 0% to 30% for chronic reconstructions. Conclusions The ranges in the Constant score may favor acute reconstructions, but because of the heterogeneity in the surgical techniques in the literature, no definitive recommendations can be made regarding optimal timing. Level of Evidence Level IV, systematic review of Level I through IV studies.
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Affiliation(s)
| | | | - Philip-C. Nolte
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
- Department of Trauma and Orthopedic Surgery, BG Trauma Center Ludwigshafen, Ludwigshafen, Germany
| | | | - Peter J. Millett
- The Steadman Clinic, Vail, Colorado, U.S.A
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
- Address correspondence to Peter J. Millett, M.D., M.Sc., Steadman Philippon Research Institute, The Steadman Clinic, 181 W Meadow Dr, Ste 400, Vail, CO 81657, U.S.A.
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Lau ETC, Hong CC, Poh KS, Manohara R, Ng DZ, Lim JL, Kumar VP. A relook at the reliability of Rockwood classification for acromioclavicular joint injuries. J Shoulder Elbow Surg 2021; 30:2191-2196. [PMID: 33582181 DOI: 10.1016/j.jse.2021.01.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 12/20/2020] [Accepted: 01/10/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Controversies for treatment of acromioclavicular joint injuries in particular type III injuries may be partially attributed to the lack of a standardized method of radiography and measurement technique. Previous studies looking at the Rockwood classification showed poor inter- and intraobserver reliability (Kappa value approximately 0.20-0.50). We hypothesized that the use of unilateral instead of bilateral acromioclavicular joint radiographs was the cause of this finding. In this article, we standardized the methodology to perform the radiograph and to measure the coracoclavicular distances. We designed the study to focus on the reliability of differentiating type III and type V injuries. METHODS A standardized radiographic protocol for bilateral Zanca view was established in our institution. All patients who underwent this radiographic examination over a 3-year period were reviewed. Radiographs of 55 patients with significant (type III or V) injury met the inclusion criteria. For the interobserver reliability, a retrospective radiographic review was performed by 6 orthopedic surgeons and graded as either type III or V. For intraobserver reliability, a similar process was repeated by 3 observers after a period of 6 weeks. RESULTS Going by the majority agreement of the 6 reviewers, there were 34 type III injuries and 19 type V injuries. The Fleiss kappa for interobserver reliability was calculated to be 0.624. The Cohen kappa for intraobserver reliability was calculated to be 0.696. DISCUSSION The use of a standardized radiographic protocol-taking bilateral Zanca views on the same radiographic plate-would help eliminate a significant amount of variability and improve the reliability of classifying acromioclavicular joint injuries using the Rockwood classification, which uses a relative measure to the contralateral site as its definition criteria. Other possible sources of poor reliability may include the masking of injuries by muscle spasm, resulting in a misdiagnosis of a high-grade injury as a lower-grade one and the possible need to subclassify type III injuries. CONCLUSION Reliability of the Rockwood classification can be improved through the use of a standardized radiographic protocol to improve the detection of vertical instability. Similar to Rockwood dividing up Tossy grade 3 injuries when he noted the differential outcome and intervention, Rockwood type III injuries would likely require further subclassification as it remains an anomalous tool with high variability. Further studies are required to understand the pathologic basis of transition of type III into type V injury.
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Affiliation(s)
| | - Choon Chiet Hong
- Department of Orthopaedic Surgery, National University Hospital, Singapore
| | - Keng Soon Poh
- Department of Orthopaedic Surgery, National University Hospital, Singapore
| | - Ruben Manohara
- Department of Orthopaedic Surgery, National University Hospital, Singapore
| | - Dennis Zhaowen Ng
- The Orthopaedic Centre (Gleneagles), Gleneagles Medical Centre, Singapore
| | - Joel Louis Lim
- Department of Orthopaedic Surgery, National University Hospital, Singapore
| | - Veerasingam Prem Kumar
- Department of Orthopaedic Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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14
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Jeong JY, Chun YM. Treatment of acute high-grade acromioclavicular joint dislocation. Clin Shoulder Elb 2020; 23:159-165. [PMID: 33330252 PMCID: PMC7714286 DOI: 10.5397/cise.2020.00150] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/06/2020] [Indexed: 02/07/2023] Open
Abstract
Acromioclavicular (AC) joint dislocations account for about 9% of shoulder injuries. Among them, acute high-grade injury following high-energy trauma accounts for a large proportion of patients requiring surgical treatment. However, there is no gold standard procedure for operative treatment of acute high-grade AC joint injury, and several different procedures have been used for this purpose in clinical practice. This review article summarizes the most recent and relevant surgical options for acute high-grade AC joint dislocation patients and the outcomes of each treatment type.
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Affiliation(s)
- Jeung Yeol Jeong
- Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Yong-Min Chun
- Department of Orthopedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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15
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Hunter TJA, Abdus-Samee M, Balasubramanian S, Grocott N, McClelland D. Medium- to long-term results of acromioclavicular joint stabilisation using the Ligament Augmentation Reconstruction System (LARS) ligament. Shoulder Elbow 2020; 12:163-169. [PMID: 32565917 PMCID: PMC7285975 DOI: 10.1177/1758573219833697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 01/30/2019] [Accepted: 01/31/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Opinion is divided as to optimum management of grade III acromioclavicular joint injuries that have failed conservative management. We objectively investigated the radiological and functional outcome of acromioclavicular joint reconstruction using the Ligament Augmentation Reconstruction System (LARS®). METHODS Retrospective review of patients with LARS reconstruction of acromioclavicular joint dislocations with minimum six-year follow-up. Functional assessment was performed using the constant score, Disability of Arm Shoulder and Hand score and simple satisfaction score. Radiological assessment was undertaken using plain radiographs. Results were compared with the uninjured limb. RESULTS Twenty-four of 25 patients were included. Mean constant score for the injured shoulder was 87.0, Disability of Arm Shoulder and Hand score was 11.6. All patients indicated that they would have the operation again. There were five complications including two patients that suffered small cracks in the clavicle. Coracoid erosion was frequently seen but was most often minor. In two cases, this resulted in a complete dissociation of the coracoid tip but without functional detriment. DISCUSSION LARS is a safe and effective method of acromioclavicular joint reconstruction producing good results, and we recommend its use for these injuries. We also caution clinicians who use cerclage methods to be aware of coracoid erosion when following up their patients.
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Affiliation(s)
- Thomas JA Hunter
- Royal Stoke University Hospital, University Hospitals of North Midlands, Stoke-on-Trent, UK
| | | | | | - Natalie Grocott
- Royal Stoke University Hospital, University Hospitals of North Midlands, Stoke-on-Trent, UK
| | - Damian McClelland
- Royal Stoke University Hospital, University Hospitals of North Midlands, Stoke-on-Trent, UK
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Nolte PC, Lacheta L, Dekker TJ, Elrick BP, Millett PJ. Optimal Management of Acromioclavicular Dislocation: Current Perspectives. Orthop Res Rev 2020; 12:27-44. [PMID: 32184680 PMCID: PMC7062404 DOI: 10.2147/orr.s218991] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 02/19/2020] [Indexed: 12/14/2022] Open
Abstract
Injuries to the acromioclavicular (AC) joint are common and mostly involve younger, male individuals. Whereas the majority of AC joint dislocations can be treated nonoperatively with a trial of immobilization, pain medication, cryotherapy, and physiotherapy, there are patients that do not respond well to conservative management and may require surgical treatment. Identifying and treating these patients according to the type and chronicity of AC joint dislocation is paramount. To date, a myriad of surgical techniques have been proposed to address unstable AC joint dislocations and are indicative of the uncertainty that exists in optimal management of these injuries. Historically research has focused on the restoration of the coracoclavicular ligament complex. However, recently the importance of the acromioclavicular capsule and ligaments has been emphasized. This review aims to provide the reader with an overview of current treatment strategies and research, as well as future perspectives.
