Acute Acromioclavicular Joint Disruption Research Articles

Dual fixation for coracoid fracture with acute acromioclavicular joint disruption: a case series

Abstract Introduction The management of acute disruption of the acromioclavicular joint (ACJ) in conjunction with a concomitant coracoid fracture has been discussed. This combined orthopedic injury is uncommon because radiographs alone may not always be enough to identify the coracoid component clearly. There are different options for management, ranging from nonsurgical, single, or double fixation strategy. The purpose of this study was to evaluate the results of a clavicular hook plate combined with a coracoid screw fixation in patients who engage in high-demand activities and athletes over a minimum of a year of follow-up. Patients and methods Following the dual fixation strategy, seven patients were followed clinically and radiologically with a mean follow-up 16 weeks, through which a rehabilitation program was adhered to. The range of motion around the shoulder, American Shoulder & Elbow Surgeons, and constant scores were utilized to evaluate patients clinically during their last follow-up visit. Furthermore, radiological assessment of the reduction of the ACJ according to coracoclavicular distance (CCD) and CCD ratio. Results The findings in this study showed a statistically significant improvement between the 3, 6, and 12-month American Shoulder & Elbow Surgeons scores, which were 39.1 ± 14, 67.4 ± 1, and 86.7 ± 5, respectively (P<0.001). The mean range of motions for active shoulder abduction and forward elevation was 171.4 ± 6.3° and 156.4 ± 12.8°, respectively. 9 ± 0.9 mm was the mean CCD, and 1.07% was the mean CCD ratio. Conclusion A stable fixation construct with significant functionality can be successfully achieved through the dual fixation strategy using a coracoid screw and hook plate with no coracoclavicular ligament reconstruction in the treatment of concomitant coracoid fracture and acute ACJ injuries in athletes and high-demand patients.

Retraction Notice - Hong Kong Journal of Orthopaedic Research

The following article is being withdrawn. Amr Elshahhat, Moheib Sayed Ahmed. Dual fixation for coracoid fracture with acute acromioclavicular joint disruption: A case series. Hong Kong Journal of Orthopaedic Research, 2022;5(3):32-37. DOI: 10.37515/ortho.8231.5301

Dual fixation for coracoid fracture with acute acromioclavicular joint disruption: A case series

Introduction: Management of concomitant coracoid fracture with acute acromioclavicular joint disruption has been a matter of debate. The coracoid component is not always radiographically recognized; thus, this combined orthopedic injury is not often common. Management options varied from conservative to surgical management with single or dual fixation strategy. This study aimed at outcome evaluation of clavicular hook plate with coracoid screw fixation in athletics and patients with high-demand activities for at least one year follow-up. Material and methods: Included patients underwent fixation through clavicular hook plate and coracoid screw. The hook plate was removed after an average period of 16.1 weeks, rehabilitation program was followed. Patients were subjected at final follow-up visit to clinical assessment via ROMs, constant, and ASES scores. Besides, radiological judgement of acromioclavicular joint reduction as per CCD and CCD ratio. Results: The average ASES Scores were 39.1±14.6, 67.4±11.5, and 86.7±5.7 at 3, 6, and 12 months, respectively with a statistically significant improvement in between (P-value <0.001). The mean active shoulder abduction and forward elevation ROMs were 156.4°±12.8° and 171.4°±6.3°. The average CCD was 9.04±0.9 mm (7.6-10.2 mm), and the mean CCD ratio was 1.07±0.03% (1.01-1.11%). Conclusion: Dual fixation via hook plate and coracoid screw without CCL reconstruction provides a stable fixation construct with considerable functional and radiological outcome in high demand patients with acute traumatic ACJ disruption combined with coracoid fracture. Study Design: Case series study.

Arthroscopically Assisted Double-Loop Suture Repair for Acute Acromioclavicular Joint Disruption

The surgical management of acute high-grade acromioclavicular (AC) joint (ACJ) injuries has evolved during the last decades. Numerous surgical techniques exist and recently arthroscopically assisted or all endoscopic techniques have gained popularity due to certain advantages. The goals of the new anatomic coracoclavicular ligament reconstruction techniques are to achieve anatomic reduction of the ACJ to allow and facilitate primary healing of AC and coracoclavicular (CC) ligaments, and also to minimize the risk of associated complications. We regularly use the open repair with double-loop sutures for the acute ACJ disruption, as described by Dimakopoulos et al. at 2006. In this surgical technique article, we present the arthroscopically assisted technique for the double-loop suture repair.

