Acromioclavicular Joint Reconstruction Research Articles

AB120. SOH24AB_052. A bibliometric analysis of the 50 most-cited articles on acromioclavicular joint reconstruction

AB120. SOH24AB_052. A bibliometric analysis of the 50 most-cited articles on acromioclavicular joint reconstruction

An In Vitro Study Demonstrating the Significance of Acromioclavicular Ligament Repair in Restoring Horizontal and Rotational Acromioclavicular Joint Stability.

The principle of joint reconstruction surgery is to try to recreate the native joint biomechanics and stability. With respect to acromioclavicular joint (ACJ) surgery, much focus to date has been on restoring the superoinferior stability. There is concern that persistent horizontal instability following ACJ reconstruction could lead to poorer patient outcomes; therefore, we evaluated whether acromioclavicular (AC) ligament repair offers improved horizontal stability in conjunction with ACJ reconstruction. A whole-body human cadaver was used. The ACJ was exposed and subjected to a constant 70N load on the lateral end of the clavicle to test the anteroposterior (AP), superoinferior (SI), and horizontal pivot angle (HPA) around the ACJ. The AC and coracoclavicular (CC) ligaments were subsequently divided, and the above three parameters were re-tested. Ligament augmentation and reconstruction system (Corin Group, Cirencester, UK), LockDown (LockDown Medical Limited, Redditch, UK), Endobutton (Smith and Nephew Inc.,London, UK), and Neoligament implant (Xiros Ltd., Leeds, UK) were used to reconstruct the CC ligaments and tested with and without AC repair. The native ACJ allowed an average 2.48 mm AP and 3.88 mm SI translation with a 27° HPA. All synthetic implants significantly improved the vertical stability of the ACJ but allowed up to a four-fold increase in AP translation. Coupled with ACJ repair, all the reconstructions were far superior, especially in restoring horizontal stability. The implants varied in their approach to fixation and concentrated primarily on the reconstruction of CC ligaments. Our study was able to demonstrate that AC repair significantly improves the stability of the construct and significantly reduces vertical and horizontal instability.

Clavicular tunnel widening after acromioclavicular joint reconstruction: comparison between single and double clavicular tunnel techniques.

Acromioclavicular joint (ACJ) reconstruction using artificial ligaments is a common surgical treatment for Rockwood grade III or higher injuries. These techniques use bone tunnels in the clavicle and coracoid to insert the Tightrope implants. This multicenter retrospective study compares long term radiographic follow up of clavicular tunnel widening in two groups of patients with high-grade ACJ injury who underwent reconstruction using two different surgical techniques. The first group of 23 patients underwent an arthroscopic single clavicular tunnel ACJ reconstruction. The second group of 23 patiënts underwent an open double clavicular tunnel reconstruction. Inclusion criteria are Rockwood grade III or higher injury and minimum 18 months of follow-up. Exclusion criteria are distal clavicle fracture and additional stabilization techniques. Radiographic results were measured on anteroposterior shoulder radiographs taken at the first and last follow-up. Clavicular tunnel widening is the main outcome measurement. Secondary outcomes are heterotopic ligament calcifications, migration of buttons, tunnel fracture and loss of acromioclavicular reduction. The mean clavicular tunnel widening in the single clavicular tunnel technique is 1.91 mm. In the double clavicular tunnel technique, the widening of the medial tunnel is 2.52 mm and 3.59 mm in the lateral tunnel. The difference in widening between the single tunnel and the lateral tunnel is significant (p=0.003). A very clear observation on all follow-up X-rays was a reorientation of the clavicular tunnels towards the coracoid. The double clavicular tunnel technique has more tunnel widening in both tunnels compared to the single bundle technique.

