Treatment Of Acromioclavicular Joint Dislocation Research Articles

Efficacy of allogeneic tendon material coracoclavicular ligament reconstruction combined with Kirschner wire and titanium alloy hook plate material fixation in the treatment of acromioclavicular joint dislocation.

To compare the effects of allogeneic tendon coracoclavicular ligament reconstruction combined with Kirschner wire fixation and clavicular hook plate fixation on early postoperative pain, postoperative shoulder joint function score and shoulder joint mobility in patients with acromioclavicular joint dislocation. From January 2020 to January 2023, 43 patients with acromioclavicular joint dislocation admitted to Xi 'an Honghui Hospital were included. Among them, 24 patients were treated with the clavicular hook plate technique (Hook Plate,HP) group, and 19 patients were treated with allogeneic tendon coracoclavicular ligament reconstruction combined with the Kirschner wire technique (Allogeneic Tendon, AT) group. The Constant-Murley score of shoulder joint function 6months after operation, postoperative shoulder joint activity, preoperative and postoperative pain, operation time, intraoperative blood loss and complications were compared between the two groups. All 43 patients were followed up for an average of 9.7 (9-12) months. The intraoperative blood loss in the allogeneic tendon group was less than in the hook plate group. The Constant-Murley shoulder function score was higher than that in the hook plate group 6 months after the operation. The abduction and lifting activity was greater than that in the hook plate group. The visual analogue scale scores at 3days and 14 days after operation were lower than those in the hook plate group. The difference was statistically significant (p < 0.001). There was 1 case (5.3%) of exudation around the Kirschner needle track in the allogeneic tendon reconstruction group, and 5 cases (20.8%) of complications in the hook plate group, including 1 case of internal fixation stimulation, 2 cases of acromion impingement syndrome, 1 case of acromioclavicular joint osteoarthritis, and 1 case of shoulder joint stiffness. The complication rate of the allogeneic tendon group was lower than that of the hook plate group. The clinical efficacy of allogeneic tendon coracoclavicular ligament reconstruction combined with Kirschner wire fixation in treating acromioclavicular joint dislocation (Rockwood type III-V) is better than hook plate internal fixation. The patients have less early postoperative pain and better recovery of shoulder joint function and shoulder joint mobility.

Surgical treatment of acromioclavicular joint dislocation of Rockwood III/IV: a retrospective study on clavicular hook plate versus arthroscopic TightRope loop titanium button

PurposeTo compare the clinical efficacy of arthroscopic TightRope loop titanium button and clavicular hook plate in the treatment of acromioclavicular joint (ACJ) dislocation of Rockwood III/IV.MethodsA retrospective analysis of patients with ACJ dislocation in our hospital from January 2018 to December 2020 was conducted. The patients were assigned to be treated with arthroscopic TightRope loop titanium button (TR group) or clavicular hook plate (HP group). The preoperative, intraoperative and postoperative data and imaging findings of the two groups were compared.ResultsA total of 58 eligible patients were enrolled in this study. Compared with HP group, TR group had shorter incision length and less blood loss during operation. Postoperative follow-up ranged from 12 to 24 months (mean 15.4 months). At 6 months and 12months postoperatively, compared with HP group, TR group had lower VAS and higher CMS, and the difference was statistically significant. At 12 months postoperatively, compared with HP group, TR group had lower ACJ gap and coracoclavicular joint(CCJ) distance, and the difference was statistically significant.In HP group, there were 3 cases of subacromial impact, 1 case of redislocation, 2 cases of traumatic arthritis and 2 cases of wound infection. There was 1 case of redislocation in TR group.ConclusionsCompared with clavicular hook plate, arthroscopic TightRope loop titanium button is minimally invasive, safe and effective in the treatment of ACJ dislocation, and has a good trend in clinical application.

Presurgical perspective and postsurgical evaluation of acromioclavicular joint instability.

