Chronic Acromioclavicular Dislocation Research Articles

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.

A New Modification of the ‘Surgilig’ Technique for the Reconstruction of Chronic Acromioclavicular Dislocations

A New Modification of the ‘Surgilig’ Technique for the Reconstruction of Chronic Acromioclavicular Dislocations

Open anatomical reconstruction surgical technique with allograft for the treatment of chronic acromioclavicular dislocations

Las luxaciones acromioclaviculares crónicas son lesiones cuyo tratamiento quirúrgico de elección actualmente es objeto de debate. En este artículo describimos una técnica de reconstrucción anatómica abierta de los ligamentos conoide y trapezoide, así como el refuerzo de los ligamentos acromioclaviculares con aloinjerto para el tratamiento quirúrgico de las luxaciones acromioclaviculares crónicas. El injerto, junto a una cinta de polietileno de alta resistencia, se pasa por sendos orificios en la clavícula, que remedan las inserciones nativas de los ligamentos conoide y trapezoide, y por debajo de la coracoides para restablecer la estabilidad coracoclavicular. La cinta se anuda sobre la superficie superior de la clavícula, lo que ayuda a la reducción al tiempo que contribuye a mantener la estabilidad vertical, y los extremos del injerto se fijan sobre el acromion para llevar a cabo la reconstrucción de los ligamentos acromioclaviculares superiores. El procedimiento finaliza con la reparación de los ligamentos acromioclaviculares anterior y posterior mediante la utilización de 2 implantes todo-sutura colocados en la clavícula distal y con la cuidadosa reparación de la fascia trapezoidal, logrando restituir, de este modo, tanto la estabilidad vertical como la horizontal.

Anatomical ligament reconstruction with allograft in chronic acromioclavicular dislocations restores joint stability and function. Short-term outcomes in 14 cases

Objetivo: analizar los resultados a corto plazo de una técnica anatómica que reconstruye los complejos ligamentosos acromioclavicular y coracoclavicular con ayuda de un aloinjerto tendinoso para el tratamiento de las luxaciones acromioclaviculares de más de 3 semanas de evolución. Métodos: estudio longitudinal prospectivo de una serie de casos con luxaciones acromioclaviculares de más de 3 semanas de evolución que fueron tratados con una técnica de reconstrucción anatómica de los complejos ligamentosos acromioclavicular y coracoclavicular con aloinjerto de tendón tibial. Se analizaron los resultados radiológicos y funcionales con las escalas de Constant-Murley, American Shoulder and Elbow Surgeons (ASES)-hombro y Quick-DASH (Disabilities of the Arm, Shoulder and Hand); además, se evaluó la estabilidad de la articulación acromioclavicular y la cinética escapulotorácica. Resultados: se evaluaron 14 sujetos al menos un año tras la cirugía –media: 2,7 (1,1) años–. Hubo mejorías significativas en las 3 escalas clínicas evaluadas: Constant-Murley pasó de 64,4 (13,0) en el preoperatorio a 93,6 (12,6) al finalizar el seguimiento (p

Arthroscopic Coracoclavicular Reconstruction Combined with Open Acromioclavicular Reconstruction Using Knot Hiding Clavicular Implants Is a Stable Solution

