Acromioclavicular Joint Disruption Research Articles

Paper # 143: Clinical Results of a Novel Arthroscopically-Assisted Coracoclavicular Ligament Repair for Chronic Acromioclavicular Joint Disruptions

Paper # 143: Clinical Results of a Novel Arthroscopically-Assisted Coracoclavicular Ligament Repair for Chronic Acromioclavicular Joint Disruptions

Surgical Outcome Following Arthroscopic Fixation of Acromioclavicular Joint Disruption With the TightRope Device

The objective of this study was to evaluate the preliminary radiographic and clinical results of grade IV and V acromioclavicular joint disruption repair using the arthroscopic Arthrex acromioclavicular TightRope (Naples, Florida) fixation technique. Numerous procedures have been described for surgical management of acromioclavicular joint disruption. The TightRope device involves an arthroscopic technique that allows nonrigid anatomic fixation of the acromioclavicular joint. A cohort of 10 men and 2 women with a mean age of 43 years (range, 25-61 years) underwent the acromioclavicular joint TightRope procedure between April 2007 and October 2009. Eleven patients had either Rockwood grade IV or V disruptions and 1 sustained a distal third clavicle fracture with acromioclavicular joint disruption. Data was collected from a chart review. Patients were evaluated clinically, radiographically, by the simple shoulder test, and by overall satisfaction. There were 2 failures of reduction and 1 loss of reduction at final radiographic follow-up. The rate of fixation failure was 16.6%. All patients had >110° of total elevation. The majority of patients obtained satisfactory functional results according to the Simple Shoulder Test averaging 11 of 12 questions answered positively (range, 7-12; standard deviation, 1.50) and 11 of 12 patients were satisfied with the procedure. At final phone interview at approximately 2 years postoperatively, 6 patients were lost to follow-up. The remaining patients were all satisfied with the procedure and no patients reported subjective loss of reduction or deterioration of function. Simple Shoulder Test average was maintained with 11 of 12 positively answered questions (range, 7-12; standard deviation, 2.0) This case series revealed a high rate of fixation failure with the TightRope system. Still, most patients were satisfied with the procedure and achieved high functional shoulder results.

Die Fraktur der lateralen Klavikula

Fractures of the lateral clavicle end account for 12-15 percent of all clavicle fractures. In contrast to the clear treatment of midshaft fractures the therapy of the distal third is still open to controversy. The high non-union rate up to 40 percent that occurs with the lateral end fractures shows the special biomechanical mechanisms. The role of the coracoclavicular ligaments is comparable to the acromioclavicular joint disruption. To make a clear decision about the therapy we need a treatment based classification such as the one by Jäger and Breitner, which distinguishes four different fracture types. The treatment options reach from conservative therapy up to numerous different operative techniques. The aim of this article is to demonstrate a simple and save way for the diagnosis and therapy of that special kind of fracture.

Preliminary Results of the ‘Surgiligtm’ Synthetic Ligament in the Management of Chronic Acromioclavicular Joint Disruption

BackgroundChronic instability of the acromioclavicular joint is relatively common and normally occurs following a fall onto the point of the shoulder. Reconstruction of the joint [Weaver-Dunn procedure] using the coracoacromial...

Treatment of Tossy III Acromioclavicular Joint Injuries Using Hook Plates and Ligament Suture

The management of acromioclavicular (AC) injuries has long been debated. We analyzed our results in treating such cases using hook plates and ligament suture. : Retrospective nonrandomized study. Level I Trauma Center (University Hospital). Twenty-five patients (mean age 41 years) with complete Tossy III AC joint disruptions. Using the Rockwood classification, 15 dislocations were classified as type V injuries, 9 as type III injuries, and 1 as a type IV injury. All patients were operatively treated using AC hook plates with ligament suturing after a median delay of 7 days. Clinical and radiographic evaluation using Constant-Murley functional score and Taft et al criteria. : A retrospective clinical and radiographic evaluation of 23 patients was performed after an average follow-up period of 30 months. The mean Constant score was 97 (range, 90-100) points, and the mean Taft score was 10.6 points. All but 1 patient were satisfied with their treatment outcome. Eight cases showed some loss of reduction after plate removal. A poor correlation existed, however, between clinical and radiographic results. The hook plate is a reliable fixation tool for complete AC joint dislocations, ensuring immediate stability and allowing early mobilization with good functional and cosmetic results. Routine plate removal should however be reevaluated.

