Acromioclavicular Dislocation Research Articles

Osteonecrosis of Humeral Head after Arthroscopic Capsular Release for Postoperative Shoulder Joint Stiffness: A Case Report

An arthroscopic capsular release (ACR) is used for persistent shoulder stiffness after an index surgery. No cases of post-ACR humeral head osteonecrosis have been reported to date. A 56-year-old male patient underwent open reduction and internal fixation using a hook plate for acromioclavicular joint dislocation. Despite hardware removal, the patient presented with unresolved shoulder pain and range-of-motion (ROM) limitations. He had a history of hypertension, chronic hepatitis B infection, and alcohol consumption. His preoperative ROM was 90° for active forward flexion, 90° for abduction, 40° for external rotation, and at a sacral level for internal rotation. His preoperative functional status was a visual analog scale (VAS) score of 4, an American Shoulder and Elbow Surgeons (ASES) score of 51, and a Constant–Murley (CMS) score of 48 through normal radiography and magnetic resonance imaging. A standard ACR was performed with a 360° release of the joint capsule via electrocautery ablation. Six months post-ACR, his ROM (forward flexion: 135°; abduction: 135°; external rotation: 70°; internal rotation: T10 vertebra) and functional outcomes (VAS 2; ASES 79; CMS 75) were significantly improved, without an interval change in radiographic assessment. However, 15 months post-operation, the patient experienced a recurrence of shoulder pain and subsequently underwent triamcinolone injections in both the 15th and 21st postoperative months. Radiography revealed humeral head osteonecrosis. Patients with intrinsic or extrinsic risk factors related to humeral head circulation disturbance should be monitored for humeral head osteonecrosis post-ACR.

Long-Term Functional Outcomes and Athletic Ability in Shoulder Sports After Anatomic Coracoclavicular Ligament Reconstruction for Chronic Type 3 and 5 Acromioclavicular Joint Injuries.

Promising short- and midterm outcomes have been seen after anatomic coracoclavicular ligament reconstruction (ACCR) for chronic acromioclavicular joint (ACJ) injuries. To evaluate long-term outcomes and shoulder-related athletic ability in patients after ACCR for chronic type 3 and 5 ACJ injuries. It was hypothesized that these patients would maintain significant functional improvement and sufficient shoulder-sport ability at a long-term follow-up. Case series; Level of evidence, 4. Included were 19 patients (mean age, 45.9 ± 11.2 years) who underwent ACCR for type 3 or 5 ACJ injuries between January 2003 and August 2014. Functional outcome measures included the American Shoulder and Elbow Surgeons (ASES), Rowe, Constant-Murley, Simple Shoulder Test (SST), and Single Assessment Numeric Evaluation (SANE) scores as well as the visual analog scale (VAS) for pain, which were collected preoperatively and at the final follow-up. Postoperative shoulder-dependent athletic ability was assessed using the Athletic Shoulder Outcome Scoring System (ASOSS). Shoulder activity level was evaluated using the Shoulder Activity Scale (SAS), while the Subjective Patient Outcome for Return to Sports (SPORTS) score was collected to assess the patients' ability to return to their preinjury sporting activity. The mean follow-up time was 10.1 ± 3.8 years (range, 6.1-18.8 years). Patients achieved significant pre- to postoperative improvements on the ASES (from 54.2 ± 22.6 to 83.5 ± 23.1), Rowe (from 66.6 ± 18.1 to 85.3 ± 19), Constant-Murley (from 64.6 ± 20.9 to 80.2 ± 22.7), SST (from 7.2 ± 3.4 to 10.5 ± 2.7), SANE (from 30.1 ± 23.2 to 83.6 ± 26.3), and VAS pain scores (from 4.7 ± 2.7 to 1.8 ± 2.8) (P < .001 for all), with no significant differences between type 3 and 5 injuries. At the final follow-up, patients achieved an ASOSS of 80.6 ± 32, SAS level of 11.6 ± 5.1, and SPORTS score of 7.3 ± 4.1, with no significant differences between type 3 and 5 injuries. Four patients (21.1%) had postoperative complications. Patients undergoing ACCR using free tendon allografts for chronic type 3 and 5 ACJ injuries maintained significant improvements in functional outcomes at the long-term follow-up and achieved favorable postoperative shoulder-sport ability, activity, and return to preinjury sports participation.

