Acromioclavicular joint dislocation: reconstruction of coracoclavicular ligament with fiber tape by using a new knot technique

Comparison of hook plate with versus without double-tunnel coracoclavicular ligament reconstruction for repair of acute acromioclavicular joint dislocations: A prospective randomized controlled clinical trial

Objective To compare the efficacy between hook plate combined with coracoclavicular ligament functional reconstruction by conjoined tendon transfer and single hook plate surgery in the treatment of Rockwood type III and type V acute acromioclavicular joint dislocations. Methods A prospective cohort study was conducted to analyze the clinical data of 37 patients with Rockwood type III and V acute acromioclavicular dislocations admitted to Jiangning Hospital Affiliated to Nanjing Medical University from October 2011 to April 2016. According to the random number method, the patients were divided into combined tendon and ligament reconstruction group (ligament reconstruction group, 19 patients) and clavicular hook plate group (single plate group, 18 patients). In the ligament reconstruction group, there were 14 males and five females, aged (47.0±11.4)years, and there were 10 patients with type III and nine with type V. In the simple plate group, there were 12 males and six females, aged (45.0±11.2)years, and there were 11 patients with type III and seven with type V. In the ligament reconstruction group, the acromioclavicular joint was reduced by clavicular hook plate, and the oblique ligament and the conical ligament were reconstructed by lateral half-inversion of the short head tendon of biceps brachii combined with tendon. The double-bundle functional reconstruction of coracoclavicular ligament was performed. In single plate group, hook plate was used to reduce acromioclavicular joint. The intraoperative blood loss, incision length, operation time, and visual analogue score (VAS) before operation and after 1 year follow-up were compared. Constant-Murley score and Karlsson score were used to evaluate the effect of operation. X-ray films were taken regularly to observe the reduction and maintenance of acromioclavicular joint dislocation. The complications were recorded. Results All patients were followed up for 17-24 months [(20.0±1.7)months]. There was no significant difference in intraoperative blood loss between the two groups (P>0.05). In the ligament reconstruction group and single plate group, the incision length was (13.4±0.8)cm and (6.6±0.7)cm (P 0.05); the VAS at 1 year after operation was (2.1±0.9)points and (3.8±1.4)points (P<0.05). X-ray showed good reduction of acromioclavicular joint in ligament reconstruction group, with no loss of reduction occurred after removal of hook plate. In the simple plate group, loss of reduction, resorption of distal clavicle bone and bone fusion occurred after removal of hook plate. The Constant-Murley scores in the ligament reconstruction group and the single plate group were (89.5±2.9)points and (79.6±5.0)points respectively; the excellent and good rates of Karlsson score were 89.5% (17/19) and 61.1% (11/18) (bothP<0.05), respectively. In the ligament reconstruction group, one patient complained of pain and swelling at the tendon. In the single plate group, loss of reduction occurred in three patients after removal of internal fixator; obvious subacromial osteolysis was seen in seven patients at 1 year after operation; and impingement sign was positive in nine patients at 1 year after operation. Conclusion The overall surgical effect of hook plate combined with coracoclavicular ligament functional reconstruction by conjoined tendon transfer is superior to single hook plate surgery in the treatment of type Rockwood III and Rockwood V acute acromioclavicular joint dislocations, though with longer operation time and bigger incision. Key words: Acromioclavicular joint; Dislocations; Coracoclavicular ligament

Objective To compare the clinical outcomes of palmaris longus tendon(PLT)and iliotibial tract fascia graft(ITFG)for coracoclavicular ligament(CCL)reconstruction combined with hook plate fixation in the treatment of acromioclavicular joint(AGJ)dislocation. Methods A retrospective study was conducted to evaluate the outcomes of 68 patients with ACJ dislocation of Rockwood type Ⅲ and above who had been treated in our department with CCL reconstruction using PLT or ITFG in addition to hook plate fixation from January 2008 to January 2014. They were 57 males and 11 females, with an average age of 36. 1 years(range, from 19 to 55 years). The patients were divided into 2 groups according to their grafts used in CCL reconstruction: 36 cases in PLT group and 32 in ITFG group. They were firstly treated with CCL reconstruction followed by hook plate fixation. The hook plates were removed at 6 months after operation. The acromioclavicular and coracoclavicular distances were measured on the postoperative anteroposterior radiographs of the injured shoulders. The outcomes were assessed at the final follow-ups according to Constant-Murley shoulder score and Karlsson criteria. The 2 groups were compatible without significant differences in preoperative general data(P> 0. 05). Results The 68 patients were followed up for an average of 18 months(range, from 16 to 22 months). The acromioclavicular and coracoclavicular distances measured in PLT group at 12 months after operation were significantly larger than those measured in ITFG group(P 0. 05). Conclusion In the treatment of ACJ dislocation of Rookwood type Ⅲ and above, CCL reconstruction using ITFG may lead to better radiographic outcomes than that using PLT, though the 2 grafts lead to similar functional recovery of the injured shoulders. Key words: Acromioclavicular joint; Dislocations; Ligament; Reconstructive surgical procedures