Long-Term Shoulder Function After Type I and II Acromioclavicular Joint Disruption

Long-Term Shoulder Function After Type I and II Acromioclavicular Joint Disruption

Long-Term Shoulder Function after Type I and II Acromioclavicular Joint Disruption

Background Acromioclavicular joint separations are very common lesions, with the majority falling into Rockwood classification type I and II. It is generally agreed that conservative treatment of these injuries leads to good functional results, although there are some studies that suggest these injuries are associated with a high incidence of persistent symptoms. Hypothesis Type I and II acromioclavicular joint disruption significantly impairs long-term shoulder function. Study Design Case series; Level of evidence, 4. Methods The shoulder function of 23 patients who were treated for type I or II acromioclavicular joint disruption was evaluated at a mean of 10.2 years after injury. The objective and subjective measures of the injured shoulder were assessed using Constant, University of California-Los Angeles Shoulder Scale, and Simple Shoulder Test scores and were compared with results of the uninjured shoulder. Results At an average follow-up of 10.2 years, 12 of 23 patients (52%) reported at least occasional acromioclavicular joint symptoms. The average Constant score for the injured shoulder was 70.5 and 86.8 for the uninjured shoulder (P < .001). The average University of California-Los Angeles Shoulder Scale score for the injured shoulder was 24.1 and 29.2 for the uninjured shoulder (P < .001). The average Simple Shoulder Test value for the injured shoulder was 9.7 and 10.9 for the uninjured shoulder (P < .002). The extent of acromioclavicular joint disruption and acromioclavicular joint width did not have any statistically significant influence on the shoulder functional scores. Conclusion Type I and II acromioclavicular joint disruptions impair long-term shoulder function in about half of patients 10 years after injury.

Biomechanical and Radiographic Analysis of Partial Coracoclavicular Ligament Injuries

Background A spectrum of acromioclavicular joint injuries may exist between type II acromioclavicular joint disruption (coracoclavicular strain) and type III acromioclavicular joint injuries (coracoclavicular disruption). This may help explain the variability in outcomes seen in patients with type II acromioclavicular injuries. Hypothesis Injury to either the conoid or trapezoid ligaments would lead to instability of the acromioclavicular joint after complete acromioclavicular joint injury. A secondary hypothesis was that the resulting instability could be recognized with Zanca radiographs. Study Design Controlled laboratory study. Methods The acromioclavicular ligaments were sectioned in 40 cadaveric shoulder specimens. Ten intact specimens were loaded to failure to evaluate the normal failure patterns of the coracoclavicular ligaments. Thirty specimens then had either the conoid or trapezoid ligament sectioned after creation of complete acromioclavicular joint injury. Preinjury and postinjury radiographs and stability testing quantified the effect of coracoclavicular joint injury on acromioclavicular joint stability. Results During failure testing, the conoid always failed first. Sectioning of the conoid led to significant increases in posterior and superior displacement on radiographs and with materials testing. Sectioning of the trapezoid led to significant increases in posterior displacement for materials testing and superior displacement on radiographs. Conclusion Sectioning of the acromioclavicular ligaments in conjunction with partial disruption of the coracoclavicular ligament complex led to significant changes in both radiographic and mechanical measures of acromioclavicular stability. The conoid fails first when a load is applied to the coracoclavicular complex in a superior direction. Clinical Relevance Zanca radiograph may detect incomplete injury to the coracoclavicular ligaments associated with acromioclavicular disruption.