Coracoclavicular and acromioclavicular ligament reconstruction with a double-bundle semitendinosus autograft and cortical buttons for chronic acromioclavicular joint dislocations: clinical and imaging outcomes

BackgroundThere are few clinical and radiographic studies of coracoclavicular (CC) ligament reconstruction in chronic acromioclavicular (AC) joint dislocation. Additionally, reported AC joint reduction rates vary. HypothesisArthroscopically assisted double-bundle semitendinosus tendon autografts with CC and AC ligament reconstruction for AC joint reconstruction provide AC joint stability and improved function at the final visit. MethodsIn this retrospective study of prospectively collected data, 21 patients surgically treated for chronic AC joint dislocation (Rockwood III–V) were assessed clinically and radiographically preoperatively, and at day 1, 3 months, 12 months, and at a final visit (> 24 months) postoperatively. Clinical assessments included Constant and ASES scores. The CC vertical distance (CCD) on the affected and unaffected sides [CCD ratio (%)] on the anterosuperior view were measured. AC joint vertical reduction loss was defined as an increase in the CCD ratio of > 25%. Horizontal AC joint instability was evaluated on axillary views. Pearsons’ correlation coefficients were generated to examine the relationships among postoperative clinical scores, CCD ratio, interval from injury to surgery, and age at the time of surgery. ResultsTwenty-one shoulders in 21 patients (mean age, 40.0 years at the time of surgery; 16 men, 5 women) were evaluated with a mean 31.7-month follow-up period. The mean Constant scores, ASES scores, and CCD ratios significantly improved from preoperatively to the final visit [57.4 ± 10.1, 49.1 ± 12.1, 101.6 ± 64.1 preoperatively; 89.6 ± 5.3, 96.5 ± 4.2, 9.9 ± 34.5 at the final visit, respectively (P < 0.001 for all)]. Vertical AC and horizontal AC joint instability were observed in four shoulders (19.0%) and in one shoulder (4.8%), respectively. However, there was no significant correlation between the increase in CCD and clinical scores at the final visit (Constant score; r = 0.179, P = .438: ASES score; r = -0.260, P = .256) or the interval from injury to surgery (r = 0.099, P = .669) or age at the time of surgery (r = 0.019, P = .935). No clinical complications were associated with clinical symptoms. ConclusionsPatients who underwent the index procedure achieved significant improvement in shoulder function without complications related clinical symptom after a mean follow-up interval of 31.7 months. In contrast, the rates of total ACJ instability in the vertical and horizontal planes were unsatisfactory but compatible with those in previous studies.

Acromioclavicular joint dislocation: a novel surgical technique for acromioclavicular joint reduction with coracoclavicular ligament reconstruction and anatomic conoid ligament reconstruction

The management of acromioclavicular (AC) joint dislocations remains controversial. Many implant designs offer a single pole of coracoclavicular (CC) fixation. Furthermore, previously described techniques for reconstruction of the CC ligaments are limited in their ability to replicate the obliquity of the native CC ligaments. We describe a novel technique for AC joint reduction and reconstruction using posterior to anterior obliquity of the medial clavicular tunnel with a dual-limb suture fixation method and allograft augmentation.

Acromioclavicular Joint Reconstruction with Modified Weaver–Dunn Operation Versus Hamstring Tendon Autograft Comparative Study

Abstract Background: The dislocation of the acromioclavicular joint (ACJ) is recognized as one of the most frequently occurring injuries most often after either direct or indirect force is applied to the affected shoulder. The best method of AC reconstruction is still controversial. Modified Weaver–Dunn operation (WD) is one of the popular operations. Recent ACJ reconstruction methods include the usage of the gracilis, semitendinosus auto grafts, synthetic grafts, end buttons, nonabsorbable sutures, suture anchors, and tight-rope system. Aim and Objectives: Clinical and radiological results of hamstring autograft versus modified WD operation for reconsrtuction of coracoclavicular and acromioclavicular ligaments. Patients and Methods: This prospective study was carried out at the orthopedic department of Benha University Hospital carried out on 30 cases with chronic ACJ dislocation. They divided into two groups. The modified WD technique was employed on 15 patients, whereas an autogenous semitendinosus tendon graft was used on the other 15. There was a comparison of radiographs taken before and after surgery. Results: Mean surgical time and coracoclavicular (CC) distance differed statistically between groups. Neither demographic data nor postoperative information (pain, range of motion, and postop) showed a difference of statistical significance between the groups. Constant score and post operative American Shoulder and Elbow Surgeons Score (ASES) and post operative complications show no statistically significant difference. Conclusion: Both AC and CC reconstruction by hamstring tendon autograft showed good-to-excellent outcomes with no implant-related complications as some other treatment methods, also more anatomical procedure more than WD operation with better biomechanical vertical and horizontal stability.

