Mean Coracoclavicular Distance Research Articles

Functional and Radiological Outcome after Anatomic Coracoclavicular Ligament Reconstruction for Type III to Type V Acromioclavicular Joint Dislocation Using Semitendinous Autograft

INTRODUCTION: Acromioclavicular joint dislocation is a commonly encountered shoulder injury. Various surgical methods are available for the treatment of complete ACJ dislocation (type III to VI), however, optimal surgical treatment is still controversial. The purpose of this study was to evaluate the radiological and functional outcome of anatomic coracoclavicular reconstruction (ACCR) using semitendinosus autograft with suture augmentation for type III to V ACJ dislocation. MATERIALS AND METHODS: It was a single centered, cross sectional, observational study conducted at Department of Orthopedics and Traumatology, Dhulikhel Hospital. Twenty-three consecutive patients who underwent ACCR with semitendinosus autograft from Jan 2017 to Dec 2019 were included in the study. Patients below 18 years of age and patients with previous ipsilateral shoulder injury were excluded. The radiological outcome was assessed using coracoclavicular (CC) distance and functional outcome using DASH score and Constant score. Paired t-test and Pearson correlation were used for inferential analysis. RESULTS: Mean age of the patient was 33.83 ± 7.08 years. Mean duration of follow up was 28.17 ± 6.19 months. Mean CC distance at final follow up was 9.93 ± 1.12 mm. Mean DASH score was 5.60 ± 5.35 and mean Constant score was 88.04 ± 12.13. There were 12 (52.17%) excellent outcomes, 6 (26.08%) good outcomes, 2 (8.69%) fair outcomes and 3 (13.04%) poor outcomes based on Constant scores. CONCLUSIONS: ACCR with suture augmentation is an effective method for management of type III to V acromioclavicular joint dislocation.

The Accuracy of Distal Clavicle Fracture Classifications-Do We Need an Amendment to Imaging Modalities or Fracture Typing?

Background: Despite its fair-to-moderate reliability, the “modified Neer classification” is widely accepted and used. The purpose of this study was to reevaluate its applicability. Methods: Of n = 59 patients with distal clavicle fractures, fractures were classified on standard radiographs. Afterwards, an MRI examination was performed, and fractures reclassified. The primary outcome parameter was quantifying the rate of misclassification. The secondary outcome parameters were the evaluation of the ligamentous injury constellations. Results: In all cases, the fracture course and ligamental integrity could be assigned to the fracture type. Correction of the classification was necessary in n = 5 (8.5%) cases. In n = 3 (5%) cases, a correction was necessary from Neer I to Craig IIc and thus from conservative to operative treatment. Mean coracoclavicular distance (CCD) in Neer I was 10.2 ± 2.1 mm versus 14.2 ± 3.9 mm in Craig IIc (p = 0.02). The mean fracture angle in Neer I was 25.1 ± 3.3° versus 36.8 ± 4.4° in Craig IIc (p = 0.02). Conclusion: Cross-sectional imaging resulted in higher precision. Nevertheless, recommendations remain for standard radiographs. The CCD and fracture angle should be considered. An angle of >30° can be assumed as a parameter of instability. A previously undescribed fracture type does not seem to exist. The modified Neer classification is an appropriate and complete fracture classification.

Functional and Radiographic Outcomes of Intraoperatively Decreasing the Coracoclavicular Distance to 50% of the Unaffected Side in Stabilization of Acute Acromioclavicular Joint Injury: A Retrospective Evaluation.

Background:The postoperative failure rate of acromioclavicular (AC) joint fixation using the coracoclavicular (CC) stabilization technique is high. Studies have reported that compared with normal intraoperative anatomic reduction, intraoperative overreduction of the AC joint is more successful in achieving a satisfactory anatomic radiographic outcome at 1- to 2-year follow-up.Purpose:To evaluate the functional and radiographic outcomes and complications in patients with acute AC joint injury who underwent combined CC stabilization and AC capsular repair in which the CC distance was intraoperatively decreased to 50% of the unaffected side.Study Design:Case series; Level of evidence, 4.Methods:In this retrospective study, we collected and analyzed the data of patients with an acute AC joint injury (Rockwood type 5) who underwent combined CC stabilization and AC capsular repair during which the CC distance was decreased 50% compared with the unaffected side. At 2-year follow-up, we evaluated functional outcomes (American Shoulder and Elbow Surgeons [ASES] score), radiographic outcomes (alignment of the AC joint in the vertical and horizontal planes, tunnel widening), and complications (infection, clavicular fracture).Results:The study included 20 patients with a mean ± SD age of 42.20 ± 10.10 years. The mean follow-up period was 33.75 ± 11.50 months. At the 2-year follow-up, the mean ASES score was 95.13 ± 5.61. The overreduction alignment, anatomic alignment, and loss reduction alignment rates were 0% (0/20 patients), 95% (19/20 patients), and 5% (1/ 20 patients), respectively. No statistically significant difference was found in the mean CC distance between the affected and unaffected sides on radiographic evaluation. The mean medial clavicular tunnel width and lateral clavicular tunnel width were 5.03 ± 0.68 mm and 4.47 ± 0.67 mm, respectively. None of the patients experienced fractures or infections.Conclusion:Excellent functional and radiographic outcomes and no complications were seen at 2-year follow-up in patients with acute AC joint injury who underwent combined CC stabilization and AC capsular repair with the CC distance intraoperatively decreased to 50% of the unaffected side.