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Affiliation(s)
- Philip C Nolte
- Steadman Philippon Research Institute, Vail, CO, USA.,Department of Trauma and Orthopedic Surgery, BG Trauma Center Ludwigshafen, Ludwigshafen, Germany
| | - Lucca Lacheta
- Steadman Philippon Research Institute, Vail, CO, USA.,Center for Musculoskeletal Surgery, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Travis J Dekker
- Steadman Philippon Research Institute, Vail, CO, USA.,Eglin Air Force Base, 96th Medical Group, United States Air Force, Eglin, FL, USA
| | | | - Peter J Millett
- Steadman Philippon Research Institute, Vail, CO, USA.,The Steadman Clinic, Vail, CO, USA
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Tamaoki MJS, Lenza M, Matsunaga FT, Belloti JC, Matsumoto MH, Faloppa F. Surgical versus conservative interventions for treating acromioclavicular dislocation of the shoulder in adults. Cochrane Database Syst Rev 2019; 10:CD007429. [PMID: 31604007 PMCID: PMC6788812 DOI: 10.1002/14651858.cd007429.pub3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Dislocation of the acromioclavicular joint is one of the most common shoulder injuries in a sport-active population. The question of whether surgery should be used remains controversial. This is an update of a Cochrane Review first published in 2010. OBJECTIVES To assess the effects (benefits and harms) of surgical versus conservative (non-surgical) interventions for treating acromioclavicular dislocations in adults. SEARCH METHODS We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (to June 2019), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library 2019, Issue 6), MEDLINE (1946 to June 2019), Embase (1980 to June 2019), and LILACS (1982 to June 2019), trial registries, and reference lists of articles. There were no restrictions based on language or publication status. SELECTION CRITERIA We included all randomised and quasi-randomised trials that compared surgical with conservative treatment of acromioclavicular dislocation in adults. DATA COLLECTION AND ANALYSIS At least two review authors independently performed study screening and selection, 'Risk of bias' assessment, and data extraction. We pooled data where appropriate and used GRADE to assess the quality of evidence for each outcome. MAIN RESULTS We included five randomised trials and one quasi-randomised trial. The included trials involved 357 mainly young adults, the majority of whom were male, with acute acromioclavicular dislocation. The strength of the findings in all studies was limited due to design features, invariably lack of blinding, that carry a high risk of bias. Fixation of the acromioclavicular joint using hook plates, tunnelled suspension devices, coracoclavicular screws, acromioclavicular pins, or (usually threaded) wires was compared with supporting the arm in a sling or similar device. After surgery, the arm was also supported in a sling or similar device in all trials. Where described in the trials, both groups had exercise-based rehabilitation. We downgraded the evidence for all outcomes at least two levels, invariably for serious risk of bias and serious imprecision.Low-quality evidence from two studies showed no evidence of a difference between groups in shoulder function at one year, assessed using the Disability of the Arm, Shoulder, and Hand questionnaire (DASH) (0 (best function) to 100 (worst function)): mean difference (MD) 0.73 points, 95% confidence interval (CI) -2.70 to 4.16; 112 participants. These results were consistent with other measures of function at one-year or longer follow-up, including non-validated outcome scores reported by three studies. There is low-quality evidence that function at six weeks may be better after conservative treatment, indicating an earlier recovery. Very low-quality evidence from one trial found no difference between groups in participants reporting pain at one year: risk ratio (RR) 1.32, 95% CI 0.54 to 3.19; 79 participants. There is very low-quality evidence that surgery may not reduce the risk of treatment failure, usually resulting in non-routine secondary surgery: 14/168 versus 15/174; RR 0.99, 95% CI 0.51 to 1.94; 342 participants, 6 studies. The main source of treatment failure was complications related to surgical implants in the surgery group and persistent symptoms, mainly discomfort, due to the acromioclavicular dislocation in the conservatively treated group.There is low-quality evidence from two studies that there may be little or no difference between groups in the return to former activities (sports or work) at one year: 57/67 versus 62/70; RR 0.96, 95% CI 0.85 to 1.10; 137 participants, 2 studies. Low-quality but consistent evidence from four studies indicated an earlier recovery in conservatively treated participants compared with those treated with surgery. There is low-quality evidence of no clinically important difference between groups at one year in quality of life scores, measured using the 36-item or 12-item Short Form Health Survey (SF-36 or SF-12) (0-to-100 scale, where 100 is best score), in either the physical component (MD -0.63, 95% CI -2.63 to 1.37; 122 participants, 2 studies) or mental component (MD 0.47 points, 95% CI -1.51 to 2.44; 122 participants). There is very low-quality and clinically heterogenous evidence of a greater risk of an adverse event after surgery: 45/168 versus 16/174; RR 2.82, 95% CI 1.65 to 4.82; 342 participants, 6 studies; I2 = 48%. Common adverse outcomes were hardware complications or discomfort (18.5%) and infection (8.7%) in the surgery group and persistent symptoms (7.1%), mainly discomfort, in the conservatively treated group. The majority of surgical complications occurred in older studies testing now-outdated devices known for their high risk of complications. The very low-quality evidence from one study (70 participants) means that we are uncertain whether there is a between-group difference in patient dissatisfaction with cosmetic results.It is notable that the evidence for function, return to former activities, and quality of life came from the two most recently conducted studies, which tested currently used devices and interventions in clearly defined participant populations that represented the commonly perceived population for which there is uncertainty over the use of surgery. There were insufficient data to conduct subgroup analysis relating to type of injury and whether surgery involved ligament reconstruction or not. AUTHORS' CONCLUSIONS There is low-quality evidence that surgical treatment has no additional benefits in terms of function, return to former activities, and quality of life at one year compared with conservative treatment. There is, however, low-quality evidence that people treated conservatively had improved function at six weeks compared with surgical management. There is very low-quality evidence of little difference between the two treatments in pain at one year, treatment failure usually resulting in secondary surgery, or patient satisfaction with cosmetic result. Although surgery may result in more people sustaining adverse events, this varied between the trials, being more common in techniques such as K-wire fixation that are rarely used today. There remains a need to consider the balance of risks between the individual outcomes: for example, surgical adverse events, including wound infection or dehiscence and hardware complication, against risk of adverse events that may be more commonly associated with conservative treatment such as persistent symptoms or discomfort, or both.There is a need for sufficiently powered, good-quality, well-reported randomised trials of currently used surgical interventions versus conservative treatment for well-defined injuries.
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Affiliation(s)
- Marcel JS Tamaoki
- Universidade Federal de São PauloDepartment of Orthopaedics and TraumatologyRua das Rosas, 126 apto 73São PauloSao PauloBrazil04038‐032
| | - Mário Lenza
- Faculdade Israelita de Ciencias da Saude Albert Einstein and Hospital Israelita Albert EinsteinOrthopaedic Department and School of MedicineAv. Albert Einstein, 627/701São PauloSão PauloBrazilCEP 05651‐901
| | - Fabio T Matsunaga
- Universidade Federal de São PauloDepartment of Orthopaedics and TraumatologyRua das Rosas, 126 apto 73São PauloSao PauloBrazil04038‐032
| | - João Carlos Belloti
- Universidade Federal de São PauloDepartment of Orthopaedics and TraumatologyRua das Rosas, 126 apto 73São PauloSao PauloBrazil04038‐032
| | - Marcelo H Matsumoto
- Universidade Federal de São PauloDepartment of Orthopaedics and TraumatologyRua das Rosas, 126 apto 73São PauloSao PauloBrazil04038‐032
| | - Flávio Faloppa
- Universidade Federal de São PauloDepartment of Orthopaedics and TraumatologyRua das Rosas, 126 apto 73São PauloSao PauloBrazil04038‐032
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Qi W, Xu Y, Yan Z, Zhan J, Lin J, Pan X, Xue X. The Tight-Rope Technique versus Clavicular Hook Plate for Treatment of Acute Acromioclavicular Joint Dislocation: A Systematic Review and Meta-Analysis. J INVEST SURG 2019; 34:20-29. [PMID: 31084402 DOI: 10.1080/08941939.2019.1593558] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Weihui Qi
- Department of Orthopaedic, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, China
- The Second School of Medicine, Wenzhou Medical University, China
| | - Yunyun Xu
- Department of Orthopaedic, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, China
- The Second School of Medicine, Wenzhou Medical University, China
| | - Zijian Yan
- Department of Orthopaedic, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, China
- The Second School of Medicine, Wenzhou Medical University, China
| | - Jingdi Zhan
- Department of Orthopaedic, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, China
- The Second School of Medicine, Wenzhou Medical University, China
| | - Jian Lin
- Department of Orthopaedic, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, China
- The Second School of Medicine, Wenzhou Medical University, China
| | - Xiaoyun Pan
- Department of Orthopaedic, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, China
- The Second School of Medicine, Wenzhou Medical University, China
| | - Xinghe Xue
- Department of Orthopaedic, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, China
- The Second School of Medicine, Wenzhou Medical University, China
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Mazzoleni S, Battini E, Galgani M, Tenucci M, Dario P, Calvosa G. Motion Tracking for Quantitative and Qualitative Assessment of Upper Limb Movements Following Acromioclavicular Joint Ligament Reconstruction: A Pilot Study. Open Biomed Eng J 2018. [DOI: 10.2174/1874120701812010135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Technological tools as robotic devices and wearable sensors can provide accurate and repeatable measurements of physical variables (e.g., position, velocities, forces) which can be used for quantitative and qualitative assessment of movement analysis and upper limb motor performance.
Objective:
The study aims to propose a quantitative and qualitative assessment of upper limb motor performance by means of seven kinematic parameters recorded by a passive mechatronic device in patients who underwent a surgical procedure for ligament reconstruction following acromioclavicular joint dislocation.
Method:
Five patients (mean age: 40 ± 12 years) with acromioclavicular joint dislocation were enrolled.
A passive end-effector mechatronic device characterized by 7 degrees of freedom and designed for the assessment of upper limb motor performance - especially for measuring the hand position in three-dimensional space - was used.
The Constant-Murley score and seven kinematic parameters were used as clinical outcome measure and quantitative and qualitative assessment, respectively.
Results:
The preliminary results of this study show no significant differences between the impaired arm and unimpaired arm: the end-effector passive mechatronic device used in this study is able to provide an overall assessment of the upper limb motor performance following shoulder impairment.
Conclusion:
The motion tracker can be easily used as effective tool for quantitative and qualitative assessment of upper limb motor performance, even several years after the surgical operation.
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Zheng J, Chen J, Chen L, Ni Y, Lin Z. A novel hybrid fixation (coracoclavicular screw supplemented with K-wire) for the treatment of acute acromioclavicular joint dislocation: A prospective study. Int J Surg 2018; 59:61-66. [PMID: 30292002 DOI: 10.1016/j.ijsu.2018.09.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 09/18/2018] [Accepted: 09/27/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to compare the radiological and clinical outcomes of clavicular hook plate fixation and the coracoclavicular lag screw supplemented with K-wire fixation in the treatment of acute acromioclavicular joint dislocation. METHODS Between January 2012 to December 2015, 81 patients with acute acromioclavicular joint dislocation were included in this prospective study. 43 patients were treated with clavicular hook plate fixation (Group A) and 38 patients were treated with coracoclavicular lag screw supplemented with K-wire fixation (Group B). Incision length, operation duration, blood loss volume, intraoperative fluoroscopy times and length of hospitalization were recorded. Radiographic outcomes, functional outcomes and complications were also recorded. RESULTS Both two groups could achieve good radiographic and functional outcomes after operation. Group B exhibited significantly shorter operation duration, shorter length of incision, less blood loss volume and shorter length of hospitalization than Group A (P < 0.001). In addition, significant difference could be found between the two groups regarding the VAS scores three month postoperatively and the final follow-up (P < 0.001). However, there was no significant difference in radiographic and functional outcomes between the two groups (P > 0.05). CONCLUSION The two groups can both achieve satisfactory radiological and functional outcomes in treating acute AC joint dislocation. However, CC screw fixation supplemented with K-wire exerts some advantages regarding the incision length, operation duration, blood loss volume, length of hospitalization. Furthermore, it can better relieve the pain caused by dislocation. Therefore, the novel hybrid fixation (CC screw fixation supplemented with K-wire) provides an alternative treatment for acute AC joint dislocation.
