ACROMIOCLAVICULAR AND CORACOCLAVICULAR RECONSTRUCTIONBY NYLON TAPE VERSUS CORACOCLAVICULAR SCREW IN MANAGEMENT OF ACUTE ACROMIOCLAVICULAR DISLOCATION

Abstract

Background & Purpose: A number of different surgical techniques were described to treat acute acromioclavicular (AC) joint dislocations which aim to restore joint congruity and mechanical stability. The purpose of this study was to compare functional, radiological outcomes and fixation related complications of acromioclavicular and coracoclavicular (CC) reconstruction by nylon tape versus coracoclavicular screw in management of acute acromioclavicular dislocation.Patients &Methods: In the periodfrom September 2017 to December 2019, a prospectiverandomized controlled clinical trial was conducted in Ain Shams University hospitals including 30 cases with types III and V AC injuries. They were divided into two groups, 15 patients underwent AC and C Creconstruction by nylon tape (Group A) and the other 15 patients underwent coracoclavicular screw (Group B).The patients were evaluated forpain, range of motion (ROM), radiologic findings (CC distance difference between both sides was measured), American Shoulder and Elbow Surgeons(ASES), and Constant scores. Postoperative complications were recorded and assessment of time of returning to the work was done. The evaluation was done preoperatively and each time of follow up with a minimum period of one year.Results: After a mean follow up period of 15±2.7 months for group A and 14.37±4.74 months for group B, patients of both groups showed highly significant improvement between mean preoperative and postoperative pain, ROM, Constant, ASES scores and CC distance difference. Group A showed better results as regard mean postoperative ROM, Constant score and ASES score than group B, while group B showed better results as regard mean postoperative pain score and CC distance difference. However, there was no statistically significant difference between the 2 groups. In group A the mean post-operative pain and ROM scores (both as a part of constant score) was 12.67 (±3.2) and 33.53 (±2.9) respectively while in group B was 12.92 (±3.34) and 32.83 (±2.98) respectively. The mean post-operative Constant and ASES scores was 86.93 (±7.22) and 89.93 (±7.5) respectively for group A and 86.17 (±8.33) and 87.58 (±6.08) respectively for group B. Radiographic CC distance difference (mm) between both shoulders at one year postoperatively was 2.27 in group A and 2.13 in group B. There was a statistically significant difference between the mean time to return to work for patients in group A (3.2 months) and patients in group B (4.2 months). Complete loss of reduction occurred in three patients in group B, two cases of subluxation (50 % of the preoperative CC distance difference) in group A, one case of wound infection in each group and one case of fracture clavicle in group B. Conclusion: Both AC and CC reconstruction by nylon tape and CC screw procedures are valid surgical options and have adequate outcome in treatment of patients with acute AC dislocation. However there are some concerns about the failure rate and the need of another operation for screw removal that was present in CC screw group which affects patient satisfaction in that group.