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

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

Shoulder injuries in Brazilian professional football players: epidemiological analysis of 3828 games

ObjectivesFootball is a globally played sport that poses potential risks for musculoskeletal injuries. Upper-limb injuries have a lower incidence rate than lower-limb injuries but can still cause absenteeism and performance impairment in football players. This descriptive epidemiological study aimed to evaluate and compare the epidemiological data on shoulder injuries among professional football players in two major Brazilian football championships. MethodsData were collected throughout the championships, and club physicians medically evaluated each player during official games using two online forms. The collected information included the player's age and position, injury diagnosis, laterality, location on the field where the injury occurred, playing time, imaging examinations performed, need for surgical treatment, time to return to play (TRP), and recurrence of the injury. The incidence of injuries was evaluated using the Federation Internationale de Football Association (FIFA) incidence formula. ResultsA total of 107 shoulder injuries were recorded (4.3% of all injuries), with a FIFA incidence of 0.847. Glenohumeral dislocations (GHDs) and acromioclavicular dislocations (ACDs) accounted for 37.38% and 35.51% of all shoulder injuries, respectively. Goalkeepers and defenders presented, respectively, a 2.15 and 1.57 times increased risk of suffering shoulder injuries, while attackers presented a 0.63 times decreased risk. Injury recurrence was observed in 14.95% of cases, with GHDs and ACDs showing recurrence rates of 35.00% and 5.26%, respectively. Surgery was performed in 9.35% of cases, with GHDs representing 50% of all surgeries. The average TRP was 22.37 days, with severe and major injuries accounting for 11.21% and 10.28% of all injuries, respectively. Goalkeepers had the highest average TRP of 36.15 days. Recurring injuries had a higher average TRP of 33.44 days compared to nonrecurring injuries, which had an average TRP of 20.43 days. Surgically treated injuries had the highest average TRP of 112.5 days. ConclusionShoulder injuries in the professional football scenario are of great concern due to the high recurrence rate and need for surgical treatment, which will lead to a long TRP. These findings emphasize the need to implement prevention protocols and effective treatments to reduce the consequences of such injuries, which are usually underestimated in this sport. Level of evidenceIII.

Acromioclavicular joint dislocation and concomitant labral lesions: a systematic review.

Acromioclavicular (AC) joint dislocations frequently co-occur with intra-articular glenohumeral pathologies. Few comprehensive studies have focused on labral tears specifically associated with AC joint trauma. This systematic review will address this gap. A comprehensive electronic search was conducted across PubMed, Cochrane Library, and Google Scholar (pages 1-20) spanning from 1976 to May 19, 2023. Seven studies met the inclusion criteria for this systematic review, consisting of three retrospective studies and four case series. These studies collectively involved 1,044 patients, of whom 282 had concomitant labral lesions. The pooled prevalence of intra-articular labral injuries associated with acute AC joint dislocation was 27%. The prevalence of these labral lesions varied significantly between studies, ranging from 13.9% to 84.0% of patients, depending on the study and the grade of AC joint dislocation. Various types of labral tears were reported, with superior labrum anterior to posterior (SLAP) lesions being the most common. The prevalence of SLAP lesions ranged from 7.2% to 77.4%, with higher grades of AC joint dislocations often associated with a higher prevalence of SLAP tears. Moreover, grade V dislocations exhibited a complete correlation with SLAP tears. The studies yielded contradictory findings regarding older age and higher grades of AC joint dislocation as risk factors for concurrent labral lesions. This review underscores the frequent association between labral lesions and AC joint dislocations, particularly in cases of lower-grade injuries. Notably, SLAP lesions emerged as the predominant type of labral tear.