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Affiliation(s)
- Junju Zheng
- Department of Orthopaedic Surgery, The Dingli Clinical Institute of Wenzhou Medical University (Wenzhou Central Hospital), Wenzhou, Zhejiang, 325000, PR China
| | - Jiaru Chen
- Department of Orthopaedic Surgery, The Dingli Clinical Institute of Wenzhou Medical University (Wenzhou Central Hospital), Wenzhou, Zhejiang, 325000, PR China
| | - Lin Chen
- Department of Orthopaedic Surgery, The Dingli Clinical Institute of Wenzhou Medical University (Wenzhou Central Hospital), Wenzhou, Zhejiang, 325000, PR China
| | - Yueping Ni
- Department of Orthopaedic Surgery, The Dingli Clinical Institute of Wenzhou Medical University (Wenzhou Central Hospital), Wenzhou, Zhejiang, 325000, PR China
| | - Zhou Lin
- Department of Orthopaedic Surgery, The Dingli Clinical Institute of Wenzhou Medical University (Wenzhou Central Hospital), Wenzhou, Zhejiang, 325000, PR China.
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21
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Tiefenboeck TM, Boesmueller S, Popp D, Payr S, Joestl J, Binder H, Schurz M, Komjati M, Fialka C, Ostermann RC. The use of the LARS system in the treatment of AC joint instability - Long-term results after a mean of 7.4 years. Orthop Traumatol Surg Res 2018; 104:749-754. [PMID: 29581067 DOI: 10.1016/j.otsr.2018.02.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 02/16/2018] [Accepted: 02/27/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND The acromioclavicular (AC) joint is of great importance for shoulder stability and one of the most frequently injured regions of the shoulder. HYPOTHESIS AC joint reconstruction with the ligament augmentation & reconstruction system (LARS™) leads to a good-to-excellent outcome at long-term follow-up. PATIENTS AND METHODS This study was performed as a retrospective single-centre data analysis of a level-I trauma centre. All patients treated operatively for an acute AC dislocation with the LARS™ between 2003 and 2013 were included. RESULTS The study group consisted of three female (6%) and 44 male patients (94%) with an average age of 37 years and a minimum follow-up of two years. The overall mean clinical outcomes at latest follow-up were: Constant 93, DASH 2.64, ASES 96, SST 97, UCLA 34 and VAS 0.4-representing a good-to-excellent outcome in all patients. Overall, 45 patients (96%) reported to be very satisfied with the achieved result at latest follow-up. In five patients, (11%) complications occurred during the follow-up period, requiring surgical revision in four of the five patients (80%). CONCLUSION AC joint reconstruction with the LARS™ achieves good-to-excellent clinical and functional outcomes at long-term follow-up with a surgical revision rate of 8.5%. LEVEL OF EVIDENCE Retrospective follow-up study, case series, level IV.
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Affiliation(s)
- T M Tiefenboeck
- Medical University of Vienna, Department of Orthopedics and Trauma Surgery, Division of Trauma Surgery, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | | | - D Popp
- Medical University of Vienna, Department of Orthopedics and Trauma Surgery, Division of Trauma Surgery, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - S Payr
- Medical University of Vienna, Department of Orthopedics and Trauma Surgery, Division of Trauma Surgery, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - J Joestl
- Medical University of Vienna, Department of Orthopedics and Trauma Surgery, Division of Trauma Surgery, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - H Binder
- Medical University of Vienna, Department of Orthopedics and Trauma Surgery, Division of Trauma Surgery, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - M Schurz
- Medical University of Vienna, Department of Orthopedics and Trauma Surgery, Division of Trauma Surgery, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - M Komjati
- Department of Orthopaedics, Hospital of sacred Heart of Jesus, 1030 Vienna, Austria
| | - C Fialka
- AUVA Trauma Center Meidling, Vienna, Austria; Sigmund Freud University, 1020 Vienna, Austria
| | - R C Ostermann
- Medical University of Vienna, Department of Orthopedics and Trauma Surgery, Division of Trauma Surgery, Waehringer Guertel 18-20, 1090 Vienna, Austria
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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: 1.4] [Reference Citation Analysis] [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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Functional and Radiographic Outcomes After Allograft Anatomic Coracoclavicular Ligament Reconstruction. J Orthop Trauma 2018; 32:204-210. [PMID: 29558374 DOI: 10.1097/bot.0000000000001079] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To analyze the functional and radiographic outcomes of anatomic coracoclavicular ligament reconstruction (ACCR) using allograft tendon without interference screw fixation. DESIGN Retrospective nonrandomized study. SETTING Level I trauma center (University Hospital). PATIENTS Seventeen patients (mean age of 44 years) with Rockwood III through V acromioclavicular joint disruptions. Twelve of 17 patients had a primary reconstruction, including 4 patients sustaining their injuries as part of a polytrauma incident. Five of 17 patients were revisions of a previously failed acromioclavicular reconstruction procedure. INTERVENTION Open ACCR using hamstring allograft with high-strength suture augmentation and knotted graft fixation without interference screws. MAIN OUTCOME MEASURES Clinical and patient reported outcome measures including Simple Shoulder Test, American Shoulder and Elbow Surgeons scores, and visual analog scale scores for pain and radiographic outcomes. RESULTS The average final postoperative Simple Shoulder Test and American Shoulder and Elbow Surgeons scores were 10.8 and 80.5, respectively. The average final postoperative visual analog scale pain was 1.8. All patients demonstrated clavicle tunnel widening on final postoperative radiographs compared with immediate postoperative radiographs. The overall complication rate was 36%, with no clavicle or coracoid fractures. CONCLUSIONS Open ACCR using hamstring allograft tendon secured with a square knot and high-strength suture augmentation yields equivalent outcomes to those repairs requiring an additional interference screw. Clavicle tunnel widening predictably occurs, but the clinical significance is undetermined. It appears therefore that an interference screw is not needed. Larger comparison studies are needed. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Domos P, Sim F, Dunne M, White A. Current practice in the management of Rockwood type III acromioclavicular joint dislocations-National survey. J Orthop Surg (Hong Kong) 2018; 25:2309499017717868. [PMID: 28681672 DOI: 10.1177/2309499017717868] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Our aim was to conduct this survey among consultant shoulder surgeons in the United Kingdom to document the current management of Rockwood type III acromioclavicular joint (ACJ) injuries. METHODS British Elbow and Shoulder Society Research Committee-approved online survey was used and 137 responses were collected within 3 months. RESULTS One hundred percent of responders would treat type III injuries conservatively initially. Routine physiotherapy would be offered by 86% of surgeons. The patient's factors that influence the decision to consider surgery are pre-injury functional demand, current functional deficit, pain and patient request for surgery. Across all groups the mean time to surgical intervention from injury was 3.8 months. About 45% of all consultants would use the same technique for all cases and there were differences between the varieties of techniques used by surgeons, depending on their degree of experience. LockDown was the most widely used technique in all groups of patients. This was followed by Ligament Augmentation & Reconstruction System (LARS), hook plate and Arthroscopic TightRope/DogBone technique for acute injuries. LARS, modified Weaver-Dunn and ACJ resection were used most commonly after LockDown for delayed cases. CONCLUSION Our survey revealed the current trends in clinical practice to treat symptomatic Rockwood type III ACJ injuries, but it also confirmed the controversial and complex management differences, which vary among shoulder surgeons in the United Kingdom.
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Affiliation(s)
- Peter Domos
- 1 Department of Trauma and Orthopaedics, Peterborough City Hospital, Peterborough, UK
| | - Frank Sim
- 1 Department of Trauma and Orthopaedics, Peterborough City Hospital, Peterborough, UK
| | - Mike Dunne
- 1 Department of Trauma and Orthopaedics, Peterborough City Hospital, Peterborough, UK
| | - Andrew White
- 1 Department of Trauma and Orthopaedics, Peterborough City Hospital, Peterborough, UK
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Issa SP, Payan C, Le Hanneur M, Loriaut P, Boyer P. Arthroscopically assisted reduction of acute acromioclavicular joint dislocation using a single double-button device: Medium-term clinical and radiological outcomes. Orthop Traumatol Surg Res 2018; 104:33-38. [PMID: 29233762 DOI: 10.1016/j.otsr.2017.11.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 07/26/2017] [Accepted: 11/08/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Double-button devices for endoscopic management of acute acromioclavicular joint dislocation (ACJD) provide satisfactory short-term functional and radiological results. However, little exists in the literature regarding the long- and medium-term results of these implants, especially regarding the evolution of the acromioclavicular joint (ACJ). HYPOTHESIS Satisfactory and steady long- and medium-term outcomes can be achieved in patients with acute ACJD undergoing endoscopically assisted ACJ repair using a single double-button device. MATERIAL AND METHOD A retrospective single-center study was conducted in patients with acute Rockwood III and IV ACJD treated endoscopically with a single double-button device from October 2008 to October 2010, allowing a minimum 5-year follow-up. Functional evaluation used Constant and Quick-DASH scores. Clinical evidence of dislocation recurrence was combined with bilateral Zanca views to assess coracoclavicular distance. Acromioclavicular osteoarthritis was evaluated on the Paxinos test and Zanca views. RESULTS Nineteen of the 25 operated patients were seen at a mean 76.9±8.5 months' follow-up. Mean age was 34.4±8.3 years. Mean Constant and Quick-DASH scores were 96.2±5.1 and 0.9±1.6 points, respectively. Four patients had a recurrence of their initial dislocation, 3 of whom had positive Paxinos test, whereas the 15 patients without recurrence had a negative test (p=0.004). Five patients had radiological evidence of ACJ osteoarthritis: all 4 patients with recurrence and 1 without (p=0.001). CONCLUSION Long- and medium-term radioclinical outcome of endoscopically assisted management of acute ACJD using a single double-button device seems to be satisfactory and steady over time. Recurrence of the initial dislocation appears to be related to onset of degenerative ACJ arthropathy. LEVEL OF EVIDENCE Therapeutic type IV-Retrospective case series.