Acromioclavicular joint (ACJ) dislocations are a common cause of pain in patients of any age. Athletes who participate in contact sports, such as hockey, football, rugby, and soccer, are particularly susceptible to such injuries. The ACJ has an important role in the function of the upper limb, and its complexity of movement makes it susceptible to acute injuries and chronic dysfunction with debilitating effects that must be treated appropriately and promptly to preserve function. Recently, ACJ has received increasing attention due to the development of new surgical techniques for the restoration of normal function and stability. There is some agreement about the treatment of ACJ dislocations, but controversy remains about the treatment of Rockwood grade III dislocations, and a new approach to these injuries is suggested by ISAKOS. Overall, the paper summarizes new concepts in the anatomy of the ACJ and reviews the utility of imaging methods in ACJ dislocations as well as their treatment and complications.

Surgical treatment of the acromioclavicular joint dislocation: modern trends and prospects

Background. Acromioclavicular joint dislocations constitute from 6.8 to 26.1 % of all dislocations and rank third after dislocations of the shoulder and forearm. In the structure of acute traumatic injuries to the shoulder girdle, the proportion of acromioclavicular joint dislocations is above 12 %. These injuries are more common in men of the most working age (from 30 to 40 years) and in athletes engaged in contact sports. Poor outcomes of surgical treatment vary from 9 to 12 %. The aim of the study: to determine modern principles of surgical treatment for acromioclavicular joint dislocations, problematic issues and advanced solutions. Materials and methods. Analysis of literature sources was carried out using PubMed, UpToDate, Scopus, Web of Science, MEDLINE, The Cochrane Library, Embase, Global Health, CyberLeninka databases by search: acromioclavicular joint dislocations, surgical treatment. Results. The most common classification of acromioclavicular joint dislocations is Rockwood classification that includes six dislocation types. Despite the quite detailed classification of injuries to the acromioclavicular ligament according to Rockwood, the Tossy classification is more simplified, but meets practical needs, and distinguishes three types of damage. Stabilization of the clavicle with metal structures is realized by fixing to the coracoid process or acromion of the scapula, the latter is a priority. The disadvantages of the most used metal fixators were identified that require their optimization and development of innovative structures. The reasoned direction regarding static stabilizer restoration is plastic replacement of both ligamentous complexes. Conclusions. A priority direction is to stabilize the clavicle by fixing its acromial end to the acromion of the scapula with metal structures among which a hook plate and the Weber method are the most used. However, significant disadvantages in their use necessitate the development of innovative designs. A promising direction for the restoration of static clavicle stabilizers is surgical methods that combine the restoration of the coracoclavicular and acromioclavicular ligaments. The objective need to create channels for grafts leads to a weakening in the mechanical strength of the bony structures, so research regarding the direction, diameter, and location of these channels requires further investigation.

Clinical evaluation of treatment with hook plate in patients with acromioclavicular joint dislocation

Objectives: Treatment of acromioclavicular joint dislocations vary. In this study, we aim to examine the functional results of patients who underwent hook plate fixation due to dislocation of acromioclavicular joint. Methods: We retrospectively observed 21 patients who had been treated with hook plate due to dislocation of acromioclavicular joint. At follow up, Constant-Murley scoring system was performed for shoulder function evaluation, while radiological results were performed by X-ray. Results: Seventeen of these patients were male and four were female. Eleven of these patients had Rockwood type 5 joint dislocation and ten had Rockwood type 3 joint dislocation. The mean age was 36.7 ± 13.37 years (range: 19-61 years). The mean follow-up period was 27.3 ± 19.3 months (range: 10-59). Constant-Murley shoulder scoring was excellent in 18 patients (93.6) and good (82.5) in 3 patients. While one patient had wound site infection and one patient had plate broken, no one had any neurological damage. Except for the failed implants, plate removal was not performed because the patients did not have plate-related complaints. At follow-up, it was observed that the acromioclavicular joint was in the reduced position on direct radiographs. Conclusions: We observed good clinical and functional results for the treatment of acromioclavicular joint dislocation with hook plate treatment. The hook plate method is a safe and effective method in the acute treatment of type 3-5 injuries according to the Rockwood classification.