PurposeThe purpose of this noninterventional, register-based study was to report the outcomes and wound healing of surgically treated chronic acromioclavicular (AC) dislocations using a tendon graft and knot-hiding titanium implants.MethodsThirty-two cases with chronic AC separation underwent an arthroscopic coracoclavicular (CC) ligament reconstruction and an open AC ligament reconstruction using knot-hiding titanium implants. The wound healing was assessed 2 months after the operation. The Nottingham Clavicle score, Constant score, and Simple Shoulder Test were obtained postoperatively and at a minimum of one-year postsurgery. The radiographic change in distance between the clavicular and coracoid cortices and clavicular tunnel diameter was measured. General patient satisfaction with the outcome (poor, fair, good, or excellent) was also assessed 1 year postoperatively.ResultsThe mean Nottingham Clavicle score increased from a preoperative mean of 41.66 ± 9.86 to 96.831 ± 5.86 (P ≤ .05). The Constant score increased from a preoperative mean of 44.66 ± 12.54 to 93.59 ± 7.01 (P ≤ .05). The Simple Shoulder Test score increased from a preoperative mean of 7.00 ± 2.14 to 11.84 ± .63 (P ≤ .05). The coracoclavicular distance increased from 11.32 ± 3.71 to 13.48 ± 3.79 mm (P ≤ .05). The clavicular drill hole diameter increased from 6 mm to a mean of 6 to a mean of 8.13 ± 1.12 mm. Twenty-three (71.9%) patients reported an excellent outcome, and nine (28.1%) reported a good outcome. One clavicular fracture occurred but no coracoid fractures. There was one reconstruction failure leading to a reoperation.ConclusionsIn this series, combining the arthroscopic CC ligament reconstruction to an open reconstruction of the AC joint with a tendon graft proved to be a stable solution. The knot-hiding titanium implant effectively eliminated the problems related to the clavicular wound healing.Level of EvidenceLevel IV, therapeutic case series.

Arthroscopy-Assisted Reconstruction of the Coracoclavicular and Acromioclavicular Ligaments Using a Tendon Graft and Knot-Hiding Clavicular Implants in Chronic Acromioclavicular Separations

The purpose of this study is to introduce an arthroscopy-assisted technique to treat chronic acromioclavicular (AC) dislocation. The method involves reconstructing both the coracoclavicular (CC) and AC ligaments in a practical and reliable way using a semi-tendon graft and knot-hiding implants. In the CC reconstruction, the anterior graft limb replaces the trapezoid ligament, whereas the dorsal limb is wrapped around the dorsal edge of the clavicle to reconstruct the conoid ligament. One 5.5-mm drill hole is needed in the clavicle since the semitendinosus graft and the interconnecting supportive suture share the same drill hole. A 2.4-mm drill hole through the coracoid is needed for the interconnective suture. The technique uses knot-hiding titanium implants that are designed to be used with a tendon graft. After finishing the arthroscopic CC reconstruction, the dorsal end of the tendon graft is openly taken over the AC joint to openly reconstruct the superior AC ligament. The AC capsule is then plicated over the reconstruction. The arthroscopic part of the reconstruction is not technically difficult for an experienced arthroscopic shoulder surgeon. For success, it is essential to achieve a tension-free reduction of the distal clavicle and to provide sufficient recovery time postoperatively.

Postoperative Comparative Evaluation of Patients Undergoing Surgical Treatment for Acute Versus Chronic Acromioclavicular Dislocations.

Objectives The present study evaluates and compares the surgical treatment of acute and chronic acromioclavicular dislocations (ACDs) to define the most effective therapeutic plan. Methods A retrospective study consisting of 30 patients submitted to the surgical treatment of types III and V ACDs between 2011 and 2018; the subjects were separated according to a temporal classification in acute (< 3 weeks; subgroup I) and chronic (> 3 weeks; subgroup II) subgroups. All patients underwent a postsurgical evaluation with a standardized protocol containing epidemiological, functional, and radiological data. Results Subgroup I presented a visual analog scale (VAS) score of 1.10, a Constant-Murley score of 92.3, and a University of California at Los Angeles (UCLA) Shoulder Rating score of 33.5. The coracoclavicular (CC) distance was of 11.0 mm, and the average increase in CC space was lower than 8.9% compared to the contralateral shoulder. In subgroup II, the VAS score was of 1.11, the Constant-Murley score was of 94.2, and the UCLA score was of 32.4. The CC distance was of 13.8 mm, with a 22.9% increase in CC space compared to the contralateral side. Conclusion Although there was no significant difference between the evaluated items, subgroup I tended to present a lower CC distance ( p = 0.098) and a lower percentage increase in CC distance ( p = 0.095) compared to subgroup II. Thus, the surgical treatment must be performed within three weeks after the trauma to try to avoid such trend. If the acute treatment is not possible, the modified Weaver Dunn technique has good clinical and functional outcomes.