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Affiliation(s)
- S-P Issa
- Service de chirurgie orthopédique et de traumatologie, hôpital Cochin, Assistance publique-hôpitaux de Paris (AP-HP), 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
| | - C Payan
- Service de chirurgie orthopédique et de traumatologie, hôpital Bichat-Claude-Bernard, hôpitaux universitaires Paris Nord-Val-de-Seine (HUPNVS), Assistance publique-Hôpitaux de Paris (AP-HP), 46, rue Henri-Huchard, 75018 Paris, France
| | - M Le Hanneur
- Service de chirurgie orthopédique et de traumatologie, hôpital Européen Georges-Pompidou (HEGP), Assistance publique-hôpitaux de Paris (AP-HP), 20, rue Leblanc, 75015 Paris, France
| | - P Loriaut
- Institut de chirurgie orthopédique, clinique des Lilas, 41-49, avenue du Maréchal-Juin, 93260 Les Lilas, France
| | - P Boyer
- Service de chirurgie orthopédique et de traumatologie, hôpital Bichat-Claude-Bernard, hôpitaux universitaires Paris Nord-Val-de-Seine (HUPNVS), Assistance publique-Hôpitaux de Paris (AP-HP), 46, rue Henri-Huchard, 75018 Paris, France
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Operative Versus Nonoperative Management of Acute High-Grade Acromioclavicular Dislocations: A Systematic Review and Meta-Analysis. J Orthop Trauma 2018; 32:1-9. [PMID: 29257778 DOI: 10.1097/bot.0000000000001004] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Management of high-grade acromioclavicular (AC) joint dislocations has been controversial. Recent studies suggest no difference in outcomes between operative and nonoperative management of Rockwood types III-V injuries. The objective of this meta-analysis is to compare outcomes between operative and nonoperative management of high-grade AC joint dislocations. DATA SOURCES Search was conducted using PubMed, Embase, and Cochrane databases through October 2016. A broad search strategy was used to identify English, comparative studies of AC joint dislocations. STUDY SELECTION Inclusion criteria included comparative studies of AC joint dislocations in adult patients with acute, high-grade AC dislocations. DATA EXTRACTION Two authors independently reviewed and assessed for bias according to the U.S. Preventative Task Force Quality Rating Criteria. Data were extracted for validated functional scores, clinical and radiographic outcomes, and complications. DATA SYNTHESIS Nineteen studies (n = 954) were included in the meta-analysis. Operative group had better cosmetic outcome (odds ratio [OR] = 0.05; P < 0.00001) and radiographic reduction (OR = 24.94; P < 0.0001). Constant scores favored the operative group, although the difference may not be clinically significant (MD = 3.14; P = 0.03). Nonoperative treatment was associated with faster return to work (MD = 4.17, P < 0.0001), lower implant complications (OR = 7.19, P < 0.0001), and reduced infection rate (OR = 3.65, P = 0.007). No difference was found for DASH Score, return to sport, radiologic evidence of osteoarthritis, and need for surgery after failed management. CONCLUSIONS No clinical difference in functional outcome scores was detected between operative and nonoperative management of high-grade AC joint dislocations. Patients in the nonoperative cohort had a more rapid return to work, but were associated with a poorer cosmetic outcome. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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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: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 11/27/2017] [Accepted: 12/05/2017] [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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28
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da Silva RC, Pavei BS, Ferrari MB, Sanchez G, Horta Barbosa LB, Gomes JLE. Acromioclavicular Joint Dislocation: Repair Through Open Ligament Transfer and Nonabsorbable Suture Fixation. Arthrosc Tech 2017; 6:e1263-e1270. [PMID: 29354426 PMCID: PMC5622208 DOI: 10.1016/j.eats.2017.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 05/02/2017] [Indexed: 02/03/2023] Open
Abstract
Acromioclavicular (AC) joint instability is a fairly common and particularly limiting injury that may result in persistent pain and reduced quality of life. In most cases, conservative management is successful. However, in the case of a severe AC joint dislocation, surgical intervention may be warranted. Previous surgical techniques for treatment of AC joint instability include screw fixation between the coracoid and clavicle, coracoacromial ligament transfer from its acromial insertion to the clavicle, and reconstruction of the coracoacromial and/or coracoclavicular ligaments. The purpose of this Technical Note is to describe our preferred technique for the treatment of a high-grade AC dislocation through coracoacromial ligament transfer to the lateral clavicle and nonabsorbable suture fixation between the coracoid process and clavicle.
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Affiliation(s)
- Ricardo Canquerini da Silva
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil,Address correspondence to Ricardo Canquerine da Silva, M.D., Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350—Santa Cecilia, 90035-903, Porto Alegre, Rio Grande do Sul, Brazil.Hospital de Clínicas de Porto AlegreRua Ramiro Barcelos2350—Santa Cecilia90035-903, Porto AlegreRio Grande do SulBrazil
| | | | - Márcio B. Ferrari
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - George Sanchez
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
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Tiefenboeck TM, Popp D, Boesmueller S, Payr S, Joestl J, Komjati M, Binder H, Schurz M, Ostermann RC. Acromioclavicular joint dislocation treated with Bosworth screw and additional K-wiring: results after 7.8 years - still an adequate procedure? BMC Musculoskelet Disord 2017; 18:339. [PMID: 28778193 PMCID: PMC5545010 DOI: 10.1186/s12891-017-1692-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 07/24/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The acromioclavicular (AC) joint dislocation is a major reason for shoulder instability. Different concepts of treatment and surgical methods are described in the literature. Thus, the purpose of this study was to present our data of long-term follow-up of patients having undergone treatment of acromioclavicular (AC) joint dislocation using the Bosworth Screw with additional K-wiring. METHODS This study was conducted as a retrospective single centre data analysis. All patients treated operatively for AC joint dislocation with a Bosworth screw and additional K-wire fixation at our Department were asked to participate in this study. RESULTS The study population consisted of 22 patients, 20 male and 2 female, with a mean age of 40 years ±15.6 years. Three grade-II lesions, 13 grade-III lesions, four grade-IV lesions and two grade-V lesions according to the Rockwood classification were found. The overall mean clinical outcome at the latest follow up was: Constant 95, DASH 6.4, ASES 94.6, SST 99.02, UCLA 33.1, ACJI 91.82 and VAS 0.29 - representing a good-to-excellent long-term outcome in all patients after at least 2 years follow-up (range; 2 - 19 years). Overall, 19 patients (86%) reported to be very satisfied with the achieved result, 15 patients (68%) reported to be able to participate in every sports activity and 16 patients (73%) reported to be able to perform their daily work without limitations. Overall, complications occurred in three patients (14%). Only one patient remained unsatisfied with the achieved result. CONCLUSION Summarizing, our reported results showed that surgical fixation of acute AC joint dislocation with a Bosworth screw and additional K-wire fixation leads to good-to-excellent functional outcome and highly satisfactory results in the majority of patients. Despite its complications, in accordance with our results, Bosworth screw fixation with additional K-wiring in AC joint dislocation represents an adequate surgical procedure. LEVEL OF EVIDENCE Level IV, retrospective study.
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Affiliation(s)
- Thomas M Tiefenboeck
- Department of Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria.
| | - Domenik Popp
- Department of Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | | | - Stephan Payr
- Department of Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Julian Joestl
- Department of Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Micha Komjati
- Department of Orthopaedics, Hospital of sacred Heart of Jesus, Vienna, Austria
| | - Harald Binder
- Department of Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Mark Schurz
- Department of Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Roman C Ostermann
- Department of Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
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30
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Horst K, Garving C, Thometzki T, Lichte P, Knobe M, Dienstknecht T, Hofman M, Pape HC. Comparative study on the treatment of Rockwood type III acute acromioclavicular dislocation: Clinical results from the TightRope ® technique vs. K-wire fixation. Orthop Traumatol Surg Res 2017; 103:171-176. [PMID: 27940250 DOI: 10.1016/j.otsr.2016.11.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 10/28/2016] [Accepted: 11/11/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND HYPOTHESIS The aim of this study was to address the inconsistency regarding the operative treatment of Rockwood type III acromioclavicular joint separation. We compared results after single- and double TightRope® reduction with results after acromioclavicular transfixation via K-wires only and additional ligament augmentation in acute acromioclavicular (AC) joint separations graded Rockwood type III, and hypothesized that the TightRope® technique leads to better clinical and radiological results. MATERIALS AND METHODS We conducted a retrospective clinical cohort study and included 42 consecutive patients (mean age 43 years [24-66]) diagnosed and operatively treated between 2004 and 2012 (mean follow-up was 54.6 months [15-118]). Specific shoulder scores as well as scores reflecting the patients' overall mental and physical health status were used. Radiological evaluation was also performed. RESULTS The SF12 test revealed comparability between all subgroups. Specific shoulder tests and a visual analogue scale demonstrated comparable results. Radiographic measurements showed a significant reduction in the AC distance and CC distance after surgery in all subgroups. The early complication rate was 9.5% for all patients, while late complications occurred in 14.3% of all cases. CONCLUSIONS Compared to the established methods, the operative TightRope® procedures represent a safe alternative in Rockwood III injuries. All investigated techniques predominantly led to good and excellent clinical results in acute Rockwood type III AC joint instabilities. Avoidance of material removal and shorter hospital stays appear to speak in favour for the TightRope® technique. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- K Horst
- Department of Orthopaedic Trauma at Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany.
| | - C Garving
- Klinik für Unfall-, Schulter- und Handchirurgie, Krankenhaus Agatharied, Norbert-Kerkel-Platz, 83734 Hausham, Germany
| | - T Thometzki
- Department of Orthopaedic Trauma at Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany
| | - P Lichte
- Department of Orthopaedic Trauma at Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany
| | - M Knobe
- Department of Orthopaedic Trauma at Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany
| | - T Dienstknecht
- Department of Orthopaedic Trauma at Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany
| | - M Hofman
- Department of Orthopaedic Trauma at Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany
| | - H-C Pape
- Department of Orthopaedic Trauma at Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany
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31
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Jensen G, Ellwein A, Voigt C, Katthagen JC, Lill H. [Injuries of the acromioclavicular joint: Hook plate versus arthroscopy]. Unfallchirurg 2016; 118:1041-53; quiz 1054-5. [PMID: 26601846 DOI: 10.1007/s00113-015-0108-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Acute acromioclavicular (AC) joint injuries are common in clinical practice. The hook plate is a well-established conventional operative treatment option for high grade instability; however, arthroscopically-assisted flexible double button techniques are increasingly being used. Both procedures lead to good or excellent results. The advantages of the hook plate are the simple surgical technique and the possibility of an early functional aftercare. The minimally invasive one-step procedure with the possibility of identification and treatment of frequently concomitant glenohumeral pathologies is advantageous for the arthroscopic technique but mobilization is more restrictive. Available comparative studies have shown no significant clinical differences but a tendency towards better results with a higher degree of acceptance among patients for the arthroscopic and minimally invasive non-rigid double button procedures.
