Acute Acromioclavicular Joint Dislocation Research Articles

Incidence of Associated Injuries with Acute Acromioclavicular Joint Dislocations Types III through V

Background Traumatic acromioclavicular (AC) joint dislocations are common injuries among the active population. The injury mechanism requires excessive force delivered by a fall or blow to the shoulder. Associated injuries may occur and remain undetected if they are masked by the painful and prominent AC joint injury. Hypothesis Intra-articular injuries associated with high-grade AC joint dislocations are common. Study Design Case series; Level of evidence, 4. Methods Between 2002 and 2007, 77 patients (68 male, 9 female; average age, 35.5 years; range, 17-62 years) were surgically treated for acute AC joint dislocations (Rockwood type III, 5; type IV, 30; and type V, 42). All patients underwent diagnostic glenohumeral joint arthroscopy. Concomitant intra-articular injuries were identified and treated. Results Intra-articular injuries were found in 14 of 77 patients (18.2%). Superior labral anterior posterior (SLAP) lesions were observed in 11 of 77 patients 14.3% (SLAP I, 3; II, 2; III, 3; and IV, 3). Nineteen percent of Rockwood V lesions had associated SLAP lesions (SLAP I excluded), whereas only 3.4% of Rockwood IV lesions showed SLAP lesions. A complete supraspinatus tear was detected in 1 case, and partial articular-sided supraspinatus tears were detected in 2 cases. Four patients sustained an accompanying fracture. Conclusion Concomitant injuries to the shoulder girdle obtained during traumatic AC joint separation may be more frequent than previously thought. Clinical diagnosis may be difficult in the setting of an acute and painful dislocated AC joint. Shoulder arthroscopy during arthroscopic AC joint stabilization may aid in detecting associated injuries.

Arthroscopic Stabilization of Acute Acromioclavicular Joint Dislocation Using the Tightrope System

More severe cases of acute acromioclavicular joint dislocation necessitate surgical stabilization. Arthroscopic techniques have been described, and we describe here a simple safe technique using the Tightrope Syndesmosis system (Arthrex, Naples, Fla), which provides a secure reduction during the period of ligament healing. We present the early clinical follow-up (mean, 15 months) of a cohort of 10 patients with severe cases of acute acromioclavicular joint dislocation treated with this new technique.

Minimally Invasive Coracoclavicular Stabilization with Suture Anchors for Acute Acromioclavicular Dislocation

Background The management of acute acromioclavicular (AC) joint dislocation is controversial. Purpose The authors describe a surgical technique involving securing the clavicle to the coracoid process using suture anchors for the treatment of acute AC joint injury. Study Design Case series; Level of evidence, 4. Methods Twenty patients were evaluated retrospectively, clinically, and radiographically, for a mean of 41.2 months. Results At last follow-up, the mean Constant score for the 20 patients was 89.5. Eighteen patients (90%) maintained complete AC joint reduction in both anteroposterior and axillary views. Slight loss of reduction was noted in 2 patients (10%), but their functional outcomes were good. No fixation failure or pulling out of suture anchors was encountered. Conclusion This minimally invasive technique using a suture anchor for the treatment of acute AC dislocation is easily performed.

견봉 쇄골 관절 탈구의 수술적 치료 - Weaver-Dunn 변법과 Phemister 변법의 비교 -

Abstract — Surgical Treatment of Acromioclavicular Dislocation -Comparison of modified Weaver-Dunn method and modified Phemister method- Ki-Cheol Bae, M.D., Sung-Won Sohn, M.D. * , Chul-Hyun Cho, M.D., and Su-Won Jung, M.D. Department of Orthopedic Surgery, School of Medicine, Keimyung University, Deagu, Korea Purpose : To compare the clinical and radiological results between the modified Weaver-Dunn method and modi-fied Phemister method in the acute acromioclavicular joint dislocation. Materials and Methods : We reviewed 19 patients who were treated for the acute acromioclavicular joint disloca-tion from 2001 to 2002. 10 patients were operated with the modified Weaver-Dunn method (group A) and the otherswith modified Phemister method (group B). The classification of preoperative injury was analyzed by using theRockwood system, the clinical assessment of preoperative and postoperative by the modified UCLA rating scale andthe radiological assessment by simple x-ray. Results : With the modified UCLA rating scale, group A showed 5 cases(50%) of excellent and 5 cases(50%) ofgood, group B showed 4 cases(44.4%) of excellent and 5 cases(55.6%) of good. In the radiologic findings of the cora-coclavicular distances, group A was 16.2 mm at preoperative, 8.8 mm at postoperative, 9.7 mm at last follow-up andgroup B was 12.9 mm, 6.7 mm and 7.9 mm respectively. Postoperatively there were no complications such as surgi-cal wound infection and failure of Kirschner wires .