Chronic acromioclavicular dislocations: multidirectional stabilization without grafting

ObjectiveClinical and radiological evaluation of the surgical treatment of chronic acromioclavicular (AC) dislocations with triple button device and AC joint augmentation.Materials and MethodsThis retrospective study included 21 patients with chronic AC dislocations. All patients underwent bilateral-weighted Zanca and Alexander views as well as the Constant score (CS) and Acromioclavicular Joint Instability Scoring System (ACJI).ResultsA total of 21 patients (19 men and 2 women) with the mean age of 30.7 ± 11.7 years (range, 19-62 years) were able to participate in clinical and radiographic follow-up. After a mean follow-up of 49.7 ± 17.1 months (range, 13-60 months), the results of the CS were 95.2 ± 5.5 (range, 85-100) and ACJI test 89.7 ± 7.9 (range, 75-100), showing no significant differences with the uninjured shoulder (CS, 96.2 ± 3.9; range, 85-100; ACJI, 95.7 ± 4.1; range, 85-100). At the final review, we observed that the preoperative coracoclavicular distance (Zanca view) improved from 12.8 ± 1.5 mm to 8.5 ± 1.3 mm and the AC distance (Alexander view) from 7.8 ± 2.3 mm to 0.99 ± 0.91 mm. Compared with healthy shoulder, these differences were not significant. Osteoarthritis or radiological calcifications were not associated with worse clinical outcomes.ConclusionThe triple button device is an acceptable alternative surgical method for chronic AC joint dislocations. The surgical technique is simple; it does not need a graft, nor does it present major complications, and material extraction is unnecessary.

Surgical treatment of acute and chronic AC joint dislocations: Five-year experience with conventional and modified LARS fixation by a single surgeon

BackgroundDifferent surgical fixation methods are available for the treatment of acromioclavicular (AC) joint dislocations. The aim of this study was to present the results of five years of experience with the Ligament Augmentation and Reconstruction System (LARS) fixation technique by a single surgeon. MethodsA single-center retrospective cohort study was performed. All patients treated for an AC joint dislocation with LARS fixation by the same surgeon between 2012 and 2016 (n = 20) were eligible for inclusion. All these dislocations were unstable injuries, Rockwood type-III or higher, requiring acute or chronic repair. The primary outcome was the QuickDASH score. Secondary outcomes were the Subjective Shoulder Value (SSV), Numerical Rating Scale (NRS) pain score, return to work, complications, and implant removal. Results17 patients (85%) were available for final follow-up. The median follow-up was 23 months (IQR; 17─34). The median QuickDASH score was 7 (IQR; 2–18), the median SSV was 90 (IQR; 80–90), and the median NRS pain score was 2 (IQR; 1–3). Patients returned to work after a median of 8 weeks (IQR; 6–12). There was no significant difference in functional outcome scores between acute and chronic repair, or between the conventional and modified LARS fixation groups. There were two major complications requiring revision surgery, one ruptured LARS ligament and one case of deep wound infection. Implant removal was performed in one patient. ConclusionsThe LARS ligament fixation technique seems to be effective for the treatment of AC joint dislocations, resulting in good short- and mid-term patient-reported functional outcome. LARS fixation might also be an acceptable treatment option for active patients with symptomatic chronic AC dislocations. Level of evidenceLevel III, Retrospective Comparative Study, Treatment Study.

Intraoperative and Postoperative Complications after Arthroscopic Coracoclavicular Stabilization.