Technical Notes and Tips: Coraco-Clavicular Sling for Acromio-Clavicular Joint Disruption

The coraco-clavicular sling, using a variety of materials, is a popular method for repair of grade 3/4 acromio-clavicular joint disruptions.1 The most demanding part of the procedure involves passing the sling around the coracoid. By using an additional glove with the tip of the index finger cut off, the sling material can be secured at the tip on the finger. After minimal blunt dissection, the finger can be passed medially, and a suitably curved clip laterally, around the coracoid. The open tips of the clip can be palpated with the index finger and the sling material can be easily directed into the tips. The sling is then pulled through (Fig. 1). Figure 1 Illustration of the technique.

Coraco-Clavicular Sling for Acromio-Clavicular Joint Disruption

Coraco-Clavicular Sling for Acromio-Clavicular Joint Disruption

Minimally Invasive Coracoclavicular Ligament Augmentation With a Flip Button/Polydioxanone Repair for Treatment of Total Acromioclavicular Joint Dislocation

Treatment of complete acromioclavicular joint disruption remains controversial and ranges from rehabilitation to extensive surgical reconstruction. However, high-grade injuries (type IV, V, and VI) are typically treated surgically. Most reconstruction techniques addressing these injuries selectively focus on coracoclavicular ligament augmentation because it has been shown to be the primary stabilizer of the acromioclavicular joint. The conventional coracoclavicular polydioxanone (PDS) loop, which is widely performed, has been detected to have some pivotal disadvantages, including anterior subluxation of the clavicle, extensive preparation of the coracoid, and bony avulsion of the clavicle as a result of rotational clavicle movement. Therefore we present an augmentation technique that reduces these complications by replicating the orientation of the native coracoclavicular ligament complex and providing a minimally invasive subcoracoid and clavicular fixation of a double PDS loop by use of 2 flip buttons, typically used for extracortical anterior cruciate ligament graft fixation. The key step of the procedure includes the anatomic, secure, and stable placement of the double PDS cerclage under the coracoid base transferring a flip button through a coracoid bone tunnel. Our clinical experience shows that the presented technique is easy to perform and has a comparable invasiveness to recently presented arthroscopic techniques.

Functional Coracoclavicular Stabilization for Acute Acromioclavicular Joint Disruption

This article presents a coracoclavicular functional stabilization technique to restore the anteroposterior and vertical displacement of the disrupted clavicle and thus facilitate early joint motion and final shoulder function.

Double-Loop Suture Repair for Acute Acromioclavicular Joint Disruption

Background Although it has been established that surgical treatment for acromioclavicular joint disruption (types IV-VI and type III in overhead throwing athletes and heavy laborers) is preferred, the literature is inconclusive about the best type of surgery. Purpose With the goal of avoiding the potential complications of hardware use, the authors present a coracoclavicular functional stabilization technique with the intention to restore the anteroposterior and superior displacement of the clavicle. Study Design Case series; Level of evidence, 4. Methods From 1999 to 2003, 38 patients with an acute, complete acromioclavicular joint separation (34 men, 4 women; mean age, 33.5 years) underwent surgical reconstruction with the described coracoclavicular loop stabilization technique. With this technique, the superior and anteroposterior displacement of the clavicle can be easily controlled using 2 pairs of Ethibond No. 5 nonabsorbable sutures—one passed in front and the other behind the clavicle, through a central drill hole, 2 cm from its lateral end, directly above the base of the coracoid process (at the corresponded attachment of coracoclavicular ligaments). Passive shoulder motion was encouraged by the second postoperative day. Results Thirty-four patients were available for the last clinical and radiologic evaluation. At a mean follow-up of 33.2 months (range, 18-59 months), the mean Constant-Murley score was 93.5 points (range, 73-100 points), and 2 cases with slight loss of reduction (less than half of the width of the clavicle) were detected. Complications included 1 case with superficial infection and 1 patient (basketball player) with persistent tenderness in the acromioclavicular joint without signs of secondary arthritis. The incidence of periarticular ossification was 17.6% and did not affect the final outcome. Secondary degenerative changes were not detected. Conclusion Considering the nearly anatomical reconstruction, the avoidance of hardware complications, and the low rate of recurrence, this technique may be an attractive alternative to the management of acute acromioclavicular joint separations.