To explore the clinical outcomes of acromioclavicular joint (ACJ) dislocation treated with coracoclavicular ligament (CCL) reconstruction using lateral half of conjoined tendon and tractusiliotibialis with hook plate fixation. Comparative study on their advantages and disadvantages in order to provide the materials for the clinic. From June 2005 to June 2012, the patients with Rockwood type III or severer ACJ dislocation were randomly divided into 2 groups. They underwent CCL reconstruction using lateral half of conjoined tendon (conjoined tendon reconstruction group, n = 36) and tractusiliotibialis (tractusiliotibialis reconstruction group, n = 38) with subsequent fixation of hook plates. During the follow-up, the AC and CC distances were measured on postoperative plain films after a removal of hook plates. And the outcomes were assessed according to Karlsson criteria and Constant-Murley shoulder score. Ranked data were analyzed with the use of χ2 test and measurement date with two-sample t test. Results A total of 74 patients were followed up for an average of 20 (12 - 24) months. No significant inter-group differences existed in age, gender, injured side or classification. And there was no statistical difference in ACor CC distance between two groups within 6 months (P > 0. 05) after a removal of hook plates. The AC and CC distances of conjoined tendon reconstruction group were larger than those of tractusiliotibialis reconstruction group (t = 2. 313, P = 0. 026; t = 2. 114, P = 0. 041) within 12 months. The AC and CC distances of 12 months were both larger than those of 6 months (t =2. 631, P =0. 017; t = 2. 297, P = 0. 032). According to the Constant-Murley shoulder score, conjoined tendon reconstruction group was less than tractusiliotibialis reconstruction group (85. 2 ± 10. 2 vs 93. 1 ± 6. 9, t = 2. 965, P = 0. 006). According to the Karlsson Criteria, the excellent and good rate of functional recovery was 75. 00% in conjoined tendon reconstruction group versus 94. 74% in tractusiliotibialis reconstruction group (χ2 = 8. 111, P = 0. 044). The efficacy of Rockwood type III acromioclavicular joint dislocation for reconstructing coracoclavicular ligament using tractusiliotibialis is better than conjoined tendon. The AC and CC distances increase after a removal of hook plates while it is more obvious for conjoined tendon tractusiliotibialis reconstruction.

Objective To compare the clinical outcomes of different coracoclavicular ligament (CCL) reconstruction combined with hook plate fixation in the treatment of acromioclavicular joint (ACJ) dislocation of Rookwood type Ⅲ-Ⅴ. Methods A retrospective study was conducted to evaluate the outcomes of 76 patients with ACJ dislocation of Rockwood type Ⅲ-Ⅴ who had been treated with CCL reconstruction using iliotibial tract fascia graft or palmaris longus tendon in addition to hook plate fixation from January 2012 to March 2016. The patients were divided into 2 groups according to their grafts used in CCL reconstruction:group A (39 cases using iliotibial tract fascia graft) and group B (37 cases using palmaris longus tendon iliotibial tract fascia graft). They were firstly treated with CCL reconstruction followed by hook plate fixation. The acromioclavicular and coracoclavicular distances were measured on the postoperative anteroposterior radiographs of the injured shoulders. The outcomes were assessed at the final follow-ups according to Constant-Murley shoulder score and Karlsson criteria. Results The acromioclavicular distances and coracoclavicular distances measured in group A at 12 months after operation were significantly smaller than those measured in group B: (4.7 ± 0.7) mm vs. (5.4 ± 1.3) mm, (7.5 ± 1.5) mm vs. (8.5 ± 1.6) mm, P 0.05). The total incidence of complications in group A and there showed no statistical difference compared with that of group B (P > 0.05). Conclusions In the treatment of ACJ dislocation of Rookwood type Ⅲ-Ⅴ, CCL reconstruction using iliotibial tract fascia graft may lead to better radiographic outcomes than compared with that using palmaris longus tendon, though the 2 grafts lead to similar functional recovery of the injured shoulders. Key words: Acromioclavicular joint; Dislocations; Ligament; Reconstructive surgical procedures