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Affiliation(s)
- G Jensen
- Abteilung des Berufsgenossenschaftlichen Unfallkrankenhauses Hamburg, Klinik für Unfall- und Wiederherstellungschirurgie, Diakoniekrankenhaus Friederikenstift gGmbH Hannover, Humboldtstr. 5, 30169, Hannover, Deutschland.
| | - A Ellwein
- Abteilung des Berufsgenossenschaftlichen Unfallkrankenhauses Hamburg, Klinik für Unfall- und Wiederherstellungschirurgie, Diakoniekrankenhaus Friederikenstift gGmbH Hannover, Humboldtstr. 5, 30169, Hannover, Deutschland
| | - C Voigt
- Abteilung des Berufsgenossenschaftlichen Unfallkrankenhauses Hamburg, Klinik für Unfall- und Wiederherstellungschirurgie, Diakoniekrankenhaus Friederikenstift gGmbH Hannover, Humboldtstr. 5, 30169, Hannover, Deutschland
| | - J C Katthagen
- Abteilung des Berufsgenossenschaftlichen Unfallkrankenhauses Hamburg, Klinik für Unfall- und Wiederherstellungschirurgie, Diakoniekrankenhaus Friederikenstift gGmbH Hannover, Humboldtstr. 5, 30169, Hannover, Deutschland
| | - H Lill
- Abteilung des Berufsgenossenschaftlichen Unfallkrankenhauses Hamburg, Klinik für Unfall- und Wiederherstellungschirurgie, Diakoniekrankenhaus Friederikenstift gGmbH Hannover, Humboldtstr. 5, 30169, Hannover, Deutschland
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32
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Cano-Martínez JA, Nicolás-Serrano G, Bento-Gerard J, Picazo-Marín F, Andrés-Grau J. Acute high-grade acromioclavicular dislocations treated with triple button device (MINAR): Preliminary results. Injury 2016; 47:2512-2519. [PMID: 27663286 DOI: 10.1016/j.injury.2016.09.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 09/12/2016] [Accepted: 09/14/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Describe the clinical and radiological results of triple button device in the treatment of high-grade AC dislocations (Rockwood, type V) and assess whether improves vertical and horizontal stability compared to the techniques previously described. MATERIAL AND METHODS This retrospective study included 39 patients with type V acromioclavicular dislocations treated with Twin Tail TightRope™ system (triple button device). Of the 39 patients, 33 (26 men and 7 women) were able to participate in clinical and radiographic follow up. At the time of surgery, the mean age was 25years±7(range, 17-49). All patients underwent bilateral-weighted Zanca (CC distance) and Alexander view (AC distance) as well as the Constant Score (CS) and Acromioclavicular Joint Instability Scoring System (ACJI). Radiological and clinical outcome was assessed during routine follow-up examinations preoperatively, postoperatively, 1, 3, 6 months and every year after the surgery. The presence of calcification, degenerative changes, mobilization of implants and bone resorption were also assessed. RESULTS After a mean follow up of 25±4months (range 14-38), the results of the Constant (CS) were 94.1±5,5 (range 76-100) and test ACJI 87.3±9,8 (range 65-100), showing no significant differences with the uninjured shoulder (CS 95.8±2.5, range 83-100; ACJI 94.1±3.7, range 80-100). At final review, we observed that preoperative coracoclavicular distance (Zanca View) improved from 21,75±1.97mm to 8,73mm±0.75 and the acromioclavicular distance (Alexander View) from 12,65mm±1.99 to 0,35±0.3mm. Compared with healthy shoulder, these differences were not significant. There was no loss of reduction with this system in the vertical plane. 4 patients (12.12%) revealed signs of posterior instability with worse clinical test results. The presence of degenerative joint changes (6,06%), calcifications (27,2%) or mobilization of the implant (18,18%) was not associated with worse clinical outcomes. CONCLUSION Twin Tail device using minimally invasive technique improves stability in the vertical and, specially in the horizontal plane relative to the previously described techniques without increasing number of complications.
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Affiliation(s)
- José Antonio Cano-Martínez
- Department of Orthopaedic Surgery, University of Murcia, Los Arcos del Mar Menor General Hospital, Paraje Torre Octavio, 54, CP: 30739, Pozo Aledo, San Javier, Murcia, Spain.
| | - Gregorio Nicolás-Serrano
- Department of Orthopaedic Surgery, University of Murcia, Los Arcos del Mar Menor General Hospital, Paraje Torre Octavio, 54, CP: 30739, Pozo Aledo, San Javier, Murcia, Spain
| | - Julio Bento-Gerard
- Department of Orthopaedic Surgery, University of Murcia, Los Arcos del Mar Menor General Hospital, Paraje Torre Octavio, 54, CP: 30739, Pozo Aledo, San Javier, Murcia, Spain
| | - Francisco Picazo-Marín
- Department of Orthopaedic Surgery, University of Murcia, Los Arcos del Mar Menor General Hospital, Paraje Torre Octavio, 54, CP: 30739, Pozo Aledo, San Javier, Murcia, Spain
| | - Josefina Andrés-Grau
- Department of Orthopaedic Surgery, University of Murcia, Los Arcos del Mar Menor General Hospital, Paraje Torre Octavio, 54, CP: 30739, Pozo Aledo, San Javier, Murcia, Spain
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Kim YJ, Chun YM. Treatment of Acute Acromioclavicular Joint Dislocation: Kirschner's Wire Trans-acromial Fixation versus AO Locking Hook Plate Fixation. Clin Shoulder Elb 2016. [DOI: 10.5397/cise.2016.19.3.149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Faggiani M, Vasario GP, Mattei L, Calò MJ, Castoldi F. Comparing mini-open and arthroscopic acromioclavicular joint repair: functional results and return to sport. Musculoskelet Surg 2016; 100:187-191. [PMID: 27287544 DOI: 10.1007/s12306-016-0411-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 05/26/2016] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Acromioclavicular joint (ACJ) dislocation is a common injury that can result from sports activities. The surgical technique for the treatment of Type III and Type IV injuries, according to the Rockwood classification, remains controversial. The purpose of the study was to determine the functional outcome after minimally invasive and arthroscopic surgery. The mini-open surgery was done with MINAR® system, whereas the arthroscopic technique was done with Dog BoneTM Button. STUDY DESIGN Retrospective Cohort study. METHODS We reviewed 31 who were surgically treated for acute acromioclavicular dislocation Type III and Type IV (2012-2015). We excluded subjects with chronic dislocation or other injury. We selected 16 patients (average age 37). Half of the sample patients were treated with mini-open surgery with the MINAR® system, and the other half of the patients were treated with the Dog Bone arthroscopic technique. The Constant Shoulder Score, the Oxford Shoulder Score, the Simple Shoulder Test and the Subjective Patient Outcome for Return to Sports (SPORTS) score were used to assess functional outcome of the treated shoulder. RESULTS Mean follow-up was 13 months (range 6-27 months). The mean Constant Shoulder Score was 91.10 (range 82.76-96.66), Oxford Shoulder Score was 46.19 (range 42.00-48.00), the Simple Shoulder Test was 10.50 (range 9.00-12.00), and the SPORTS score was 7.88 (range 3-10). There is a statistically significant difference between the sample operated with the mini-open surgery and the group operated with arthroscopic technique. The probability of return to their sport, according to the results of the SPORTS score, was significantly higher for patients treated with the MINAR® system (p < 0.001). However, the objective parameter of Constant scale is statistically better in patients operated by arthroscopic technique (p < 0.05; p < 0.001). CONCLUSION Restoration of ACJ anatomy is the key to a successful therapy. The surgical technique should be personalized. The miny-open surgery and also the arthroscopic surgery are adequate with good clinical results. However, according to the SPORTS score, the patients treated with mini-open surgery returned to their sport with less pain and better performance than those belonging to the other group.