BackgroundArthroscopic stabilization of torn coracoclavicular (CC) ligaments gained popularity recently. However, loss of reduction after the operation and complications unique to this technique involving tunnel placement through the distal clavicle and coracoid process are concerns. The purpose of this study was to report intraoperative and early postoperative complications associated with this procedure.MethodsThis study retrospectively evaluated 18 consecutive patients who had undergone arthroscopic stabilization for torn CC ligaments between 2014 and 2015. The indications for surgery were acute or chronic acromioclavicular dislocation and acute fracture of the distal clavicle, associated with CC ligament disruption. Clinical outcomes were evaluated with the American Shoulder and Elbow Surgeons (ASES) and the University of California, Los Angeles (UCLA) scores. Intra- and postoperative complications and reoperations were investigated.ResultsThere were six female and 12 male patients with a mean age of 47 years (range, 22 to 86 years). At a mean follow-up of 17 ± 10 months (range, 10 to 28 months), the mean ASES score was 88.8 ± 19.9 and the mean UCLA score was 30.9 ± 5.2. Intraoperatively, seven complications developed: breach of lateral cortex of the coracoid process in five patients, medial cortex of the coracoid process in one, and anterior cortex of the clavicle in one. Postoperative complications developed in eight patients: four ossifications of the CC interspace, four tunnel widening of the clavicle, one bony erosion on the clavicle, and one superficial infection. A loss of reduction was found in six patients. Reoperation was performed in three patients for loss of reduction in two and superficial infection in the other.ConclusionsArthroscopic CC stabilization resulted in high rates of intraoperative and early postoperative complications. Most of them were related to the surgical technique involving bone tunnel placement in the coracoid process and the clavicle.

Arthroscopic-assisted Acromioclavicular and Coracoclavicular Ligaments Reconstruction for Chronic Acromioclavicular Dislocations: Surgical Technique.

Chronic acromioclavicular (AC) instability is a rare posttraumatic shoulder condition that can lead to undesirable symptoms like persistent pain, muscle fatigue, loss of strength, or even scapular dyskinesis. It is well known that in these cases the superior functional results depend on the restoration of the anatomy and stability of the AC joint in both vertical and horizontal planes. Considering the ligaments degeneration and atrophy in chronic AC joint dislocations, we present an arthroscopic-assisted reconstruction of both the coracoclavicular and AC ligaments using autograft augmentation. In details the coracoclavicular ligaments component is reconstructed using the Tightrope suspension device augmented with a palmaris longus autograft and by the nonanatomic coracoacromial ligament transfer (modified Weaver-Dunn). The AC part is restored by suturing the remainder palmaris longus autograft on the acromion and on the deltotrapezial fascia. Using the construct provided by this technique all the possible ruptured ligaments are reconstructed, optimizing the vertical and horizontal stability of the area, and promising excellent long-term radiologic and functional results.

Prognostic factors to succeed in surgical treatment of chronic acromioclavicular dislocations

Prognostic factors to succeed in surgical treatment of chronic acromioclavicular dislocations

Operative Fixation of Chronic Acromioclavicular Joint Dislocation With Hook Plate and Modified Ligament Transfer.

The optimal treatment for acute dislocation of the acromioclavicular (AC) joint remains unclear, and prior randomized trials did not reveal any significant improvements in the operative groups. However, it is clear that some patients treated nonoperatively are dissatisfied with their outcome and request surgical correction. This video demonstrates one method of repair of a chronic dislocation of the AC joint in a patient with significant symptomatology following nonoperative treatment of a high-grade AC dislocation. This video demonstrates the open reduction of a chronically dislocated AC joint. After mobilization of the distal clavicle and debridement of the joint, a step cut is made in the anterior surface of the distal clavicle. The coracoacromial (CA) ligament is then identified and mobilized, taking care to preserve its acromial origin. An anterior acromioplasty is then performed with a microsaggital saw. The AC joint is reduced, and the acromial fragment is sculpted to fit the step cut in the distal clavicle, where it is then fixed with a small-fragment cancellous screw in lag fashion. The blade of the hook plate is then contoured to fit under the acromion (posteriorly) to hold the joint in a reduced position. The deltoid is repaired with number 1 absorbable sutures, followed by a standard closure. Results are improved and complications minimized when care is taken to not avoid overreduction of the clavicle: an intraoperative radiograph, and/or comparison to the opposite side, may be useful. We do not shorten or resect the entire distal clavicle: this has been shown to lead to worse outcomes. We have found that CA transfer with a fragment of attached acromial bone results in more reliable healing than a CA transfer alone (the Weaver-Dunn transfer). In the setting of a chronic AC dislocation, hook plate fixation provides excellent reduction of the joint and a stable mechanical environment: this allows for the optimal healing of the ligament transfer. Typically, 6-12 months postoperatively, the hook plate can be removed to improve motion and reduce local irritation because joint stability is then provided by the transfer with bone-to-bone healing.