Precontoured Locking Compression Plate with Titanium Alloy Cable System: In Treatment of Neer Type IIb Distal Clavicle Fracture.

ObjectiveTo describe a new method which involves anatomical distal clavicle plate fixation and titanium alloy cable system‐augmented coracoclavicular ligament reconstruction to manage Neer type IIb distal clavicle fracture.MethodsBetween January 2013 and June 2018, 28 patients with acute Neer type IIb lateral clavicle fracture were treated by a new method – precontoured locking compressive distal clavicular plate fixation of the fracture combined with titanium alloy cable system‐augmented reconstruction of the coracoclavicular ligament. There were 11 females and 17 males treated in this way. There were 15 cases of the right side and 13 of the left. The mean age of the patients was 48.5 years (range, 18–78 years). The mean time from injury to surgery was 3.9 days (range, 1–7 days). After completing the preoperative examinations and evaluations, surgeries were performed for all these patients, anatomical distal clavicle plates were used for fractures, and titanium alloy cables were implanted for the augmented reconstruction of coracoclavicular ligaments. Postoperative protocols, including arm sling management and rehabilitative activities, were unified and recommended to all the patients. These patients were followed up for at least 1 year. The mean duration of postoperative follow‐up was 23.3 months (range, 12–52 months). At the last follow‐up, the coracoclavicular distances were recorded and shoulder functional outcomes were assessed by the Constant scores and the Fudan University Shoulder Scores (FUSSs) questionnaires.ResultsRadiographic bony unions were achieved in all patients within 20 weeks. Functional and radiographic outcomes were retrospectively evaluated. The mean coracoclavicular distance was 9.61 ± 0.61 mm on the injured side vs 9.62 ± 0.57 mm on the contralateral uninjured side. The mean Constant score and mean FUSS were 90.1 ± 6.6 (range, 68–98) and 86.1 ± 7.2 (range, 64–95) respectively, which indicating good restoration of function and high level of satisfaction for both the patients and their physical therapists. There were a few major complications, including one delayed healing of the skin, one severe shoulder stiffness, three incidences of moderate shoulder stiffness, and five incidences of symptomatic hardware. There is no deep infections, neurovascular injuried, delayed union or nonunion, peri‐implant fracture, loss of reduction, implant malposition or failure, or other severe complications.ConclusionThis combined method for the treatment of Neer type IIb distal clavicle fracture could yield high bony union rate, good functional outcome, and low complication rate. Further prospective randomized controlled studies are needed to confirm the benefits of this method of treatment.

Arthroscopic Coracoclavicular Ligament Reconstruction of Chronic Acromioclavicular Dislocations Using Autogenous Semitendinosus Graft: A Two-Year Follow-up Study of 58 Patients

PurposeTo determine the results of operatively treated chronic acromioclavicular (AC) joint dislocations after 2-year follow-up.MethodsFifty-eight patients with chronic acromioclavicular separations underwent arthroscopic coracoclavicular ligament reconstructions using semitendinosus autografts. Constant and Simple Shoulder Test scores were determined before and 2 years after surgery as a part of standard clinical practice. General patient satisfaction with the outcome (poor, fair, or excellent) also was assessed. In addition, for purposes of routine clinical follow-up, the coracoclavicular distance was measured from the inferior cortex of the clavicle to the superior cortex of the coracoid using anteroposterior radiographs taken 2 years after surgery. The results were compared with postoperative radiographs and changes in the distance were recorded. The clavicular drill hole was similarly measured 2 years after surgery to detect possible tunnel widening.ResultsThe mean preoperative Constant score increased from a preoperative mean of 52.6 ± 16.5 to 94.7 ± 7.9 at 2 years postoperatively (P = .000). The Simple Shoulder Test score increased from a preoperative mean of 7.7 ± 1.64 to 11.8 ± 0.7 (P = .000). The mean coracoclavicular distance increased from 10.5 ± 3.4 to 12.4 ± 3.9 mm (P = .009). The diameter of the clavicular drill hole increased from 6.0 mm to a mean of 8.4 mm. Two coracoid fractures were observed, but no clavicular fractures. One patient experienced a deep infection, leading to total reconstruction failure, and 2 patients had superficial postoperative infections. Forty-five patients (85%) reported excellent subjective outcomes, and 8 (15%) reported a fair outcome.ConclusionsThe outcomes of this series of coracoclavicular ligament reconstruction were favorable and the number of serious complications was small. However, clavicular wound issues were a significant problem. Coracoclavicular ligament reconstruction is a challenging procedure, but satisfactory results can be achieved with careful patient selection and good technique.Level of EvidenceLevel IV, therapeutic case series

Results of acromioclavicular joint reconstruction using a novel minimally invasive technique.