Introduction Acromioclavicular joint (ACJ) injuries can result from a multitude of causes. Most injuries occur during activities with high-impact risks such as contact sports, football, ice hockey, and wrestling, with male athletes at greater risk than female athletes. The stability of AC joint depends on the joint capsule, the acromioclavicular (AC) and coracoclavicular (CC) ligaments, and the intraarticular fibrocartilaginous disc. The choice of the required surgical technique for the management of AC disruption is a controversial issue owing to the abundance of the surgical options described for treatment. However, the clinical superiority of these procedures remains debatable, and various complications have been reported. Hypothesis This hypothesis is that the anatomical reconstruction of the CC ligaments may render better long-term functional and radiological results compared with the use of a hook plate in ACJ dislocations. Patients and methods This is a prospective nonrandomized comparative study that was held between August 2011 and January 2017 at Cairo University Hospitals. It included 64 patients with acute AC dislocation type III–VI and divided into two groups: group A, which underwent anatomic reconstruction of CC and AC ligaments, and group B, which underwent ACJ dislocation using the hook plate. The mean age of group A patients was 43.22±11.46 years, whereas it was 41.56±8.70 years in group B. There were 22 male and 10 female patients in group A compared with 21 male and 11 female patients in group B. The mean time from injury was 8.41±3.41 weeks in group A compared with 9.91±1.59 weeks in group B. The average follow-up was 64.06±4.24 months in group A versus 63.94±3.79 months in group B. The clinical outcome was assessed preoperatively and postoperatively at 1, 2, and 5 years using the visual analog scale, Constant score, and American shoulder and elbow surgeon score. Radiological assessment included the measurement of the CC distance (vertical displacement) and the anteroposterior (horizontal) displacement preoperatively and postoperatively at 1 year and at the final follow-up. Results Regarding the clinical outcome, the visual analog scale score improved from 7.06±1.22 preoperatively to 1.06±1.07 at 5-year follow-up in group A, whereas it improved from 7.5±0.92 preoperatively to 2.97±0.59 at 5-year follow-up in group B, with P=0.000. Similarly, the American shoulder and elbow surgeon score improved from 26.64±8.15 preoperatively to 92.06±5.37 postoperatively in group A, whereas in group B, it improved from 19.87±7.56 preoperatively to 77.1±5.40 postoperatively (P=0.000). The constant score in group A improved from 20.44±2.66 preoperatively to 92.91±3.64 postoperatively, and in group B, it improved from 20.13±2.29 preoperatively to 80.53±4.76 postoperatively (P=0.000). The radiological assessment at the final follow-up showed that the anteroposterior (horizontal) displacement in group A was 4.31±2.62 preoperatively and became 1.06±1.01 postoperatively, whereas in group B, it was 5.56±2.12 preoperatively and became 3.41±1.29 postoperatively, with a statistically significant difference (P=0.000). The superior displacement in group A was 21.57±5.09 mm preoperatively and decreased to 10.61±1.02 postoperatively compared with 23.99±5.92 preoperatively, which decreased to 13.36±3.67 postoperatively in group B, with statistically significant difference (P=0.001). Conclusion The concomitant anatomical reconstruction of the CC and AC ligaments using autograft provides long-term functional outcome and mechanical stability in both the vertical and horizontal translation compared with the hook plate fixation in acute unstable ACJ dislocation.