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Affiliation(s)
- M Faggiani
- Department of Orthopaedics and Traumatology, CTO and Maria Adelaide Hospital, University of Turin Medical School, 29, Via Zuretti, 10126, Turin, TO, Italy.
| | - G P Vasario
- Department of Orthopaedics and Traumatology, CTO and Maria Adelaide Hospital, University of Turin Medical School, 29, Via Zuretti, 10126, Turin, TO, Italy
| | - L Mattei
- Department of Orthopaedics and Traumatology, CTO and Maria Adelaide Hospital, University of Turin Medical School, 29, Via Zuretti, 10126, Turin, TO, Italy
| | - M J Calò
- Department of Orthopaedics and Traumatology, CTO and Maria Adelaide Hospital, University of Turin Medical School, 29, Via Zuretti, 10126, Turin, TO, Italy
| | - F Castoldi
- Department of Orthopaedics and Traumatology, CTO and Maria Adelaide Hospital, University of Turin Medical School, 29, Via Zuretti, 10126, Turin, TO, Italy
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Song T, Yan X, Ye T. Comparison of the outcome of early and delayed surgical treatment of complete acromioclavicular joint dislocation. Knee Surg Sports Traumatol Arthrosc 2016; 24:1943-50. [PMID: 25119054 DOI: 10.1007/s00167-014-3225-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 07/31/2014] [Indexed: 12/23/2022]
Abstract
PURPOSE The aim of this study is to compare the clinical and radiographic results and the complication rate between early and delayed surgical treatment of acromioclavicular joint (ACJ) dislocation. METHODS Publications in the management of ACJ dislocation are identified from the PubMed database between January 1993 and December 2013 using "acromioclavicular joint" and "dislocation" as keywords. The eligibility criteria included are as follows: (1) ACJ dislocation; (2) intervention, early compared with delayed surgical treatment or the surgical treatment for acute compared with chronic ACJ dislocation; (3) human; and (4) English articles. Exclusion criteria consist of the following: (1) type I and type II ACJ dislocation, (2) no definition of the time of early and delayed surgery in studies, (3) no comparison between the clinical result of early and delayed surgery in studies, (4) laboratory studies, radiographic studies, biomechanical studies, (5) the cases including fractures or revisions in studies, and (6) systematic analyses. RESULTS Eight studies comparing early and delayed surgical treatment of ACJ dislocation are included in this systematic review. According to Constant scores and shoulder subjective value, early surgery has better functional outcomes than delayed surgery in the treatment of ACJ dislocation (P < 0.05). Partial-dislocation/re-dislocation is found at 26.0 % in early and 38.1 % in delayed surgical treatment (P < 0.05). The rate of CC ossification in early surgical treatment is found as the same as the delayed. The complication rates are found at 12.5 % in early surgical treatment and 17.7 % in the delayed, which is not significantly different. CONCLUSION Early surgical treatment may have superiority to the delayed procedure in the management of ACJ dislocation with better functional outcomes and more satisfied reduction. However, high-quality evidence studies are required to provide stronger support for this opinion in the future. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Tengfei Song
- Department of Orthopaedic Surgery, Shanghai Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Xu Yan
- Department of Orthopaedic surgery, 455 Hospital of PLA, 338 West Huaihai Road, Shanghai, 200052, China
| | - Tianwen Ye
- Department of Orthopaedic Surgery, Shanghai Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China.
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Reliability of radiographic measurements for acromioclavicular joint separations. Orthop Traumatol Surg Res 2015; 101:S291-5. [PMID: 26548513 DOI: 10.1016/j.otsr.2015.09.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 09/03/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The treatment of acromioclavicular (AC) joint separations is controversial, particularly for Rockwood type III injuries. Rockwood type IV injuries, which correspond to horizontal instability, are very likely under-diagnosed. The objective of this study was to evaluate the inter- and intra-observer reproducibility of the Rockwood classification through an evaluation of standard radiographs, as described in the original article. MATERIAL AND METHODS This was a prospective radiographic study using protocol-based data from the 2014 symposium of the French Society of Arthroscopy (SFA). Fifteen anonymized radiological records were analysed by six independent examiners on two occasions, 1 week apart. The records consisted of a comparative A/P view of the two acromioclavicular joints (Zanca view), an axillary lateral view and dynamic lateral views (Tauber protocol) to uncover dynamic horizontal instability. A detailed analysis protocol was implemented that included absolute and relative measurements on each view; the relative measurements were used to account for radiographic magnification. RESULTS The inter- and intra-observer reproducibility on the A/P radiographs was good to excellent. The reproducibility was fair to good on the lateral views, but the measurements varied greatly from one subject to another, and significant errors were found with certain records. The reproducibility of the dynamic views proposed by Tauber was poor to fair. DISCUSSION Radiographic analysis of AC joint separations is reproducible in the vertical plane, which makes it possible to diagnose Rockwood type II, III and V injuries. On the other hand, static and dynamic analyses in the horizontal plane do not have good reproducibility and do not contribute to make an accurate diagnosis of Rockwood type IV injuries. LEVEL OF EVIDENCE Level I, Diagnostic study.
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Millett PJ, Horan MP, Warth RJ. Two-Year Outcomes After Primary Anatomic Coracoclavicular Ligament Reconstruction. Arthroscopy 2015; 31:1962-73. [PMID: 25998014 DOI: 10.1016/j.arthro.2015.03.034] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 03/11/2015] [Accepted: 03/19/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to report the clinical and structural outcomes after anatomic coracoclavicular ligament reconstruction (ACCR) with free tendon allografts in patients with grade III and grade V acromioclavicular (AC) joint dislocations. METHODS Thirty-one shoulders underwent primary ACCR with tendon allografts for Rockwood grade III and grade V AC joint dislocations. Preoperative data included patient demographic characteristics, injury characteristics, and surgical history, along with American Shoulder and Elbow Surgeons (ASES) scores, Short Form 12 Physical Component Summary (SF-12 PCS) scores, and various pain scales. Outcome measures were also collected a minimum of 2 years postoperatively with the addition of Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores; Single Assessment Numeric Evaluation (SANE) scores; and patient satisfaction. In addition, preoperative and postoperative coracoclavicular distances were analyzed using standard anteroposterior radiographs. RESULTS ACCR was performed in 31 patients (31 shoulders) with a mean age of 43.9 years (range, 21 to 71 years). In 7 patients (22.6%) a complication occurred that required a subsequent surgical procedure including graft rupture/attenuation (2), clavicle fractures (2), distal clavicle hypertrophy (2), and adhesive capsulitis (1). Of the remaining 24 patients, 20 (83.3%) had subjective outcome data available after a minimum 2-year follow-up period (mean, 3.5 years; range, 2.0 to 6.2 years). The mean postoperative ASES and SF-12 PCS scores significantly improved when compared with the preoperative baseline values (58.9 v 93.8 for ASES scores [P < .001] and 45.3 v 54.4 for SF-12 PCS scores [P = .007]). At final follow-up, the SANE and QuickDASH scores were 89.1 and 5.6, respectively, with a median patient satisfaction rating of 9 of 10. CONCLUSIONS Patients who did not require revision surgery showed excellent postoperative outcome scores: The mean ASES score was 93.8, the mean SANE score was 89.1, and the mean QuickDASH score was 5.6, with a median patient satisfaction rating of 9 of 10. Further study regarding ACCR techniques should focus on decreasing the risks of complications and maintaining reduction of the AC joint. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Peter J Millett
- Center for Outcomes-based Orthopaedic Research, Steadman Philippon Research Institute, Vail, Colorado, U.S.A.; The Steadman Clinic, Vail, Colorado, U.S.A..
| | - Marilee P Horan
- Center for Outcomes-based Orthopaedic Research, Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Ryan J Warth
- Center for Outcomes-based Orthopaedic Research, Steadman Philippon Research Institute, Vail, Colorado, U.S.A
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Yoon JP, Lee BJ, Nam SJ, Chung SW, Jeong WJ, Min WK, Oh JH. Comparison of results between hook plate fixation and ligament reconstruction for acute unstable acromioclavicular joint dislocation. Clin Orthop Surg 2015; 7:97-103. [PMID: 25729525 PMCID: PMC4329540 DOI: 10.4055/cios.2015.7.1.97] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 06/25/2014] [Indexed: 01/28/2023] Open
Abstract
Background In the present study, we aimed to compare clinical and radiographic outcomes between hook plate fixation and coracoclavicular (CC) ligament reconstruction for the treatment of acute unstable acromioclavicular (AC) joint dislocation. Methods Forty-two patients who underwent surgery for an unstable acute dislocation of the AC joint were included. We divided them into two groups according to the treatment modality: internal fixation with a hook plate (group I, 24 cases) or CC ligament reconstruction (group II, 18 cases). We evaluated the clinical outcomes using a visual analog scale (VAS) for pain and Constant-Murley score, and assessed the radiographic outcomes based on the reduction and loss of CC distance on preoperative, postoperative, and final follow-up plain radiographs. Results The mean VAS scores at the final follow-up were 1.6 ± 1.5 and 1.3 ± 1.3 in groups I and II, respectively, which were not significantly different. The mean Constant-Murley scores were 90.2 ± 9.9 and 89.2 ± 3.5 in groups I and II, respectively, which were also not significantly different. The AC joints were well reduced in both groups, whereas CC distance improved from a mean of 215.7% ± 50.9% preoperatively to 106.1% ± 10.2% at the final follow-up in group I, and from 239.9% ± 59.2% preoperatively to 133.6% ± 36.7% at the final follow-up in group II. The improvement in group I was significantly superior to that in group II (p < 0.001). Furthermore, subluxation was not observed in any case in group I, but was noted in six cases (33%) in group II. Erosions of the acromion undersurface were observed in 9 cases in group I. Conclusions In cases of acute unstable AC joint dislocation, hook plate fixation and CC ligament reconstruction yield comparable satisfactory clinical outcomes. However, radiographic outcomes based on the maintenance of reduction indicate that hook plate fixation is a better treatment option.