Arthroscopic reconstruction of acute acromioclavicular joint disruption using dog-bone button construct: A prospective study

IntroductionInjuries to the acromioclavicular joint (AC) are not uncommon accounting for 9% of all shoulder injuries. Surgical management is the mainstay of treatment in severe injuries. Numerous surgical techniques have been described in the literature with variable results. Arthroscopic stabilization using a suspensory fixation is one of the most commonly performed procedure. Current study was done to evaluate the functional and radiological results of arthroscopic acromioclavicular joint reconstruction using dog bone button, a special type of suspensory fixation. Materials and methodsOur study included 14 cases of Rockwood type III and V acute AC joint disruptions. A thorough clinico-radiological evaluation was done preoperatively including a Zanca view and compared with the contralateral side. All patients underwent arthroscopic acromioclavicular joint reconstruction using dog bone button. Radiological and functional results were studied during follow up at 6 weeks, 3 months and 6 months. Functional results were assessed using DASH (Disabilities of the Arm, Shoulder and Hand) score. ResultsThe mean pre-operative coracoclavicular (CC) distance was 16.11 mm with SD ± 1.94 and mean post-operative CC distance was 10.76 mm with SD of ±2.76. Mean DASH scores during follow up were 60, 9.71 and 0.36 at 6 weeks, 3 months and 6 months respectively. There was a significant difference in the pre and post-operative CC distance and DASH t scores (P < 0.001). ConclusionOur study results infer that arthroscopic AC joint reconstruction using dog bone button construct in acute cases provides good functional and radiological results. No significant postoperative complications were associated with the same procedure.

Arthroscopic fixation of acute acromioclavicular joint disruption with TightRope™: Outcome and complications after minimum 2 (2-5) years follow-up.

To evaluate the midterm results of arthroscopic reconstruction of acute acromioclavicular (AC) joint disruption using TightRope™ system. We retrospectively assess the results of 24 patients of acute AC joint dislocation who were operated using TightRope system. Constant and University of California, Los Angeles (UCLA) scores and coracoclavicular distance were calculated pre- and postoperatively. Data was entered into MS excel and analyzed using the SPSS version 17. The mean follow-up was 39.45 months. Constant and UCLA scores were significantly increased postoperatively. Six patients had partial loss of reduction within 3-6 months and two patients had a failure of construct. Constant score was significantly lower in these patients. TightRope reconstruction of the AC joint is a reproducible and safe alternative to many other techniques of AC joint reconstruction. Early subluxation remains a concern and may reflect the need for technique modification.

The Functional Outcome of Management of Acute Acromioclavicular Joint Disruption Using Tension Band Wiring

The Functional Outcome of Management of Acute Acromioclavicular Joint Disruption Using Tension Band Wiring

Is Coraco-Clavicular Stabilisation Alone Sufficient for the Endoscopic Treatment of Severe Acromio-Clavicular Separation (Rockwood Types III, IV, and V)?

The primary objective was to evaluate correlations linking anatomical to functional outcomes after endoscopically assisted repair of acute acromio-clavicular joint disruption (ACJD). Our hypothesis was that at 1 year combined acromio-clavicular and coraco-clavicular stabilisation improves radiological outcomes compared to coraco-clavicular stabilisation alone. A prospective multicentre study evaluated clinical outcome (pain, QuickDASH, and Constant’s score), and anatomical outcomes (standard XRays and dynamic radiographs). 116 patients (48% type III, 30% type IV, 22% type V), minimal FU was 1 year. Coraco-clavicular stabilisation was achieved using a double endobutton in 93% of patients, and concomitant acromio-clavicular stabilisation in 50%. The Constant’s score ≥85/100 and a subjective QuickDASH functional disability score ≤10 in 75% of patients. The radiographic analysis showed significant improvements and in the horizontal plane. The anatomical outcome correlated significantly with the functional outcome (absolute R value =0.19 and p=0.045). Implantation of a biological graft significantly improved both the anatomical outcome in the vertical plane (p=0.04) and acromio-clavicular stabilisation in the horizontal plane (p=0.02). The coraco-clavicular ratio on the antero-posterior radiograph was adversely affected by a longer time from injury to surgery (p=0.02). This study demonstrates that acute ACJD requires stabilisation in both planes, i.e., at the coraco-clavicular junction and at the acromio-clavicular joint. Implantation of a biological graft should be considered when the time from injury to surgery is longer than 10 days.

Arthroscopic fixation for acute acromioclavicular joint disruption using the TightRope device.

