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Ko SH, Lee CC, Jeon YD, Han JW, Lee KJ. Long-term Clinical Outcomes After TightRope Versus Hook Plate Fixation for Acute Acromioclavicular Joint Dislocation. Orthop J Sports Med 2023; 11:23259671231165097. [PMID: 37152617 PMCID: PMC10155023 DOI: 10.1177/23259671231165097] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/17/2023] [Indexed: 05/09/2023] Open
Abstract
Background There is limited information regarding the long-term efficacy of techniques for surgical fixation after acromioclavicular (AC) joint dislocation. Purpose To evaluate the efficacy of hook plate (HP) and TightRope (TR) fixation for acute AC joint dislocations by comparing the long-term clinical and radiological patient outcomes. Study Design Cohort study, Level of evidence, 3. Methods This study retrospectively analyzed data from 61 patients with acute AC joint dislocation between July 2011 and November 2015. The patients were grouped according to surgical procedure: HP (n = 36) and TR (n = 25). Clinical outcomes at final follow-up were evaluated using the visual analog scale (VAS) for pain; the American Shoulder and Elbow Surgery score; the Korean Shoulder Score; and the University of California, Los Angeles (UCLA) shoulder score. Side-to-side coracoclavicular (CC) distance on radiographs, postoperative complications, and the rate of subacromial erosion in the HP group were also assessed between procedures. Results The mean follow-up period was 7.0 ± 1.0 years, and there were no significant differences in pain or outcome scores between the HP and TR groups (all P > .05). Forward flexion was better in the TR group (172.6° ± 5.6°) versus the HP group (166.0° ± 10.8°; P = .002). The percentages of patients with a difference in the side-to-side CC distance of <5 mm were 83.3% and 72.0% in the HP and TR groups, respectively (P = .288). Complications were found in 2 patients in the HP group and 1 in the TR group (P ≥ .999). Subacromial erosion was observed in 41.7% of patients after HP fixation, with no difference in VAS pain scores at the final follow-up in patients with versus without subacromial erosion (P = .719). Conclusion When comparing HP with TR fixation for the treatment of acute AC joint dislocations, there were no significant differences in functional outcome scores, final CC distance, or complications. Slightly better forward flexion was seen after TR fixation. Subacromial erosion occurred in 40% of patients after HP fixation, but this did not affect long-term VAS pain scores. Both surgical techniques are effective treatment options for AC joint dislocation.
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Affiliation(s)
- Sang Hun Ko
- Department of Orthopaedic Surgery,
University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Republic
of Korea
| | - Chae-Chill Lee
- Department of Orthopaedic Surgery,
University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Republic
of Korea
| | - Young Dae Jeon
- Department of Orthopaedic Surgery,
University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Republic
of Korea
- Young Dae Jeon, MD,
Department of Orthopaedic Surgery, University of Ulsan College of Medicine,
Ulsan University Hospital, 25 Daehakbyeongwon-ro, Dong-gu, Ulsan, 44033,
Republic of Korea ()
| | - Jung Won Han
- Department of Orthopaedic Surgery,
University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Republic
of Korea
| | - Kyung Joo Lee
- Department of Orthopaedic Surgery,
University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Republic
of Korea
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Johnson SM, Esquivel AO, Lovse L, Cracchiolo AM, Bishai SK, Chen C, Lemos SE. Anatomic Acromioclavicular Joint Reconstruction with and without Acromioclavicular Ligament Reconstruction: A Comparative Biomechanical Study. Shoulder Elbow 2023; 15:166-172. [PMID: 37035618 PMCID: PMC10078810 DOI: 10.1177/17585732211068322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 08/09/2021] [Accepted: 07/29/2021] [Indexed: 11/15/2022]
Abstract
Background The purpose of this study was to determine if adding a reconstructed superior acromioclavicular (AC) joint ligament adds significant biomechanical stability to the AC joint over anatomic coracoclavicular (CC) ligament reconstruction alone. Methods Fourteen cadaver shoulders were used for the comparison of biomechanical stability among the anatomic CC ligament reconstruction alone, CC and AC ligament reconstruction, and the intact groups by measuring the displacement under cyclic loads. A load to failure test was then performed in the vertical direction at a loading rate of 2 mm /sec to determine surgical-repair joints' tolerance to the maximum failure load. Results The average peak-to-peak displacement induced by cyclic load in the sagittal axis and vertical axis direction was not significantly different between CC ligament reconstruction, CC and AC ligament reconstruction, and intact groups. The maximum failure load for the CC reconstruction (224.9 ± 91.8 N (Mean ± SEM)) was lower than CC/AC reconstruction groups (326.2 ± 123.3 N). The CC/AC reconstruction group failed at a significantly higher load (t test, p = 0.016) than the CC reconstruction group. Conclusion CC/AC reconstruction surgical technique yielded a better shoulder stability than CC ligament alone reconstruction that may better maintain reduction of the AC joint.Level of Evidence: Level II.
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Affiliation(s)
- Steven M Johnson
- Detroit Medical Center Sports Medicine, Detroit, Michigan, United States
- Detroit Medical Center Sports Medicine Othropaedic Surgery Fellowship Program, Detroit, Michigan, United States
- Christus Trinity Clinic, Palestine, TX, United States
| | - Amanda O Esquivel
- Detroit Medical Center Sports Medicine, Detroit, Michigan, United States
- Department of Mechanical Engineering, University of Michigan-Dearborn, Detroit, MI, United States
| | - Lisa Lovse
- Detroit Medical Center Sports Medicine, Detroit, Michigan, United States
- Detroit Medical Center Sports Medicine Othropaedic Surgery Fellowship Program, Detroit, Michigan, United States
| | | | - Shariff K Bishai
- Michigan State University College of Osteopathic Medicine, East Lansing, MI, United States
| | - Chaoyang Chen
- Detroit Medical Center Sports Medicine, Detroit, Michigan, United States
| | - Stephen E Lemos
- Detroit Medical Center Sports Medicine, Detroit, Michigan, United States
- Detroit Medical Center Sports Medicine Othropaedic Surgery Fellowship Program, Detroit, Michigan, United States
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3
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Peebles LA, Aman ZS, Kraeutler MJ, Mulcahey MK. Qualitative and Quantitative Anatomic Descriptions of the Coracoclavicular and Acromioclavicular Ligaments: A Systematic Review. Arthrosc Sports Med Rehabil 2022; 4:e1545-e1555. [PMID: 36033198 PMCID: PMC9402469 DOI: 10.1016/j.asmr.2022.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 04/28/2022] [Indexed: 11/28/2022] Open
Abstract
Purpose Methods Results Conclusions Clinical Relevance
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Affiliation(s)
- Liam A. Peebles
- Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Zachary S. Aman
- Sidney Kimmel Medical College, Philadelphia, Pennsylvania, U.S.A
| | - Matthew J. Kraeutler
- Department of Orthopaedic Surgery, St. Joseph’s University Medical Center, Paterson, New Jersey, U.S.A
| | - Mary K. Mulcahey
- Department of Orthopaedic Surgery, New Orleans, Louisiana, U.S.A
- Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
- Address correspondence to Mary K. Mulcahey, M.D., 1430 Tulane Ave., #8632, New Orleans, LA 70112.
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Anatomic reconstruction of the acromioclavicular joint provides the best functional outcomes in the treatment of chronic instability. Knee Surg Sports Traumatol Arthrosc 2021; 29:2237-2248. [PMID: 32458032 DOI: 10.1007/s00167-020-06059-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 05/10/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE To systematically review the outcomes of surgical treatments of chronic acromioclavicular joint dislocation. METHODS Studies were identified by electronic databases (Ovid, PubMed). All studies reporting functional and radiological outcomes of surgical treatments of chronic acromioclavicular joint dislocations were included. Following data were extracted: authors and year, study design, level of evidence, number of patients, age, classification of acromioclavicular joint dislocation, time to surgery, surgical technique, follow-up, clinical and imaging outcomes, complications and failures. Descriptive statistics was used, when a data pooling was not possible. Comparable outcomes were pooled to generate summary outcomes reported as frequency-weighted values. Quality appraisal was assessed through the MINORS checklist. RESULTS Fourty-four studies were included for a total of 1020 shoulders. Mean age of participants was 38 years. Mean follow-up was 32.9 months. Arthroscopic techniques showed better results than open approach (p < 0.0001). Synthetic reconstructions demonstrated better functional outcomes compared to internal fixation and biologic techniques (p < 0.0001). Among biologic techniques, combined coracoclavicular and acromioclavicular ligaments reconstruction showed better Constant (p = 0.0270) and ASES (p = 0.0113) scores compared to isolated coracoclavicular ligaments reconstruction; anatomic biologic non-augmented graft reconstruction showed better Constant (p < 0.0001), VAS (p < 0.0001) and SSV (p = 0.0177) results compared to augmented techniques. No differences in functional outcomes could be found between anatomic biologic non-augmented graft versus synthetic reconstructions. Overall, methodological quality of the included studies was low. CONCLUSION Anatomic reconstructions, both synthetic and biologic, showed the best functional results. LEVEL OF EVIDENCE IV.
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5
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Cano-Martínez JA, Nicolás-Serrano G, Bento-Gerard J, Marín FP, Grau JA, Antón ML. Chronic acromioclavicular dislocations: multidirectional stabilization without grafting. JSES Int 2020; 4:519-531. [PMID: 32939479 PMCID: PMC7479045 DOI: 10.1016/j.jseint.2020.04.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective Clinical and radiological evaluation of the surgical treatment of chronic acromioclavicular (AC) dislocations with triple button device and AC joint augmentation. Materials and Methods This retrospective study included 21 patients with chronic AC dislocations. All patients underwent bilateral-weighted Zanca and Alexander views as well as the Constant score (CS) and Acromioclavicular Joint Instability Scoring System (ACJI). Results A total of 21 patients (19 men and 2 women) with the mean age of 30.7 ± 11.7 years (range, 19-62 years) were able to participate in clinical and radiographic follow-up. After a mean follow-up of 49.7 ± 17.1 months (range, 13-60 months), the results of the CS were 95.2 ± 5.5 (range, 85-100) and ACJI test 89.7 ± 7.9 (range, 75-100), showing no significant differences with the uninjured shoulder (CS, 96.2 ± 3.9; range, 85-100; ACJI, 95.7 ± 4.1; range, 85-100). At the final review, we observed that the preoperative coracoclavicular distance (Zanca view) improved from 12.8 ± 1.5 mm to 8.5 ± 1.3 mm and the AC distance (Alexander view) from 7.8 ± 2.3 mm to 0.99 ± 0.91 mm. Compared with healthy shoulder, these differences were not significant. Osteoarthritis or radiological calcifications were not associated with worse clinical outcomes. Conclusion The triple button device is an acceptable alternative surgical method for chronic AC joint dislocations. The surgical technique is simple; it does not need a graft, nor does it present major complications, and material extraction is unnecessary.
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Affiliation(s)
- José Antonio Cano-Martínez
- Department of Orthopaedic Surgery, University of Murcia, Los Arcos del Mar Menor General Hospital, Murcia, Spain
| | - Gregorio Nicolás-Serrano
- Department of Orthopaedic Surgery, University of Murcia, Los Arcos del Mar Menor General Hospital, Murcia, Spain
| | - Julio Bento-Gerard
- Department of Orthopaedic Surgery, University of Murcia, Los Arcos del Mar Menor General Hospital, Murcia, Spain
| | - Francisco Picazo Marín
- Department of Orthopaedic Surgery, University of Murcia, Los Arcos del Mar Menor General Hospital, Murcia, Spain
| | - Josefina Andres Grau
- Department of Orthopaedic Surgery, University of Murcia, Los Arcos del Mar Menor General Hospital, Murcia, Spain
| | - Mario López Antón
- Department of Orthopaedic Surgery, University of Murcia, Los Arcos del Mar Menor General Hospital, Murcia, Spain
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Aldhuhoori S, Almasri M, Nicholls SG, Pollock JW, Rollins M, Howard L, Lapner P. What outcomes are important in the recovery from acromio-clavicular (AC) joint pathology? A focus group study with patients and surgeons. Disabil Rehabil 2020; 44:1830-1838. [PMID: 32805156 DOI: 10.1080/09638288.2020.1805800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Acromio-clavicular (AC) joint pathology is a disabling condition that can restrict quality of life through chronic pain and functional limitation. The objective of this study was to determine symptoms and patient-centred outcomes identified by patients with AC pathology and from experienced shoulder surgeons. METHODS Qualitative research methods were undertaken with patient and surgeon focus groups. Patients with AC-joint pathology were invited to participate and were stratified into two cohorts: AC instability and AC osteoarthritis (OA). RESULTS Sixteen patients participated in five patient focus group discussions including 10 patients with AC instability and six patients with AC OA. Four surgeons participated in two focus groups. Although some themes were common to both AC Instability and AC OA, a number of themes were unique to each. A number of themes were identified that do not appear in existing AC joint scores. CONCLUSION Although many factors affecting the AC joint were common to instability and OA pathology, several factors appear to be unique to each and do not appear in existing AC joint metrics. These symptoms and patient-centered outcomes may be used by clinicians in the assessment of patients with AC pathology and in the development of rehabilitation programs.Implications for rehabilitationA thorough understanding of symptoms and patient-centred outcomes associated with acromio-clavicular arthritis and instability is necessary in order to conduct an accurate clinical assessment and design an effective rehabilitation program that meets the clinical needs of patients.Patients in this study identified several themes relevant to assessment and rehabilitation program development including pain location, type of pain (eg. burning pain), and specific activities that induced pain that do not exist in current existing tools.Our finding that certain themes were only raised in either acromio-clavicular instability or osteoarthritis suggests that there may be differences in important outcomes for patients depending on the underlying cause of the acromio-clavicular joint pathology. By incorporating these themes into clinical assessments, outcomes important to patients may be elicited to monitor response to rehabilitation following injury or surgery.