The Surgical Treatment of Acute Acromioclavicular Joint Dislocation Using C-C Sling Method and Modified Phemister Operation

Purpose: The purpose of this study was to compare the method of using coraco-clavicular (C-C) sling with modified Phemister operation by postoperative clinical results, radiologic analysis and complications. Materials and Methods: 33 patients of acromioclavicular joint dislocation were included in this study. Thirteen patients were treated with simple C-C sling method and twenty patients were treated with modified Phemister operation. The assesment of clinical and radiological evaluation were performed and the final results were examined by using the Weitzman’s classification. Results: In the final result of C-C sling method group, forward elevation 161, external rotation 70, internal rotation T8 level, Visual Analogue Scale (VAS) 83.3 points were checked. In modified Phemister operation group, forward elevation 155?, external rotation 67?, internal rotation T6 level, VAS 83.8 points were checked. In coracoclavicular distance of C-C sling method group, pre-operation 12.82 mm and last follow up 8.37 mm were checked. In modified Phemister operation group, pre-operation 12.8 mm and last follow up 7.7 mm were checked. In functional evaluation by the Weitzman criteria, C-C sling group had excellent 8, good 1, fair 1 and modified Phemister group had excellent 13, good 4, fair 3. Conclusion: C-C sling method would be the better than the Modified Phemister operation because of short operation time and smaller skin incision.

Clinical and radiologic outcomes of surgical and conservative treatment of type III acromioclavicular joint injury

The management of acute acromioclavicular joint dislocations is controversial. The purpose of this study was to compare the incidence of posttraumatic anatomic alterations after surgical or conservative treatment of type III injuries and to analyze their effect on the outcome. Forty-three patients were evaluated retrospectively, clinically and radiographically, at a 12-month minimum follow-up. Thirty-two were treated surgically, using the Phemister technique, and 11 had conservative treatment. A comparison of the overall clinical results in both groups showed no statistically significant differences. The acromioclavicular joint was anatomically reduced in only half of the surgical patients. Those shoulders treated surgically showed a significantly higher incidence of osteoarthritis and coracoclavicular ligament ossification. Differences in clavicular deformity or osteolysis were not significant. None of these abnormalities had any influence on the clinical result. Because operative and conservative treatments achieve equally good clinical results and surgery carries a higher risk of osteoarthritis, we recommend managing this injury conservatively.

Using Suture Anchors in the Treatment of an Acromioclaviclar Dislocation

Purpose : We introduce a surgical technique using suture anchors in the treatment of acromioclaviclar dislocation. Materials and Methods : Eighteen patients, who underwent surgery (using a suture anchor) for an acute acromioclavicular joint dislocation, were followed up minimum of six months. The clinical results on Imatami clinical scoring and serial radiology findings were analyzed. Results : Most of the cases showed satisfactory results. The clinical evaluation showed that seven cases (39%) were excellent and ten cases (56%) were good. Serial radiographic finding (preoperative, postoperative, postoperative 6 months) was evaluated. The mean preoperative, postoperative and postoperative 6 months coracoclavicular interval ratios were 2.41, 0.9 and 1.21, respectively. The early complications encountered were one case of a superficial infection at the insertion site of the smooth pin and one case of smooth pin migration. Conclusion : The use of suture anchors in the treatment of an acromioclaviclar dislocation is a superior method cosmetically due to the need for only a small operative incision, minimal destruction of acromioclaricular joint, secure fixation to early physical exercise and require additional surgery to remove the internal fixative.

Failure of acromioclavicular reconstruction using Gore-Tex graft due to aseptic foreign-body reaction and clavicle osteolysis: A case report

Surgical treatment for acromioclavicular (AC) joint separation can involve reduction of the joint and stabilization of the clavicle to the coracoid by use of screws, 36 Lowe G.P. Fogarty M.J. Acute acromioclavicular joint dislocation results of operative treatment with the Bosworth screw. Aust N Z J Surg. 1977; 47: 664-667 Crossref PubMed Scopus (19) Google Scholar , 50 Tsou P.M. Percutaneous cannulated screw coracoclavicular fixation for acute acromioclavicular dislocations. Clin Orthop. 1989; 243: 112-121 PubMed Google Scholar sutures, 3 Bargren J.H. Erlanger S. Dick H.M. Biomechanics and comparison of two operative methods of treatment of complete acromioclavicular separation. Clin Orthop. 1978; 130: 267-272 Crossref PubMed Scopus (51) Google Scholar , 10 Breslow M.J. Jazrawi L.M. Bernstein A.D. Kummer F.J. Rokito A.S. Treatment of acromioclavicular joint separation suture or suture anchors?. J Shoulder Elbow Surg. 2002; 11: 225-229 Abstract Full Text Full Text PDF PubMed Scopus (79) Google Scholar or synthetic materials such as polyester (Dacron, DuPont, Wilmington, DE), 12 Chen S.K. Chou P.P. Cheng Y.M. Lin S.Y. Surgical treatment of complete acromioclavicular separations. Kaohsiung J Med Sci. 1997; 13: 175-181 Google Scholar , 15 Fleming R.E. Tornberg D.N. Kiernan H. An operative repair of acromioclavicular separation. J Trauma. 1978; 18: 709-712 Crossref Scopus (28) Google Scholar , 20 Goldberg J.A. Viglione W. Cumming W.J. Waddell F.S. Ruz P.A. Review of coracoclavicular ligament reconstruction using Dacron graft material. Aust N Z J Surg. 1987; 57: 441-445 Crossref PubMed Scopus (37) Google Scholar carbon fiber, 39 Milka S. Wojcik B. Nowak R. Early results of coracoclavicular ligament reconstruction with carbon fiber prosthesis in patients with acromioclavicular dislocation. Chir Narzadow Ruchu Ortop Pol. 1994; 59 ([in Polish]): 491-496 Google Scholar and polytetrafluoroethylene (Gore-Tex; W. L. Gore Associates, Flagstaff, AZ). 56 Weinstein D.M. McCann P.D. McIlveen S.J. Flatow E.L. Bigliani L.U. Surgical treatment of complete acromioclavicular dislocations. Am J Sports Med. 1990; 18: 106-107 Crossref Scopus (11) Google Scholar The use of a Gore-Tex graft for coracoclavicular (CC) stabilization was first described by Morrison and Lemos 41 Morrison D.S. Lemos M.J. Acromioclavicular separation. Reconstruction using synthetic loop augmentation. Am J Sports Med. 1995; 23: 105-110 Crossref PubMed Scopus (110) Google Scholar in 1995 and has the proposed advantage of increased fixation strength. Although numerous reports have shown poor long-term results for Gore-Tex grafts used for anterior cruciate ligament (ACL) reconstruction, there have been no reports of failure of Gore-Tex grafts used for CC stabilization. We describe a case of a 50-year-old man who underwent AC joint reduction and stabilization with a Gore-Tex graft, which was complicated by an aseptic foreign-body reaction and distal clavicle osteolysis, resulting in failure.

