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

The deltotrapezial fascia stabilizes the AC-joint and its reconstruction restores the horizontal stability in AC-joint separations: a biomechanical comparison

BACKGROUND

Various techniques are available for the reconstruction of acromioclavicular joint (ACJ) dislocations, with the main focus being on restoration of the AC capsule or coracoclavicular ligaments. Recent research has underlined the significance of the deltotrapezial fascia (DTF) and related muscles as dynamic stabilizers of the ACJ. The Hypothesis was that a reconstruction of the DTF increases the stability of the ACJ in the horizontal plane more than a complete transection of the fascia, while not restoring the stability of the native state.

HYPOTHESIS

Reconstruction of the DTF increases the stability of the ACJ in the horizontal plane more than a complete transection of the fascia, while not restoring the stability of the native state.

METHODS

Five pairs of human cadaveric shoulders including the torsos were included in the study and underwent cyclic anterior-posterior loading using an electromechanical testing machine. The shoulders were put into 3 groups: group N (n = 10): native ACJ; group T (n = 10): ACJ with transected DTF; group R (n = 10): ACJ with reconstruction of the DTF after transection. The dislocation was recorded with a 3D optical measuring system.

RESULTS

Group N showed a mean horizontal displacement of 2.94 mm (±1.26), group T showed a mean anterior displacement of 3.33 mm (±1.37), and group R showed a mean anterior displacement of 2.95 mm (±1.08). The mean anterior displacement for group T was significantly higher after every measured number of cycles compared with groups N and R. There was no significant difference in mean anterior displacement between groups N and R.

CONCLUSION

The transection of the DTF results in significantly reduced stability in the horizontal plane of the ACJ. A reconstruction of the DTF restores the stability of the native ACJ in the horizontal plane. Further clinical and biomechanical investigations should focus on reconstruction techniques of the DTF.

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

OBJECTIVE

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.

METHODS

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.

RESULTS

All patients underwent loop plate elastic fixation under endoscopy during 24 to 48 months 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.

CONCLUSION

The modified three-incision endoscopic technique optimizes the surgical incision, reduces trauma, is minimally invasive, and provides rapid rehabilitation with satisfactory clinical outcomes.