AC joint injury is a common disorder with a reported incidence of three to four cases per 100.000. A multitude of surgical techniques has been described for the treatment of the AC joint injuries with no clear consensus regarding the optimal treatment. We hypothesized that we would obtain favorable clinical outcomes using a novel minimally-invasive polymer cerclage wire system compared to other reported techniques in the literature. All adult patients treated with subacute AC separations in our department between the dates of 2014-2017 were retrospectively reviewed clinically and radiographically. Clinical outcomes scores that were obtained preoperatively and postoperatively included ASES score, constant score and the UCLA shoulder rating scale. Five patients with Type 5 AC separations were included in this study who underwent surgical treatment by the same orthopedic surgeon (G.H.) using the same minimally-invasive technique. The mean follow-up period was 22.4 months (range 18 to 29). Mean preoperative coracoclavicular (CC) distance was 19.7 mm (range 16.4 to 24.5 mm) on the surgical side and 9.48 mm on the contralateral side. Mean early postoperative CC distance was 7.1 mm (range 4.5 to 11.2 mm). At the latest follow-up, the mean CC distance was 13.8 mm (range 7.3 to 21.2 mm). Mean preoperative Constant score was 48, the UCLA shoulder rating score was 14.8, and the ASES shoulder score was 49.26. Mean follow up Constant score was 91.6, UCLA shoulder rating score was 33.8 and ASES shoulder score was 93.75. No neurovascular complication was observed after procedure. There were no cases of clinical or radiographic failure or loss of fixation. No AC joint arthritis was observed at the latest follow-up. We present a novel minimally-invasive polymer cerclage wire technique which provides comparable results as other reported arthroscopic and open techniques for Type 5 AC joint separations.

Precontoured Clavicular Locking Plate with Broad Lateral End: A Newly Designed Plate for Lateral Third Clavicle Fractures.

Introduction: Various treatment modalities are available but no consensus has been reached for optimal treatment of lateral third clavicle fractures. Precontoured locking plates with broad lateral end for multiple screws fixation is a newly designed plate for lateral third clavicle fractures. The objective of our study was to analyse the functional outcomes as well as complications of this technique in a significant number of cases with long follow-up duration.Materials and Methods: Forty-six patients with distal third clavicle fractures were treated by precontoured clavicular locking plate with broad lateral end. Functional outcomes were assessed on the basis of Constant-Murley Shoulder Outcome Score and University of California, Los Angeles (UCLA) Shoulder Rating Score, active shoulder range of motion, time for fracture union and coraco-clavicular distance.Results: The mean Constant-Murley score was 92.56±4.47 (range: 79-98) for injured side and 96.22±2.23 (range: 90-100) for normal side with p-Value 0.56. Mean coraco-clavicular distance at final follow-up was 10.52±1.13 mm (range 9.7 to 11.7 mm) in injured side and 10.25±0.98 mm (range 9.6 to 11.2 mm) in normal side. Mean UCLA Shoulder Rating Score was 32.55±2.12 (range: 27-34) for injured side and 33.46±1.88 (range: 31- 35) on normal side with p value 0.58. No major complications that necessitated revision of surgery occurred in our study.Conclusion: This newly designed plate seemed extremely useful in successful union of lateral third clavicle fractures, with reduced rate of complications like fixation failures, iatrogenic rotator cuff injury, AC joint osteoarthritis and sub-acromial bursitis, with good functional outcomes.

Comparative analysis of locking plate versus hook plate osteosynthesis of Neer type IIB lateral clavicle fractures.