Finite element analysis of different reconstruction methods of coracoclavicular ligament for acromioclavicular joint dislocation

This study aims to examine the biomechanical effects of different reconstruction methods, including single-bundle, double-bundle anatomical reconstruction, and double-bundle truly anatomical reconstruction of the coracoclavicular ligament on the acromioclavicular joint using finite element analysis, to provide a theoretical basis for the clinical application of truly anatomical coracoclavicular ligament reconstruction. One volunteer, aged 27 years old, with a height of 178 cm and a weight of 75 kg, was selected for CT scanning of the shoulder joint. Three-dimensional finite element models of single-bundle reconstruction, double-bundle anatomical reconstruction, and double-bundle truly anatomical reconstruction of coracoclavicular ligament were established by using Mimics17.0, Geomagic studio 2012, UG NX 10.0, HyperMesh 14.0 and ABAQUS 6.14 software. The maximum displacement of the middle point of the distal clavicle in the main loading direction and the maximum equivalent stress of the reconstruction device under different loading conditions were recorded and compared. The maximum forward displacement and the maximum backward displacement of the middle point of the distal clavicle in the double-bundle truly anatomic reconstruction were the lowest, which were 7.76 mm and 7.27 mm respectively. When an upward load was applied, the maximum displacement of the distal clavicle midpoint in the double-beam anatomic reconstruction was the lowest, which was 5.12 mm. Applying three different loads forward, backward, and upward, the maximum equivalent stress of the reconstruction devices in the double-beam reconstruction was lower than that in the single-beam reconstruction. The maximum equivalent stress of the trapezoid ligament reconstruction device in the double-bundle truly anatomical reconstruction was lower than that in the double-bundle anatomical reconstruction, which was 73.29 MPa, but the maximum equivalent stress of the conoid ligament reconstruction device was higher than that of the double-bundle anatomical reconstruction. The truly anatomical reconstruction of coracoclavicular ligament can improve the horizontal stability of acromioclavicular joint and reduce the stress of the trapezoid ligament reconstruction device. It can be a good method for the treatment of acromioclavicular joint dislocation.

Return to Play After Surgical Treatment for Acromioclavicular Joint Dislocation: A Systematic Review

Background: Acromioclavicular (AC) joint dislocation is a common clinical problem among young and athletic populations. Surgical management is widely used for high-grade dislocations (Rockwood III-VI) and in high-demand athletes at high risk of recurrence. Purpose: To systematically review the evidence in the literature to ascertain the rate and timing of return to play (RTP) and the availability of specific criteria for safe RTP after surgical treatment for AC joint dislocation. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic literature search based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was conducted in the PubMed database. Clinical studies were eligible for inclusion if they reported on RTP after surgical treatment for AC joint dislocation. Statistical analysis was performed with SPSS. Results: We found 120 studies including 4327 cases meeting our inclusion criteria. The majority of patients were male (80.2%), with a mean age of 37.2 years (range, 15-85) and a mean follow-up of 34.5 months. Most were recreational athletes (79%), and the most common sport was cycling. The overall rate of RTP was 91.5%, with 85.6% returning to the same level of play. Among collision athletes, the rate of RTP was 97.3%, with 97.2% returning to the same level of play. In overhead athletes, the rate of RTP was 97.1%, with 79.2% returning to the same level of play. The mean time to RTP was 5.7 months (range, 1.5-15). Specific RTP criteria were reported in the majority of the studies (83.3%); time to return to play was the most commonly reported item (83.3%). Type III Rockwood injuries had the highest RTP rate at 98.7% and the earliest RTP at 4.9 months. Among the different surgical techniques, Kirschner wire fixation had the highest rate of RTP at 98.5%, while isolated graft reconstruction had the earliest RTP at 3.6 months. Conclusion: The overall rate of RTP was reportedly high after surgical treatment for AC joint dislocation, with the majority of patients returning to their preinjury levels of sport. There is a lack of consensus in the literature for what constitutes a safe RTP, with further focus on this topic required in future studies.