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Affiliation(s)
- Saif Aldhuhoori
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Mahmoud Almasri
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Stuart G Nicholls
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Canada
| | - J Whitcomb Pollock
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Meaghan Rollins
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Lisa Howard
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Peter Lapner
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Canada
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The Infinity-Lock System for Chronic Grade III AC Joint Dislocation: A Novel Technique, Rehabilitation Protocol and Short Term Results. J Clin Med 2020; 9:jcm9082519. [PMID: 32764304 PMCID: PMC7464969 DOI: 10.3390/jcm9082519] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 07/27/2020] [Indexed: 12/17/2022] Open
Abstract
Background: the choice of treatment of chronic grade III acromioclavicular (AC) joint dislocation is controversial. Several surgical techniques have been described in the literature, responding differently to nonoperative treatment. The aim of this study is to describe a modified technique of stabilizing an AC joint dislocation with the new Infinity-Lock Button System, in order to demonstrate that it is effective in optimizing outcomes and decreasing complications. Methods: this is a retrospective study of 15 patients who underwent surgical stabilization of the AC joint dislocation between 2018 and 2019, through modified surgical technique using the Infinity-Lock Button System. Active range of motion (ROM), Specific Acromio Clavicular Score (SACS) and Constant Score (CS) were evaluated preoperatively and postoperatively at last 18 months follow up. Patients rated their outcomes as very good, good, satisfactory, or unsatisfactory. Results: a total of twelve patients rated their outcome as very good and three as good; no patients were dissatisfied with surgery. The mean Constant Score increased from 38 points preoperatively to 95 postoperatively, the average SACS score decreased from 52 points preoperatively to 10 postoperatively, both significantly. No complications were detected. Conclusion: the described technique is effective for treatment of chronic grade III AC joint dislocation, resulting in elevated satisfaction ratings and predictable outcomes. Nevertheless, further longer term follow-up studies are required.
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8
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Kani KK, Porrino JA, Mulcahy H, Chew FS. Surgical techniques for management of acromioclavicular joint separations: review and update for radiologists. Skeletal Radiol 2020; 49:1195-1206. [PMID: 32193563 DOI: 10.1007/s00256-020-03417-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/08/2020] [Accepted: 03/09/2020] [Indexed: 02/02/2023]
Abstract
Imaging plays a central role in the postoperative management of acromioclavicular (AC) joint separations. There are more than 150 described techniques for the surgical management of AC joint injuries. These procedures can be categorized as varying combinations of the following basic techniques: a) soft-tissue repair, b) trans-articular AC joint fixation, c) coracoclavicular (CC) fixation, d) non-anatomic reconstruction of the CC ligaments, e) anatomic reconstruction of the CC ligaments, f) distal clavicle resection, and g) dynamic muscle transfer. The goals of this article are to describe the basic techniques for the surgical management of AC joint separations with an emphasis on technique-specific complications and postoperative imaging assessment.
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Affiliation(s)
- Kimia Khalatbari Kani
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Jack A Porrino
- Yale School of Medicine, Radiology and Biomedical Imaging, New Haven, CT, 06520-8042, USA
| | - Hyojeong Mulcahy
- Department of Radiology, University of Washington, 4245 Roosevelt Way NE, Box 354755, Seattle, WA, 98105, USA
| | - Felix S Chew
- Department of Radiology, University of Washington, 4245 Roosevelt Way NE, Box 354755, Seattle, WA, 98105, USA
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9
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Lobao MH, Canham RB, Melvani RT, Parks BG, Murthi AM. Synthetic coracoclavicular ligament vs. coracoclavicular suspensory construct for treatment of acromioclavicular dislocation: a biomechanical study. J Shoulder Elbow Surg 2020; 29:1440-1449. [PMID: 32081633 DOI: 10.1016/j.jse.2019.11.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 11/04/2019] [Accepted: 11/16/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND A synthetic ligament (LockDown, Worcestershire, England) has become available to treat complete acromioclavicular dislocation with promising clinical results and potential benefit to avoid postoperative loss of reduction. We investigated the biomechanics of this synthetic ligament in a simulated immediate postoperative rehabilitation setting, hypothesizing that the synthetic ligament would demonstrate less superior coracoclavicular displacement to cyclic loading and higher ultimate load-to-failure values than a coracoclavicular suspensory construct. METHODS Seven matched-pair cadaveric shoulders (mean age at time of death, 79 years) were loaded cyclically and to failure. One specimen in each pair was randomly assigned to the synthetic ligament or coracoclavicular suspensory construct. Superiorly directed 70-N cyclic loading for 3000 cycles at 1.0 Hz was applied through the clavicle in a fixed scapula simulating physiologic states during immediate postoperative rehabilitation, followed by a load-to-failure test at 120 mm/min. RESULTS After 3000 cycles, the superior displacement of the clavicle in the synthetic ligament (9.2 ± 1.1 mm) was 225% greater than in the coracoclavicular suspensory construct (2.8 ± 0.4 mm, 95% confidence interval [CI] 3.4, 8.3; P < .001). Average stiffness of the synthetic ligament (32.8 N/mm) was 60% lower than that of the coracoclavicular suspensory construct (81.9 N/mm, 95% CI 43.3, 54.9; P < .001). Ultimate load-to-failure of the synthetic ligament was 23% (95% CI 37.9, 301.5; P = .016) lower than the coracoclavicular suspensory construct (580.5 ± 85.1 N and 750.2 ± 135.5 N, respectively). CONCLUSION In a simulated immediate postoperative cadaveric model, the synthetic ligament demonstrated poorer biomechanics than the coracoclavicular suspensory construct. These findings suggest that a coracoclavicular suspensory construct may be preferable to a synthetic ligament if early rehabilitation is intended.
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Affiliation(s)
- Mario H Lobao
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - R Bruce Canham
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Roshan T Melvani
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Brent G Parks
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Anand M Murthi
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA.
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Hunter TJA, Abdus-Samee M, Balasubramanian S, Grocott N, McClelland D. Medium- to long-term results of acromioclavicular joint stabilisation using the Ligament Augmentation Reconstruction System (LARS) ligament. Shoulder Elbow 2020; 12:163-169. [PMID: 32565917 PMCID: PMC7285975 DOI: 10.1177/1758573219833697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 01/30/2019] [Accepted: 01/31/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Opinion is divided as to optimum management of grade III acromioclavicular joint injuries that have failed conservative management. We objectively investigated the radiological and functional outcome of acromioclavicular joint reconstruction using the Ligament Augmentation Reconstruction System (LARS®). METHODS Retrospective review of patients with LARS reconstruction of acromioclavicular joint dislocations with minimum six-year follow-up. Functional assessment was performed using the constant score, Disability of Arm Shoulder and Hand score and simple satisfaction score. Radiological assessment was undertaken using plain radiographs. Results were compared with the uninjured limb. RESULTS Twenty-four of 25 patients were included. Mean constant score for the injured shoulder was 87.0, Disability of Arm Shoulder and Hand score was 11.6. All patients indicated that they would have the operation again. There were five complications including two patients that suffered small cracks in the clavicle. Coracoid erosion was frequently seen but was most often minor. In two cases, this resulted in a complete dissociation of the coracoid tip but without functional detriment. DISCUSSION LARS is a safe and effective method of acromioclavicular joint reconstruction producing good results, and we recommend its use for these injuries. We also caution clinicians who use cerclage methods to be aware of coracoid erosion when following up their patients.
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Affiliation(s)
- Thomas JA Hunter
- Royal Stoke University Hospital, University Hospitals of North Midlands, Stoke-on-Trent, UK
| | | | | | - Natalie Grocott
- Royal Stoke University Hospital, University Hospitals of North Midlands, Stoke-on-Trent, UK
| | - Damian McClelland
- Royal Stoke University Hospital, University Hospitals of North Midlands, Stoke-on-Trent, UK
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11
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Nolte PC, Lacheta L, Dekker TJ, Elrick BP, Millett PJ. Optimal Management of Acromioclavicular Dislocation: Current Perspectives. Orthop Res Rev 2020; 12:27-44. [PMID: 32184680 PMCID: PMC7062404 DOI: 10.2147/orr.s218991] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 02/19/2020] [Indexed: 12/14/2022] Open
Abstract
Injuries to the acromioclavicular (AC) joint are common and mostly involve younger, male individuals. Whereas the majority of AC joint dislocations can be treated nonoperatively with a trial of immobilization, pain medication, cryotherapy, and physiotherapy, there are patients that do not respond well to conservative management and may require surgical treatment. Identifying and treating these patients according to the type and chronicity of AC joint dislocation is paramount. To date, a myriad of surgical techniques have been proposed to address unstable AC joint dislocations and are indicative of the uncertainty that exists in optimal management of these injuries. Historically research has focused on the restoration of the coracoclavicular ligament complex. However, recently the importance of the acromioclavicular capsule and ligaments has been emphasized. This review aims to provide the reader with an overview of current treatment strategies and research, as well as future perspectives.
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Affiliation(s)
- Philip C Nolte
- Steadman Philippon Research Institute, Vail, CO, USA.,Department of Trauma and Orthopedic Surgery, BG Trauma Center Ludwigshafen, Ludwigshafen, Germany
| | - Lucca Lacheta
- Steadman Philippon Research Institute, Vail, CO, USA.,Center for Musculoskeletal Surgery, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Travis J Dekker
- Steadman Philippon Research Institute, Vail, CO, USA.,Eglin Air Force Base, 96th Medical Group, United States Air Force, Eglin, FL, USA
| | | | - Peter J Millett
- Steadman Philippon Research Institute, Vail, CO, USA.,The Steadman Clinic, Vail, CO, USA
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12
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Ochen Y, Beks RB, Emmink BL, Wittich P, van der Velde D, Houwert R, Keizer J. Surgical treatment of acute and chronic AC joint dislocations: Five-year experience with conventional and modified LARS fixation by a single surgeon. J Orthop 2020; 17:73-77. [PMID: 31879478 PMCID: PMC6919342 DOI: 10.1016/j.jor.2019.08.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 08/13/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Different surgical fixation methods are available for the treatment of acromioclavicular (AC) joint dislocations. The aim of this study was to present the results of five years of experience with the Ligament Augmentation and Reconstruction System (LARS) fixation technique by a single surgeon. METHODS A single-center retrospective cohort study was performed. All patients treated for an AC joint dislocation with LARS fixation by the same surgeon between 2012 and 2016 (n = 20) were eligible for inclusion. All these dislocations were unstable injuries, Rockwood type-III or higher, requiring acute or chronic repair. The primary outcome was the QuickDASH score. Secondary outcomes were the Subjective Shoulder Value (SSV), Numerical Rating Scale (NRS) pain score, return to work, complications, and implant removal. RESULTS 17 patients (85%) were available for final follow-up. The median follow-up was 23 months (IQR; 17─34). The median QuickDASH score was 7 (IQR; 2-18), the median SSV was 90 (IQR; 80-90), and the median NRS pain score was 2 (IQR; 1-3). Patients returned to work after a median of 8 weeks (IQR; 6-12). There was no significant difference in functional outcome scores between acute and chronic repair, or between the conventional and modified LARS fixation groups. There were two major complications requiring revision surgery, one ruptured LARS ligament and one case of deep wound infection. Implant removal was performed in one patient. CONCLUSIONS The LARS ligament fixation technique seems to be effective for the treatment of AC joint dislocations, resulting in good short- and mid-term patient-reported functional outcome. LARS fixation might also be an acceptable treatment option for active patients with symptomatic chronic AC dislocations. LEVEL OF EVIDENCE Level III, Retrospective Comparative Study, Treatment Study.