A Self-Designed Endobutton Installation Device for Coracoclavicular Stabilization in Acute Rockwood Type III Acromioclavicular Joint Dislocation.

Endobutton technique could provide flexible coracoclavicular (CC) stabilization for acromioclavicular joint (ACJ) dislocation and achieved good clinical outcomes. However, the difficult part of this technique was placement of the Endobutton to the coracoid base. In this study, we designed an Endobutton installation device to place the Endobutton at the coracoid base. And we examined the clinical and radiographic outcomes of patients with acute Rockwood type III ACJ dislocation repaired with Endobutton using this device. We designed an Endobutton installation device to place the Endobutton at the coracoid base to achieve CC stabilization. We retrospectively reviewed 42 patients with acute Rockwood type III ACJ dislocation who underwent CC stabilization with Endobuttons placed either using this novel device (group I, n = 19) or the traditional technique (CC stabilization without using special device, group II, n = 23) from January 2015 to April 2020. The two groups were compared regarding the operative time, intraoperative blood loss, and clinical and radiologic outcomes at final follow-up. The operation-related complications were also evaluated. The Student's t test and the Mann-Whitney U-test were used to compare differences in continuous variables. Differences in categorical variables were assessed with either the Pearson's chi-squared test or Fisher's exact test. Forty-two patients were clinically followed up for a minimum of 12 months. Compared with group II, group I had a significantly shorter mean operative time (56.05 ± 7.82 min vs. 65.87 ± 7.43 min, p < 0.01) and significantly lesser mean intraoperative blood loss (67.89 ± 14.75 mL vs. 94.78 ± 25.01 mL, p < 0.01). At final follow-up, there were no significant differences between the two groups in the visual analog scale score for pain, Oxford Shoulder Score, Disabilities of the Arm, Shoulder, and Hand score, and postoperative CC distance of the affected side. Loss of reduction occurred in four patients in group I and three patients in group II (p = 0.68); there were no other operation-related complications in either group. The Endobutton installation device makes placement of the Endobutton at the coracoid base easier and achieves satisfactory clinical and radiologic outcomes without additional complications in acute Rockwood type III ACJ dislocation.

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

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

PROSPECTIVE STUDY OF COMPLETE ACROMIOCLAVICULAR JOINT DISLOCATION REPAIR BY DOUBLE ENDOBUTTON METHOD

Objectives: Double-endobutton technique offers a better treatment for dislocation when compared to conventional method for the acromioclavicular (AC) joint disturbance treatment. Hence, we have planned to assess the experimental outcomes of complete AC joint dislocation through double endobutton method. Methods: Thirty subjects among 20–68 years with a complete AC joint dislocation were studied. Diagnosis has been made by radiograph of both clavicle anteroposterior stress view and all subjects were subjected to Double Endobutton practice. Outcome was assessed using visual analog score, disabilities of the arm, shoulder, and hand, coracoclavicular, and constant shoulder score. Results: Among 30 subjects, male subjects were found to be 18 subjects with 34.43±7.65 years as the mean age between them. There was a substantial decrease in VAS score and DASH score from pre-operative to post-operative. A substantial development in the subjective shoulder value (28.4% vs. 98.12%; p=0.001) and Constant–Murley score (32.43% vs. 96.76%; p=0.005) from pre-operative to post-operative was observed with the subjects. At final follow-up, 28 patients showed excellent outcome and fair outcome in two patients. Further, no subjects were reported with any additional difficulties. Conclusion: This practice offers a modest, affordable, single-stretch surgical procedure that re-establishes coraco-clavicular interval and sustains until the native ligaments rebuild. This technique also demonstrates to be an outstanding alternate modal in rectifying whole AC joint dislocation.

MSK Diagnostic Ultrasound for the Assessment of the Acromioclavicular Joint.