Evaluation of the coracoid bone tunnel placement on Dog Bone™ button fixation for acromioclavicular joint dislocation: a cadaver study combined with finite element analysis

BackgroundDog Bone™ button fixation is frequently used to treat acromioclavicular joint (ACJ) dislocation. However, various studies have reported complications after fixation.ObjectiveTo investigate the effect of the coracoid bone tunnel location on the treatment of ACJ dislocation through single-tunnel coracoclavicular (CC) ligament fixation with the Dog Bone™ button.MethodsSix cadaveric shoulders were used. Each specimen was subjected to five testing conditions in the following order: (1) normal ACJ (Gn); (2) acromioclavicular and CC ligaments were removed (G0); (3) CC ligament reconstruction was performed using the Dog Bone™ technique, and the coracoid bone tunnel was at the center of the coracoid base (G1); (4) reconstruction was performed at 5 mm distal from the G1 site, along the axis of the coracoid (G2); (5) reconstruction was performed at 10 mm distal from the G1 site, along the axis of the coracoid (G3). The angles of pronation and supination of the clavicle under the same load (30 N) were measured. Next, a finite element (FE) model was created using computed tomography (CT) images of the normal shoulder. Model 1 (M1), model 2 (M2), and model 3 (M3) correspond to G1, G2, and G3, respectively. A force of 70 N was applied as a vertical upward load to the distal clavicle. Subsequently, the von Mises stress, the strain LE along the FiberWire, and the displacement nephogram of the three models were obtained.ResultsAfter single-tunnel CC ligament fixation using the Dog Bone™ technique, the clavicle in the G2 group (20.50 (19.50, 21.25) °, 20.00 (18.75, 21.25) °) had the best rotational stability. The peak von Mises stress, the strain LE along the FiberWire, and the maximum displacement were smaller in M2 than in M1 and M3.ConclusionsWhen the coracoid bone tunnel was located 5 mm anterior to the center of the coracoid base (along the axis of the coracoid), the clavicle showed greater rotational stability.

A Modified Endoscopic Technique with Three Incisions for Rockwood Types III and V Acromioclavicular Joint Dislocation

Acromioclavicular joint dislocation is one of the most common shoulder injuries in young men. With the advancement of minimally invasive technology, arthroscopy of acromioclavicular joint dislocation has been recognized for its good curative effect. This study aimed to explore the technical details and clinical efficacy of a modified minimally invasive endoscopic treatment for acromioclavicular joint dislocation. Clinical data of patients receiving the three-incision endoscopic treatment were retrospectively reviewed between July 2013 and July 2019. A total of 72 patients with acromioclavicular joint dislocation of Rockwood type III (n=42) and type V (n=30) were included in this study. Postoperative routine radiography was performed to evaluate acromioclavicular joint reduction and fixation. In addition, functional recovery of the shoulder joint was assessed using the American Shoulder and Elbow Surgeons (ASES) and Constant-Murley scores. Differences between the preoperative and postoperative data were compared using paired t-tests. All patients underwent loop plate elastic fixation under endoscopy during 24 to 48months of follow-up. Postoperative radiography showed that the acromioclavicular joint achieved anatomical reduction. The ASES score (91.1 ± 4.2) was significantly improved compared to the preoperative ASES score (62.4 ± 3.1) (t=46.65, P < 0.0001). The Constant-Murley score (93.1 ± 4.6) was also significantly higher than that before the operation (40.7 ± 6.4) (t=56.41, P < 0.0001). No postoperative complications occurred. During follow-up, four patients had mild acromioclavicular joint degeneration but no obvious pain symptoms. The modified three-incision endoscopic technique optimizes the surgical incision, reduces trauma, is minimally invasive, and provides rapid rehabilitation with satisfactory clinical outcomes.

Comparison of Clinical Effects of Minimally Invasive Tension Band Technique and Hook Plate in the Treatment of Acromioclavicular Joint Dislocation

Comparison of Clinical Effects of Minimally Invasive Tension Band Technique and Hook Plate in the Treatment of Acromioclavicular Joint Dislocation

The correlation between acromial osteolysis and acromion types in the treatment of acromioclavicular joint dislocation with hook plate.