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Affiliation(s)
- Yassine Ochen
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Surgery, St. Antonius Hospital, Leidsche Rijn, the Netherlands
| | - Reinier B. Beks
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Surgery, Diakonessenhuis Hospital, Utrecht, the Netherlands
| | - Benjamin L. Emmink
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Surgery, St. Antonius Hospital, Leidsche Rijn, the Netherlands
| | - Philippe Wittich
- Department of Surgery, St. Antonius Hospital, Leidsche Rijn, the Netherlands
| | | | - R.Marijn Houwert
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jort Keizer
- Department of Surgery, St. Antonius Hospital, Leidsche Rijn, the Netherlands
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Xará-Leite F, Andrade R, Moreira PS, Coutinho L, Ayeni OR, Sevivas N, Espregueira-Mendes J. Anatomic and non-anatomic reconstruction improves post-operative outcomes in chronic acromio-clavicular instability: a systematic review. Knee Surg Sports Traumatol Arthrosc 2019; 27:3779-3796. [PMID: 30806755 DOI: 10.1007/s00167-019-05408-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 02/06/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE To systematize the surgical outcomes of anatomic and non-anatomic reconstruction in patients with chronic acromio-clavicular joint (ACJ) instability and determine which technique is superior. METHODS This review was conducted according to the PRISMA guidelines. PubMed and Cochrane Library databases were searched up to April 30th, 2018 for original articles that assessed the outcomes of one or more surgical techniques of anatomic and non-anatomic reconstruction in patients with chronic ACJ instability. The Methodological Index for Non-randomized Studies (MINORS) was used to assess study quality. Pre-to-post meta-analysis was performed for both anatomic and non-anatomic reconstructions. RESULTS Twenty-eight studies were included comprising 799 patients (mean age of 36.6 years old and 84% males) with a mean follow-up of 34.6 months (range 13 to 74). Surgical techniques included anatomic (tendinous or synthetic grafts/constructs) and non-anatomic reconstruction (Weaver-Dunn or Modified Weaver-Dunn, conjoined tendon transfer, or temporary hook plate). There were significant pre-to-post improvements on the constant score with an average improvement ranging from 11.1 to 50.7 (p < 0.01). Average failure rate was 7.6% (7.5% for anatomic and 8.5% for non-anatomic reconstruction). Non-comparative studies had a mean MINORS score of 9 points (out of 16) and comparative studies 17 (out of 24) with excellent interrater agreement (k = 0.910). CONCLUSION Both anatomic and non-anatomic ACJ reconstructions provide significant post-operative improvements, but definitive conclusions on optimal technique remain elusive. Notwithstanding, comparative studies support the use of anatomic ACJ reconstruction which should be preferably used. However, until superiority is demonstrated by robust studies, surgeons should supplement their decision-making with experience and patient preference. LEVEL OF EVIDENCE IV.
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Affiliation(s)
| | - Renato Andrade
- Clínica do Dragão, Espregueira-Mendes Sports Centre-FIFA Medical Centre of Excellence, Porto, Portugal
- Dom Henrique Research Centre, Porto, Portugal
- Faculty of Sports, University of Porto, Porto, Portugal
| | - Pedro Silva Moreira
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | | | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Canada
| | - Nuno Sevivas
- Clínica do Dragão, Espregueira-Mendes Sports Centre-FIFA Medical Centre of Excellence, Porto, Portugal
- Dom Henrique Research Centre, Porto, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Orthopaedics Department, Hospital de Braga, Braga, Portugal
| | - João Espregueira-Mendes
- Clínica do Dragão, Espregueira-Mendes Sports Centre-FIFA Medical Centre of Excellence, Porto, Portugal.
- Dom Henrique Research Centre, Porto, Portugal.
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal.
- School of Medicine, University of Minho, Braga, Portugal.
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Borbas P, Churchill J, Ek ET. Surgical management of chronic high-grade acromioclavicular joint dislocations: a systematic review. J Shoulder Elbow Surg 2019; 28:2031-2038. [PMID: 31350107 DOI: 10.1016/j.jse.2019.03.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 03/10/2019] [Accepted: 03/13/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND To date, no gold-standard technique exists for the treatment of chronic acromioclavicular joint (ACJ) instability. We systematically reviewed the clinical results of 3 main categories of ACJ reconstruction for high-grade chronic instability. METHODS A literature search was performed according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The inclusion criteria were clinical studies involving patients with ACJ instability (Rockwood grades III-VI) for at least 6 weeks, managed with ACJ stabilization, with a minimum 1-year follow-up. Depending on the surgical technique, patients were divided into 1 of 3 groups: nonbiological fixation between the coracoid and clavicle, for example, suture loops and synthetic ligaments (group 1); biological reconstruction of the coracoclavicular ligaments, for example, allograft or autograft ligament reconstruction (group 2); and ligament and/or tendon transfer, for example, the Weaver-Dunn procedure (group 3). Patient demographic characteristics, functional scores, radiographic outcomes, and complications were compared. RESULTS Two independent investigators reviewed 960 articles. A total of 27 studies met the inclusion criteria, comprising 590 patients divided into 1 of 3 groups. The complication rates were similar among the 3 groups: 15% for nonbiological fixation, 15% for biological reconstruction, and 17% for ligament and/or tendon transfer, with failure rates of 8%, 7%, and 5%, respectively. In terms of functional results, the mean Constant score was 87.2 points for nonbiological fixation (n = 89), 92.4 points for biological reconstruction (n = 86), and 87.4 points for ligament and/or tendon transfer (n = 49). CONCLUSION On comparison of the results of 3 different ACJ reconstruction methods, all techniques showed similar complication rates. Among the level II studies, ACJ reconstruction with a tendon graft showed superior results.
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Affiliation(s)
- Paul Borbas
- Melbourne Orthopaedic Group, Melbourne, Victoria, Australia
| | | | - Eugene T Ek
- Melbourne Orthopaedic Group, Melbourne, Victoria, Australia; Department of Surgery, Monash Medical Centre, Monash University, Melbourne, Victoria, Australia.
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15
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Athar MS, Ashwood N, Arealis G, Hamlet M, Salt E. Acromioclavicular joint disruptions: A comparison of two surgical approaches 'hook' and 'rope'. J Orthop Surg (Hong Kong) 2019; 26:2309499017749984. [PMID: 29353523 DOI: 10.1177/2309499017749984] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Acromioclavicular joint injuries are common shoulder girdle injuries most commonly resulting from a direct blow to the acromion with the arm adducted. Type-I or type-II acromioclavicular joint injuries can be managed with sling immobilization, early shoulder motion, and physiotherapy. The management of type-III injuries remains controversial and is individualized. Type IV and V injuries should be treated surgically. A myriad of surgical techniques for the management of acromioclavicular joint injuries have been reported. METHODS We present a comparative study of 76 patients treated with two most common modalities of treatment for AC joint disruption and that is Hook plate stabilisation (n=52) or arthroscopically assisted tight rope stabilisation (n=24). The primary objective was to establish whether hook plate stabilization was superior compared to arthroscopic tight rope fixation in reducing pain and increasing function in the short-term and long-term for patients with AC joint disruptions III-IV. We also wanted to assess how quickly patients returned to their work/job. It was a prospective study, we included all the patients operated between 2008 and 2015 for AC joint disruption by the two shoulder surgeons of our department. All patients followed a strict physiotherapy protocol and were assessed at 6 weeks, 3 months and 12 months. We used the Harm and cost criteria of assessment and the patient specific functional outcome scores. RESULTS Both modalities of treatment have high patient satisfaction rate, return to work is faster in tight rope group but after a year both group of patients returned to their premorbid state. Removal of hook plate is not mandatory and lysis of acromion is rare (1% in our series). CONCLUSION Despite the fact that both methods yielded similar results and have statistically similar number of complications, the type of postoperative complications was different between groups. The plate group had more postoperative pain and worse function but both aspects improved after plate removal. The rope group had more complex complications including deep infection and recurrence of deformity and fracture. These differences should be taken into consideration when consenting the patient regarding possible treatment.
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Affiliation(s)
- M S Athar
- 1 Queen's Hospital - Burton Hospitals NHS Foundation Trust Burton upon Trent, UK
| | - Neil Ashwood
- 1 Queen's Hospital - Burton Hospitals NHS Foundation Trust Burton upon Trent, UK
| | | | - Mark Hamlet
- 1 Queen's Hospital - Burton Hospitals NHS Foundation Trust Burton upon Trent, UK
| | - Emma Salt
- 1 Queen's Hospital - Burton Hospitals NHS Foundation Trust Burton upon Trent, UK
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16
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Gowd AK, Liu JN, Cabarcas BC, Cvetanovich GL, Garcia GH, Manderle BJ, Verma NN. Current Concepts in the Operative Management of Acromioclavicular Dislocations: A Systematic Review and Meta-analysis of Operative Techniques. Am J Sports Med 2019; 47:2745-2758. [PMID: 30272997 DOI: 10.1177/0363546518795147] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Acromioclavicular (AC) instability is a frequent injury affecting young and athletic populations. Symptomatic, high-grade dislocations may be managed by a myriad of operative techniques that utilize different grafts to achieve reduction. Comparative data are lacking on the ability of these techniques to achieve excellent patient outcomes and stable AC reduction and to minimize complications. PURPOSE To systematically review the outcomes and complications of different techniques of AC joint reconstruction. STUDY DESIGN Systematic review and meta-analysis. METHODS The MEDLINE, Scopus, Embase, and Cochrane Library databases were accessed to perform a systematic review of the scientific literature from 2000 to 2018 using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria with the following keywords: "acromioclavicular" and "reconstruction." Included articles were evaluated for loss of reduction, complication rate, revision rate, and change in coracoclavicular distance. Articles were stratified by graft and surgical material used: suture only, Endobutton with suture, TightRope, GraftRope, synthetic artificial ligament, tendon graft, and Weaver-Dunn coracoacromial ligament transfer. These outcomes were pooled using a random-effects model and stratified by surgical technique and arthroscopic versus open reconstruction. RESULTS Fifty-eight articles were included in the analysis, with 63 homogeneous populations composed of 1704 patients. The mean age was 37.1 years (range, 15-80 years) with a mean follow-up of 34.3 months (range, 1.5-186 months). The overall failure rate was 20.8% (95% CI, 16.9%-25.2%). The overall pooled complication rate was 14.2% (95% CI, 10.5%-18.8%). The most common complications were infection (6.3% [95% CI, 4.7%-8.2%]), fracture to the coracoid or distal clavicle (5.7% [95% CI, 4.3%-7.6%]), and hardware/button failure (4.2% [95% CI, 3.1%-5.8%]). There were no differences between arthroscopic and open techniques in regard to loss of reduction (P = .858), overall complication rate (P = .774), and revision rate (P = .390). Open surgery had a greater rate of clavicular/coracoid fractures than arthroscopic surgery (P = .048). Heterogeneity, best assessed from the pooled loss of reduction, was measured as I2 = 64.0%. CONCLUSION Open and arthroscopic AC joint reconstruction techniques have no differences in loss of reduction, the complication rate, and the revision rate based on the available literature. Complications are significant, and profiles vary between surgical techniques, which should be evaluated in the decision making of selecting the technique.
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Affiliation(s)
- Anirudh K Gowd
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Joseph N Liu
- Loma Linda University Medical Center, Loma Linda, California, USA
| | - Brandon C Cabarcas
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | | | | | - Brandon J Manderle
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Nikhil N Verma
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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Deans CF, Gentile JM, Tao MA. Acromioclavicular joint injuries in overhead athletes: a concise review of injury mechanisms, treatment options, and outcomes. Curr Rev Musculoskelet Med 2019; 12:80-86. [PMID: 30806899 PMCID: PMC6542865 DOI: 10.1007/s12178-019-09542-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE OF THE REVIEW To review the relevant literature surrounding acromioclavicular (AC) joint injuries particularly pertaining to overhead athletes. RECENT FINDINGS The AC joint is a unique anatomic and biomechanical portion of the shoulder that can be problematic for athletes, particularly throwers, when injured. Treatment of these injuries remains a topic in evolution. Low-grade injuries (Rockwood types I & II) are typically treated non-operatively while high-grade injuries (types IV, V, and VI) are considered unstable and often require operative intervention. Type III AC separations remain the most controversial and challenging as no clear treatment algorithm has been established. A wide variety of surgical techniques exist. Unfortunately, relatively little literature exists with regard to overhead athletes specifically. Treatment of AC joint injuries remains challenging, at times, particularly for overhead athletes. Operative indications and techniques are still evolving, and more research is needed specifically surrounding overhead athletes.