The acromioclavicular joint (ACJ), a key element in shoulder movement and stability, is prone to various injuries such as sprains, dislocations, and osteoarthritis, typically resulting from physical trauma or wear and tear. Accurate and timely diagnosis is paramount for effective treatment and rehabilitation. Musculoskeletal (MSK) ultrasound has emerged as a pivotal diagnostic tool due to its ability to visualize soft tissues and provide real-time imaging. This non-invasive tool is also invaluable for monitoring healing progress and the evolution of osteoarthritic changes. This article reviews the application of MSK ultrasound in the evaluation of ACJ injuries, highlighting its advantages, specific applications, and recent technological advancements that enhance its diagnostic capabilities.

Acromioclavicular joint reconstruction using Ethibond No. 5 Ortho Tape

Abstract Surgical reconstruction of acromioclavicular joint dislocation often requires exposure and instrumentation. This increases the chances of injury to the surrounding neurovascular structures. We present a safe, simple, and effective technique of primary fixation of Type 3 and Type 4 acromioclavicular joint dislocation, using a nonabsorbable suture material/ Ortho Tape, relying on the mechanical principles, without the need of any autograft or metal implants.

Pediatric AC Joint Fracture Dislocation: Arthroscopy-assisted Reduction and Internal Bracing

Introduction: Acromioclavicular joint injuries are common injuries around shoulder and comprise around 9–12% and are rare in pediatric population. Many surgeries have been described which include open stabilization, arthroscopic assisted, or complete arthroscopic. We describe our technique of arthroscopic-assisted fixation in AC joint acute injuries, in which we arthroscopically pass fiber tape and tunnels across coracoid base and clavicle to stabilize the upward forces, followed by double breasting for AC joint with fiber tape to balance the horizontal forces. Case Report: A 9-year-old female kid with a history of falls with left shoulder pain and diagnosed with fracture dislocation of the left ac joint. The patient in beach chair position. Arthroscopically, fibertape was passed through a drill hole near to cc ligament and cinch loop was done through it and around coracoid. With a mini-incision, AC joint further stabilized. Conclusion: Similar case reports are very few and arthroscopic management of same is nearly none. Advantages of our procedure are relatively low cost of the implant, and no anchors or metal implants at AC joint to avoid impingement. Open AC joint stabilization addresses the disc in joint. Disadvantages are a long learning curve. Keywords: Pediatric AC joint, acromioclavicular joint dislocation, arthroscopic AC joint, AC joint internal bracing, acute AC joint dislocation.

Treatment of Nonunion after a Fracture of the Clavicle at the Sling Area in a Patient with an Acromioclavicular Joint Dislocation Using the Modified Phemister Procedure Augmented with Coracoclavicular Sling: A Case Report

Treatment of Nonunion after a Fracture of the Clavicle at the Sling Area in a Patient with an Acromioclavicular Joint Dislocation Using the Modified Phemister Procedure Augmented with Coracoclavicular Sling: A Case Report

3D printing-assisted surgery for the treatment of proximal clavicle fracture with ipsilateral acromioclavicular joint dislocation: a case description.

3D printing-assisted surgery for the treatment of proximal clavicle fracture with ipsilateral acromioclavicular joint dislocation: a case description.

Modified Weaver Dunn Versus Ligamentous Reconstruction Grafts in Chronic Acromioclavicular Joint Dislocation: A Systematic Review and Meta-Analysis of Comparative Studies.

Acromioclavicular (AC) joint trauma is a frequent sports injury. Modified Weaver Dunn (MWD) is a commonly used technique to address this injury. However, tendinous grafts (Autogenous Palmaris Longus or Semitendinosus tendons) are increasingly being used due to the biologic weakness of MWD. Three search was done until January 2024 with data extraction consisting of adverse events (infections and failures), Constant-Murley score, American Shoulder and Elbow Surgeons score, and postoperative coracoclavicular distance. Four studies were included in this metaanalysis. Tendinous graft was shown to have statistically better ASES and Constant-Murley scores. Furthermore, there were no difference in adverse events, and postoperative coracoclavicular distance. The tendinous graft showed no differences in adverse events, and postoperative coracoclavicular distance when compared to modified Weaver Dunn. However, it showed higher postoperative ASES and Constant-Murley score without analysis of the minimal clinical important difference making the difference solely statistical. 3.