This study aimed to radiologically evaluate the effect of hook plates used in the treatment of acromioclavicular joint (ACJ) dislocations on the development of subacromial osteolysis (SAO) according to acromion types. A total of 43 patients with mean age of 38.5 (19-77) years who were diagnosed with AC dislocation and applied neutral clavicular hook plate between 2013 and 2020 were retrospectively evaluated. Acromion types were determined by measuring acromion slope angle on lateral shoulder radiography and 3-dimensional (D)-CT of the patients. Presence of SAO was classified according to the severity of erosion in the subacromial region (grade I: minimal osteolysis, grade II: subacromial erosion <2 mm, grade III: subacromial erosion >2 mm, grade IV: cut-through of the acromion) on postoperative 3D - CT and correlation with acromion types was analyzed. Incidence of SAO was significantly higher among type 1 acromion compared to type 2 and type 3 acromion (P = .003). While osteolysis was observed in 21 patients, no osteolysis was observed in 22 patients. Osteolysis occurred in all patients with type 1 acromion, 7 patients with type 2 acromion, and 5 patients with type 3 acromion. Since the hook tip in the sagittal plane passes posterior to the center of the acromion and the concavity of the subacromial surface is inadequate in the type 1 acromion, we believe that the increased pressure applied by the hook tip on the subacromial cartilage increases the risk of SAO. We predict that the use of hook plates with an angle of 15-20 degrees, similar to the patient's AC angle, rather than neutral hook plate, will reduce the risk of osteolysis in patients with type 1 acromion.

Clinical features, radiographical findings and outcome evaluation for the treatment of acromioclavicular joint dislocation with lock hook plate

Background: Acromioclavicular joint (ACJ) dislocation is a common shoulder injury. Currently, there is no consensus on conservative treatment and surgical technique options. Reduction and fixation with hook surgery are effective in treating acute ACJ dislocation. However, there are very few studies evaluating the results of this method. Objectives: To describe the clinical characteristics, radiographical findings and evaluate outcomes of acute ACJ dislocation treated by internal fixation with a lock hook plate. Materials and methods: A prospective clinical study on 35 patients diagnosed with ACJ dislocation grade III or higher according to Rockwood classification were assigned surgical treatment with a hook plate, at Can Tho Central General Hospital in 2020- 2022. We documented the general characteristics of patients, clinical features, radiographical findings and treatment outcomes. Results: 35 patients (26 men/9 women, 44.2 y) were included in the study. The ACJ dislocation of grades III and V were almost equal in proportion. The averaged surgery time was approximately 60 minutes. The result of reduction of ACJ was 100%. According to the Constant-Murley Score, the functional results increased from 54.8±4.2 before surgery to 88.5±3.8 after 6 months of surgery, and the Constant-Murley level achieved 100% good to excellent.The satisfaction level of patients was 77.1% very satisfied and 22.9% satisfied. Conclusion: Reduction and fixation surgery with lock hook plate in the treatment of acute ACJ dislocation (&lt;3 weeks) is one of the suitable methods with the ability to reduce and rehabilitate good function of the joint so that the patients can return to activity and work soon.

Arthroscopic treatment of acromioclavicular joint dislocation and clinical results

Arthroscopic treatment of acromioclavicular joint dislocation and clinical results

Combination of Clavicular Hook Plate with Coracoacromial Ligament Transposition in Treatment of Acromioclavicular Joint Dislocation.

ObjectiveTo evaluate the clinical efficacy of Arbeitsgemeinschaft für Osteosynthesefragen (AO) clavicular hook plate (CHP) combined with coracoacromial ligament transposition for Rockwood III‐V dislocation of AC joint, providing an alternative choice for AC joint dislocation treatment.MethodsTwenty‐five patients diagnosed with Rockwood III‐V dislocation of acromioclavicular (AC) joint, including 18 males and seven females, aged 43.5 ± 2.4 years old on average, who had undergone open reduction and AO CHP in combination with coracoacromial (CC) ligament transposition between January 2010 and December 2015, were retrospectively analyzed. Among them, 17 cases were diagnosed as type III, five cases were type IV, and three cases were type V. The surgery mainly included three main steps: bone flap incision, drilling in the clavicle, and hook plate fixation and AC joint reposition. The treatment efficacy was evaluated through clinical examinations and imaging studies for the shoulder joint, including gross observation and measuring coracoid clavicle distance (CC‐Dist) using orthophoria X‐ray before and 1 year after the surgery, and University of California (UCLA) shoulder rating scale.ResultsAll the patients were followed up three to four times in 18 months (12–24 months) on average, and the UCLA rating results showed that there were 17 excellent cases (68%), five good cases (20%), and three fair cases (12%). The CC‐Dist values after the surgery reduced to 9.7 ± 0.7 mm, which was significantly (P < 0.05) lower compared to that before the surgery (15.8 ± 1.6 mm). Most (88%) of the cases showed almost normal joint function and good anatomical arrangement of the acromioclavicular joint, without any secondary dislocation, and for them, 12 ± 2 weeks on average were needed to regain the normal function of shoulder joint movement.ConclusionDue to the stable fixation, fewer complications, and satisfactory therapeutic effect with great clinical value, the combination of AO CHP and CC ligament transposition is expected to be used for treating Rockwood III‐V dislocation of AC joint.