Evaluation of the results of acute acromioclavicular joint reconstruction using Double Endobutton technique

Abstract Background Acromioclavicular joint (ACJ) dislocation is a common injury, which accounts for ~9% of all shoulder injuries. Surgical techniques for reconstructing or repairing ACJ dislocation have evolved over the last decades. Recent surgical techniques focus on reconstruction of the coracoclavicular ligament to recover the stability of ACJ. Patients and methods This was a prospective case series study that included 23 patients with acute ACJ dislocation, admitted to the Department of Orthopaedic Surgery and Traumatology, Faculty of Medicine, Kafr El Sheikh and Benha University. All cases were treated by coracoclavicular repair using Double Endobutton technique and Ethibond suture. The follow-up period ranged from 18 to 24 months postoperatively. Outcomes were assessed using Constant score and DASH score at of 6 weeks, 3, 6, 12 months, and final follow up. Radiological assessment was done using Zanca view and stress anteroposterior radiographs of both shoulders to compare acromiohumeral interval at the end of follow up. Results This study included 23 patients that were admitted to our department. Their mean age were 34.2 ± 2.3 years. The average time between injury and surgery was 5.2 ± 1.4 days. There were 20 men and three females. Regarding DASH score it improved from preoperative value of 88.3 ± 11.2 points to 14.3 ± 2.4 points. Regarding Constant score, it improved significantly from preoperative value of 45.3 ± 2.2 points to a postoperative value of 92.3 ± 3.6 points. Regarding acromiohumeral interval, the mean distance was 9.3 mm immediate postoperative period, and it was 10.1 at the end of follow up (P&gt;0.05). Conclusion ACJ reconstruction using Double Endobutton technique is safe, easy, and effective technique in cases with acute ACJ dislocation with little postoperative complications and excellent clinical and radiological outcomes.

Mid-term clinical and sonographic outcomes of minimally invasive acromioclavicular joint reconstruction: mini-open versus arthroscopically assisted

IntroductionThe current literature describes various operative stabilization strategies which achieve good clinical outcomes after acute acromioclavicular joint (ACJ) dislocation. The aim of this study was to compare the mid-term clinical and sonographic treatment outcomes after minimally invasive mini-open and arthroscopic reconstruction.Materials and methodsWe conducted a retrospective two-center study of patients with acute ACJ dislocation. Surgical treatment was performed using either a mini-open approach (MIOP) or an arthroscopic technique (AR). The primary outcome parameters of this study were the sonographically measured acromioclavicular (ACD) and coracoclavicular distances (CCD). Secondary outcome parameters included the Constant–Murley score (CS), range of motion (ROM), postoperative pain scale (VAS), return to daily routine, return to sports, complications, as well as operative revisions.ResultsAfter a mean follow-up of 29 months, 30 patients were included in this study with an average age of 41.3 ± 14.8 years (MIOP) and 41.2 ± 15.4 years (AR). The sonographic ACD (MIOP 9.11 mm vs. AR 8.93 mm, p = 0.41) and CCD (MIOP 25.08 mm vs. AR 24.36 mm, p = 0.29) distances showed no statistically significant differences. Furthermore, there was no statistically significant difference when compared to the contralateral side (p = 0.42). With both techniques, patients achieved excellent clinical outcome parameters without statistically significant differences in CS (MIOP 95 vs. AR 97, p = 0.11) and VAS (MIOP 1.76 vs. AR 1.14, p = 0.18). The return to daily activity and return to sport rates did not differ. There were neither complications nor revisions in both groups.ConclusionBoth minimally invasive techniques for acute ACJ stabilization achieved excellent clinical and sonographic outcomes without one technique being statistically superior to the other.