Evaluation of Functional and Radiological Outcome of Arthroscopic-Assisted Anatomical Coracoclavicular (CC) and Acromioclavicular (AC) Ligament Reconstruction in Chronic AC Joint Dislocation

Evaluation of Functional and Radiological Outcome of Arthroscopic-Assisted Anatomical Coracoclavicular (CC) and Acromioclavicular (AC) Ligament Reconstruction in Chronic AC Joint Dislocation

Biological Reconstruction of Acromioclavicular Joint Ligament Using Semitendinosus Autograft: A Prospective Study on Functional Outcomes and Complications

Abstract Introduction: The acromioclavicular (AC) joint, a crucial point of shoulder articulation, facilitates overhead and across-the-body arm movements. Athletes, especially those in high-contact or fall-prone sports, frequently experience AC joint injuries. These injuries, based on the Rockwood classification, range from type I to type VI, with treatments varying accordingly. One innovative treatment method reconstructs both ligaments using a semitendinosus autograft, aiming for an anatomical and functional restoration of the joint. This study evaluates the outcomes and complications of this method. Methodology: Study design: A prospective study from January 2021 to July 2022. Data source: Patients with Rockwood type III to VI AC joint ligament disruptions treated at Osmania General Hospital. Sample size: 14 patients. Surgical Technique for Acromioclavicular Ligament Reconstruction: Detailed steps encompassing patient positioning, graft harvesting and preparation, surgical approach, graft fixation, and postoperative care. Results: A total of 14 patients with AC disruptions (12 men and 2 women) treated with semitendinosus reconstruction were followed up for 24 months. Out of 14, 13 were Rockwood type III and 1 was type V ACJ dislocations. The mean patient age was 41 years (25–59 years). Functional outcome was assessed according to the constant-Murley score, according to which 7 patients had excellent, 6 had good, and 1 had an adequate outcome. We had only 1 case of surgical site infection leading to delayed rehabilitation leading to loss of abduction. Discussion: AC joint disruptions represent a significant percentage of shoulder injuries, especially among young, active individuals. Conservative treatments are typical for lower-grade injuries, but high-grade injuries often necessitate more invasive approaches. Our study included 14 patients, focusing on a semitendinosus autograft reconstruction. The historical Weaver–Dunn procedure, though once popular, has been phased out due to recurrence and strength issues. Our method, avoiding the controversial coracoid tunnel drilling, has shown promising results with no recorded fractures. Conclusion: The semitendinosus autograft method, with its biological orientation for coracoclavicular ligament reconstruction, presents fewer complications, especially in terms of coracoid fractures and reduction losses.

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 &amp; 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 &amp; Elbow Surgeons scores, which were 39.1 ± 14, 67.4 ± 1, and 86.7 ± 5, respectively (P&lt;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.

Comparison of Surgical Techniques Used in Treating Acromioclavicular Dislocation in Patients Participating in Sports: A Systematic Review

Comparison of Surgical Techniques Used in Treating Acromioclavicular Dislocation in Patients Participating in Sports: A Systematic Review

Functional and Radiologic Results of Tight Rope Technique in Acute Rockwood Type 5 Acromioclavicular Separations