Background In recent years, the incidence of acromioclavicular joint dislocation has been increasing. The main causes are falling from high places, car accidents and sports injuries. Rockwood et al. classified AC joint dislocation into 6 types, which has certain guiding significance for the choice of treatment methods. The conservative treatment of Rockwood type I and II dislocation is satisfactory, while type III and other dislocations require surgical treatment to repair the completely broken coracoclavicular ligament. A large number of surgical methods for acromioclavicular joint dislocation have been reported in literatures, but the surgical choice is controversial.With the development of biomechanics research and material science, more and more surgeons tend to reconstruct coracoclavicular ligament to treat AC joint dislocation. Most surgeons regard the coracoclavicular ligament as a single bundle without reconstructing the trapezoidal ligament and the conical ligament separately. The double-bundle reconstruction reported in a few literatures is not an exact anatomical reconstruction. In this paper, we introduce a method of complete anatomical reconstruction of coracoclavicular ligament with double-bundle Endobutton loop-plate and Ethibond-2 suture according to the anatomy origin. The method was applied to 22 patients with type III-V acromioclavicular joint dislocation, including fresh or old injuries. They were followed up for at least 12 months to evaluate the early clinical outcome. Methods 1. Patient information: Twenty patients with acromioclavicular joint dislocation diagnosed by Jiangsu People's Hospital from August 2013 to June 2015 were included. Another 2 patients from September to December 2015 in Nanjing Qixia District Hospital were also included in this study. There were 15 males and 7 females, with an average age of 44.5 (17-71) years. The dislocation of acromioclavicular joint was unilateral, including 9 cases on the left side, 13 cases on the right side and 13 cases on the dominant side. The causes of injuries included 12 falls, 7 car accidents and 3 sports injuries. X-ray and CT was performed on bilateral shoulder before operation to determine the Rockwood classification, including 7 cases of type III, 1 case of type IV and 14 cases of type V. The including criteria was Rockwood III or above of acromioclavicular joint dislocation and no other history of fracture, dislocation or trauma of the affected limb. The average operation time from injury to reconstruction of coracoclavicular ligament was 24.5 (2-182) years. Old injuries defined as that the treatment was delayed for more than 3 weeks after injury. There were 6 cases of old dislocation and 16 cases of fresh dislocation. This study was approved by the Medical Ethics Committee of the First Affiliated Hospital of Nanjing Medical University. All patients signed the informed consent and agreed to complete anatomical reconstruction of coracoclavicular ligament for acromioclavicular dislocation. 2. Operative methods: Under general anesthesia, we took the beach chair position. A 10 cm long arc incision was made from the distal clavicle to the tip of coracoid process. The skin, subcutaneous, superficial fascia and deep fascia were incised to expose the upper surface of distal clavicle. During this process, the insertion of deltoid and trapezius muscle were dissected minimally, and the coracoid process was exposed through the groove between deltoid and pectoralis major muscles, so as to avoid injuring the cephalic vein.According to the anatomical position of the trapezoidal ligament and the conical ligament, the coracoid process and clavicle were drilled with a 2.0 mm K-wire. The insertion point on clavicle is the projection of trapezoidal and conical ligament on supraclavicle surface, and the outlet point is the attachment of the trapezoidal and conical ligament on the subclavicle surface. The insertion point on the coracoid process is the attachment of conical and trapezoid ligament on the upper surface. The outlet point on coracoid process is on basal surface. The drill diameter should be 3.0 mm to avoid penetrating the cortex of the coracoid process and keep the adjacent bone channels at a certain distance.A double-folded No.2 Ethibond suture A was passed through the clavicle and coracoid tunnel in turn under the guide of suture passer. The acromioclavicular joint is repositioned by manipulation. The acromioclavicular joint is temporarily fixed with a 2.0 mm K-wire. The full reduction of acromioclavicular joint is confirmed by fluoroscopy during operation. The length of the loop is measured by comparing two ethibond sutures of the same length. A suitable size of endobutton (A) is selected according to the measured length. Then pass another No.2 ethibond suture B through the first hole and the fourth hole of the looped plate A, and then take a No.2 ethibond suture C through the loop . Under the guidance of suture A, suture B and C were passed through the tunnel of clavicle and coracoid process. Suture B is gently pulled to place the plate A at the base of coracoid process. Suture C is gently pulled to make the loop pass through the tunnel of coracoid process and clavicle. A plate B without loop is placed in the loop passing through the first and fourth hole of plate B, respectively. After removing K-wire, fluoroscopy showed satisfactory reduction and reliable fixation . Then we explore the acromioclavicular joint, using absorbable suture to strengthen the acromioclavicular joint capsule. After a large amount of saline irrigation, close the wound layer by layer. 3. Postoperative rehabilitation: The patients were encouraged to increase the active ROM of shoulder after 6 weeks. Gradual resistance training was postponed to 8 weeks after operation. Normal physical work and physical exercise could be resumed 6 months after operation. 4. Functional Evaluation: VAS score and Constant score were performed at 3, 6 and 12 months after operation. AP and axillary view of bilateral shoulder joints were re-examined. Coracoclavicular space of affected side and healthy side was measured before and after operation. Coracoclavicular space refers to the vertical distance between the lowest point of the subclavicle surface and the highest point of the upper surface of the coracoid process. All scores and measurements were independently completed by three physicians. 5. Statistical Analysis: Each data is averaged by three times of evaluation results, and all data are expressed by mean±standard deviation. Normality test was performed on each group of data. Paired t test and Wilcoxon test were used before and after operation. P<0.05 showed significant difference. Data were processed by SPSS l8.0 software. Results The patients were followed up for 12 to 24 months (the average follow-up time was 17.7 + 4.0 months) . The visual analogue score of pain decreased from 5.0 to 0.2 after 12 months (P 0.91,) . Four patients with AC joint arthritis complained of mild pain in the shoulder joint. Nonsteroidal anti-inflammatory and analgesic drugs were given orally with good results. Constant score did not decrease significantly. During the follow-up period, no serious complications such as re-dislocation and clavicular or coracoid process fracture were found. Conclusions Complete anatomical reconstruction of coracoclavicular ligament with double-bundle Endobutton is a safe, reliable and novel surgical method. It has been applied to the treatment of Rockwood III-V fresh or old acromioclavicular dislocation with good clinical results. Key words: Acromioclavicular joint dislocation; Coracoclavicular ligament; Complete anatomical reconstruction; Trapezoidal ligament; Conical ligament