Tunnel-free acromioclavicular joint reconstruction is associated with improved initial reduction and higher patient satisfaction

Many surgical techniques have been described for acromioclavicular (AC) joint reconstruction. Creation of bone tunnels through the clavicle or coracoid has been shown to be a risk factor for fracture. Use of an AC reconstruction technique that does not create bone tunnels may obviate this risk. This study aims to evaluate clinical outcomes of AC joint reconstruction using a tunnel-free technique compared to reconstruction using a cortical button and clavicular drill holes. Consecutive patients who underwent AC joint reconstruction by a single surgeon in a subspecialty referral practice were included. One group of patients received cortical button fixation (button group), in which sutures were passed around the coracoid, brought up through a drill hole in the clavicle, and tied over a cortical button. The other group of patients received tunnel-free fixation, in which a self-locking tape suture was passed in a cerclage fashion around the base of the coracoid and the clavicle and tensioned with a tensioning device (cerclage group). Both groups underwent reconstruction of the coracoclavicular (CC) ligament and AC joint capsule using tibialis anterior allograft. Patient-reported outcome scores and satisfaction were collected and compared between groups. Radiographs were reviewed to evaluate CC ligament distance and loss of reduction. Twenty-two patients were included in the study (button n= 10, cerclage n= 12). Preoperative demographics and injury characteristics were not different between groups. Average radiographic follow-up was not different between groups (button: 231 days, cerclage: 105 days). Postoperative American Shoulder and Elbow Surgeons, visual analog scale, and Single Assessment Numeric Evaluation scores were similar between groups. Two postoperative clavicle fractures were sustained in the button group. These occurred through clavicular drill holes and were preceded by tunnel widening. No fractures occurred in the cerclage group. CC distance at initial follow-up was significantly less in the cerclage group (button: 11.2 ± 4.5 mm, cerclage: 7.0 ± 2.9 mm, P=.023). Loss of reduction was similar throughout the postoperative period (button: 4.3 ± 2.6 mm, cerclage: 4.8 ± 4.1 mm, P >.05. Forty percent of patients were unsatisfied with their clavicle after button fixation (n= 4/10), compared with zero after cerclage fixation (n= 0/12, P=.03). Reasons for dissatisfaction were fracture (n= 2) and persistent cosmetic deformity (n= 2). Tunnel-free AC joint reconstruction is associated with improved initial radiographic appearance and patient satisfaction compared to single cortical button fixation. Postoperative clavicle fracture and persistent cosmetic deformity drive patient dissatisfaction, which may be minimized by avoiding clavicular drill holes and using a tensioned self-locking cerclage suture to improve initial reduction.

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

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.

AB107. SOH23ABS_014. Acromioclavicular joint reconstruction: an analysis of the readability and quality of online patient information

Background: Currently, patients use the internet for health information relating to surgery. The aim of this study is to assess the readability and quality of online health information relating to acromioclavicular joint reconstruction. We hypothesize that the information will be of poor quality and be too difficult to read for the average patient.

The Floating Clavicle: Surgical Technique for Management of an Ipsilateral Acromioclavicular and Sternoclavicular Joint Dislocation

Bipolar “floating” clavicle injuries are infrequent upper-extremity injuries that occur secondary to a high-energy trauma, which can cause dislocation at the sternoclavicular (SC) and acromioclavicular joints. Given the rarity of this injury, there is not a consensus regarding clinical management. Although anterior dislocations can be managed nonoperatively, posterior dislocations may pose a threat to chest-wall structures and typically are managed surgically. Here, we present our preferred technique for concomitant management of a locked posterior SC joint dislocation with associated grade 3 acromioclavicular joint dislocation. Reconstruction of both ends of the clavicle was performed in this case, using a figure-of-8 gracilis allograft and nonabsorbable suture reconstruction for the SC joint, and an anatomic acromioclavicular joint and coracoclavicular ligament reconstruction with semitendinosus allograft and nonabsorbable suture.

Long-term follow-up in a single-bundle arthroscopic acromioclavicular joint reconstruction after Rockwood III to VI dislocation.