Arthroscopic Anatomical Acromioclavicular Joint Reconstruction using a Button Device and a Semitendinosus Graft.

ObjectiveTo report a new technique for anatomical acromioclavicular (AC) joint reconstruction.MethodsIn order to minimize such complications, the authors describe a new anatomical and biological AC joint repair. This technique aims to provide greater stability by using two anatomically placed clavicular tunnels and a combined construct with a double endobutton cortical fixation for primary stabilization, and to be biologically advantageous by using an autologous semitendinosus (ST) tendon graft. Additionally, the coracoclavicular ligament reconstruction is complemented with an AC joint cerclage and capsular reinforcement, which will protect the biological construction in its initial stage of healing.ResultsThis technique provides adequate primary and secondary biomechanical stability by passing both a semitendinosus autogenous graft and a double endobutton device, through anatomically placed and small diameter clavicle holes, without the need for coracoid drilling. Our technique showed encouraging results regarding pain resolution, range of motion, and function. At final follow‐up we experienced excellent results with average pain score of 1.6, and average ROM of 159° of forward flexion, 160° of abduction, 68° of external rotation, and internal rotation level at T11. Postoperative function also showed great improvements with average ASES of 85 points, an average Constant Score of 87 and a Subjective Shoulder Value of 89 points. This technique also achieved perfectly acceptable radiographic results, with an average coracoclavicular distance increase of 0.8 mm. Regarding complications, our sample showed one case of AC join subluxation, two cases of internal saphenous nerve injury, and two partial graft tears at the suture‐button interface, with none of these requiring surgical revision.ConclusionThis technique is advantageous in treatment of acromioclavicular joint dislocation and can be performed in both the subacute and chronic setting.

A modified single-endobutton technique combined with nice knot for treatment of Rockwood type III or V acromioclavicular joint dislocation

PurposeDouble-endobutton technique, as a widely accepted strategy for the treatment of acromioclavicular joint dislocation, is undergoing constant improvement. This study aims to assess the clinical effect of a modified single-endobutton combined with the nice knot in the fixation of Rockwood type III or V acromioclavicular joint dislocation.MethodsFrom January 2016 to June 2019, 16 adult patients (13 males and 3 females) with Rockwood type III or V acromioclavicular joint dislocation were treated with a modified single-endobutton technique combined with the nice knot in our department. The age ranged from 18 to 64 years old with an average of 32.8 years old. Operative time, intraoperative blood loss, post-operative clinical outcomes and radiographic results were recorded and analyzed. Preoperative and last follow-up scores in the Constant-Murley Scale, Neer score, Rating Scale of the American Shoulder and Elbow Surgeons and VAS scale and complications such as infection, re-dislocation, implant loosening, medical origin fracture and hardware pain were recorded and evaluated.ResultsSixteen patients were followed up for 6 to 18 months with an average of 10.3 months. The operative time was 50–90 min with an average of (62.5 ± 3.10) min. The intraoperative blood loss was 30–100 ml, with an average of (55.0 ± 4.28) ml. The complications, such as wound infection, internal fixation failure and fractures, were not found in these cases. According to Karlsson criteria, there were excellent in 14 cases, good in 2 cases at the final follow-up. The mean VAS score of the patients was 5.88 ± 0.26 preoperatively, compared with 0.19 ± 0.14 at the final follow-up evaluation. The difference was statistically significant (P < 0.05). The mean Constant score was 45.5 ± 2.0 preoperatively, compared to 94.0 ± 0.73 at the final follow-up evaluation. The difference was statistically significant (P < 0.05). Patients had statistically significant preoperative and postoperative AC (acromioclavicular distance) and CC (coracoclavicular distance) distances (P < 0.05); 6 months postoperatively the AC(P = 0.412) and CC(P = 0.324) distances were not statistically significant compared to the healthy side.ConclusionNice knot provides a reliable fixation for the single-endobutton technique in the treatment of acromioclavicular dislocations. The modified single-endobutton technique combined with the nice knot can achieve good clinical outcomes in the treatment of Rockwood type III or V acromioclavicular joint dislocation.