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Affiliation(s)
| | - Joseph M Gentile
- Novant Health Orthopedics & Sports Medicine, Huntersville, NC, USA
| | - Matthew A Tao
- University of Nebraska Medical Center, 985640, Omaha, NE, 68198, USA.
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18
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Ramsingh V, Yewlett AD, Pullen HC. Three intrasubstance failures of a LARS™ ligament used for ligament reconstruction. Ann R Coll Surg Engl 2019; 101:e79-e83. [PMID: 30602284 DOI: 10.1308/rcsann.2018.0212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We report three cases of intrasubstance failure of a LARS™ (Ligament Augmentation and Reconstruction System) artificial ligament used for acromioclavicular joint reconstruction. The LARS™ ligament failed within four months of the index procedure. All patients underwent a revision procedure following an unsuccessful trial of conservative management. A modified second loop technique was employed during the revision procedure for all cases using the LARS™ ligament. All three patients achieved full recovery to pre-injury level function.
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Affiliation(s)
- V Ramsingh
- Aneurin Bevan University Health Board , UK
| | | | - H C Pullen
- Aneurin Bevan University Health Board , UK
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19
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Mazzoleni S, Battini E, Galgani M, Tenucci M, Dario P, Calvosa G. Motion Tracking for Quantitative and Qualitative Assessment of Upper Limb Movements Following Acromioclavicular Joint Ligament Reconstruction: A Pilot Study. Open Biomed Eng J 2018. [DOI: 10.2174/1874120701812010135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Technological tools as robotic devices and wearable sensors can provide accurate and repeatable measurements of physical variables (e.g., position, velocities, forces) which can be used for quantitative and qualitative assessment of movement analysis and upper limb motor performance.
Objective:
The study aims to propose a quantitative and qualitative assessment of upper limb motor performance by means of seven kinematic parameters recorded by a passive mechatronic device in patients who underwent a surgical procedure for ligament reconstruction following acromioclavicular joint dislocation.
Method:
Five patients (mean age: 40 ± 12 years) with acromioclavicular joint dislocation were enrolled.
A passive end-effector mechatronic device characterized by 7 degrees of freedom and designed for the assessment of upper limb motor performance - especially for measuring the hand position in three-dimensional space - was used.
The Constant-Murley score and seven kinematic parameters were used as clinical outcome measure and quantitative and qualitative assessment, respectively.
Results:
The preliminary results of this study show no significant differences between the impaired arm and unimpaired arm: the end-effector passive mechatronic device used in this study is able to provide an overall assessment of the upper limb motor performance following shoulder impairment.
Conclusion:
The motion tracker can be easily used as effective tool for quantitative and qualitative assessment of upper limb motor performance, even several years after the surgical operation.
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20
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Barwood SA, French JA, Watson LA, Balster SM, Hoy GA, Pizzari T. The Specific AC Score (SACS): a new and validated method of assessment of isolated acromioclavicular joint pathology. J Shoulder Elbow Surg 2018; 27:2214-2223. [PMID: 30001828 DOI: 10.1016/j.jse.2018.04.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 04/03/2018] [Accepted: 04/09/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Acromioclavicular (AC) joint (ACJ) pathology is a common cause of shoulder dysfunction, and treatment recommendations vary. When the efficacy of treatment is evaluated, the ability to measure outcomes specific to the population is essential. The aim of the current research was to develop and validate a specific ACJ questionnaire. METHODS Items for the "Specific AC Score" (SACS) were generated through the use of an expert panel, existing questionnaires, and patient feedback. Preliminary data analysis identified redundancy of items resulting in the questionnaire being refined. The final SACS was evaluated in 125 patients requiring surgical intervention of the ACJ. Internal consistency (the Cronbach α and corrected item-total correlation), content validity, criterion validity, responsiveness, and test-retest reliability (intraclass correlation coefficient) were examined and compared with the Shoulder Pain and Disability Index, Oxford Shoulder Score, and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form. The minimum detectable change score was calculated. RESULTS The Cronbach α for the total scale preoperatively and postoperatively was high (preoperatively = 0.91, postoperatively = 0.93). All 3 domains (Pain, Function, Quality of Life) demonstrated acceptable internal consistency (α > 0.70), and the correlation between items in each domain was satisfactory. The responsiveness was excellent (effect size, -2.32; standard response mean, -1.85) and was higher than the other general shoulder questionnaires. There were no relevant floor or ceiling effects. Reliability was high (intraclass correlation coefficient, 0.89) and the minimum detectable change was 6.5 points. DISCUSSION This new ACJ-specific questionnaire has been robustly developed, has good measurement properties, and has excellent responsiveness. The SACS is recommended for measuring outcomes in ACJ patients.
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Affiliation(s)
- Shane A Barwood
- Department of Shoulder Surgery, Melbourne Orthopaedic Group, Windsor, Victoria, Australia
| | - Jacqui A French
- Department of Shoulder Surgery, Melbourne Orthopaedic Group, Windsor, Victoria, Australia.
| | - Lyn A Watson
- Department of Shoulder Surgery, Melbourne Orthopaedic Group, Windsor, Victoria, Australia
| | - Simon M Balster
- Department of Shoulder Surgery, Melbourne Orthopaedic Group, Windsor, Victoria, Australia
| | - Greg A Hoy
- Department of Shoulder Surgery, Melbourne Orthopaedic Group, Windsor, Victoria, Australia
| | - Tania Pizzari
- Department of Rehabilitation, Nutrition and Sport, Latrobe University, Bundoora, Victoria, Australia
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21
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Tiefenboeck TM, Boesmueller S, Popp D, Payr S, Joestl J, Binder H, Schurz M, Komjati M, Fialka C, Ostermann RC. The use of the LARS system in the treatment of AC joint instability - Long-term results after a mean of 7.4 years. Orthop Traumatol Surg Res 2018; 104:749-754. [PMID: 29581067 DOI: 10.1016/j.otsr.2018.02.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 02/16/2018] [Accepted: 02/27/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND The acromioclavicular (AC) joint is of great importance for shoulder stability and one of the most frequently injured regions of the shoulder. HYPOTHESIS AC joint reconstruction with the ligament augmentation & reconstruction system (LARS™) leads to a good-to-excellent outcome at long-term follow-up. PATIENTS AND METHODS This study was performed as a retrospective single-centre data analysis of a level-I trauma centre. All patients treated operatively for an acute AC dislocation with the LARS™ between 2003 and 2013 were included. RESULTS The study group consisted of three female (6%) and 44 male patients (94%) with an average age of 37 years and a minimum follow-up of two years. The overall mean clinical outcomes at latest follow-up were: Constant 93, DASH 2.64, ASES 96, SST 97, UCLA 34 and VAS 0.4-representing a good-to-excellent outcome in all patients. Overall, 45 patients (96%) reported to be very satisfied with the achieved result at latest follow-up. In five patients, (11%) complications occurred during the follow-up period, requiring surgical revision in four of the five patients (80%). CONCLUSION AC joint reconstruction with the LARS™ achieves good-to-excellent clinical and functional outcomes at long-term follow-up with a surgical revision rate of 8.5%. LEVEL OF EVIDENCE Retrospective follow-up study, case series, level IV.
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Affiliation(s)
- T M Tiefenboeck
- Medical University of Vienna, Department of Orthopedics and Trauma Surgery, Division of Trauma Surgery, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | | | - D Popp
- Medical University of Vienna, Department of Orthopedics and Trauma Surgery, Division of Trauma Surgery, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - S Payr
- Medical University of Vienna, Department of Orthopedics and Trauma Surgery, Division of Trauma Surgery, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - J Joestl
- Medical University of Vienna, Department of Orthopedics and Trauma Surgery, Division of Trauma Surgery, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - H Binder
- Medical University of Vienna, Department of Orthopedics and Trauma Surgery, Division of Trauma Surgery, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - M Schurz
- Medical University of Vienna, Department of Orthopedics and Trauma Surgery, Division of Trauma Surgery, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - M Komjati
- Department of Orthopaedics, Hospital of sacred Heart of Jesus, 1030 Vienna, Austria
| | - C Fialka
- AUVA Trauma Center Meidling, Vienna, Austria; Sigmund Freud University, 1020 Vienna, Austria
| | - R C Ostermann
- Medical University of Vienna, Department of Orthopedics and Trauma Surgery, Division of Trauma Surgery, Waehringer Guertel 18-20, 1090 Vienna, Austria
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22
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Zhu Y, Hsueh P, Zeng B, Chai Y, Zhang C, Chen Y, Wang Y, Maimaitiaili T. A prospective study of coracoclavicular ligament reconstruction with autogenous peroneus longus tendon for acromioclavicular joint dislocations. J Shoulder Elbow Surg 2018; 27:e178-e188. [PMID: 29397294 DOI: 10.1016/j.jse.2017.12.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 11/28/2017] [Accepted: 12/03/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Anatomic coracoclavicular (CC) ligament reconstruction (ACCR) provides good outcomes for Rockwood type III and VI acromioclavicular (AC) joint dislocations. Various grafts have been used, but complications from graft harvesting are not uncommon. This study examined the clinical and radiographic outcomes of patients with AC joint dislocations repaired with the autogenous anterior half of the peroneus longus tendon (AHPLT) to achieve ACCR. METHODS Patients with a Rockwood type III to V AC joint dislocation and magnetic resonance imaging of the disruption of the CC ligaments, as well as the AC capsule, were prospectively recruited. Patients received ACCR using an autogenous AHPLT graft and were evaluated clinically and radiographically preoperatively and at 1, 3, 6, and 12 months postoperatively. RESULTS A total of 18 patients (mean age, 51 years) were prospectively recruited and received an autogenous AHPLT graft ACCR. Fifteen patients completed clinical and radiographic follow-up examinations at 12 months. The mean Constant score (CS) was 51 preoperatively and 93 at 12 months (P <.005). No significant difference was noted at 12 months between the CS of the injured and contralateral shoulder. The mean American Orthopedic Foot and Ankle Society score at 12 months was 99, and this was not different from the value at any other time point. Loss of reduction occurred in 10 patients (56%), and tunnel widening was observed in 9 (50%), but neither was significantly correlated with functional outcome. CONCLUSION Autogenous AHPLT appears to be a reliable tendon graft source for CC ligament reconstruction.
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Affiliation(s)
- Yu Zhu
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Peilin Hsueh
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Bingfang Zeng
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yimin Chai
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Changqing Zhang
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yunfeng Chen
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
| | - Yuchen Wang
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Tuerxun Maimaitiaili
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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23
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Domos P, Sim F, Dunne M, White A. Current practice in the management of Rockwood type III acromioclavicular joint dislocations-National survey. J Orthop Surg (Hong Kong) 2018; 25:2309499017717868. [PMID: 28681672 DOI: 10.1177/2309499017717868] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Our aim was to conduct this survey among consultant shoulder surgeons in the United Kingdom to document the current management of Rockwood type III acromioclavicular joint (ACJ) injuries. METHODS British Elbow and Shoulder Society Research Committee-approved online survey was used and 137 responses were collected within 3 months. RESULTS One hundred percent of responders would treat type III injuries conservatively initially. Routine physiotherapy would be offered by 86% of surgeons. The patient's factors that influence the decision to consider surgery are pre-injury functional demand, current functional deficit, pain and patient request for surgery. Across all groups the mean time to surgical intervention from injury was 3.8 months. About 45% of all consultants would use the same technique for all cases and there were differences between the varieties of techniques used by surgeons, depending on their degree of experience. LockDown was the most widely used technique in all groups of patients. This was followed by Ligament Augmentation & Reconstruction System (LARS), hook plate and Arthroscopic TightRope/DogBone technique for acute injuries. LARS, modified Weaver-Dunn and ACJ resection were used most commonly after LockDown for delayed cases. CONCLUSION Our survey revealed the current trends in clinical practice to treat symptomatic Rockwood type III ACJ injuries, but it also confirmed the controversial and complex management differences, which vary among shoulder surgeons in the United Kingdom.