Controversy exists on optimal operative treatment of vertically unstable Neer IIB lateral clavicle fractures. Aim of this study was to analyse and compare clinical and radiological results and complications of locking plate osteosynthesis (LPO) versus hook plate osteosynthesis (HPO) with acromioclavicular joint (ACJ) stabilization. The hypothesis was, that HPO would recreate coracoclavicular stability more effectively and potentially lead to a superior outcome. This retrospective, observational cohort study included 32 patients (19 HPO, 13 LPO) with a mean age of 44.1 ± 14.2years at surgery. The mean follow-up period was 54.2months (range 25.2-111.4months). Besides standard radiography, bilateral coracoclavicular distances were assessed by means of preoperative and follow-up stress radiographs after implant removal. Clinical outcome measures included the Constant score (CS), the Oxford shoulder score (OSS), the subjective shoulder value (SSV) and the Taft score (TS). Bone union occurred in all but one patient and proved to occur delayed in five patients (15.6%). Radiographical healing required a mean of 4.2 ± 4.0months irrespective of the type of osteosynthesis. At follow-up, mean coracoclavicular distance was increased by 34% (±36) without significant differences between both groups. HPO patients obtained a significantly lower TS (HPO: 9.5 ± 1.5 points, LPO: 11.1 ± 1.3 points; p = 0.005). Other mean score values did not differ (CS: 90.1 ± 7.4 points, OSS: 43.2 ± 9.2 points, SSV: 91.1 ± 14.7%). Sixteen patients (50.0%) experienced complications. Overall prevalence of complications was significantly higher in the HPO group (p = 0.014). Both HPO and LPO were equally effective in relation to restoration of vertical stability, overall functional outcome and fracture consolidation in treatment of Neer IIB fractures. Contrary to our hypothesis, HPO was not associated with superior recreation of the coracoclavicular distance. Considerable drawbacks of HPO were an inferior ACJ-specific outcome (Taft-Score) and a higher overall complication rate. Level of evidence IV.

Loss of reduction and complications of coracoclavicular ligament reconstruction with autogenous tendon graft in acute acromioclavicular dislocations

This study was conducted to report loss of reduction and complications after single-tunnel coracoclavicular (CC) ligament reconstruction with autogenous semitendinosus tendon graft for acute acromioclavicular (AC) joint dislocations. This retrospective study included patients with acute, unstable AC dislocations (surgery within 6 weeks after trauma). We excluded patients with chronic injury and distal clavicle fractures with CC ligaments disruption. We measured the CC distance on anteroposterior radiographs of both clavicles, preoperatively, immediately postoperatively, and at the final follow-up visit. We evaluated clinical outcomes using the American Shoulder and Elbow Surgeons Shoulder Assessment and the University of California, Los Angeles Shoulder Rating Scale scores and perioperative complications. There were 30 patients (27 men and 3 women) with mean age of 41 years (range, 19-70 years). The mean follow-up period was 31 months (range, 12-186 months). Mean CC distance was 15.5 ± 3.7 mm (84% ± 14% of the contralateral shoulder) preoperatively, 8.9 ± 2.6 mm (9% ± 40%) immediately postoperatively (P < .001), and 10.6 ± 3.3 mm (24% ± 39%) at the final assessment (P < .001), showing an increase of the CC distance during the follow-up. Loss of reduction (defined as >25% increase of CC distance) developed in 14 patients (47%), and complications occurred in 6 patients (20%), including 3 distal clavicle fractures through the tunnel. Final clinical scores were significantly lower in patients with complications (27 vs. 33 of the University of California, Los Angeles assessment [P < .001] and 81 vs. 95 of the American Shoulder and Elbow Surgeons Shoulder assessment [P < .001]). In acute AC joint dislocation, single-tunnel CC ligament reconstruction using autogenous tendon graft resulted in loss of reduction rate of 47% and a complication rate of 20%. The development of complications adversely affected clinical outcomes.

Long-term outcomes of tension band wiring with a single K-wire in Rockwood type IV/V acute acromio-clavicular dislocations: 25 cases

BackgroundOur objective was to evaluate the long-term functional and radiological outcomes of tension band wiring with a single K-wire for acute Rockwood types IV and V acromio-clavicular dislocation (ACD). MethodsSingle-centre cross-sectional non-randomised observational cohort study of 25 shoulders treated surgically between January 2002 and December 2004, in 25 patients, 23 males and 2 females, with a mean age of 35±11years (24–46). The evaluation criteria were the absolute and weighted Constant scores, QuickDASH score, subjective shoulder value (SSV), visual analogue scale (VAS) pain score at rest and during activities, and radiographic features in clinically symptomatic patients. ResultsMean values were as follows: follow-up, 150±17months (133–167); absolute Constant score, 88±17 (71–105); weighted Constant score, 92.5±12.5 (80–105); QuickDASH, 15.5±7 (8.5–22.5); SSV, 88±17% (71–105); VAS pain score at rest, 0.2±0.7 (0–0.9); and VAS pain score while active, 1.4±2.3 (0–3.7). The weighted Constant score was less than 70% in only 8% of patients. Of the 17 patients for whom radiographs were obtained, 8 had acromio-clavicular osteoarthritis. Mean coraco-clavicular distance was 12.3±4.3mm (8–16.6) and mean acromio-clavicular distance was 5±5mm (0–10). The recurrence rate was 8%. ConclusionTension band wiring with a single K-wire for acute acromio-clavicular dislocation reliably provides good long-term functional outcomes. Recurrences are uncommon and few patients experience symptoms (8%). Level of evidenceIV, retrospective study.