Case-control study on the Endobutton plate and clavicular hook plate for the treatment of acromioclavicular joint dislocation

To study the clinical efficacy and complications of Endobutton titanium plate and clavicle hook plate in the treatment of acromioclavicular dislocation. Total 48 patients with Rockwood Ⅲ to Ⅴ acromioclavicular joint dislocation from March 2015 to May 2019 were retrospectively divided into two groups according to different surgical methods. Among the patients, 23 patients were treated with Endobutton loop titanium plate fixation (observation group), including 15 males and 8 females, ranging in age from 23 to 59 years old, with an average of(36.2±8.1) years old;Rockwood type Ⅲ in 6 cases, type Ⅳ in 11 cases and type Ⅴ in 6 cases. Twenty-five patients were treated with clavicular hook plate(control group), including 17 males and 8 females, ranging in age from 22 to 54 years old, with an average of (34.7±6.4) years old; Rockwood type Ⅲ in 6 cases, type Ⅳ in 14 cases and type Ⅴ in 5 cases. The operation time, intraoperative bleeding, hospitalization time, visual analogue scale (VAS) of pain, Constant-Murley score of shoulder function and postoperative complications were compared between the two groups. All the patients were followed up, and the duration ranged from 24 to 51 months, with a mean of (30.5±6.5) months. The amountof bleeding and hospitalization time in the observation group were (71.9±4.0) ml and(8.2±1.6) d respectively;and those in the control group were (97.6±13.4) ml and (12.8±1.2) d respectively. There was significant difference between the two groups (P<0.05). There was no significant difference in operation time between the two groups(P>0.05). The VAS scores of the observation group immediately after operation and 12 months after operation were 4.00±0.39 and 1.58±0.13 respectively, which were statistically significant compared with 7.32±0.43 and 3.09±0.23 in the control group (P<0.05). The Constant-Murley scores of shoulder function in the observation group were 59.65±0.15 and 85.97 ±0.73 immediately and 12 months after operation, which were significantly different from those in the control group 52.77±0.19 and 55.78±0.19(P<0.05). In the observation group, there were 1 case of shoulder pain and 1 case of ectopic ossification; in the control group, there were 1 case of internal fixation failure, 3 cases of acromion impact, 3 cases of shoulder pain and 3 cases of ectopic ossification. There was significant difference between the two groups (P<0.05). Compared with clavicular hook plate internal fixation in the treatment of acromioclavicular joint dislocation, Endobutton loop titanium plate internal fixation technology has the advantages of less surgical bleeding, shorter hospitalization time, less postoperative pain, good recovery of shoulder joint function and less complications.

Biomechanical analysis of a novel clavicular hook plate for the treatment of acromioclavicular joint dislocation: A finite element analysis

BackgroundClavicular hook plates are frequently used in clinical orthopedics to treat acromioclavicular joint dislocation. However, patients often exhibit acromial osteolysis and peri-implant fracture after hook plate fixation. To solve the above problems, we developed a novel double-hook clavicular plate and used finite element analysis (FEA) to investigate its biomechanical properties. MethodsA finite element (FE) model was constructed and validated. Then, a double-hook clavicular plate, a single-hook clavicular plate, and an anatomical double-hook clavicular plate was implanted into the acromioclavicular joint and fixed with screws in groups 1, 2 and 3, respectively. Finally, a load was applied, and some indicators were recorded and analyzed. ResultsFor both the proximal clavicular rotation angle and the distal clavicular displacement, the range of motion in groups 1 and 3 was more than 90% lower than that in group 2. The maximum von Mises stress of the clavicle in groups 1 and 3 was more than 45% lower than that in group 2. The maximum stress of the acromion in group 2 was significantly higher than that in groups 1 and 3, and that in group 3 was less than that in group 1, for both cortical and cancellous bone. ConclusionsThe double-hook clavicular plate could immediately reconstruct the stability of the acromioclavicular joint, effectively reducing the stress of the bone around the clavicle and screws. Additionally, the double-hook clavicular plate could reduce the peak stress of the acromion and produce a more uniform stress distribution.