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Affiliation(s)
- Peter Domos
- 1 Department of Trauma and Orthopaedics, Peterborough City Hospital, Peterborough, UK
| | - Frank Sim
- 1 Department of Trauma and Orthopaedics, Peterborough City Hospital, Peterborough, UK
| | - Mike Dunne
- 1 Department of Trauma and Orthopaedics, Peterborough City Hospital, Peterborough, UK
| | - Andrew White
- 1 Department of Trauma and Orthopaedics, Peterborough City Hospital, Peterborough, UK
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Triantafyllopoulos IK, Lampropoulou-Adamidou K, Schizas NP, Karadimas EV. Surgical treatment of acute type V acromioclavicular joint dislocations in professional athletes: an anatomic ligament reconstruction with synthetic implant augmentation. J Shoulder Elbow Surg 2017; 26:e369-e375. [PMID: 28739299 DOI: 10.1016/j.jse.2017.05.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 05/17/2017] [Accepted: 05/27/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Most acromioclavicular (AC) joint injuries occur in men in their third decade of life during high-speed or high-impact body contact sports. The management of acute complete AC joint dislocation is surgical. Current surgical techniques include anatomic reconstruction of the main restraints of the AC joint and aim to improve functional outcomes and to reduce the complication rate. METHODS We present 10 cases of acute type V AC joint dislocation in professional athletes treated surgically with anatomic reconstruction of the coracoclavicular and AC ligaments and augmentation with the use of a synthetic polyester tape. The minimum follow-up of the patients was 2 years (mean, 48 months; range, 24-86 months). The postoperative functional outcome was assessed at 1 year and 2 years using the Constant-Murley, American Shoulder and Elbow Surgeons, and modified University of California-Los Angeles scoring systems. RESULTS In all cases, the postoperative scores were significantly improved (P < .005 in all comparisons with the preoperative scores), and all patients returned to their preinjury high level of activity 6 months postoperatively. Radiographs at 1 month and 6 months revealed the maintenance of reduction. There were no complications. CONCLUSION According to the results of our series of patients, demanding cases of acute AC joint dislocation Rockwood type V, in professional athletes, require anatomic fixation of both coracoclavicular and AC ligaments for return to sports as soon as possible and at the preinjury level of performance.
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Affiliation(s)
- Ioannis K Triantafyllopoulos
- Laboratory for Research of the Musculoskeletal System "Th. Garofalidis," Medical School, National and Kapodistrian University of Athens, General Hospital of Athens KAT, Athens, Greece.
| | - Kalliopi Lampropoulou-Adamidou
- Laboratory for Research of the Musculoskeletal System "Th. Garofalidis," Medical School, National and Kapodistrian University of Athens, General Hospital of Athens KAT, Athens, Greece
| | - Nikitas P Schizas
- 4th Orthopaedic Department, General Hospital of Athens KAT, Athens, Greece
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Tiefenboeck TM, Popp D, Boesmueller S, Payr S, Joestl J, Komjati M, Binder H, Schurz M, Ostermann RC. Acromioclavicular joint dislocation treated with Bosworth screw and additional K-wiring: results after 7.8 years - still an adequate procedure? BMC Musculoskelet Disord 2017; 18:339. [PMID: 28778193 PMCID: PMC5545010 DOI: 10.1186/s12891-017-1692-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 07/24/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The acromioclavicular (AC) joint dislocation is a major reason for shoulder instability. Different concepts of treatment and surgical methods are described in the literature. Thus, the purpose of this study was to present our data of long-term follow-up of patients having undergone treatment of acromioclavicular (AC) joint dislocation using the Bosworth Screw with additional K-wiring. METHODS This study was conducted as a retrospective single centre data analysis. All patients treated operatively for AC joint dislocation with a Bosworth screw and additional K-wire fixation at our Department were asked to participate in this study. RESULTS The study population consisted of 22 patients, 20 male and 2 female, with a mean age of 40 years ±15.6 years. Three grade-II lesions, 13 grade-III lesions, four grade-IV lesions and two grade-V lesions according to the Rockwood classification were found. The overall mean clinical outcome at the latest follow up was: Constant 95, DASH 6.4, ASES 94.6, SST 99.02, UCLA 33.1, ACJI 91.82 and VAS 0.29 - representing a good-to-excellent long-term outcome in all patients after at least 2 years follow-up (range; 2 - 19 years). Overall, 19 patients (86%) reported to be very satisfied with the achieved result, 15 patients (68%) reported to be able to participate in every sports activity and 16 patients (73%) reported to be able to perform their daily work without limitations. Overall, complications occurred in three patients (14%). Only one patient remained unsatisfied with the achieved result. CONCLUSION Summarizing, our reported results showed that surgical fixation of acute AC joint dislocation with a Bosworth screw and additional K-wire fixation leads to good-to-excellent functional outcome and highly satisfactory results in the majority of patients. Despite its complications, in accordance with our results, Bosworth screw fixation with additional K-wiring in AC joint dislocation represents an adequate surgical procedure. LEVEL OF EVIDENCE Level IV, retrospective study.
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Affiliation(s)
- Thomas M Tiefenboeck
- Department of Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria.
| | - Domenik Popp
- Department of Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | | | - Stephan Payr
- Department of Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Julian Joestl
- Department of Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Micha Komjati
- Department of Orthopaedics, Hospital of sacred Heart of Jesus, Vienna, Austria
| | - Harald Binder
- Department of Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Mark Schurz
- Department of Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Roman C Ostermann
- Department of Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
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Wang D, Bluth BE, Ishmael CR, Cohen JR, Wang JC, Petrigliano FA. Early complications of acromioclavicular joint reconstruction requiring reoperation. Knee Surg Sports Traumatol Arthrosc 2017; 25:2020-2024. [PMID: 27311450 DOI: 10.1007/s00167-016-4206-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 06/08/2016] [Indexed: 01/20/2023]
Abstract
PURPOSE Prior studies have reported high complication rates with acromioclavicular joint reconstruction (ACJR). However, many of these reports have suffered from small sample sizes and inclusion of older surgical techniques. The purpose of this study was to determine the rates of early complications requiring reoperation in patients treated with ACJR. METHODS From 2007 to 2011, patients who were treated with ACJR were identified using the PearlDiver database, a large insurance database in the USA. The following reoperations were then queried from this patient cohort: irrigation and debridement within 30 days of index surgery, manipulation under anaesthesia (MUA) of the shoulder joint within 3 months of index surgery, and revision ACJR, distal clavicle excision, and removal of hardware within 6 months of index surgery. RESULTS In total, 2106 patients treated with ACJR were identified. The reoperation rates for irrigation and debridement, MUA, revision ACJR, distal clavicle excision, and removal of hardware were 2.6, 1.3, 4.2, 2.8, and 6.2 %, respectively. Patients ≥35 years of age and females more likely to undergo a reoperation after ACJR. Specifically, patients ≥35 years of age were more likely to undergo MUA and revision ACJR, while patients ≥50 years of age were more likely to undergo an irrigation and debridement. Females were more likely than males to undergo revision ACJR and distal clavicle excision. CONCLUSIONS Older patients and females were more likely to experience postoperative complications requiring reoperations, including revision ACJR, distal clavicle excision, and irrigation and debridement. By analysing a large cohort of patients across multiple centres and providers, this study provides valuable insight into the recent complication profiles of ACJR, allowing surgeons to appropriately counsel patients on the risks of these procedures. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Dean Wang
- Department of Orthopaedic Surgery, David Geffen School of Medicine, University of California, Los Angeles (UCLA), 10833 Le Conte Ave, 76-143 CHS, Box 956902, Los Angeles, CA, 90095-6902, USA.
| | - Benjamin E Bluth
- Department of Orthopaedic Surgery, David Geffen School of Medicine, University of California, Los Angeles (UCLA), 10833 Le Conte Ave, 76-143 CHS, Box 956902, Los Angeles, CA, 90095-6902, USA
| | - Chad R Ishmael
- Department of Orthopaedic Surgery, David Geffen School of Medicine, University of California, Los Angeles (UCLA), 10833 Le Conte Ave, 76-143 CHS, Box 956902, Los Angeles, CA, 90095-6902, USA
| | - Jeremiah R Cohen
- Department of Orthopaedic Surgery, David Geffen School of Medicine, University of California, Los Angeles (UCLA), 10833 Le Conte Ave, 76-143 CHS, Box 956902, Los Angeles, CA, 90095-6902, USA
| | - Jeffrey C Wang
- Orthopaedic Spine Service, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Frank A Petrigliano
- Department of Orthopaedic Surgery, David Geffen School of Medicine, University of California, Los Angeles (UCLA), 10833 Le Conte Ave, 76-143 CHS, Box 956902, Los Angeles, CA, 90095-6902, USA
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Abstract
Abstract
The acromioclavicular joint represents the link between the clavicle and the scapula, which is responsible for the synchronized dynamic of the shoulder girdle. Chronic acromioclavicular joint instability involves changes in the orientation of the scapula, which provokes cinematic alterations that might result in chronic pain. Several surgical strategies for the management of patients with chronic and symptomatic acromioclavicular joint instability have been described. The range of possibilities includes anatomical and non-anatomical techniques, open and arthroscopy-assisted procedures, and biological and synthetic grafts. Surgical management of chronic acromioclavicular joint instability should involve the reconstruction of the torn ligaments because it is accepted that from three weeks after the injury, these structures may lack healing potential. Here, we provide a review of the literature regarding the management of chronic acromioclavicular joint instability. Level of evidence Expert opinion, Level V.
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Tawari GJK, Lawrence T, Stanley D. Surgical Reconstructions for Posterolateral Rotatory Instability of Elbow using a Synthetic Ligament. Shoulder Elbow 2017. [DOI: 10.1111/sae.12029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background Chronic posterolateral rotatory instability occurs as a result of disruption of the lateral ulnar collateral ligament of the elbow. It is usually treated by ligament reconstruction using an autogenous graft. We present our experience of reconstruction with the use of a synthetic polyester (LARS®; Ligament Advanced Reinforcement System; Surgical Implants and Devices, Arc-sur-Tille, France) ligament and discuss the advantages of this technique. Methods Ten consecutive cases of lateral ligament reconstruction using a LARS® ligament were reviewed. The mean age at the time of surgery was 30.2 years. The mean duration of instability symptoms preoperatively was 32.4 months. Three patients had generalized hyperlaxity. Three patients had previously undergone an unsuccessful autogenous graft reconstruction. Results The mean postoperative follow-up was 27 months. At review, seven of the 10 patients had stable elbows with no feelings of recurrent instability. This included two of the patients with generalized hyperlaxity. The mean postoperative arc of flexion/extension was 13° to 137°. The mean Mayo Elbow Performance Score was 87.5. Conclusions The use of a synthetic ligament for reconstruction of posterolateral rotatory instability of the elbow provides satisfactory stability. It avoids the associated morbidity of using an autograft, appears to be well tolerated and is particularly valuable in the treatment of complex generalized hyperlaxity problems.
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Affiliation(s)
| | - Tom Lawrence
- Department of Orthopaedics, Northern General Hospital, Sheffield, UK
| | - David Stanley
- Department of Orthopaedics, Northern General Hospital, Sheffield, UK
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Roberson TA, Tokish JM. Acromioclavicular Joint Injuries in the ?>Contact Athlete. OPER TECHN SPORT MED 2016. [DOI: 10.1053/j.otsm.2016.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Acromioclavicular joint reconstruction with the LARS ligament in professional versus non-professional athletes. Knee Surg Sports Traumatol Arthrosc 2016; 24:1961-7. [PMID: 25149645 DOI: 10.1007/s00167-014-3231-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 08/11/2014] [Indexed: 01/26/2023]
Abstract
PURPOSE To compare outcomes of acromioclavicular (AC) joint reconstruction with ligament augmentation and reconstruction system (LARS) ligament in professional and non-professional athletes at 2-year minimum follow-up. METHODS Forty-three patients (men; mean age 30, range 19-54 years) with Rockwood type III to V chronic AC joint dislocations underwent AC joint reconstruction with LARS ligament and standardized rehabilitation. Patients were divided into two groups: professionals (22) and non-professionals (21). Clinical and radiological evaluations were performed preoperatively, at 3- and 24-month follow-up. RESULTS All clinical (Oxford and Constant) scores and patient satisfaction improved significantly from preoperative to follow-up intervals (p < 0.00001). However, professionals showed nonsignificant improvements from 3- to 24-month follow-up in Constant. Although groups differed preoperatively in Constant (p = 0.037), they were not different in preoperative-to-postoperative differences in clinical scores, postoperative final satisfaction and median time to return to unrestricted activity [4 (interquartiler range 3-5) months to return to full sport in professionals]. Follow-up radiographs revealed an AC joint ratio (clavicle inferior-to-superior translation as ratio of AC joint height) of 0.09 and 0.16 in 8/22 professionals, 0.19 and 0.31 in 9/21 non-professionals, 0.14 and 0.24 in 17/43 overall patients at 3- and 24-month follow-up, respectively. Slight loss of reduction (0.25 < AC joint ratio < 0.50): 21 %. There were no significant clinical-radiographic correlations. Complication: one coracoid fracture at follow-up and one wound infection. CONCLUSIONS AC joint reconstruction with LARS ligament did not reveal differences in clinical outcomes between groups, with 2 % of failures (re-dislocations) at 2-year minimum follow-up. Superior radiological outcomes in professionals were not correlated to clinical results. LEVEL OF EVIDENCE Therapeutic study-prospective comparative study, Level II.