Treatment of acute acromioclavicular joint dislocation or lateral clavicular fracture with clavicular hook plate

目的 探讨AO/ASIF锁骨钩钢板在重度肩锁关节脱位(PostⅢ-Ⅵ型)及锁骨远端骨折(NeerⅡ型)治疗中的临床效果.方法 2000年1月～2002年9月,对36例重度肩锁关节脱位和8例锁骨远端骨折,行切开复位锁骨钩钢板内固定与喙锁韧带修补术.术后采用Constant Murley法评定肩关节功能.结果术后2.5～12个月取出钢板.随访时间2～23个月,3例失访.术后无病例发生伤口感染、内固定松动或断裂,内固定取出后无病例发生脱位及骨折.内固定术后肩关节评分均值为89分(健侧的95%),其中外展活动均值为7.9(健侧的88%);内固定取出术后肩关节评分均值为92分(健侧的98%),外展活动均值为8.8(健侧的98%).结论 AO/ASIF锁骨钩钢板是治疗重度肩锁关节脱位和锁骨远端骨折(NeerⅡ型)的一种较好治疗方法。

The anatomic coracoclavicular ligament reconstruction

The surgical management of chronic or acute acromioclavicular joint dislocations can be divided into three broad groups. These are repair of the acromioclavicular and coracoclavicular ligaments, reconstruction of the acromioclavicular or coracoclavicular ligaments, and tendon transfer. Biomechanical analysis of the coracoclavicular and acromioclavicular ligaments has determined that the coracoclavicular ligaments play a major role with/without the acromioclavicular ligaments intact. Based on this biomechanical analysis, we have devised a novel technique to reconstruct anatomically the coracoclavicular ligaments. The anatomic position of the coracoclavicular ligaments is discussed as determined by osteological measurements as well as the technique.

Surgical Treatment of the Acute Acromioclavicular Joint Dislocation Using a Wolter Plate

Purpose : To introduce the surgical technique of acute acromioclavicular joint dislocation using a Wolter plate and to evaluate its efficacy after surgical treatment. Materials and Methods : Twenty-six patients who underwent surgical treatment of the acute acromioclavicular joint dislocation using a Wolter plate and who were followed up minimally for one year were reviewed. We analyzed the clinical results of pain, function, range of motion and radiologic reduction state of the acromioclavicular joint. Results : All cases showed satisfactory results. By clinical evaluation, twelve cases (46%) were excellent and fourteen cases (54%) were good. By radiologic evaluation, twenty cases (77%) were excellent and six cases (23%) were good. By postoperative X-ray, ver-tical displacement of the clavicle was restored in all cases. No complications such as infection, loosening of screws, plate failure or redislocation after removal of the plate occurred. Conclusion : Acromioclavicular joint reconstruction using a Wolter plate is believed to be a useful method, which minimizes injury of the joint articular surface and provides enough stability for postoperative rehabilitation.

ACUTE ACROMIOCLAVICULAR JOINT DISLOCATION: RESULTS OF OPERATIVE TREATMENT WITH THE BOSWORTH SCREW

The results are reported in 21 patients who had acute acromioclavicular joint dislocation treated by open reduction and Bosworth screw fixation, with an average follow-up period of ten years. Nineteen patients had a good or excellent functional result. Good cosmetic results were obtained. Full recovery of shoulder movement occurred in all patients but one, although coracoclavicular calcification was a frequent finding. Complications following this technique were few.

Treatment of Acute Acromioclavicular Joint Dislocation by a Modified Bosworth Method

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