Short-term clinical and radiological outcomes of treatment of acromioclavicular joint dislocations with the TightRope technique

Background/Aim: High-grade acromioclavicular joint injuries are usually treated surgically. However, there is still no consensus on which technique should be performed. We investigated the short-term clinical and radiological outcomes of the patients treated with the TightRope technique. Methods: In this retrospective cohort study, 15 patients (13 males and 2 females) who had an acromioclavicular joint injury and were treated with the TightRope technique between October 2015 and May 2019 were evaluated. The patients who had Rockwood type III (1 patient), type IV (8 patients), and type V (6 patients) injuries and had been followed up for at least 1 year were included in the study. At the final visits, the patients were evaluated functionally with VAS, DASH, and Constant scores, as well as radiologically by measuring the coracoclavicular distance on bilateral shoulder AP X-rays. Results: The mean duration of follow-up was 25.2 (5.6) months. Mean time to surgery was 3.0 (2.2) days and mean time to return to work was 8.8 (1.7) weeks. The coracoclavicular distance was 11.6 (2.1) mm on the affected side and 10.2 (0.8) mm in the other shoulder. Mean VAS, DASH, and Constant scores at the final visit were 1, 10, and 92, respectively. Conclusion: Use of the TightRope technique for the treatment of acromioclavicular dislocations might be effective like other methods that contribute to early regaining of range of motion of the shoulder joint, in addition to reduction of the dislocation.

Treatment of severe acromioclavicular joint dislocation with double strand titanium cable and clavicular hook plate guided by self-made guide device

To compare the clinical efficacy of titanium cable biomimetic reconstruction of coracoclavicular ligament and clavicular hook plate in the treatment of acromioclavicular joint dislocation. The clinical data of 39 patients with severe acute acromioclavicular joint dislocation from January 2017 to December 2018 were retrospectively analyzed, 19 patients in double strand titanium cable group, including 13 males and 6 females, aged from 26 to 67 years old; Rockwood classification:10 cases of type Ⅲ, 4 cases of type Ⅳ and 5 cases of type Ⅴ;8 cases of traffic injury and 11 cases of fall injury;the time from injury to operation was 3 to 6 days. There were 20 patients in steel plate group, including 15 males and 5 females, aged from 25 to 71 years old. Rockwood classification:11 cases of type Ⅲ, 4 cases of typeⅣ, 5 cases of type Ⅴ;7 cases of traffic injury, 13 cases of fall injury;the time from injury to operation was 2 to 7 days. The length of incision, operation time, intraoperative blood loss, cost, VAS score before and after operation, and Constant-Murley score before and after operation were compared between two groups. Postoperative X-ray films were taken to observe the reduction and maintenance of acromioclavicular joint dislocation. Complications were recorded. Thirty-six patients were followed up for 12 to 14 months. The amount of intraoperative blood loss in the two groups was basically the same. The operation incision in double strand titanium cable group was shorter, the operation time in steel plate group was shorter, and the operation cost in double strand titanium cable group was less. One week and one year after operation, the pain of double strand titanium cable group was less than that of steel plate group. One year after operation, the Constant-Murley score of double strand titanium cable group was higher than that of steel plate group. The postoperative X-ray showed that the acromioclavicular joint in double strand titanium cable group was well reduced, and there was 1 case with slight reduction loss. In the plate group, there was no reduction loss after removal of the clavicular hook plate, and 8 patients had distal clavicular bone atrophy or acromion bone resorption. In steel plate group, 4 cases had long-term postoperative pain, postoperative dysfunction and other complications. The clinical effect of coracoclavicular ligament reconstruction with double strand titanium cable is better than that of clavicular hook plate in the treatment of severe acute acromioclavicular joint dislocation, with less trauma (no secondary operation) and lower cost.