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Song T, Yan X, Ye T. Comparison of the outcome of early and delayed surgical treatment of complete acromioclavicular joint dislocation. Knee Surg Sports Traumatol Arthrosc 2016; 24:1943-50. [PMID: 25119054 DOI: 10.1007/s00167-014-3225-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 07/31/2014] [Indexed: 12/23/2022]
Abstract
PURPOSE The aim of this study is to compare the clinical and radiographic results and the complication rate between early and delayed surgical treatment of acromioclavicular joint (ACJ) dislocation. METHODS Publications in the management of ACJ dislocation are identified from the PubMed database between January 1993 and December 2013 using "acromioclavicular joint" and "dislocation" as keywords. The eligibility criteria included are as follows: (1) ACJ dislocation; (2) intervention, early compared with delayed surgical treatment or the surgical treatment for acute compared with chronic ACJ dislocation; (3) human; and (4) English articles. Exclusion criteria consist of the following: (1) type I and type II ACJ dislocation, (2) no definition of the time of early and delayed surgery in studies, (3) no comparison between the clinical result of early and delayed surgery in studies, (4) laboratory studies, radiographic studies, biomechanical studies, (5) the cases including fractures or revisions in studies, and (6) systematic analyses. RESULTS Eight studies comparing early and delayed surgical treatment of ACJ dislocation are included in this systematic review. According to Constant scores and shoulder subjective value, early surgery has better functional outcomes than delayed surgery in the treatment of ACJ dislocation (P < 0.05). Partial-dislocation/re-dislocation is found at 26.0 % in early and 38.1 % in delayed surgical treatment (P < 0.05). The rate of CC ossification in early surgical treatment is found as the same as the delayed. The complication rates are found at 12.5 % in early surgical treatment and 17.7 % in the delayed, which is not significantly different. CONCLUSION Early surgical treatment may have superiority to the delayed procedure in the management of ACJ dislocation with better functional outcomes and more satisfied reduction. However, high-quality evidence studies are required to provide stronger support for this opinion in the future. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Tengfei Song
- Department of Orthopaedic Surgery, Shanghai Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Xu Yan
- Department of Orthopaedic surgery, 455 Hospital of PLA, 338 West Huaihai Road, Shanghai, 200052, China
| | - Tianwen Ye
- Department of Orthopaedic Surgery, Shanghai Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China.
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Scillia AJ, Cain EL. Acromioclavicular Joint Reconstruction. Arthrosc Tech 2015; 4:e877-83. [PMID: 27284528 PMCID: PMC4887285 DOI: 10.1016/j.eats.2015.08.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 08/25/2015] [Indexed: 02/03/2023] Open
Abstract
Our technique for acromioclavicular joint reconstruction provides a variation on coracoclavicular ligament reconstruction to also include acromioclavicular ligament reconstruction. An oblique acromial tunnel is drilled, and the medial limb of the gracilis graft, after being crossed and passed beneath the coracoid and through the clavicle, is passed through this acromial tunnel and sutured to the trapezoid graft limb after appropriate tensioning. Tenodesis screws are not placed in the bone tunnels to avoid graft fraying, and initial forces on the graft are offloaded with braided absorbable sutures passed around the clavicle.
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Affiliation(s)
- Anthony J. Scillia
- American Sports Medicine Institute, Birmingham, Alabama, U.S.A.,Department of Orthopaedics, School of Health and Medical Sciences, Seton Hall University, South Orange, New Jersey, U.S.A.,Address correspondence to Anthony J. Scillia, M.D., Department of Orthopaedics, School of Health and Medical Sciences, Seton Hall University, 400 S Orange Ave, South Orange, NJ 07079, U.S.A.
| | - E. Lyle Cain
- American Sports Medicine Institute, Birmingham, Alabama, U.S.A
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Vascellari A, Schiavetti S, Battistella G, Rebuzzi E, Coletti N. Clinical and radiological results after coracoclavicular ligament reconstruction for type III acromioclavicular joint dislocation using three different techniques. A retrospective study. JOINTS 2015; 3:54-61. [PMID: 26605251 DOI: 10.11138/jts/2015.3.2.054] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE 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). METHODS 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. RESULTS 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. CONCLUSIONS 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 OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
| | | | | | - Enrico Rebuzzi
- Orthopaedic and Traumatology Department, Oderzo Hospital, Oderzo, Italy
| | - Nicolò Coletti
- Orthopaedic and Traumatology Department, Oderzo Hospital, Oderzo, Italy
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Virk M, Apostolakos J, Cote M, Baker B, Beitzel K, Mazzocca A. Operative and Nonoperative Treatment of Acromioclavicular Dislocation. JBJS Rev 2015; 3:01874474-201510000-00005. [DOI: 10.2106/jbjs.rvw.n.00092] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Parnes N, Friedman D, Phillips C, Carey P. Outcome After Arthroscopic Reconstruction of the Coracoclavicular Ligaments Using a Double-Bundle Coracoid Cerclage Technique. Arthroscopy 2015; 31:1933-40. [PMID: 26008952 DOI: 10.1016/j.arthro.2015.03.037] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 03/06/2015] [Accepted: 03/19/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE We report the outcome of an arthroscopic technique for coracoclavicular ligament reconstruction using an anatomic coracoid cerclage. METHODS Between March 2011 and September 2012, 12 consecutive patients with symptomatic chronic (>4 weeks from injury) type V acromioclavicular separation for which nonoperative treatment failed were treated with arthroscopic double-bundle reconstruction of the coracoclavicular ligaments using tendon allograft by the first author. The clinical records, operative reports, and preoperative and follow-up radiographs were reviewed. The visual analog scale score, Subjective Shoulder Value, Simple Shoulder Test score, and Constant-Murley score were evaluated preoperatively and at each follow-up appointment. RESULTS The study included 12 shoulders in 12 young active-duty soldiers with symptomatic high-grade acromioclavicular separation who were treated with a technique for arthroscopic reconstruction of the coracoclavicular ligaments. The mean age was 25 years (range, 20 to 35 years). The injury occurred during sports activity in 11 patients. One patient was injured in a motorcycle accident. The mean time from injury to surgery was 17.8 months (range, 1.5 to 72 months). The minimum length of follow-up was 24 months (mean, 30.4 months; range, 24 to 42 months). The mean preoperative and postoperative outcome scores were significantly different (P < .0001) for all subjective outcome measures. The mean Constant-Murley score improved from 58.4 (range, 51 to 76) to 96 (range, 88 to 100). The mean visual analog scale score improved from 8.1 (range, 7 to 10) to 0.58 (range, 0 to 2). The mean Subjective Shoulder Value improved from 32.9% (range, 10% to 70%) to 95% (range, 80% to 100%). The mean Simple Shoulder Test score improved from 6 (range, 5 to 8) to 11.83 (range, 11 to 12). All patients returned to their normal preinjury level of activity by 6 months. Radiographs at last follow-up showed no loss of reduction with maintenance of the coracoclavicular interval. There was 1 complication (8.5%), a postoperative superficial wound infection, that was treated accordingly. CONCLUSIONS We present an arthroscopic technique for double-bundle tendon graft reconstruction of the coracoclavicular ligaments using the coracoid cerclage technique. This method showed good outcomes and maintenance of radiographic reduction with high patient satisfaction and a low complication rate. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Nata Parnes
- Tri County Orthopedics, Carthage, New York, U.S.A
| | | | - Cameron Phillips
- New York Presbyterian Lower Manhattan, New York, U.S.A.; Kingsbrook Jewish Medical Center, New York, U.S.A
| | - Paul Carey
- Department of Orthopaedic Surgery, Guthrie Army Health Clinic, Fort Drum, New York, U.S.A..
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Luxação acromioclavicular: tratamento e reabilitação. Perspectivas e tendências atuais do ortopedista brasileiro. Rev Bras Ortop 2015. [DOI: 10.1016/j.rbo.2014.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Arliani GG, Utino AY, Nishimura EM, Terra BB, Belangero PS, Astur DC. Acromioclavicular dislocation: treatment and rehabilitation. Current perspectives and trends among Brazilian orthopedists. Rev Bras Ortop 2015; 50:515-22. [PMID: 26535196 PMCID: PMC4610976 DOI: 10.1016/j.rboe.2015.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 09/15/2014] [Indexed: 11/28/2022] Open
Abstract
Objective To evaluate the approaches and procedures used by Brazilian orthopedic surgeons in treatment and rehabilitation of acromioclavicular dislocation of the shoulder. Methods A questionnaire comprising eight closed questions that addressed topics relating to treatment and rehabilitation of acromioclavicular dislocation was applied to Brazilian orthopedic surgeons over the three days of the 45th Brazilian Congress of Orthopedics and Traumatology, in 2013. Results A total of 122 surgeons completely filled out the questionnaire and formed part of the sample analyzed. Most of them came from the southeastern region of the country. In this sample, 67% of the participants would choose surgical treatment for patients with grade 3 acromioclavicular dislocation. Regarding the preferred technique for surgical treatment of acute acromioclavicular dislocation, a majority of the surgeons used subcoracoid ligature with acromioclavicular fixation and transfer of the coracoacromial ligament (25.4%). Regarding complications found after surgery had been performed, 43.4% and 32.8% of the participants, respectively, stated that residual deformity of the operated joint and pain were the complications most seen during the postoperative period. Conclusions Although there was no consensus regarding the treatment and rehabilitation of acromioclavicular dislocation, evolution had occurred in some of the topics analyzed in this questionnaire applied to Brazilian orthopedists. However, further controlled prospective studies are needed in order to evaluate the clinical and scientific benefit of these trends.
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Affiliation(s)
- Gustavo Gonçalves Arliani
- Centro de Traumatologia do Esporte (Cete), Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil
| | - Artur Yudi Utino
- Centro de Traumatologia do Esporte (Cete), Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil
| | - Eduardo Misao Nishimura
- Centro de Traumatologia do Esporte (Cete), Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil
| | - Bernardo Barcellos Terra
- Centro de Traumatologia do Esporte (Cete), Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil
| | - Paulo Santoro Belangero
- Centro de Traumatologia do Esporte (Cete), Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil
| | - Diego Costa Astur
- Centro de Traumatologia do Esporte (Cete), Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil
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Vitali M, Pedretti A, Naim Rodriguez N, Franceschi A, Fraschini G. Vascular graft employment in the surgical treatment of acute and chronic acromio-clavicular dislocation. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2015. [PMID: 26198779 DOI: 10.1007/s00590-015-1672-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To show the efficiency and safety of a surgical treatment in both acute and chronic acromio-clavicular junction (ACJ) dislocations. DESIGN Retrospective. SETTING Department of Orthopedics and Traumatology at IRCCS San Raffaele Hospital. PATIENTS/PARTICIPANTS This study was performed on 37 subjects classified as Rockwood grade III-V or Tossy III ACJ dislocation. PROCEDURE The surgical treatment was carried out by placing a vascular graft (GorePropaten(®)) between the tip of the coracoid process and the mid-lateral side of the clavicle with two temporary percutaneous K-wires positioned in a parallel manner in the AC ligament through the acromion and clavicle for 30 days to improve stability. MAIN OUTCOME MEASUREMENTS Outcomes were assessed using the Constant Shoulder (CS) score, DASH score, subjective satisfaction, and stability of AC joint at 24 months. UCLA scores taken preoperatively and at 15-month follow-up were used to perform statistical analysis significance using a control group treated conservatively. Postoperative X-rays were examined to assess joint stability after 24 months. RESULTS Preoperative CS score was 51 ± 12 in the acute group and 55 ± 15 in the chronic group. Follow-up mean CS score was 88 ± 11 in the acute group and 82 ± 20 in the chronic group at 24 months. Preoperative DASH score was 19 ± 3 in the acute group and 14 ± 5 in the chronic group. Mean DASH score was 3.60 ± 7 in the acute group and 6.42 ± 6 in the chronic group. Preoperative UCLA scores were 14.6 ± 2 and 15 ± 7 in the acute group and chronic group, respectively. At 15-month follow-up, UCLA scores of 28.1 ± 1.9 and 27.7 ± 1 in the acute and chronic group, respectively, showed a significant improvement (p < 0.05) compared with UCLA scores taken preoperatively and at 15 months in the control group treated conservatively of 15.8 ± 0.9 and 16.2 ± 0.9, respectively. Results were good to excellent in 10 patients from the acute group and 23 patients from the chronic group who presented clinical stability of the AC joint without pain. Postoperative radiography showed anatomical repositioning of the ACJ and joint stability in 35 cases, but only two patients showed a partial re-dislocation at the 24-month X-ray follow-up. No infections, either deep or superficial, or nerve palsies were reported. CONCLUSIONS Given the results obtained during the study and the response of the patients in both acute and chronic groups, the authors found that the employment of a vascular graft combined with temporary percutaneous K-wires is able to improve the patient's clinical outcome following an acromio-clavicular joint dislocation.