This retrospective study presents the clinical and radiographic results of a single-bundle arthroscopic acromioclavicular joint reconstruction in 45 patients with a mean follow-up of 4.8 years. Patients with a Rockwood grade III or higher were included. Clinical results were based on satisfaction, pain and functional scores. These outcome scores were compared to coracoclavicular distance measurement on X-ray. Secondly, clinical outcome scores were compared between patients who had surgery in the first 6 weeks after trauma and patients treated after 6 weeks. Overall, X-ray showed a good reduction in 71.1% of the patients (less than 50% loss of reduction). These patients showed better clinical results than patients with radiographical failure in terms of satisfaction (p = .001), Constant (p = .001), DASH (p = .031) and SPADI (p = .005) scores. In total, 78% of the patient had surgery in the first 6 weeks after trauma. When treated later (mean time to surgery of 8.8 months), patients showed worse results for satisfaction (p = .003) and DASH score (p = .006), suggesting that treatment of chronic cases might warrant additional fixation techniques. As a conclusion, these results showed that, in the acute approach, single-bundle arthroscopic coracoclavicular fixation is a good treatment in acromioclavicular joint dislocation Rockwood grade III or higher.

Transcoracoid Drilling for Coracoclavicular Ligament Reconstructions in Patients With Acromioclavicular Joint Dislocations Result in Eccentric Tunnels

To determine the location of coracoid inferior tunnel exit with superior-based tunnel drilling and coracoid superior tunnel exit with inferior-based tunnel drilling. Fifty-two cadaveric embalmed shoulders (mean age 79 years, range 58-96 years) were used. A transcoracoid tunnel was drilled at the center of the base. Twenty-six shoulders were used for the superior-to-inferior tunnel drilling approach and 26 shoulders for the inferior-to-superior tunnel drilling approach. The distances to the margins of the coracoid process, from both the entry and exit points of the tunnel, were measured. Paired Student t-tests were used to compare the distance from the center of the tunnel and the medial and lateral coracoid border and the apex. The mean difference for the distances between superior entry and inferior exit from the apex was 3.65 ± 3.51 mm (P= .002); 1.57 ± 2.27 mm for the lateral border (P= .40) and 5.53 ± 3.45 mm for the medial border (P= .001). The mean difference for the distances between inferior entry and superior exit from the apex was 16.95 ± 3.11 mm (P= .0001); 6.51 ± 3.2 mm for the lateral border (P= .40) and 1.03 ± 2.32 mm for the medial border (P= .045). Inferior-to-superior drilling resulted in 4 (15%) cortical breaks. Both superior-to-inferior and inferior-to-superior tunnel drilling directed the tunnel from a more anterior and medial entry to a posterior-lateral exit. Superior-to-inferior drilling resulted in a more posteriorly angled tunnel. When using a 5-mm reamer and inferior-to-superior tunnel drilling, cortical breaks were observed at the inferior and medial margin of the tunnel exit. Arthroscopic-assisted acromioclavicular joint reconstruction using conventional jigs may result in an eccentric coracoid tunnel, possibly introducing stress risers and fractures. To avoid cortical breaks and eccentric tunnel placement, open drilling from superior-to-inferior with a superiorly centered guide pin and arthroscopic visualization of a centered inferior exit should be considered.

SURGICAL TREATMENT OF ACROMIOCLAVICULAR DISLOCATION: HOOK PLATE VERSUS SUTURE BUTTON.

We aimed to compare the functional and radiographical outcomes of reconstruction of acute unstable acromioclavicular joint (ACJ) dislocation using Hook Plate (HP) versus Suture Endobutton (SE) fixation techniques. Forty-six consecutive patients with grade III to V ACJ dislocation according to Rockwood classification who underwent either HP or SE fixation in the period between January 2017 and June 2020 were evaluated. The treatment modalities were divided into either HP or SE fixation. The radiological assessment included standard anterior-posterior (AP) views to evaluate coracoclavicular (CC) distances for vertical reduction. CC distances were grouped as preoperative (CC1), early postoperative (CC2), and late postoperative (CC3). The distance variance between CC2 and CC3 was referred as ΔCC (CC3 - CC2). A statistically significant difference was found in ΔCC between the two groups (p=0.008). ΔCC was significantly higher in the SE group compared to the HP group (p<0.05). The Constant and UCLA Scores of patients in the SE group were found to be significantly higher than in the HP group patients. Clinical outcomes were more satisfactory in patients with acute unstable ACJ dislocation who underwent SE compared to HP procedures, at the end of the first year. Evidence Level IV; Case Series.