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Affiliation(s)
- Jong Pil Yoon
- Department of Orthopaedic Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Byoung-Joo Lee
- Department of Orthopaedic Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Sang Jin Nam
- Department of Orthopaedic Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Seok Won Chung
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Korea
| | - Won-Ju Jeong
- Department of Orthopaedic Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Woo-Kie Min
- Department of Orthopaedic Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Joo Han Oh
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Band Wiring and Coracoclavicular Screw in Acromioclavicular Dislocations. RAZAVI INTERNATIONAL JOURNAL OF MEDICINE 2014. [DOI: 10.5812/rijm.20336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Warth RJ, Lee JT, Millett PJ. Arthroscopically-Assisted Anatomic Coracoclavicular Ligament Reconstruction With Tendon Grafts: Biomechanical Rationale, Surgical Technique, and a Review of Clinical Outcomes. OPER TECHN SPORT MED 2014. [DOI: 10.1053/j.otsm.2013.10.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Shimi M, Elidrissi M, Mechchat A, Elibrahimi A, Elmrini A. [Interest of hook plate technique in recent acromioclavicular dislocations Rockwood stage III and V: about 12 cases]. Pan Afr Med J 2014; 17:203. [PMID: 25161747 PMCID: PMC4142631 DOI: 10.11604/pamj.2014.17.203.2779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 12/05/2013] [Indexed: 11/11/2022] Open
Affiliation(s)
- Mohammed Shimi
- Service de Chirurgie Ostéoarticulaire B4, CHU Hassan II, Fès, Maroc
| | | | - Atif Mechchat
- Service de Chirurgie Ostéoarticulaire B4, CHU Hassan II, Fès, Maroc
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Sabharwal S, Patel NK, Gauher S, Holloway I, Athansiou T, Athansiou T. High methodologic quality but poor applicability: assessment of the AAOS guidelines using the AGREE II instrument. Clin Orthop Relat Res 2014; 472:1982-8. [PMID: 24566890 PMCID: PMC4016437 DOI: 10.1007/s11999-014-3530-0] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 02/12/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND The American Academy of Orthopaedic Surgeons (AAOS) is a globally recognized leader in musculoskeletal and orthopaedic education. Clinical guidelines are one important focus of the AAOS' educational efforts. Although their recommendations sometimes generate controversy, a critical appraisal of the overall quality of these guidelines has not, to our knowledge, been reported. QUESTIONS/PURPOSES We wished to assess the overall quality of the AAOS guidelines using the AGREE II (Advancing Guideline Development, Reporting and Evaluation in Health Care) instrument. METHODS All 14 guidelines available on the AAOS website as of August 2, 2013 were evaluated. Appraisal was performed by three reviewers, independently, using the AGREE II instrument. This is an internationally recognized and validated assessment tool for evaluating guideline quality. Interrater reliability was calculated and descriptive statistics were performed. Strong interrater reliability was shown using a Spearman's Rho test (correlation coefficient ≥ 0.95). RESULTS The overall results for AGREE II domains across all 14 guidelines were: scope and purpose (median score, 95%), stakeholder involvement (median score, 83%), rigor of development (median score, 94%), clarity of presentation (median score, 92%), applicability (median score, 48%), and editorial independence (median score, 79%). CONCLUSIONS This study showed that the overall quality of the AAOS guidelines is high, however their applicability was found to be poor. The value of guidelines that have a high quality but that are difficult for clinicians to implement is questionable. Numerous suggestions have been proposed to improve applicability including; health economist involvement in guideline production, implementation of pilot studies and audit to monitor uptake of the guidelines and clinician feedback sessions and barrier analysis studies. Future AAOS guidelines should consider and implement steps that can improve their applicability.
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Affiliation(s)
- Sanjeeve Sabharwal
- />Department of Surgery and Cancer, Imperial College, 10th Floor QEQM Building, St Mary’s Hospital, London, W2 1NY UK
| | - Nirav K. Patel
- />Department of Surgery and Cancer, Imperial College, 10th Floor QEQM Building, St Mary’s Hospital, London, W2 1NY UK
| | - Salman Gauher
- />Department of Orthopaedic Surgery, The North West London Hospitals NHS Trust, Northwick Park Hospital, Harrow, UK
| | - Ian Holloway
- />Department of Orthopaedic Surgery, The North West London Hospitals NHS Trust, Northwick Park Hospital, Harrow, UK
| | - Thanos Athansiou
- />Department of Surgery and Cancer, Imperial College, 10th Floor QEQM Building, St Mary’s Hospital, London, W2 1NY UK
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de Figueiredo EA, Belangero PS, Ejnisman B, Pochini ADC. Complex shoulder injuries in sports. BMJ Case Rep 2014; 2014:bcr2014203661. [PMID: 24695687 PMCID: PMC3987643 DOI: 10.1136/bcr-2014-203661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2014] [Indexed: 11/03/2022] Open
Abstract
A 26-year-old Olympic wrestling athlete presented with a pectoralis major muscle injury, glenohumeral instability and acromioclavicular joint dislocation separately. The patient underwent surgical treatment to repair these injuries. The pectoralis major muscle was reconstructed with a semitendinosus tendon graft using the endobutton technique, as described by Pochini et al. Treatment of the traumatic anterior instability was performed using the technique described by Bristow-Latarjet, and the acromioclavicular joint dislocation was repaired using the modified technique of Weaver-Dunn with the aid of an anchor. The athlete exhibited a rapid recovery and could return to normal activities 6 months after surgery. At present, 18 months postoperatively, the patient is asymptomatic.
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Jensen G, Katthagen JC, Alvarado LE, Lill H, Voigt C. Has the arthroscopically assisted reduction of acute AC joint separations with the double tight-rope technique advantages over the clavicular hook plate fixation? Knee Surg Sports Traumatol Arthrosc 2014; 22:422-30. [PMID: 23124627 DOI: 10.1007/s00167-012-2270-5] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2012] [Accepted: 10/19/2012] [Indexed: 12/11/2022]
Abstract
PURPOSE The purpose of this study was to compare the results after arthroscopically assisted double TightRope(®)-(TR) reduction with results after clavicular hook plate (HP) fixation in acute high-grade acromioclavicular (AC) joint separations. METHODS Between 2004 and 2010, 69 consecutive patients with acute AC joint separations type Rockwood III and V were subjected to surgical reconstruction. 56 patients (81 %) were available for evaluation. Thereof, 30 (median age: 39 years; n = 12 acute Rockwood III and n = 18 Rockwood V injuries) were treated by a clavicular HP and 26 (median age: 39 years; n = 10 acute Rockwood III and n = 16 Rockwood V injuries) using the double TR technique. Group HP was evaluated at a median of 48 (7-77) months after surgery and the TR group 17 (7-29) months after stabilization. Visual Analogue Scale (VAS) for Pain, Simple Shoulder Test (SST), Constant Score (CS) and Taft Score (TS) were assessed. Sonographic measurements were performed to evaluate recurrent instability. RESULTS Clinical examination demonstrated comparable results without significant differences. In the groups HP and TR, the VAS was median 0.8 (range, 0.0-7.5) and 0.4 (range, 0.0-5.7), the SST reached median 11 (range, 0-12 points) and 12 points (range, 8-12 points). The CS was median 92.4 % (range, 21.5-105.4 %) and 94.0 % (range, 54.6-105.3 %) and the TS median 10 (range, 3-12 points) and 10 points (range, 5-12 points). Sonographic measurements showed a mean coracoclavicular (CC) distance of 25.3 ± 4.5 (HP) and 25.5 ± 4.3 mm (TR) (n.s.). In both groups, CC distance of the operated side was significantly higher compared to the uninjured side. The complication rate was 13 % in group HP and 12 % in group TR. CONCLUSIONS In acute high-grade AC joint instabilities, both techniques lead to mostly good and excellent clinical results, although comparable partial recurrent vertical instability could be observed. Diagnosis and therapy of concomitant glenohumeral injuries and no obligatory implant removal are advantages of the arthroscopic procedure.
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Affiliation(s)
- Gunnar Jensen
- Department of Trauma and Reconstructive Surgery, Friederikenstift Hospital Hannover, Humboldtstraße 5, 30169, Hannover, Germany,
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Martetschläger F, Horan MP, Warth RJ, Millett PJ. Complications after anatomic fixation and reconstruction of the coracoclavicular ligaments. Am J Sports Med 2013; 41:2896-903. [PMID: 24007761 DOI: 10.1177/0363546513502459] [Citation(s) in RCA: 164] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Reconstruction of the disrupted acromioclavicular (AC) joint has historically resulted in high complication rates. As a result, there has been a move toward anatomic coracoclavicular (CC) ligament fixation and reconstruction, owing to its numerous biomechanical advantages and perceived clinical advantages. PURPOSE To report and analyze the unique complications associated with these anatomic CC ligament procedures using either cortical fixation buttons (CFBs) or tendon grafts (TGs) and to evaluate the effect that these complications have on patient outcomes. STUDY DESIGN Case series; Level of evidence, 4. METHODS From January 2006 until May 2011, a total of 59 primary anatomic CC ligament procedures were performed using either CFBs or TGs. Demographic, surgical, subjective (including the American Shoulder and Elbow Surgeons [ASES], quick Disabilities of the Arm, Shoulder and Hand [QuickDASH], Short Form-12 [SF-12], and Single Assessment Numeric Evaluation [SANE] scores), and radiographic data along with surgical complications were prospectively collected and retrospectively analyzed. Construct survivorship, defined as the maintenance of reduction of the AC joint, was calculated using the Kaplan-Meier method at 12- and 24-month intervals. RESULTS Surgical treatment for AC joint dislocations was performed in 3 women (4 shoulders) and 52 men (55 shoulders) with a mean age of 43.6 years (range, 18-71 years); 13 shoulders (22.0%) underwent fixation using the CFB technique, and 46 shoulders (78.0%) underwent reconstruction using the TG technique. The overall complication rate was 27.1% (16/59) in this study. There were 3 complications (23.1%) in the CFB group, including 1 coracoid fracture and 2 cases of hardware failure resulting in a loss of reduction. There were 13 complications (28.2%) in the TG group, including 4 graft ruptures, 2 clavicle fractures, 1 case of hardware failure, 1 hypertrophic distal clavicle, 2 cases of hardware pain, 1 suture granuloma, 1 case of adhesive capsulitis, and 1 case of axillary neuropathy. Twelve- and 24-month construct survivorship was calculated to be 86.2% and 83.2%, respectively. Of the 43 shoulders that did not have a complication, mean ASES scores significantly improved from 57.5 (range, 0-97) to 91 (range, 63-100) (P < .001), and mean SF-12 physical component summary scores significantly improved from 45 (range, 25-58) to 56 (range, 43-65.8) (P < .001) after a mean 2.4-year follow-up (range, 1.0-5.7 years). There were no significant differences in outcomes between those that did and did not experience a complication, with the exception that those with complications had significantly decreased median patient satisfaction compared with those without complications (3.5 vs 9, respectively; P = .049). CONCLUSION Anatomic procedures to treat disrupted CC ligaments using either CFBs or TGs resulted in an overall complication rate of 27.1% (16/59). Construct survivorship was calculated to be 86.2% at 12 months and 83.2% at 24 months. Good to excellent outcomes could only be reported in those patients who did not have a complication.