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Affiliation(s)
- Matteo Vitali
- Department of Orthopedics and Traumatology, San Raffaele Hospital, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
| | - Alberto Pedretti
- Department of Orthopedics and Traumatology, San Raffaele Hospital, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
| | - Nadim Naim Rodriguez
- Department of Orthopedics and Traumatology, San Raffaele Hospital, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy.
| | - Alessandro Franceschi
- Department of Orthopedics and Traumatology, San Raffaele Hospital, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
| | - Gianfranco Fraschini
- Department of Orthopedics and Traumatology, San Raffaele Hospital, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
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Liu X, Huangfu X, Zhao J. Arthroscopic treatment of acute acromioclavicular joint dislocation by coracoclavicular ligament augmentation. Knee Surg Sports Traumatol Arthrosc 2015; 23:1460-1466. [PMID: 24318508 DOI: 10.1007/s00167-013-2800-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 11/25/2013] [Indexed: 10/25/2022]
Abstract
PURPOSE Coracoclavicular (CC) ligament augmentation has been a method to treat acromioclavicular (AC) joint dislocation in recent years. The purpose of this paper is to describe our arthroscopic CC ligament augmentation technique in treating type III and V acute AC joint dislocations and to report the early clinical and radiological results. METHODS From 2010 to 2011, twelve patients suffering from acute type III or V AC joint dislocations were arthroscopically treated in our department, by CC ligament augmentation after AC joint reduction. The post-operative outcomes were assessed through physical examination, radiographic examination and the Constant-Murley Shoulder Score. RESULTS All patients post-operatively experienced anatomical reduction in their AC joint dislocation. No intraoperative complications occurred. At a mean follow-up at 24 months (ranging from 18 to 32 months), the mean Constant-Murley Shoulder Score significantly improved from 24.3 pre-operatively to 91.1 post-operatively. No neurovascular complications or secondary degenerative changes of the AC joint were detected in any of the patients. In one case, a second dislocation occurred 1 month post-operation because the patient had had another traumatic injury. This patient accepted a revision operation, but his AC joint eventually fixated into a subluxated position after his second injury. CONCLUSION Based on the resultant successful repair in all cases, the arthroscopic CC ligament augmentation method has thus far proven to be a safe and reliable technique for treatment of acute type III or V AC joint dislocation. CLINICAL RELEVANCE The arthroscopic CC ligament augmentation with a flip button/polyethylene belt repair is an efficient method to treat acute type III and V AC joint dislocations which should be popularized. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Xudong Liu
- Sports Medicine Service, Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Xuhui District, Shanghai, 200233, People's Republic of China
| | - Xiaoqiao Huangfu
- Sports Medicine Service, Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Xuhui District, Shanghai, 200233, People's Republic of China.
| | - Jinzhong Zhao
- Sports Medicine Service, Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Xuhui District, Shanghai, 200233, People's Republic of China
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Chen T, Jiang J, Chen S. Status and headway of the clinical application of artificial ligaments. ASIA-PACIFIC JOURNAL OF SPORT MEDICINE ARTHROSCOPY REHABILITATION AND TECHNOLOGY 2015; 2:15-26. [PMID: 29264235 PMCID: PMC5730644 DOI: 10.1016/j.asmart.2014.11.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 10/02/2014] [Accepted: 11/24/2014] [Indexed: 12/20/2022]
Abstract
The authors first reviewed the history of clinical application of artificial ligaments. Then, the status of clinical application of artificial ligaments was detailed. Some artificial ligaments possessed comparable efficacy to, and fewer postoperative complications than, allografts and autografts in ligament reconstruction, especially for the anterior cruciate ligament. At the end, the authors focused on the development of two types of artificial ligaments: polyethylene glycol terephthalate artificial ligaments and tissue-engineered ligaments. In conclusion, owing to the advancements in surgical techniques, materials processing, and weaving methods, clinical application of some artificial ligaments so far has demonstrated good outcomes and will become a trend in the future.
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Affiliation(s)
- Tianwu Chen
- Fudan University Sports Medicine Centre, Shanghai, China.,Department of Sports Medicine and Arthroscopy Surgery, Huashan Hospital, Shanghai, China
| | - Jia Jiang
- Fudan University Sports Medicine Centre, Shanghai, China.,Department of Sports Medicine and Arthroscopy Surgery, Huashan Hospital, Shanghai, China
| | - Shiyi Chen
- Fudan University Sports Medicine Centre, Shanghai, China.,Department of Sports Medicine and Arthroscopy Surgery, Huashan Hospital, Shanghai, China
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Joukainen A, Kröger H, Niemitukia L, Mäkelä EA, Väätäinen U. Results of Operative and Nonoperative Treatment of Rockwood Types III and V Acromioclavicular Joint Dislocation: A Prospective, Randomized Trial With an 18- to 20-Year Follow-up. Orthop J Sports Med 2014; 2:2325967114560130. [PMID: 26535287 PMCID: PMC4555529 DOI: 10.1177/2325967114560130] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: The optimal treatment of acute, complete dislocation of the acromioclavicular joint (ACJ) is still unresolved. Purpose: To determine the difference between operative and nonoperative treatment in acute Rockwood types III and V ACJ dislocation. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: In the operative treatment group, the ACJ was reduced and fixed with 2 transarticular Kirschner wires and ACJ ligament suturing. The Kirschner wires were extracted after 6 weeks. Nonoperatively treated patients received a reduction splint for 4 weeks. At the 18- to 20-year follow-up, the Constant, University of California at Los Angeles Shoulder Rating Scale (UCLA), Larsen, and Simple Shoulder Test (SST) scores were obtained, and clinical and radiographic examinations of both shoulders were performed. Results: Twenty-five of 35 potential patients were examined at the 18- to 20-year follow-up. There were 11 patients with Rockwood type III and 14 with type V dislocations. Delayed surgical treatment for ACJ was used in 2 patients during follow-up: 1 in the operatively treated group and 1 in the nonoperatively treated group. Clinically, ACJs were statistically significantly less prominent or unstable in the operative group than in the nonoperative group (normal/prominent/unstable: 9/4/3 and 0/6/3, respectively; P = .02) and in the operative type III (P = .03) but not type V dislocation groups. In operatively and nonoperatively treated patients, the mean Constant scores were 83 and 85, UCLA scores 25 and 27, Larsen scores 11 and 11, and SST scores 11 and 12 at follow-up, respectively. There were no statistically significant differences in type III and type V dislocations. In the radiographic analysis, the ACJ was wider in the nonoperative than the operative group (8.3 vs 3.4 mm; P = .004), and in the type V dislocations (nonoperative vs operative: 8.5 vs 2.4 mm; P = .007). There was no statistically significant difference between study groups in the elevation of the lateral end of the clavicle. Both groups showed equal levels of radiologic signs of ACJ osteoarthritis and calcification of the coracoclavicular ligaments. Conclusion: Nonoperative treatment was shown to produce more prominent or unstable and radiographically wider ACJs than was operative treatment, but clinical results were equally good in the study groups at 18- to 20-year follow-up. Both treatment methods showed statistically significant radiographic elevations of the lateral clavicle when compared with a noninjured ACJ.
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Affiliation(s)
- Antti Joukainen
- Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Heikki Kröger
- Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland. ; BCRU, Institute of Clinical Medicine, University of Eastern Finland, Finland
| | - Lea Niemitukia
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| | | | - Urho Väätäinen
- Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland. ; Ite-Lasaretti Private Hospital, Kuopio, Finland
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Lu N, Zhu L, Ye T, Chen A, Jiang X, Zhang Z, Zhu Q, Guo Q, Yang D. Evaluation of the coracoclavicular reconstruction using LARS artificial ligament in acute acromioclavicular joint dislocation. Knee Surg Sports Traumatol Arthrosc 2014; 22:2223-7. [PMID: 23812536 DOI: 10.1007/s00167-013-2582-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Accepted: 06/10/2013] [Indexed: 02/01/2023]
Abstract
PURPOSE The most appropriate procedure for surgical treatment of severe acromioclavicular (AC) joint dislocation was still not clear. The purpose of this study is to evaluate the outcomes of coracoclavicular (CC) reconstruction with ligament augmentation and reconstruction system (LARS) artificial ligaments for the treatment of acute complete AC joint dislocation. METHODS Twenty-four patients (16 male and 8 female, ages ranged from 21 to 45) with acute complete AC joint dislocations were treated with CC reconstruction using LARS artificial ligaments. All these dislocations were unstable injuries. Clinical evaluation was used by the Constant scores and VAS. The radiographic evaluation consisted of Zanca radiographs for bilateral AC joint and axillary radiographs for the injured shoulder. RESULTS All patients had follow-up times of 36 months (range 6-60). The Constant scores rose from 62.3 ± 6.9 preoperatively to 94.5 ± 9.3 at final evaluation (P < 0.05). Preoperative VAS scores were 5.1 ± 1.7, and the VAS scores at the last review were 0.7 ± 1.4 (P < 0.05). Follow-up radiographs showed anatomical reduction in 20 patients and slight loss of reduction in 4 patients. Calcification of CC ligament in 4 patients, degenerative change around the AC joint in 2 patient and clavicular osteolysis around screws in one patient were found. CONCLUSIONS LARS artificial ligament for reconstruction of CC can provide immediate stability and allow early shoulder mobilization with good functional results and few complications. This procedure was an effective and safe method to treat grade III and more AC joint dislocations. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Nan Lu
- Department of Orthopaedic Surgery, Shanghai Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China
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Virtanen KJ, Savolainen V, Tulikoura I, Remes V, Haapamäki V, Pajarinen J, Björkenheim JM, Paavola M. Surgical treatment of chronic acromioclavicular joint dislocation with autogenous tendon grafts. SPRINGERPLUS 2014; 3:420. [PMID: 25152850 PMCID: PMC4141074 DOI: 10.1186/2193-1801-3-420] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 07/18/2014] [Indexed: 01/26/2023]
Abstract
Background Conservative treatment of acromioclavicular (AC) joint dislocation is not always successful. A consequence of persistent AC joint dislocation may be chronic pain and discomfort in the shoulder region as well a sensation of constant AC joint instability and impaired shoulder function. Stabilization of the AC joint may reduce these sequels. Materials and methods Due to chronic AC joint dislocation, 39 patients in our hospital underwent coracoclavicular (CC) ligament reconstruction with autogenous semitendinosus and gracilis tendons between May 2005 and April 2011. We examined 25 patients after a mean of 4.2 years. The outcomes were Constant shoulder Score (CS), Disabilities of the Arm, Shoulder and Hand (DASH), pain (Visual Analog Scale, VAS), cross-arm test, stability of the AC joint, and complications. The follow-up visits included anteroposterior and axillary radiographs. Results Mean CS was 83 in the injured shoulder and 91 in the uninjured shoulder (p = 0.002). Mean DASH was 14. In 14 patients, the AC joint was clinically stable; pain was minor. In radiographs, osteolysis of the lateral clavicle and tunnel widening were markedly common. Fracture of the coracoid process occurred in 5 patients, and 3 suffered a fracture of the clavicle; 2 had a postoperative infection. Conclusions Anatomic reconstruction of CC ligaments showed a moderate subjective outcome at the 4-year follow-up. After surgery, almost half the AC joints failed to stabilize. Lateral clavicle osteolysis and tunnel widening were notably common complications.