Deltotrapezial Stabilization of Acromioclavicular Joint Rotational Stability: A Biomechanical Evaluation.

Despite advances in surgical management of acromioclavicular (AC) joint reconstruction, many patients fail to maintain sustained anatomic reduction postoperatively. To determine the biomechanical support of the deltoid and trapezius on AC joint stability, focusing on the rotational stability provided by the muscles to posterior and anterior clavicular rotation. A novel technique was attempted to repair the deltoid and trapezius anatomically. Controlled laboratory study. Twelve human cadaveric shoulders (mean ± SD age, 60.25 ± 10.25 years) underwent servohydraulic testing. Shoulders were randomly assigned to undergo serial defects to either the deltoid or trapezius surrounding the AC joint capsule, followed by a combined deltotrapezial muscle defect. Deltotrapezial defects were repaired with an all-suture anchor using an anatomic technique. The torque (N·m) required to rotate the clavicle 20° anterior and 20° posterior was recorded for the following conditions: intact (native), deltoid defect, trapezius defect, combined deltotrapezial defect, and repair. When compared with the native condition, the deltoid defect decreased the torque required to rotate the clavicle 20° posteriorly by 7.1% (P = .206) and 20° anteriorly by 6.1% (P = .002); the trapezial defect decreased the amount of rotational torque posteriorly by 5.3% (P = .079) and anteriorly by 4.9% (P = .032); and the combined deltotrapezial defect decreased the amount of rotational torque posteriorly by 9.9% (P = .002) and anteriorly by 9.4% (P < .001). Anatomic deltotrapezial repair increased posterior rotational torque by 5.3% posteriorly as compared with the combined deltotrapezial defect (P = .001) but failed to increase anterior rotational torque (P > .999). The rotational torque of the repair was significantly lower than the native joint in the posterior (P = .017) and anterior (P < .001) directions. This study demonstrated that the deltoid and trapezius play a role in clavicular rotational stabilization. The proposed anatomic repair improved posterior rotational stability but did not improve anterior rotational stability as compared with the combined deltotrapezial defect; however, neither was restored to native stability. Traumatic or iatrogenic damage to the deltotrapezial fascia and the inability to restore anatomic deltotrapezial attachments to the acromioclavicular joint may contribute to rotational instability. Limiting damage and improving the repair of these muscles should be a consideration during AC reconstruction.

Open anatomical dual tunnel reconstruction of acromiao-clavicular joint using autogenous semitendinosus graft

Background: The primary constraint to the dislocation of an acromioclavicular (AC) joint is its ligaments. They prevent vertical and horizontal translations in the joint. Reconstruction of these ligaments is of prime importance for restoring the AC joint. There is uncertainty regarding the surgical treatment protocol for Rockwood's type III injury. Patients and Methods: We report a prospective cohort study on 20 patients aged between 15 and 45 years, presenting with Rockwood type III or higher rank of AC joint dislocation for open double-tunnel anatomical reconstruction of AC joint using autogenous semitendinosus graft. Patients were evaluated at the end of follow-up of 2 years using the Constant–Murley outcome scoring system. Results: Clinical and radiological evaluation performed revealed excellent results in 15, good in three, and fair in two, with no poor results recorded. Conclusion: Open double-tunnel reconstruction with semitendinosus graft is a vital technique for Rockwood type III or higher grade of AC joint dislocation management to deliver a pain-free shoulder with good strength, well-retained range of movements, and near normal regain of activities.