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Affiliation(s)
- Frank Martetschläger
- Peter J. Millett, Center for Outcomes-Based Orthopaedic Research (COOR Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 1000, Vail, CO 81657. )
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Horst K, Dienstknecht T, Andruszkow H, Gradl G, Kobbe P, Pape HC. Radiographic changes in the operative treatment of acute acromioclavicular joint dislocation - tight rope technique vs. K-wire fixation. Pol J Radiol 2013; 78:15-20. [PMID: 24505220 PMCID: PMC3908503 DOI: 10.12659/pjr.889615] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 09/27/2013] [Indexed: 11/18/2022] Open
Abstract
Background Operative treatment of higher degree acromioclavicular joint luxation is common. A new option is made available by the tight rope technique. It claims to provide adequate outcome with the use of a minimally invasive technique. First clinical studies justified its medical use, but the equivalence to established surgical methods remains unclear. We therefore analyzed radiographic data from patients that were treated with the tight rope system (TR) and compared them to those treated with K-wires (KW) fixation. Material/Methods Retrospective study with inclusion criteria: surgery for acromioclavicular joint luxation between 2004 and 2011, classified as Rockwood type III, no concomitant injury, first event injury. We compared pre- and post-operative X-rays with those taken at the end of treatment. Clinical data from follow-ups and radiographic data were evaluated. The main outcome variable was the remaining distance between the acromion and clavicle (ACD), as well as the coracoid process and clavicle (CCD). Results 27 patients (TR: n=16; KW: n=11) with comparable demographics and injury severity were included. Surgery reduced ACD (TR: p=0.002; KW: p<0.001) and CCD (TR: p=0.001; KW: p=0.003). Heterotopic ossification or postoperative osteolysis was not significantly associated with either one of the procedures. Three patients (18.75%) in the TR group showed impaired wound healing, migrating K-wires were recorded in 2 patients (18.2%) and impingement syndrome occurred in 1 patient (9.1%) with K-wires. Posttraumatic arthritis was not seen. There was a loss of reduction in 2 cases within the TR-group (12.51%) and 1 in the KW-group (9.1%). At last follow up, ACD and CCD were wider in both groups compared to the healthy side. Conclusions This study shows that the Tight rope system is an effective alternative in the treatment of higher degree acromioclavicular luxation and comparable to the established methods.
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Affiliation(s)
- Klemens Horst
- Department of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Thomas Dienstknecht
- Department of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Hagen Andruszkow
- Department of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Gertraud Gradl
- Department of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Philipp Kobbe
- Department of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Hans-Christoph Pape
- Department of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
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Prevalence and pattern of glenohumeral injuries among acute high-grade acromioclavicular joint instabilities. J Shoulder Elbow Surg 2013; 22:760-6. [PMID: 23021905 DOI: 10.1016/j.jse.2012.08.016] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Revised: 08/05/2012] [Accepted: 08/16/2012] [Indexed: 02/01/2023]
Abstract
BACKGROUND With increasing numbers of arthroscopically assisted acromioclavicular (AC) joint stabilization procedures has come an increase in reports of concomitant glenohumeral injuries among AC joint separations. The aim of the present study was to evaluate the prevalence, pattern, and cause of glenohumeral pathologies among a large patient population with acute high-grade AC joint instability. MATERIALS AND METHODS A total of 125 patients (13 women, 112 men) with high-grade AC joint dislocation (6 Rockwood II; 119 Rockwood V) underwent diagnostic glenohumeral arthroscopy before AC joint repair. Pathologic lesions were evaluated for acute or degenerative origin and, if considered relevant, treated all-arthroscopically. RESULTS Concomitant glenohumeral pathologies were found in 38 of 125 patients (30.4%). Analysis of pathogenesis distinguished different patterns of accompanying injuries: acute intra-articular lesions, related to the recent shoulder trauma, were found in 9 patients (7.2%), degenerative lesions, considered to be unrelated to the recent trauma, were found in 18 (14.4%), and 11 (8.8%) had an unclear traumatic correlation (intermediate group). Within the acute and the degenerative group, affected structures were predominantly partial, articular-sided tears of the anterosuperior rotator cuff, including instabilities of the pulley complex, followed by pathologies of the long head of the biceps and superior labrum anteroposterior lesions. The intermediate group presented mainly with articular-sided partial tears of the subscapularis tendon. CONCLUSIONS This prospective study showed a high prevalence (30%) of concomitant glenohumeral pathologies, of which some indicate additional surgical therapy and could be missed by an isolated open AC repair. Hence, the arthroscopic approach for AC joint stabilization allows for the diagnosis and treatment of associated intra-articular pathologies.
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Jensen G, Katthagen JC, Alvarado L, Lill H, Voigt C. Arthroscopically assisted stabilization of chronic AC-joint instabilities in GraftRope™ technique with an additive horizontal tendon augmentation. Arch Orthop Trauma Surg 2013; 133:841-51. [PMID: 23604789 DOI: 10.1007/s00402-013-1745-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Indexed: 01/28/2023]
Abstract
PURPOSE A chronic symptomatic acromioclavicular joint (ACJ) instability is a possible consequence of an acute ACJ separation. Besides vertical instability a horizontal component of the instability is common in high-grade ACJ separation and clinically relevant; especially, in chronic cases. A new technique of horizontal biologic ACJ augmentation with a transacromial gracilis tendon loop as an addition to the arthroscopically assisted stabilization with the GraftRope™ device is described and first clinical and sonographical results are shown. HYPOTHESIS The results after arthroscopically assisted single bundle reconstruction of the coracoclavicular (CC) ligaments with an additional horizontal tendon augmentation are comparable to the results of other stabilizing techniques in chronic ACJ instabilities. METHODS A consecutive series of 20 patients with chronic symptomatic ACJ instability was stabilized with this new technique. 16 patients were followed-up clinically and sonographically. Patient satisfaction, visual analogue scale (VAS), simple shoulder test (SST), Constant score (CS) and Taft score (TS) were assessed. Bilateral sonographic measurements were performed to evaluate recurrent instabilities. Complications and concomitant glenohumeral injuries were analyzed. RESULTS Sixteen patients (n = 2 female, n = 14 male, median age 40 (21-61) years, follow-up rate 84 %) were evaluated median 13 months (range 4-27 months) after indexed operation. 11 patients had a chronic ACJ instability after Rockwood type III, and 5 patients after Rockwood type V lesion. 6 patients suffered a recurrent symptomatic instability after operative treatment. 10 patients of the group were primary stabilized with the new technique. 15 of 16 patients were satisfied with the result of the operation at the follow-up examination. The VAS was median 4.6 of 10 points (range 1.1-7.4 points). The SST reached 9 points (range 5-12 points). The adjusted CS was median 84 % (range 46-93 %) and TS median 9 points (range 5-12 points). The sonographic measurements showed a significant difference in the CC distance between the unaffected and the affected side (21.7 vs. 24.8 mm, p = 0.009). The acromioclavicular distance was median 11 mm (range 7-17 mm) after resection of the lateral clavicle. Concomitant glenohumeral injuries were arthroscopically detected in seven patients. Postoperative complications occurred in one patient (wound infection). In one case, the clavicular washer was removed due to local paresthesia after healing of the graft. CONCLUSIONS The arthroscopically assisted stabilization of chronic ACJ instabilities with the GraftRope™ device and an additive horizontal tendon augmentation technique leads to good short-term results with a supplementary horizontal stabilization.
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Affiliation(s)
- Gunnar Jensen
- Department of Trauma and Reconstructive Surgery, Friederikenstift Hospital Hannover, Humboldtstraße 5, 30169, Hannover, Germany.
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Robb AJ, Howitt S. Conservative management of a type III acromioclavicular separation: a case report and 10-year follow-up. J Chiropr Med 2013; 10:261-71. [PMID: 22654684 DOI: 10.1016/j.jcm.2011.01.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Revised: 01/10/2011] [Accepted: 01/18/2011] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The purpose of this study is to present a 10-year prospective case of a right incomplete type III acromioclavicular (AC) separation in a 26-year-old patient. CLINICAL FEATURES A 26-year-old male patient fell directly on his right shoulder with the arm in an outstretched and overhead position. Pain and swelling were immediate and were associated with a "step deformity." The patient had limited right shoulder range of motion (ROM), strength, and function. Radiographic findings confirmed a type III AC separation on the right. At 1-year follow-up, the patient did not report any deficits in ROM or function, but did note a prominent distal clavicle on the right. At 3-, 5-, 7-, and 10-year follow-up, the patient did not report changes from 1 year. The radiographic findings at the 10-year follow-up indicated mild degenerative joint disease in both AC joints and mild elevation of the distal clavicle on the right. INTERVENTION AND OUTCOME The patient received chiropractic care to control for pain, swelling, and loss of ROM. The patient received acupuncture, joint mobilizations, palliative adhesive taping of the AC joint, Active Release Technique, and progressive resisted exercises. Radiographic study was done at the time of the injury and at 10 years to observe for any osseous changes in the AC joint. CONCLUSION The patient yielded excellent results from conservative chiropractic management that was reflected in a prompt return to work 19 days after the injury. Follow-up at 1, 3, 5, 7, and 10 years exhibited absence of residual deficits in ROM and function. The "step deformity" was still present after the injury on the right.
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Affiliation(s)
- Andrew J Robb
- Department of Undergraduate Studies, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada M2H 3J1
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Rochcongar G, Emily S, Lebel B, Pineau V, Burdin G, Hulet C. Measure of horizontal and vertical displacement of the acromioclavicular joint after cutting ligament using X-ray and opto-electronic system. Surg Radiol Anat 2012; 34:639-43. [DOI: 10.1007/s00276-012-0953-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Accepted: 03/02/2012] [Indexed: 11/28/2022]
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