Optimal treatment of chronic unstable acromioclavicular (AC) joint dislocations (stage 3-5 according the Rockwood classification) is still debated. Anatomic coracoclavicular (CC) reconstruction is a reliable option in terms of two-dimensional radiographic reduction, clinical outcomes, and return to sports, but there remain concerns regarding anterior-posterior stability of the AC joint with CC ligament reconstruction alone. The aim of the present study was to describe the mid-term results of a new hybrid technique with CC and AC ligament reconstruction for chronic AC joint dislocations. Twenty-two patients surgically treated for chronic AC joint dislocations (grade 3 to 5) were retrospectively reviewed. All patients were assessed before surgery and at final follow-up with the Constant-Murley score (CMS) and the American Shoulder and Elbow Surgeons (ASES) score. The CC vertical distance (CCD) and the CCD ratio (affected side compared to unaffected side) were measured on Zanca radiographs preoperatively, at 6months postop and at final follow-up. The same surgical technique consisting in a primary fixation with a suspensory system, coracoclavicular ligaments reconstruction with a double loop of autologous gracilis and acromioclavicular ligaments reconstruction with autologous coracoacromial ligament was performed in all cases. Twenty-two shoulders in 22 patients (19 males and 3 females) were evaluated with a mean age of 34.4 ± 9years at the time of surgery. The mean interval between the injury and surgery was 53.4 ± 36.7days. The mean duration of postoperative follow-up was 49.9 ± 11.8months. According to the Rockwood classification, there were 5 (22.6%) type-III and 17 (77.2%) type-V dislocations. Mean preoperative ASES and CMS were 54.4 ± 7.6 and 64.6 ± 7.2, respectively. They improved to 91.8 ± 2.3 (p = 0.0001) and 95.2 ± 3.1 (p = 0.0001), respectively at final FU. The mean preoperative CCD was 22.4 ± 3.2mm while the mean CCD ratio was 2.1 ± 0.1. At final FU, the mean CCD was 11.9 ± 1.4mm (p = 0.002) and the mean CCD ratio was 1.1 ± 0.1 (p = 0.009). No recurrence of instability was observed. One patient developed a local infection and four patients referred some shoulder discomfort. Heterotopic ossifications were observed in three patients. The optimal treatment of chronic high-grade AC joint dislocations requires superior-inferior and anterior-posterior stability to ensure good clinical outcomes and return to overhead activities or sports. The present hybrid technique of AC and CC ligaments reconstruction showed good clinical and radiographic results and is a reliable an alternative to other reported techniques. Level IV.