Anatomic Acromioclavicular Joint Reconstruction Using Semitendinosus Graft with Internal Bracing in Chronic Acromioclavicular Joint Dislocation: Case Series

Introduction: Acromioclavicular joint dislocations represent a frequent condition, affecting a very specific and generally active population and accounting for around 9% of all shoulder injuries. Case Presentation: We present a series of patients who underwent AC Joint reconstruction using Semitendinosus graft with internal bracing. The beach chair position is used for acromioclavicular reconstruction surgery. In this technique, we restore the anatomy, reconstruct the coracoclavicular ligament, and reinforced the acromioclavicular ligament. And it is reliable for chronic acromioclavicular joint injury. At final follow up we found excellent results with average pain score of 1.6, and average ROM of 160° of forward flexion and abduction, 70° 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 89 points. This technique also achieved acceptable radiographic results, with an average coracoclavicular distance increase of 1.4 mm Discussion &amp; Conclusion: The loss of AC joint congruence with the Weaver Dunn procedure suggested that possibly the problem wasn’t only biological. This technique seems to be especially advantageous as it allows for an anatomic, biological, and minimally invasive procedure while avoiding some of the inconveniences described in other reports. Although demanding, it can be reproducibly performed arthroscopically, and good clinical outcomes should be expected.

Akut acromioclavicularis ízületi ficamok műtéti kezelése anatómiai rekonstrukcióval

The authors audited the outcomes of various surgical interventions employed to fix the dislocations of the acromioclavicular joint in their unit. This resulted in changing their method to treat this condition. Finding a technique that results in the best functional stability of the injured joint while preserving its physiological function. In this particular area of traumatology, there is still uncertainty of the ideal way to provide the best outcome in terms of stability and function. From the currently known techniques, the authors have chosen the Minimally INvasive Acromioclavicular Joint Reconstruction (MINAR) method to be introduced in their unit. Its advantage is that it provides good stability combined with fast rehabilitation with a minimally invasive intervention. Furthermore, it is safe and easy to learn and master. It is also to be pointed out that it restores not only the stability but also the physiological functionality of the damaged joint. The authors carried out this type of operation first in 2012. They promoted the technique first in Hungary and became a 'reference centre' in the country. The authors will detail the method itself, both its indications and contraindications as well as the stages of the postoperative rehabilitation. The authors scrutinized their results with imaging and 7 years of retrospective analysis with Constant and DASH scores. These were all in support of their choice of the MINAR method. The authors concluded results congruent with international studies and recommendations. Additional analysis deducted aspects of the technique that could lead to further improvement in outcomes and highlighted areas for future study. In line with the recommendation of the European Shoulder Associates, the author's recommendation is that the MINAR technique should be the first choice of intervention for dislocations of the acromioclavicular joint. Orv Hetil. 2022; 163(50): 1992-1999.

Current concepts in acromioclavicular joint (AC) instability – a proposed treatment algorithm for acute and chronic AC-joint surgery

There exists a vast number of surgical treatment options for acromioclavicular (AC) joint injuries, and the current literature has yet to determine an equivocally superior treatment. AC joint repair has a long history and dates back to the beginning of the twentieth century. Since then, over 150 different techniques have been described, covering open and closed techniques. Low grade injuries such as Type I-II according to the modified Rockwood classification should be treated conservatively, while high-grade injuries (types IV-VI) may be indicated for operative treatment. However, controversy exists if operative treatment is superior to nonoperative treatment, especially in grade III injuries, as functional impairment due to scapular dyskinesia or chronic pain remains concerning following non-operative treatment. Patients with a stable AC joint without overriding of the clavicle and without significant scapular dysfunction (Type IIIA) may benefit from non-interventional approaches, in contrast to patients with overriding of the clavicle and therapy-resistant scapular dysfunction (Type IIIB). If these patients are considered non-responders to a conservative approach, an anatomic AC joint reconstruction using a hybrid technique should be considered. In chronic AC joint injuries, surgery is indicated after failed nonoperative treatment of 3 to 6 months. Anatomic AC joint reconstruction techniques along with biologic augmentation (e.g. Hybrid techniques, suture fixation) should be considered for chronic high-grade instabilities, accounting for the lack of intrinsic healing and scar-forming potential of the ligamentous tissue in the chronic setting. However, complication and clinical failure rates remain high, which may be a result of technical failures or persistent horizontal and rotational instability. Future research should focus on addressing horizontal and rotational instability, to restore native physiological and biomechanical properties of the AC joint.