Use of plate fixation without coracoclavicular ligament augmentation for unstable distal clavicle fractures

The purpose of this study was to evaluate the clinical and radiologic outcomes of unstable distal clavicle fractures treated with anatomic plate fixation without coracoclavicular ligament augmentation and to compare the outcome of Neer type IIA with that of type IIB. Twenty-five patients with unstable distal clavicle fractures who underwent anatomic plate fixation without coracoclavicular ligament augmentation were enrolled prospectively, including 9 patients of Neer type IIA and 16 patients of Neer type IIB. Clinical outcomes were evaluated using Constant and University of California-Los Angeles (UCLA) scores. Coracoclavicular distance was measured on plain radiographs. Bone union was achieved in all patients. Satisfactory clinical and radiologic outcomes were obtained regardless of fracture type. After operation, the mean coracoclavicular distance on the injured side was increased by 10% compared with the uninjured side. However, between the patients who showed an increased coracoclavicular distance >10% (Constant score, 89.4 ± 3.7; UCLA score, 32.6 ± 3) and the patients with increased coracoclavicular distance <10% of the uninjured side (Constant score, 88.7 ± 3.6; UCLA score, 31.9 ± 3), there was no statistically significant difference in clinical outcomes of Constant score (P = .934) and UCLA score (P = .598). In unstable distal clavicle fractures, precontoured anatomic plate fixation without coracoclavicular ligament augmentation showed satisfactory clinical outcomes and high union rates even with a small lateral fragment. Patients who had increased coracoclavicular distance also demonstrated satisfactory shoulder functional outcomes regardless of the fracture type. Therefore, anatomic plate fixation without additional coracoclavicular ligament augmentation can be considered one of the treatment options for unstable distal clavicle fracture. Level IV; Case Series; Treatment Study.

Arthroscopic Stabilization of Chronic Acromioclavicular Joint Dislocations

Background: Arthroscopically assisted single-bundle (SB) or double-bundle coracoclavicular (CC) ligament reconstruction using autologous tendon grafts has been reported to provide acromioclavicular (AC) joint (ACJ) stability in chronic instability cases. Recently, additional AC ligament reconstruction to provide triple-bundle (TB) stabilization has been introduced but lacks a comparison of clinical and radiological outcomes. Hypothesis: Arthroscopically assisted anatomic TB CC and AC reconstruction yields superior clinical and radiological results when compared with nonanatomic SB CC reconstruction. Study Design: Cohort study; Level of evidence, 2. Methods: Twenty-six patients (mean [±SD] age, 46.9 ± 12.8 years) suffering from chronic high-grade ACJ instability underwent ACJ stabilization using autologous hamstring grafts. Twelve patients underwent combined anatomic TB CC and AC reconstruction using a semitendinosus tendon with clavicular interference screw fixation (TB group), and 14 underwent isolated SB CC reconstruction using the AC GraftRope system with a gracilis tendon (SB group). After a minimum follow-up of 2 years (mean, 29.0 ± 7.4 months), patients were evaluated radiologically and clinically using the Constant, American Shoulder and Elbow Surgeons (ASES), Taft, and Acromioclavicular Joint Instability Score (ACJI) outcome measures. Results: The mean Constant score increased significantly in both groups, from 71.6 preoperatively to 88.8 postoperatively in the TB group and from 67.8 to 82.6 in the SB group (P ≤ .009). No intergroup difference was found regarding the final Constant or ASES scores. Regarding the ACJ-specific scores, the final outcomes were significantly different: 10.9 (TB group) versus 9.0 (SB group) for the mean Taft score (P = .018) and 84.7 versus 58.4, respectively, for the mean ACJI score (P = .0001). No significant radiological difference was found regarding the mean CC distance (10.7 mm [TB group] vs 13.1 mm [SB group]). The TB group showed superior horizontal ACJ stability (P = .011), which was associated with a better clinical outcome according to the ACJI and Taft scores. In the SB group, the rate of ACJ instability recurrence was higher (21% vs 8% [TB group]). Conclusion: Combined arthroscopically assisted anatomic TB CC and AC ligament reconstruction using an autologous semitendinosus tendon graft provides superior clinical and radiological results compared with isolated nonanatomic SB CC ligament reconstruction using the AC GraftRope system. In particular, the TB technique can better restore horizontal ACJ stability, which is associated with superior ACJ-specific outcome scores.