Arthroscopic reconstruction of the acromioclavicular joint disruption: surgical technique and preliminary results

Numerous operative procedures have been described for the reconstruction of acromioclavicular joint separation; however, the arthroscopic reconstruction has been rarely reported. Therefore, our objective was to propose a new technique of arthroscopic acromioclavicular joint surgery and to evaluate the preliminary results. Thirteen patients with a mean follow-up of 18 months underwent the arthroscopic acromioclavicular joint reconstruction using suture anchors and small titanium plate. The average age was 40.2 years (range 23-54 years). The shoulders were evaluated using Constant score and radiographs. The indications for surgery included acromioclavicular joint dislocation Rockwood type IV-V. Twelve patients returned to their work without pain within 3 months after operation. The average Constant score at last follow-up was 95. Postoperative radiographs confirmed anatomic reduction in ten patients, residual subluxation in two patients and redislocation of the joint in one patient. One patient had radiographic evidence of coracoclavicular ossification. All patients but one were satisfied with results and cosmetic appearance. Considering its less morbidity, excellent cosmesis, no need of hardware removal, and minimal complications from breakage or migration of metal implants, this new technique offers an attractive alternative in acromioclavicular joint stabilization.

Biomechanical Analysis of Different Operative Techniques for Complete Acromioclavicular Joint Disruptions

The goal of this study was to evaluate three different operative techniques for acromioclavicular joint fixation: trans-articular K-wire fixation; ligament reconstruction along with a synthetic augmentation device (LARS®); and coracoclavicular Bosworth screw. Mechanical properties were tested in a cadaver study in order to determine the primary mechanical stability during repetitive passive motion. Eighteen fresh cadavers were used to test a cyclic load (50 000 cycles). Secondary joint dislocation and the rate of implant loosening were monitored by standard AP stress X-ray. Metal markers in the coracoid, the acromion, and the lateral clavicle were used to measure the acromioclavicular distance increase (Δ-AC) and the coracoclavicular distance increase (Δ-CC). The range of motion was set on 30-90° of abduction for the first 25 000 cycles and then was raised to 60-120°. The least amount of vertical dislocation was seen in the K-wire and the LARS® group (mean Δ-CC 0.3 mm; range: 0-1.3 mm and 1.5 mm; range 0-6.7 mm, respectively). The Bosworth group showed significantly higher dislocation rates (4.2 mm; range 2.3-7.1 mm; p = 0.005). This was true especially when the abduction range was extended to a maximum of 120°. The rate of implant loosening in the K-wire group was higher than that in the other two groups. This study shows that the LARS® procedure and the K-wires technique give equal results concerning stability after repetitive passive motion, but with a high rate of implant loosening in the K-wire group. According to our findings, abduction should be limited to 90° after implanting a Bosworth screw in order to prevent loosening or failure of the hardware.

A comparison of the methods of distraction for stress examination of the acromioclavicular joint

Acromioclavicular joint disruption is frequently evaluated with a radiographic examination of the joint under stress (weight bearing). Certain authors recommend suspending the weights from the arm, rather than being hand-held, to allow for total muscle relaxation. This study examines the relationship between the coracoclavicular distance measured and the method of distraction. 30 normal subjects participated in the study which used ultrasound (5 MHz linear array) to measure the coracoclavicular distance under four conditions (levels of traction): non-stressed, muscles relaxed; non-stressed, muscles tensed; stressed with 7.5 kg weight hand held; stressed with 7.5 kg weight suspended from the wrist. The data were subjected to a multifactor ANOVA. The level of traction was statistically significant (p < 0.001). The data were then subjected to a Bonferroni multiple comparisons procedure. This showed a difference between the non-stressed and stressed conditions, but there was no difference between the two methods of applying stress to the joint. It was concluded that, in normal subjects, the method of performing the weight bearing examination does not have a significant effect on the magnitude of the coracoclavicular distance.

Disruption of the acromioclavicular joint: surgical anatomy and biological reconstruction

The pathological anatomy of acromioclavicular joint disruption is discussed in the light of operative findings. A method of repairing the dislocated joint is described using the coraco-acromial ligament and temporary internal fixation. It has been found to be useful in those patients who present late with pain and symptoms of instability.