Objective To report the clinical and radiological outcomes of coracoclavicular ligament reconstruction with an autogenous anterior half of the peroneus longus tendon (AHPLT) for acromioclavicular (AC) joint dislocations. Methods Between June 2013 and April 2015, a total of 24 patients with AC joint dislocation of Rockwood types Ⅲ to Ⅴ underwent surgical repair using coracoclavicular ligament reconstruction with an autogenous AHPLT graft. They were 20 men and 4 women, aged from 22 to 68 years (average, 50.7 years). The left side was affected in 15 cases and the right in 9. According to Rockwood classification, there were 5 cases of type Ⅲ, 5 ones of type Ⅳ and 14 ones of type Ⅴ. Twenty of them had acute injury and 4 chronic injury. They were evaluated preoperatively and at 1, 3, 6, and 12 months postoperatively in terms of the Constant score, American Orthopedic Foot and Ankle Society(AOFAS) ankle-hindfoot score,visual analogue scale (VAS) score, and loss of reduction on radiographs. Results Twenty patients completed clinical and radiographic follow-ups at 6 and 12 months postoperatively while the other 4 did not. At postoperative 6 and 12 months, the Constant scores were 81and 96 for the affected side and both 96 for the healthy side, respectively. The Constant score at 6 months for the affected side was significantly lower than that for the healthy side (P 0.05). At postoperative 6 and 12 months, the VAS scores for the affected side were 2 and 0 respectively, significantly lower than the preoperative one (5) (P 0.05). One patient complained of shoulder pain at postoperative 12 months. No surgical site infection or perioperative fracture was observed. Conclusions Coracoclavicular ligament reconstruction with an autogenous AHPLT proves effective for AC joint dislocations. Since it is easy and safe to harvest an autogenous AHPLT and the usable length of AHPLT graft is sufficient for reconstruction, autogenous AHPLT may be a reliable alternative to the present tendon graft sources for coracoclavicular ligament reconstruction. Key words: Shoulder joint; Dislocation; Ligaments, articular

Introduction: Injuries to the acromioclavicular (AC) joint can range from modest, transient pain to significant displacement, chronic pain, and shoulder biomechanical changes that result in long-term disability. Aim and Objective: We aimed to evaluate the functional outcome of anatomical reconstruction of ACJ using autologous semitendinosus graft in type III-VI AC joint dislocations. Materials and Methods: In this study, 20 patients with AC joint dislocation (Rockwood type III-VI) were managed by surgical fixation using autologous semitendinosus graft from November 01, 2019, to October 31, 2020, at our center. After providing written informed consent, the study enrolled patients who satisfied the inclusion criteria. Preoperative, three-month, and six-month UCLA shoulder scores were assessed. Results: Mean age of participants was 36.5 years (SD: 9.86). Radiological evaluation at each visit suggested a 100.0% success rate of this method. 95% of the participants had no complications, while 5.0% had DVT. No participants had SSI. Conclusions: Autologous semitendinosus graft fixation of type III-VI AC joint injuries is a viable surgical option with the advantages of being a biological fixation, single surgery, and having excellent functional outcomes. However, extensive multicentric comparative studies are required to draw definitive conclusions.

Background: Acromioclavicular (AC) joint dislocation is a frequent orthopedic injury, typically resulting from trauma to the shoulder. The severity of the injury can range from mild to severe, with treatment approaches varying accordingly. Higher-grade dislocations, such as Rockwood Type V, are particularly challenging for surgeons due to the complexity of the injury and the need for precise restoration of joint stability and function. This case report aims to present the successful use of a modified anatomic coracoclavicular ligament reconstruction technique in managing a Rockwood V AC joint dislocation, highlighting its potential benefits in restoring joint function and stability. Case Presentation: A 53-year-old female presented with right shoulder pain and stiffness three months after a motor vehicle accident. Physical examination revealed clavicular deformity, tenderness, and swelling. Radiographs showed upward clavicle displacement, widened AC and coracoclavicular (CC) joints, and arthritis of the distal clavicle. Diagnosed with Rockwood type V AC joint dislocation, she underwent surgery. The Mumford procedure addressed distal clavicle arthritis, while the AC joint was reconstructed with a modified anatomic CC ligament reconstruction using a semitendinosus graft. Post-surgery, the patient had favorable outcomes at 2, 4, and 18 months, with a Constant score of 89 at 18 months. A shoulder radiograph showed a CC distance of 12 mm, though a study reported no correlation between CC distance and clinical outcomes. Conclusion: The modified anatomic CC ligament reconstruction offered an effective surgical solution for managing a chronic Rockwood type V AC joint dislocation. The patient showed significant improvement in shoulder function, with no complications observed 18 months post-surgery. This technique mimics the natural ligament anatomy and offers a reliable and effective alternative to traditional methods with promising long-term outcomes.