Clinical and radiological results after coracoclavicular ligament reconstruction for type III acromioclavicular joint dislocation using three different techniques. A retrospective study

the purpose of this retrospective study was to present the outcomes of three different techniques for the treatment of type III acromioclavicular joint dislocations: arthroscopic TightRope (TR), arthroscopic GraftRope (GR), and open reconstruction of the coracoclavicular (CC) ligament using the Ligament Augmentation and Reconstruction System (LARS). eighteen patients underwent clinical and radiological evaluations after a mean follow-up time of 43 months. The following clinical outcome measures were considered: the Disability of the Arm, Shoulder and Hand outcome measure (DASH), the Nottingham Clavicle Score (NCS), and the Constant score (CS). On X-rays, the CC distance was measured. the median DASH score at follow-up was 12.5 in the TR group, 5 in the GR group, and 4.2 in the LARS group. The median NCS value was 88 in the TR group, 88 in the GR group, and 91 in the LARS group. The median CS was 100 in the TR group, 95 in the GR group, and 94.5 in the LARS group. The mean CC distance was 10.3 mm in the TR group, 13.8 in the GR group, and 16.6 in the LARS group. all three techniques proved to be reliable in providing good clinical outcomes, although none of the studied techniques demonstrated reliability in maintaining anatomical reduction after surgery. Level III, retrospective comparative study.

Percutaneous double-button fixation method for treatment of acute type III acromioclavicular joint dislocation.

The aim of this study was to evaluate the functional and radiological results of patients treated with the percutaneous double-button technique for acute acromioclavicular (AC) joint dislocation. A retrospective evaluation was performed of 13 patients surgically treated for acute Type III AC joint dislocation with the percutaneous double-button fixation method. The coracoclavicular (CC) distance of the affected side was compared with that of the healthy side on anterior-posterior radiographs obtained at the final follow-up. In the functional evaluation, Disabilities of the Arm, Shoulder and Hand (DASH), Constant, and visual analog scale (VAS) scores were used. The 13 patients in the study included 12 males and 1 female with a mean age of 43.4 years (range: 22-60 years). The mean follow-up period was 13.61 months (range: 9-24 months). The mean CC distance on the operated side was 9.23 mm (range: 8-15 mm), and when compared with the healthy side, no statistically significant difference was observed. Preoperative Constant scores of a mean of 30.3 (range: 18-42) increased to 84.4 (range: 70-90) at the final follow-up. Preoperative DASH scores had a mean of 14.1 (range: 11-28) and decreased to 0.4 (range: 0-3) at the final follow-up (p<0.001). Mean preoperative VAS score was 6.0 (range: 5-8), which decreased to 0.6 (range: 0-3) at the final follow-up (p<0.001). The percutaneous double-button fixation technique is a safe, practical, and effective fixation method that can be used as an alternative to arthroscopic and open methods for acute Type III AC joint dislocations.

Coracoclavicular Ligament Suture Augmentation with Anatomical Locking Plate Fixation for Distal Clavicle Fracture

Background: For Neer type IIB fracture of distal clavicle with coracoclavicular ligament injury, various surgical treatments have been used in literatures. However, there was no consensus on the optimal treatment. The aim of this study is to report the clinical and radiological results of open reduction and internal fixation of unstable distal clavicle fracture and suture augmentation of disrupted coracoclavicular ligament. Methods: A prospective study was performed in 23 patients with Neer type IIB distal clavicle fracture in Seoul Medical Center, Eulji Hospital, and National Medical Center. Firstly, suture anchors are inserted in the base of coracoid process and preliminary reduction was achieved by tie-off of three suture limbs around the clavicle. Then, the final fixation was completed with anatomical locking plate. Bony union and the distance between coracoclavicular ligaments were evaluated. Clinical results and complications including stiffness and secondary procedures were evaluated. Results: Bony union was achieved in all cases except one (22 of 23). At mean 14.9 months, no significant difference in the mean coracoclavicular distance was observed compared to uninjured shoulder (8.2 ± 7.9 mm versus 7.3 ± 3.4 mm, p=0.14). Pain visual analogue scale, American Shoulder and Elbow Surgeons score, Constant score, and Disabilities of the Arm, Shoulder and Hand score were 0.5, 83.4, 78.5, and 6.2, respectively. Revision surgery was performed in one case of nonunion. Four patients who complained of skin irritation underwent implant removal. Conclusions: In cases of an unstable distal clavicle fracture with coracoclavicular ligament disruption, satisfactory clinical results were obtained by locking plate fixation and coracoclavicular ligament suture augmentation concurrently.