Prognostic factors to succeed in surgical treatment of chronic acromioclavicular dislocations

IntroductionTreatment of chronic acromioclavicular joint dislocation (ACJD) remains a poorly known and controversial subject. Given the many surgical options, it is not always easy to determine which steps are indispensable. MethodsThis article reports a multicenter prospective study. The clinical and radiological follow-up involved a comparative analysis of the preoperative and postoperative data at 1 year, including pain (visual analogue scale), subjective functional incapacity (QuickDASH), and the objective Constant score, as well as a comparative analysis of vertical and horizontal movements measured on simple x-rays. ResultsBased on a series of 140 operated ACJDs, we included 24 chronic ACJDs. The mean time to surgery was 46 weeks (range, 1 month to 4 years). The patients’ mean age was 41 years, with a majority of males (75%), 72% of whom participated in recreational sports. Professionally, 40% of the subjects had jobs involving manual labor. We noted 40% grade III, 24% grade IV, and 36% grade V injury according to the Rockwood classification. In 92% of cases, coracoclavicular stabilization was provided by a double button implant, reinforced with a biological graft in 88% of the cases. In 29%, millimeters to centimeters of the distal clavicle were resected and acromioclavicular stabilization was associated in 54%. We observed complications in 33% of the cases. At 1 year postoperative, 21 patients underwent clinical and radiological follow-up (87.5%). Only 35% of the patients were satisfied or very satisfied, whereas 100% of them would recommend the operation. Full-time work was resumed in 91% of the cases and all sports could be resumed in 86%. The pre- and postoperative values at 1 year changed as follows: the mean Constant score improved from 61 to 87 (p=0.00002); the subjective QuickDASH score decreased from 41 to 9 (p=0.00002); and radiologically significant reduction of the initial displacement was observed in the vertical plane (p<10−3) and the horizontal plane (p=0.022). ConclusionIn this study, the favorable prognostic factors found were: time to surgery less than 3 months (p=0.02), associated acromioclavicular stabilization, and postoperative immobilization with a sling extended to 6 weeks. However, resection of the distal clavicle did not influence the final result. Level of proofLevel II prospective non-randomized comparative study.

Vascular graft employment in the surgical treatment of acute and chronic acromio-clavicular dislocation.

To show the efficiency and safety of a surgical treatment in both acute and chronic acromio-clavicular junction (ACJ) dislocations. Retrospective. Department of Orthopedics and Traumatology at IRCCS San Raffaele Hospital. This study was performed on 37 subjects classified as Rockwood grade III-V or Tossy III ACJ dislocation. The surgical treatment was carried out by placing a vascular graft (GorePropaten(®)) between the tip of the coracoid process and the mid-lateral side of the clavicle with two temporary percutaneous K-wires positioned in a parallel manner in the AC ligament through the acromion and clavicle for 30 days to improve stability. Outcomes were assessed using the Constant Shoulder (CS) score, DASH score, subjective satisfaction, and stability of AC joint at 24 months. UCLA scores taken preoperatively and at 15-month follow-up were used to perform statistical analysis significance using a control group treated conservatively. Postoperative X-rays were examined to assess joint stability after 24 months. Preoperative CS score was 51 ± 12 in the acute group and 55 ± 15 in the chronic group. Follow-up mean CS score was 88 ± 11 in the acute group and 82 ± 20 in the chronic group at 24 months. Preoperative DASH score was 19 ± 3 in the acute group and 14 ± 5 in the chronic group. Mean DASH score was 3.60 ± 7 in the acute group and 6.42 ± 6 in the chronic group. Preoperative UCLA scores were 14.6 ± 2 and 15 ± 7 in the acute group and chronic group, respectively. At 15-month follow-up, UCLA scores of 28.1 ± 1.9 and 27.7 ± 1 in the acute and chronic group, respectively, showed a significant improvement (p < 0.05) compared with UCLA scores taken preoperatively and at 15 months in the control group treated conservatively of 15.8 ± 0.9 and 16.2 ± 0.9, respectively. Results were good to excellent in 10 patients from the acute group and 23 patients from the chronic group who presented clinical stability of the AC joint without pain. Postoperative radiography showed anatomical repositioning of the ACJ and joint stability in 35 cases, but only two patients showed a partial re-dislocation at the 24-month X-ray follow-up. No infections, either deep or superficial, or nerve palsies were reported. Given the results obtained during the study and the response of the patients in both acute and chronic groups, the authors found that the employment of a vascular graft combined with temporary percutaneous K-wires is able to improve the patient's clinical outcome following an acromio-clavicular joint dislocation.