The injury of acromioclavicular joint is one of the causes limitation function of the shoulder joint. Choice of fixation methods of acromioclavicular joint dislocation is actual topic to research. Objective: to study by a biomechanical experiment and to substantiate influence of different fixation methods of acromioclavicular joint dislocation on range of motion of acromioclavicular and sternoclavicular joints during the upper extremity elevation. Methods: 6 prototypes of a natural skeleton 3D technology from ADS plastic were used. The capsuloligamentous components, dynamic and static stabilizations of acromioclavicular and sternoclavicular joint were modeled from artificial materials. Each model of acromioclavicular dislocation was fixed by 6 different fixations methods: «intact joint», «fixation by Weber», «Bosworth screw», «Hook-plate», «DogBone», «External fixation». During the experimental study, the range of motions was fixed in acromioclavicular and sternoclavicular joints in 90 and 180 degrees of arm elevation, each experiment was repeated 5 times. Results: range of motion in acromioclavicular and sternoclavicular joints in position of 90 degree of arm elevation, with fixation of acromioclavicular joint dislocation by Hook-plate and system of 2 mini plates and suture material (DogBone), in position of 180 degree of arm elevation with fixation of «DogBone» was physiological. Other methods of fixation — «Bosworth screw», «Weber fixation», «External fixation», «Hook plate» limited the range of motion in the acromioclavicular joint and increase motion in the sternoclavicular joint at maximal arm elevation. Conclusions: fixation of acromioclavicular joint dislocation by 2 mini plates and suture material (DogBone) gives physiological range of motion in acromioclavicular and sternoclavicular joints during arm elevation.

BackgroundIn treatment of chronic acromioclavicular (AC) joint dislocations, both the Weaver–Dunn procedure (WD) and CC ligament reconstruction (CCR) are recommended options due to the low possibility of healing of the coracoclavicular (CC) ligaments. The aim of this review was to determine whether CCR will yield favorable clinical and radiographic outcomes in the treatment of chronic AC dislocations.MethodThe Cochrane Library, EMBASE, and PubMed databases were searched for literature on chronic AC dislocations from data inception to June 30, 2021. Patient data were pooled using standard meta-analytic approaches. The Cochrane-Mantel–Haenszel method and variance-weighted means were used to analyze the outcomes. The Review Manager version 5.3 software (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark) was used to calculate the heterogenicity, mean difference, and relative risk (RR) for all outcomes in the meta-analysis.ResultsThe current analysis included four trials on this topic, and all AC joint dislocations were classified as Rockwood types III to VI. The pooled data showed that the CCR group had significantly better post-operative American Shoulder and Elbow Surgeons Shoulder (ASES) scores, Oxford Shoulder Scores (OSSs), and Nottingham Clavicle Scores (NCSs) than the WD group, with a significant difference (p < 0.001, p = 0.020, and p < 0.001, respectively). In terms of the post-operative Constant-Murley Scores (CMSs), there were no significant differences between the CCR group and the WD group (p = 0.100). The CCR group had significantly better post-operative abduction and flexion of the index shoulder than the WD group (p < 0.001 and p < 0.001, respectively). In terms of radiological outcomes, the post-operative coracoclavicular distance (CCD) with a 10 kg load was smaller in the CCR group compared to that in the WD group (p < 0.001). The overall surgical wound infection rate was 11.6% in the WD group and 12.9% in the CCR, respectively (p = 0.82).ConclusionThe CCR group had better clinical outcome scores in the ASES, OOS, NCS, abduction, flexion, and external rotation than the WD group. In terms of radiological outcomes, the CCR group showed less displacement in weight-loaded post-CCD than the WD group, which indicated that the CCR provided more stability and resistance to deformation forces.