Acromioclavicular joint dislocations: radiological correlation between Rockwood classification system and injury patterns in human cadaver species

The classification system of Rockwood and Young is a commonly used classification for acromioclavicular joint separations subdividing types I-VI. This classification hypothesizes specific lesions to anatomical structures (acromioclavicular and coracoclavicular ligaments, capsule, attached muscles) leading to the injury. In recent literature, our understanding for anatomical correlates leading to the radiological-based Rockwood classification is questioned. The goal of this experimental-based investigation was to approve the correlation between the anatomical injury pattern and the Rockwood classification. In four human cadavers (seven shoulders), the acromioclavicular and coracoclavicular ligaments were transected stepwise. Radiological correlates were recorded (Zanca view) with 15-kg longitudinal tension applied at the wrist. The resulting acromio- and coracoclavicular distances were measured. Radiographs after acromioclavicular ligament transection showed joint space enlargement (8.6 ± 0.3 vs. 3.1 ± 0.5 mm, p < 0.05) and no significant change in coracoclavicular distance (10.4 ± 0.9 vs. 10.0 ± 0.8 mm). According to the Rockwood classification only type I and II lesions occurred. After additional coracoclavicular ligament cut, the acromioclavicular joint space width increased to 16.7 ± 2.7 vs. 8.6 ± 0.3 mm, p < 0.05. The mean coracoclavicular distance increased to 20.6 ± 2.1 mm resulting in type III-V lesions concerning the Rockwood classification. Trauma with intact coracoclavicular ligaments did not result in acromioclavicular joint lesions higher than Rockwood type I and II. The clinical consequence for reconstruction of low-grade injuries might be a solely surgical approach for the acromioclavicular ligaments or conservative treatment. High-grade injuries were always based on additional structural damage to the coracoclavicular ligaments. Rockwood type V lesions occurred while muscle attachments were intact.

Treatment of Acute Acromioclavicular Joint Injuries Using AO Hook Locking Plate

BACKGROUND: To evaluate clinical and radiological outcome using AO hook locking plate in acute acromioclavicular joint injuries.METHODS: This study was based on patients with Rockwood type 3 or 5 acromioclavicular joint injuries who received surgery with AO hook locking plate from June 2008 until June 2009. Among the 22 patients, 19 of them were male and 3 were female, the mean age was 44.4 +/- 15.57 years (20-72 years) and follow-up period was 15.5 +/- 3.90 months (12-23 months). Preoperatively, postoperatively, and at the final follow-up after the plate removal, both coracoclavicular distances were measured from the anteroposterior radiograph. Also, the Shoulder Rating Scale of the University of California at Los Angeles scores (UCLA scores), the American Shoulder and Elbow Surgeons scores (ASES scores), Constant scores, and the Korean Shoulder Society scores (KSS scores) were measured at the final follow-up to evaluate the function of the shoulder joint.RESULTS: At the time of injury, the mean coracoclavicular distance of the injured side was 17.69 +/- 4.23 mm (9.57-27.82 mm) and the unaffected side was 7.55 +/- 2.20 mm (3.24-13.05 mm). The mean coracoclavicular distance measured postoperatively and at the final follow-up was 6.87 +/- 2.34 mm (4.07-14.13 mm) and 8.47 +/- 2.96 mm (4.37-17.48 mm), respectively. The mean UCLA, ASES, Constant, and KSS scores measured in the final follow-up were 33.5 +/- 1.30 (31-35), 90.8 +/- 8.36 (72-100), 78.6 +/- 8.80 (62-100), and 94.4 +/- 5.08 (84-100) each.CONCLUSIONS: From this short-term research, the surgical treatment using AO hook locking plates in acute acromioclavicular joint injuries is clinically and radiographically satisfying and considered as a useful treatment method.

Surgical treatment of vertically unstable lateral clavicle fractures (Neer 2b) with locked plate fixation and coracoclavicular ligament reconstruction

The present study evaluates the outcome of patients treated with a combination of locked plate fixation and minimal-invasive coracoclavicular (CC) ligament reconstruction for unstable lateral clavicle fractures type IIb according to Neer. Fourteen patients with an unstable lateral clavicle fracture were treated with a combination of locked plate fixation and a minimal-invasive CC ligament reconstruction. At a mean follow-up of 38 months, patients were re-evaluated using the Constant-Murley score, the Acromioclavicular (AC) joint instability score and the TAFT score. Furthermore, anterior-posterior (ap) stress radiographs and axillary views were performed in order to detect any recurrent instability. Bony union was achieved in all cases within 6-10 weeks. The mean Constant-Murley score of the affected shoulder was 93.5 points compared to 97.2 of the contralateral unaffected shoulder. The mean Taft score was 11.2 points and the mean AC joint instability score was 92 points in comparison to 96 points on the unaffected side. The mean CC distance at the time of the injury was 21 mm compared to 8.5 mm after surgery and 12 mm a the final follow-up examination. The CC distance did not differ between the postoperative X-rays and those at the time of follow-up (p = 0.068). Three plates had to be removed because of implant irritation. A combination of locked plate fixation and CC ligament augmentation in a minimal-invasive manner can be regarded as suitable for the treatment of vertically unstable lateral clavicle fractures and is associated with excellent clinical and radiological outcomes and a low complication rate.