Scapular Dyskinesis: Related Pathology

Shoulder pain is one of the most frequent causes of disability in overhead sports and often forces athletes and workers to stop their activities. Scapular dyskinesis is not an injury or a musculoskeletal diagnosis, but rather an alteration of the normal position or motion of the scapula during coupled scapulohumeral movements. The underlying pathology can be multifactorial in nature, and understanding the various contributing factors is important in order to properly diagnose and treat the patient. An additional goal should be the prevention of further pathology or symptoms. In the present article the concept of scapular dyskinesis is reviewed along with a review of the literature regarding related pathology and our observations. Scapular dyskinesis can exist in asymptomatic individuals. In symptomatic patients with shoulder pain the scapular rhythm should be evaluated and treated. Some of the associated pathologies could be subacromial impingement, internal impingement, chronic acromioclavicular dislocations grade III, chronic neck pain. Physical therapy is usually the preferred treatment of choice and effective to treat these patients.

Scapular dyskinesis and SICK syndrome in patients with a chronic type III acromioclavicular dislocation. Results of rehabilitation.

Scapular dyskinesis has been related to acromioclavicular injuries. A rehabilitation protocol has been studied in order to treat scapular dyskinesis, but it has not yet been evaluated. This rehabilitation programme was adopted to improve the shoulder function, thereby improving the scapular dyskinesis in patients with chronic acromioclavicular dislocation. Twenty-four patients diagnosed with chronic type III acromioclavicular dislocation and scapular dyskinesis that have already been conservatively treated were enrolled in the rehabilitation protocol and analysed. Fourteen of these patients had a Scapular Inferior Coracoid dysKinesis (SICK) Syndrome. The adopted rehabilitation protocol consisted of 12 strengthening and stretching exercises of the scapulae. The final follow-ups were performed after 6 weeks, 6 months and 12 months using clinical measurements of scapular position and clinical evaluation of the scapular motion. In order to evaluate the SICK scapula syndrome, we used the SICK Scapula Rating Scale. The shoulder function was evaluated with a Constant Score and a Subjective Shoulder Value. After 12 months, the follow-up concluded that the scapular dyskinesis was no longer present in 18/23 patients (78.2 %). SICK scapula syndrome was observed in 4/8 patients with a scapular malposition. The Scapula Rating Scale score in 4 patients with SICK scapula was 7.5 points. After 12 months of rehabilitation, the mean Constant Score and Subjective Shoulder Value grew up to 85 points. The scapular dyskinesis and SICK syndrome secondary to chronic type III AC dislocation can be treated with the proposed rehabilitation protocol resulting in positive improvements of the shoulder function within 6 weeks; however, patients that do not respond to the rehabilitation programme will not improve with extended rehabilitation time. It is important to advise patients of the specific exercises for the prevention/treatment of scapular dyskinesis in the rehabilitation programme after AC joint dislocation. IV.