To review outcome after arthroscopic fixation for acute acromioclavicular (AC) joint dislocation using the TightRope device. Records of 15 men and 2 women aged 19 to 52 (mean, 35) years who underwent arthroscopic fixation using the TightRope device for acute (<3 weeks) AC joint dislocation of Rockwood type III (n=6), type IV (n=1), and type V (n=10) were reviewed. Outcome was evaluated using the Constant score. The coracoclavicular (CC) distance before and after surgery was compared. The mean follow-up period was 22.1 (range, 12-37) months. The mean time to return to work was 4 (range, 1.5-12) months, excluding one failure. The mean postoperative Constant score was 86.4 (range, 63-96). The CC distance decreased from 21.5±5.2 mm preoperatively to 9.8±3.5 mm at 6 months and to 10±3.2 mm at one year. There was no over-correction. All patients had satisfactory outcome except for one who had rupture of the TightRope suture at 6 months. Two patients had partial loss of reduction (≥2 mm) after 3 to 6 months secondary to osteolysis at the clavicular button site. Arthroscopic fixation using the TightRope device for acute AC joint dislocation achieves satisfactory outcome.

Acromioclavicular and coracoclavicular cerclage reconstruction for acute acromioclavicular joint dislocations

Little information is available on the results of the different stabilization techniques described for treatment of acute acromioclavicular (AC) joint injuries. Additionally, no studies have analyzed isometric performance of the shoulder after AC stabilization. The objective of our study was to present functional outcome including isokinetic testing and radiographic evaluation of patients treated with stabilization of AC joint dislocations. Thirty-seven patients with acute type III to V AC joint disruption underwent open coracoclavicular (CC) and AC stabilization with nonabsorbable sutures. The mean follow-up was 4.5 ± 2.5 years (range, 2-10.5). The mean Constant score (CS) was 96. There were 34 (91.9%) excellent results, 1 good (2.7%), 1 satisfactory (2.7%), and 1 fair (2.7%). The disabilities of the arm, shoulder, and hand (DASH) questionnaire revealed good overall subjective evaluation with a mean of 7 points. The mean visual analog scale (VAS) pain score was 0.8. Patients with a CC distance <5 mm, or an anterosuperior AC reduction less than 50%, showed significantly better results in CS and DASH score in comparison to patients with a subluxated AC joint (P < .005). Twenty-two patients agreed to undergo isokinetic evaluation. We were unable to demonstrate any clinically significant difference between the involved and the uninvolved side. The described technique of cerclage augmentation offers an attractive alternative in AC joint stabilization, with good to excellent results. In comparison to other techniques, there were no complications related to any implants, no graft donor site morbidity, or need for implant removal.

Arthroscopically Assisted 2-Bundle Anatomical Reduction of Acute Acromioclavicular Joint Separations

Background: To achieve reduction of an acute acromioclavicular (AC) joint separation, novel procedures aim to provide stability and function by restoring the coracoclavicular anatomy. Hypothesis: Anatomical reconstruction for acute AC joint disruption using 2 flip-button devices results in satisfactory clinical function and provides a stable fixation. Study Design: Case series; Level of evidence, 4. Methods: The outcome of 23 consecutive patients (21 men, 2 women; mean age, 37.5 ± 10.2 years; range, 21-59 years) who underwent anatomical reduction for an acute AC joint dislocation using 2 flip-button devices, each separately replacing 1 coracoclavicular ligament, was evaluated clinically and radiographically preoperatively and 6, 12, and 24 months postoperatively. The evaluation included a visual analog scale for pain, the Constant score, the simple shoulder test, and the Short Form-36. An additional 7 patients had similar surgery during the same period, but 4 were lost to follow-up, 2 required surgical revision, and 1 developed postoperative infection. Results: There were 3 Rockwood type III, 3 type IV, and 17 type V separations. Mean follow-up was 30.6 ± 5.4 months (range, 24-40 months). The visual analog scale and Constant score showed significant improvements from preoperative 4.5 ± 1.9 (range, 1-7) and 34.3 ± 6.9 (range, 22-44) to postoperative 0.25 ± 0.5 (range, 0-1) and 94.3 ± 3.2 (range, 88-98) at 24 months, respectively. Postoperative radiographic AC joint alignment was unsatisfactory in 8 cases, either in the coronal, axillary, or both planes, with no different clinical outcome when compared with the remaining patients. Conclusion: Immediate anatomical reduction of an acute AC separation with flip-button devices provides satisfactory clinical results at intermediate-term follow-up. This technique should be performed by an experienced arthroscopist; tunnel and button placement are of utmost importance to avoid postoperative failure or loss of reduction.

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.