BackgroundThe identification and precise clavicle-coracoid drilling during coracoclavicular (CC) ligament reconstruction for acromioclavicular (AC) joint dislocation require a high level of experience and surgical skills. Furthermore, the improvement of flexible fixation, such as Endobutton techniques for CC ligament reconstructions is ongoing. We have developed a 3D printing technique navigation template for clavicle-coracoid drilling and a novel implant for the reconstruction. This study aimed to determine the efficiency of the navigation template for clavicle-coracoid drilling and to evaluate the biomechanical performance of the novel CC ligament reconstruction technique.MethodsA total of 24 fresh-frozen human cadaveric shoulders were randomly assigned to 1 of 3 reconstruction groups or a control group: TightRope, Triple Endobutton, and the Adjustable Closed-Loop Double Endobutton technique. Computed tomography scans, navigation template designs, and 3D printing were performed for the shoulders. Then, AC joint dislocation was simulated in the reconstruction groups, and 3 CC ligament reconstruction techniques were operated via the 3D printing template separately. Furthermore, biomechanical protocols including the translation test (load from 5 to 70 N) and the load-to-failure test were performed to characterize the behaviors and strengths. One-way ANOVA test analyzed differences in displacement under the translation load and the load at failure.ResultsCC ligament reconstructions were performed successfully along with the 3D printing navigation template in the 3 reconstruction groups. During the translation test, no significant difference was found in displacements among the 4 groups. Meanwhile, the mean load of all reconstruction groups at failure (Adjustable Closed-Loop Double Endobutton, 722.1620 N; TightRope, 680.4020 N; Triple Endobutton, 868.5762 N) was significantly larger than the control group (564.6264 N, P<0.05). The Triple Endobutton group had the maximum load at failure (P<0.05), however, no significant difference was noticed between the other 2 reconstruction groups (P>0.05).ConclusionsThe 3D printing navigation template may become helpful and reliable for AC joint dislocation surgery. Among the 3 CC ligament reconstruction techniques, the Triple Endobutton technique has the best strength in terms of biomechanics, while the biomechanical strength of the Adjustable Closed-Loop Double Endobutton technique is reliable in comparison with the TightRope technique.

Introduction:The clavicle, humerus and acromioclavicular (AC) joint separately are very commonly involved in traumatic injuries around the shoulder.Acromioclavicular joint dislocation with distal clavicle fracture is a well recognized entity in clinical practice. AC joint dislocation with mid shaft clavicle fracture is uncommon and only few cases have been reported in literature.However, to the best of our knowledge, this is the first case report to describe an acromioclavicular dislocation with ipsilateral mid shaft clavicle, mid shaft humerus and coracoid process fracture. Fractures of the humerus and clavicle along with the acromioclavicular joint dislocation were fixed at the same setting.Case Report:A 65-year-old male met with a high velocity road traffic accident. Plain radiographs showed displaced mid third clavicle fracture with acromioclavicular joint dislocation with mid shaft humerus fracture. Surgical fixation was planned for humerus with interlocking nail, clavicle with locking plate and acromioclavicular joint with reconstruction of coracoclavicular ligaments. Intraoperatively, coracoid process was found to have a comminuted fracture. The operative plan had to be changed on table as coracoclavicular fixation was not possible. So acromioclavicular joint fixation was done using tension band wiring and the coracoclavicular ligament was repaired using a 2-0 ethibond. The comminuted coracoid fracture was managed conservatively. K wires were removed at 6 weeks. Early mobilization was started.Conclusion:In acromioclavicular joint injuries, clavicle must be evaluated for any injury. Although it is more commonly associated with distal clavicle fractures, it can be associated with middle third clavicle fractures. As plain radiographs, AP view are most of the times insufficient for viewing integrity of coracoid process, either special views like Stryker notch or CT scan may help in diagnosing such concealed injuries. When associated with fractures of the humerus and clavicle, anatomical restoration of acromioclavicular joint along with anatomical reduction and a rigid fixation of associated fractures is essential. Proper rehabilitation protocol is a must for achieving promising results. In our case, we were able to achieve a stable surgical fixation of both the fractures as well as AC joint, which enabled us to start early joint mobilization and rehabilitation.