Amaç: Akut tip 5 akromioklavikular eklem çıkıklarında çift düğme implantı tekniğinin orta dönemde klinik, fonksi-yonel ve radyolojik sonuçlarını ortaya koymayı hedefledik. Materyal ve metod: Kliniğimizde Ocak 2019- Haziran 2021 tarihleri arasında akromiyoklaviküler eklem çıkığı nedeniyle çift düğme implantı tekniği kullanılarak cerrahi tedavi edilmiş hastalar geriye dönük olarak tarandı. Son poliklinik kontrollerinde hastaların omuz radyografilerinden etkilenmemiş omuzda korakoklaviküler mesafeleri ile çift düğme implantı tekniği uygulanan omuzdaki korakoklaviküler mesafeleri ölçüldü. Aynı zamanda hastaların omuz radyografileri incelenerek redüksiyon kaliteleri ve akromioklaviküler eklemin Kellgren-Lawrence sınıflama-sına göre osteoartrit durumu not edildi. Hastaların son poliklinik kontrollerinde; ağrı durumları Visual Analog Score, fonksiyonel durumları Constant-Murley omuz skorlama sistemi kullanılarak değerlendirildi. Bulgular: Çalışmaya 15’i erkek, 1’i kadın olmak üzere toplam 16 hasta dâhil edildi. Dâhil edilen hastaların yaş orta-laması 42,1 (19-66) idi. Ortalama takip süresi 28.0 (15-44) ay idi. Son poliklinik kontrolünde, etkilenmemiş omuzda ölçülen korakoklaviküler mesafe ortalama 7,7±1.0 mm , düğme implantı tekniği uygulanan omuzda ortalama kora-koklaviküler mesafe 8,4± 2.0 mm olarak ölçüldü. Redüksiyon kalitesi dağılımı; 1 hastada tip 4, 2 hastada tip 2, 1 hastada tip 3, 12 hastada ise tip 1 olarak görüldü. Hastalardan 1’inde evre 2 ve 2’sinde ise evre 3 olmak üzere toplam 3 hastada akromioklaviküler eklem osteoartriti gelişimi gözlenirken 13 hastada osteoartrit gelişimi gözlen-medi. Ameliyat sonrası son poliklinik kontrollerinde ortalama Visual analog ağrı skoru 1,3 (0-4), ortalama modifiye Constant skoru ise 86,1 (73-93) olarak ölçüldü. Sonuç: Akut tip 5 akromioklaviküler eklem çıkıklarında uygulanan çift düğme implantı tekniğinin başarılı ve güvenli bir cerrahi prosedürdür.

Quality and stability of reduction of operated acromioclavicular dislocation using dual acromioclavicular and coracoclavicular stabilization

IntroductionDual stabilization is advocated in acute acromioclavicular dislocation (ACD), but has been little assessed. ObjectiveThis preliminary study performed clinical and radiological assessment of dual acromioclavicular (AC) and coracoclavicular (CC) stabilization in acute ACD. The study hypothesis was that dual stabilization allows satisfactory reduction that remains stable over time. Materials and methodsA button was used under endoscopy for CC stabilization. For AC stabilization, a short approach was used; the joint was cleansed then stabilized by an anchored tape between the acromion and the clavicle to promote ligament healing. Clinical assessment was based on a visual analog pain scale (VAS), joint range of motion and Quick-DASH and Constant scores. Radiological reduction was assessed on the ratio of CC distance between the operated and healthy sides on two views. MRI was used in follow-up to screen for ligament healing: thickening and continuity. ResultsThirty-five patients with stage 3–5 acute dislocation were included. At a minimum 24 months’ follow-up, mean clinical scores were very satisfactory, with recovery of motion and pain relief. Radiography showed 94% stable reduction in both vertical and horizontal planes. MRI confirmed CC and AC ligament healing. Postoperative complications mainly comprised 4 cases of reduction loss (11%). One clavicle fracture occurred, at 6 months. ConclusionDual AC-CC stabilization provided very good radiographic reduction in both horizontal and vertical planes. Functional results were very satisfactory, and complications were few, with some cases of reduction loss. These good results encourage us to continue with dual stabilization in acute ACD. Level of evidenceII; prospective cohort.