EXTERNAL FIXATION COMBINED WITH A MODIFIED MINIMALLY INVASIVE AC JOINT RECONSTRUCTION SYSTEM IN ACUTE AND CHRONIC ACROMIOCLAVICULAR DISLOCATIONS

Abstract

Background: Acromioclavicular joint (ACJ) dislocations are among one of the most common injuries of the shoulder and still a challenge for surgeons. We propose a technique that combines the advantages of external fixation (to obtain a stable reduction of ACJ) and a modified suspension device system (for minimally invasive ACJ reconstruction) in acute dislocations. We tend to add associate augmentation of autologous semitendinosus graft to supply a biological reconstruction of the coracoclavicular (CC) ligaments in chronic dislocations. Material and Methods: We enrolled 8 patients, 6 with acute and 2 with chronic injuries. Inclusion criteria were the following: types IV, V, and VI ACJ dislocations; type III ACJ dislocations in high-demand patients. Exclusion criteria were the following: asymptomatic chronic ACJ dislocation without functional impairment, previous coracoid or clavicle fracture, nonparticipating patients, alcohol abusers, previous infection, and neurological problems. The external fixator was removed at 40 days after surgery and patients were followed up clinically (through Constant Score and Simple Shoulder Test Questionnaires) and radiologically for the first three months, at six months and one year after surgery. Results: In all cases, radiographic ACJ reduction was maintained at a minimum one-year follow-up. Steel wire breakage occurred in one patient but the retained tip in the clavicle was asymptomatic; we report no further complications. Shoulder active and passive range of motion was painless in all patients; the Constant score (CS) was 85/100 and the Simple Shoulder Test (SST) score was 9/10 on average at one year of follow-up. Conclusions: Our technique demonstrated stable joint reduction and good functional outcomes at one-year follow-up and it seems to be promising, but more clinical and biomechanical studies are required to confirm these encouraging results.