Distal Clavicle Osteolysis after Modified Weaver-Dunn’s Procedure for Chronic Acromioclavicular Dislocation: A Case Report and Review of Complications

Distal clavicle osteolysis after acromioclavicular joint stabilization has only been described after the use of hardware for clavicle stabilization or synthetic graft causing a foreign body reaction. This paper reports a very rare case of distal clavicle osteolysis after modified Weaver-Dunn procedure for the treatment of chronic acromioclavicular joint dislocation. The paper also provides a comprehensive review of complications of this surgical technique and discusses a potential vascular etiology and preventive strategies aimed at avoiding clavicle osteolysis.

Surgical treatment of chronic acromioclavicular dislocation with biologic graft vs synthetic ligament: a prospective randomized comparative study

BackgroundAcromioclavicular (AC) dislocation involves complete loss of articular contact; it is defined as chronic when it follows conservative management or unsuccessful surgical treatment.Materials and methodsThe study compared the clinical and radiographic outcomes of AC joint stabilization performed in 40 patients with chronic dislocation using a biological allograft (group A) or a synthetic ligament (group B). Demographic data included: M/F: 25/15; mean age: 35 ± 3.2 years; previous surgery in 11 patients, including Weaver–Dunn (3), coracoacromial ligament repair (4), stabilization with K-wires (4). Dislocation was type III in 14 (35 %) and type IV in 26 (65 %) patients. Clinical assessment was with the Constant–Murley score (pre- and postoperative) and with the modified UCLA score. Enrollment started in January 2004 and was completed in March 2008. Patients were evaluated at 1 and 4 years. Postoperative X-rays were examined to assess joint stability in the coronal and axial planes, coracoclavicular ossification, and signs of AC joint osteoarthritis and distal clavicular osteolysis.ResultsThe “biological” group achieved significantly better clinical scores than the “synthetic” group at both 1 and 4 years. Poor subjective satisfaction and lower clinical scores were found in the 3 patients (1 from group A and 2 from group B) who experienced complete postoperative dislocation. No significant correlations were found with other radiographic parameters.ConclusionsThe biological graft afforded better clinical and radiographic outcomes than the synthetic ligament in patients with chronic AC joint instability. Fixation to the clavicle constitutes the main weakness of both approaches and needs improving.

Reconstrução coracoclavicular com enxerto tendíneo na luxação acromioclavicular crônica

OBJETIVO: Apresentar os resultados radiográficos e funcionais de pacientes submetidos ao tratamento da luxação acromioclavicular crônica com reconstrução dos ligamentos coracoclaviculares com enxerto de tendão semitendíneo. MÉTODO: Quinze pacientes, entre abril de 2007 e junho de 2008, foram submetidos a reconstrução dos ligamentos coracoclaviculares com enxerto tendíneo. Dois pacientes foram excluídos do estudo por seguimento inadequado. Treze pacientes foram seguidos clinicamente e radiograficamente, em média, por 16 meses (12-26 meses). Os pacientes foram submetidos a avaliação clinica pré e pós-operatória, utilizando os escores Constant e UCLA. Radiografias pré e pós-operatórias foram comparadas. RESULTADOS: Neste grupo de 13 pacientes com seguimento mínimo de um ano, o escore Constant variou de 60,9 (26-88) na avaliação pré-operatória para 87 (60-98) na última avaliação no período pós-operatório. O escore UCLA foi de 16,8 (11-27) no pré operatório para 33 (29-35) na avaliação pós-operatória (p=0,001). No controle radiográfico com um ano de pós-operatório, encontramos 12 pacientes (92%) com a distância coracoclavicular igual comparando o ombro operado ao contralateral. Todos os ombros operados apresentavam-se sem translação na direção antero-posterior no perfil axilar. CONCLUSÃO: O resultado funcional e radiográfico foi muito satisfatório nos pacientes submetidos à reconstrução das luxações acromioclaviculares crônicas, com baixo indice de recidiva. Nivel de Evidência IV, série de casos.