Management of acute acromioclavicular joint dislocation with a double-button fixation system

IntroductionNumerous static and dynamic techniques have been described for the management of acute acromioclavicular (AC) joint dislocation. To date, no standard technique has been established and several complications have been described for each of these techniques. The purpose of the present study was to evaluate the functional and radiographic outcomes of acute AC joint reconstruction after a mini-open technique using the double-button fixation system. Patients and methodsTwelve patients with acute AC joint dislocation treated with the double-button fixation system by one surgeon were retrospectively reviewed. Functional assessment was performed by an independent reviewer using the DASH, Constant and the VAS scores. The coracoclavicular (CC) distance of the affected shoulder was assessed on a standard radiograph and compared with the contralateral normal one. ResultsEight patients were operated on for grade III AC joint dislocation and 4 for grade IV. The mean age of the patients at the time of surgery was 27.5 years. The mean follow-up was 18.25 months (range: 12–30 months). At the most recent follow-up, the mean Constant score was 94.8 (range: 84–100) showing a significant increase compared with the mean pre-operative value of 34.4 (range: 25–52) (p<0.001). The mean DASH score was significantly decreased from 19.6 (range: 14–28) preoperatively to 0.25 (range: 0–3) at the last follow-up (p<0.001). The mean VAS score showed a significant decrease from 5.75 (range: 4–7) to 0.2 (range: 0–2) (p<0.001). The mean CC distance on the operated shoulder was found to have no significant difference from the CC distance on the contralateral normal side (10.5 vs. 10mm) (p>0.05). There was no evidence of AC joint osteoarthrosis, CC calcification or osteolysis of the distal clavicle or the coracoid process. ConclusionsThe proposed mini-open technique provides adequate exposure of the base of the coracoid with minimal damage to the soft tissues surrounding the CC ligaments while ensures an excellent cosmetic result. We recommend this fast and relatively simple technique for all type IV injuries and for type III injuries in heavy manual workers and high-demand upper extremities athletes.

Semitendinosus Tendon Graft versus a Modified Weaver-Dunn Procedure for Acromioclavicular Joint Reconstruction in Chronic Cases

Background Biomechanical studies comparing various surgical techniques for acromioclavicular joint reconstruction have reported that semitendinosus tendon graft for coracoclavicular ligament reconstruction provides a substantial improvement in initial stability and a load-to-failure equivalent to the intact coracoclavicular ligaments. Although it represents a biomechanical improvement compared with coracoacromial ligament transfer, there is still a lack of prospective comparative studies confirming the clinical relevance of these biomechanical findings. Hypothesis Semitendinosus tendon graft for coracoclavicular ligament reconstruction is associated with superior clinical results compared with a modified Weaver-Dunn procedure in chronic complete acromioclavicular joint dislocation. Study Design Cohort study; Level of evidence, 2. Methods Twenty-four patients (mean age, 42 years) with painful, chronic Rockwood type III through V acromioclavicular joint dislocations were subjected to surgical reconstruction. In 12 patients, a modified Weaver-Dunn procedure was performed; in the other 12 patients, autogenous semitendinosus tendon graft was used. Clinical evaluation was performed using the American Shoulder and Elbow Surgeons shoulder score and the Constant score after a mean follow-up time of 37 months. Preoperative and postoperative radiographs were compared. Results The mean American Shoulder and Elbow Surgeons shoulder score improved from 74 ± 7 points preoperatively to 86 ± 8 points postoperatively in the Weaver-Dunn group, and from 74 ± 4 points to 96 ± 5 points in the semitendinosus tendon group (P < .001 for both techniques). The mean Constant score improved from 70 ± 8 points to 81 ± 8 points in the Weaver-Dunn group, and from 71 ± 5 points to 93 ± 7 points in the semitendinosus tendon group (P < .001). The results in the semitendinosus tendon group were significantly better than in the Weaver-Dunn group (P < .001). The radiologic measurements showed a mean coracoclavicular distance of 12.3 ± 4 mm in the Weaver-Dunn group increasing to 14.9 ± 6 mm under stress loading, compared with 11.4 ± 3 mm increasing to 11.8 ± 3 mm under stress in the semitendinosus tendon group. The difference during stress loading was statistically significant (P = .027). In the semitendinosus tendon group, horizontal displacement of the lateral clavicle end could be reduced in all cases with type IV dislocation. Conclusion Semitendinosus tendon graft for coracoclavicular ligament reconstruction resulted in significantly superior clinical and radiologic outcomes compared to the modified Weaver-Dunn procedure.