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Affiliation(s)
- Kaisa J Virtanen
- Department of Surgery, Helsinki University Central Hospital and University of Helsinki, Topeliuksenkatu 5, Helsinki, 00260 Finland
| | - Vesa Savolainen
- Department of Surgery, Helsinki University Central Hospital and University of Helsinki, Topeliuksenkatu 5, Helsinki, 00260 Finland
| | - Ilkka Tulikoura
- Department of Surgery, Helsinki University Central Hospital and University of Helsinki, Topeliuksenkatu 5, Helsinki, 00260 Finland
| | - Ville Remes
- Department of Surgery, Helsinki University Central Hospital and University of Helsinki, Topeliuksenkatu 5, Helsinki, 00260 Finland
| | - Ville Haapamäki
- Department of Radiology, Helsinki Medical Imaging Centre, Helsinki University Central Hospital, Topeliuksenkatu 5, Helsinki, 00260 Finland
| | - Jarkko Pajarinen
- Department of Surgery, Helsinki University Central Hospital and University of Helsinki, Topeliuksenkatu 5, Helsinki, 00260 Finland
| | - Jan-Magnus Björkenheim
- Department of Surgery, Helsinki University Central Hospital and University of Helsinki, Topeliuksenkatu 5, Helsinki, 00260 Finland
| | - Mika Paavola
- Department of Surgery, Helsinki University Central Hospital and University of Helsinki, Topeliuksenkatu 5, Helsinki, 00260 Finland ; Centre for Health and Social Economics, Institute for Health and Welfare, PL 30, Helsinki, 00271 Finland
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Modi CS, Beazley J, Zywiel MG, Lawrence TM, Veillette CJH. Controversies relating to the management of acromioclavicular joint dislocations. Bone Joint J 2014; 95-B:1595-602. [PMID: 24293587 DOI: 10.1302/0301-620x.95b12.31802] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The aim of this review is to address controversies in the management of dislocations of the acromioclavicular joint. Current evidence suggests that operative rather than non-operative treatment of Rockwood grade III dislocations results in better cosmetic and radiological results, similar functional outcomes and longer time off work. Early surgery results in better functional and radiological outcomes with a reduced risk of infection and loss of reduction compared with delayed surgery. Surgical options include acromioclavicular fixation, coracoclavicular fixation and coracoclavicular ligament reconstruction. Although non-controlled studies report promising results for arthroscopic coracoclavicular fixation, there are no comparative studies with open techniques to draw conclusions about the best surgical approach. Non-rigid coracoclavicular fixation with tendon graft or synthetic materials, or rigid acromioclavicular fixation with a hook plate, is preferable to fixation with coracoclavicular screws owing to significant risks of loosening and breakage. The evidence, although limited, also suggests that anatomical ligament reconstruction with autograft or certain synthetic grafts may have better outcomes than non-anatomical transfer of the coracoacromial ligament. It has been suggested that this is due to better restoration horizontal and vertical stability of the joint. Despite the large number of recently published studies, there remains a lack of high-quality evidence, making it difficult to draw firm conclusions regarding these controversial issues.
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Affiliation(s)
- C S Modi
- Toronto Western Hospital/University Health Network, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada
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Li X, Ma R, Bedi A, Dines DM, Altchek DW, Dines JS. Management of acromioclavicular joint injuries. J Bone Joint Surg Am 2014; 96:73-84. [PMID: 24382728 DOI: 10.2106/jbjs.l.00734] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Acromioclavicular joint injuries are among the most common shoulder girdle injuries in athletes and most commonly result from a direct force to the acromion with the arm in an adducted position. Acromioclavicular joint injuries often present with associated injuries to the glenohumeral joint, including an increased incidence of superior labrum anterior posterior (SLAP) tears that may warrant further evaluation and treatment. Anteroposterior stability of the acromioclavicular joint is conferred by the capsule and acromioclavicular ligaments, of which the posterior and superior ligaments are the strongest. Superior-inferior stability is maintained by the coracoclavicular (conoid and trapezoid) ligaments. Type-I or type-II acromioclavicular joint injuries have been treated with sling immobilization, early shoulder motion, and physical therapy, with favorable outcomes. Return to activity can occur when normal shoulder motion and strength are obtained and the shoulder is asymptomatic as compared with the contralateral normal extremity. The management of type-III injuries remains controversial and is individualized. While a return to the previous level of functional activity with nonsurgical treatment has been documented in a number of case series, surgical reduction and coracoclavicular ligament reconstruction has been associated with a favorable outcome and can be considered in patients who place high functional demands on their shoulders or in athletes who participate in overhead sports. Surgical management is indicated for high-grade (≥type IV) acromioclavicular joint injuries to achieve anatomic reduction of the acromioclavicular joint, reconstruction of the coracoclavicular ligaments, and repair of the deltotrapezial fascia. Outcomes after surgical reconstruction of the coracoclavicular ligaments have been satisfactory with regard to achieving pain relief and return to functional activities, but further improvements in the biomechanical strength of these constructs are necessary to avoid loss of reduction and creep with cyclic loading.
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Affiliation(s)
- Xinning Li
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for X. Li: . E-mail address for R. Ma: . E-mail address for D.M. Dines: . E-mail address for D.W. Altchek: al
| | - Richard Ma
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for X. Li: . E-mail address for R. Ma: . E-mail address for D.M. Dines: . E-mail address for D.W. Altchek: al
| | - Asheesh Bedi
- University of Michigan, 24 Frank Lloyd Wright Drive, Ann Arbor, MI 48105. E-mail address:
| | - David M Dines
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for X. Li: . E-mail address for R. Ma: . E-mail address for D.M. Dines: . E-mail address for D.W. Altchek: al
| | - David W Altchek
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for X. Li: . E-mail address for R. Ma: . E-mail address for D.M. Dines: . E-mail address for D.W. Altchek: al
| | - Joshua S Dines
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for X. Li: . E-mail address for R. Ma: . E-mail address for D.M. Dines: . E-mail address for D.W. Altchek: al
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Flint JH, Wade AM, Giuliani J, Rue JP. Defining the terms acute and chronic in orthopaedic sports injuries: a systematic review. Am J Sports Med 2014; 42:235-41. [PMID: 23749341 DOI: 10.1177/0363546513490656] [Citation(s) in RCA: 116] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although many authors report on acute injuries and chronic injuries in the orthopaedic literature, the actual terms are seldom explicitly defined. HYPOTHESIS Much of the literature pertaining to sports injuries that are acute or chronic does not define these terms. It is believed that definitions will provide clarity and specificity in future literature. STUDY DESIGN Systematic review. METHODS A systematic review of 116 articles was conducted to determine whether and how the terms acute and chronic were defined as they pertain to several commonly treated conditions: Achilles tendon rupture, distal biceps tendon rupture, pectoralis major tendon rupture, anterior cruciate ligament (ACL) tear, anterior shoulder instability, and acromioclavicular (AC) joint dislocation. Articles were isolated from various databases and search engines by use of keywords to identify relevant literature. RESULTS This study determined that the terms acute and chronic for each injury are defined, respectively, as follows: Achilles tendon rupture: <1 week, >4 weeks; distal biceps tendon rupture: <6 weeks, >12 weeks; pectoralis major tendon rupture: <6 weeks, >6 weeks; ACL tear: <6 weeks, >6 months; anterior shoulder instability: <2 weeks, >6 months; AC joint dislocation, <3 weeks, >6 weeks. CONCLUSION The current literature varies greatly in defining the terms acute and chronic in common sports injuries. The vast majority of authors imply these terms, based on the method of their studies, rather than define them explicitly. Injuries involving tendons showed greater consistency among authors, thus making a definition based on consensus easier to derive. The literature on ACL and shoulder instability in particular showed great variability in defining these terms, likely representing the more complex nature of these injuries and the fact that timing of surgery in the majority of patients does not particularly affect the complexity of the surgical approach and treatment. CLINICAL RELEVANCE Defining injuries as acute or chronic is clinically relevant in many cases, particularly concerning tendon injuries, where these terms have implications regarding the anatomic pathologic changes and tissue quality, which may necessitate augmentation and alter the initial surgical plan. In cases where these terms are less pertinent to operative treatment considerations, they bring clarity to the discussion of the acuity of the injury (as it pertains to time from insult).
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Affiliation(s)
- James H Flint
- James H. Flint, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889-5600.
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Flinkkilä TE, Ihanainen E. Results of Arthroscopy-Assisted TightRope Repair of Acromioclavicular Dislocations. Shoulder Elbow 2014; 6:18-22. [PMID: 27582904 PMCID: PMC4986652 DOI: 10.1111/sae.12040] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 07/26/2013] [Indexed: 01/16/2023]
Abstract
BACKGROUND The present study assessed results of arthroscopy-assisted TightRope (Arthrex, Naples, FL, USA) repair of acute Rockwood grade III and V acromioclavicular (AC) dislocations. METHODS We retrospectively reviewed the medical records of 57 patients with AC dislocations treated with TightRope fixation: 15 Rockwood grade III and 42 grade V. Functional results were assessed using the Constant score, and Disabilities of Arm, Shoulder and Hand (DASH) and RAND 36-ltem Health Survey scores after a mean 2.6 years of follow-up (range 1.0 years to 4.5 years). Radiographic results were assessed using the AC joint coracoclavicular (CC) distance. RESULTS Postoperative radiographs showed anatomical AC joint reduction in all patients. In nine patients, fixation failed before 6 weeks postoperatively, mainly as a result of suture breakage. For the remaining 47 patients, CC distance was well maintained at 6 weeks. At follow-up, mean (SD) CC distance was significantly increased compared to the contralateral side or postoperative radiographs [17 (4) mm versus 10 (3) mm]. Mean DASH score was 9, Constant score was 88 and the RAND 36 score showed a quality of life similar to the Finnish reference population. CONCLUSIONS Despite initial good reduction of grade III and V AC dislocations using TightRope fixation, subluxation often recurs after 6 weeks. Patients suffer minor subjective complaints that do not worsen the quality of life.
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Affiliation(s)
- Tapio E. Flinkkilä
- Division of Orthopedic and Trauma Surgery, Department of Surgery, Oulu University Hospital, Oulu, Finland,
Correspondence: Tapio Flinkkilä, Division of Orthopedic and Trauma Surgery, Department of Surgery, Oulu University Hospital, PL 21, Oulu, FIN-90029 OYS, Finland. Tel.: +358 8 3152812. Fax: +358 8 3152351. E-mail:
| | - Essi Ihanainen
- Division of Orthopedic and Trauma Surgery, Department of Surgery, Oulu University Hospital, Oulu, Finland
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Virtanen KJ, Remes VM, Tulikoura ITA, Pajarinen JT, Savolainen VT, Björkenheim JMG, Paavola MP. Surgical treatment of Rockwood grade-V acromioclavicular joint dislocations: 50 patients followed for 15–22 years. Acta Orthop 2013; 84:191-5. [PMID: 23409813 PMCID: PMC3639341 DOI: 10.3109/17453674.2013.775046] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Long-term outcome after surgery for grade-V acromioclavicular joint dislocation has not been reported. We performed a retrospective analysis of functional and radiographic outcome 15-22 years after surgery. PATIENTS AND METHODS We examined 50 patients who were treated at our hospital between April 1985 and December 1993. Various methods of stabilization were used: K-wires (n = 36), 4.5-mm screw (n = 12), or biodegradable screw (n = 2). Osteosynthesis material was removed after 6-8 weeks. Mean follow-up time was 18 (15-22) years. Outcomes were assessed with the Constant shoulder (CS) score, Disabilities of the Arm, Shoulder, and Hand (DASH) score, the simple shoulder test (SST), the Copeland shoulder impingement test, the cross-arm test, pain, stability of the AC joint, and complications. From radiographs, we evaluated AC and glenohumeral (GH) arthrosis, osteolysis of the lateral clavicle, and alignment of the clavicle with the acromion. RESULTS Mean values were 90 (75-100) in CS score, 5.1 (0-41) in DASH score, and 11 (2-12) in SST. There was no statistically significant difference in CS score between the injured shoulder and the uninjured shoulder. The AC joint was clinically stable in 42 patients. In 38 patients, the clavicle alignment with the acromion was normal in radiographs. Lateral clavicle osteolysis (10 patients) appeared to be associated with permanent AC joint dislocation. INTERPRETATION Surgery with a temporary fixation for acute grade-V AC joint dislocation leads to successful long-term functional results. Only minor disability occurred in some patients.
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Affiliation(s)
- Kaisa J Virtanen
- Department of Orthopaedics and Traumatology, Helsinki University Central Hospital and University of Helsinki
| | - Ville M Remes
- Department of Orthopaedics and Traumatology, Helsinki University Central Hospital and University of Helsinki
| | - Ilkka T A Tulikoura
- Department of Orthopaedics and Traumatology, Helsinki University Central Hospital and University of Helsinki
| | - Jarkko T Pajarinen
- Department of Orthopaedics and Traumatology, Helsinki University Central Hospital and University of Helsinki
| | - Vesa T Savolainen
- Department of Orthopaedics and Traumatology, Helsinki University Central Hospital and University of Helsinki
| | - Jan-Magnus G Björkenheim
- Department of Orthopaedics and Traumatology, Helsinki University Central Hospital and University of Helsinki
| | - Mika P Paavola
- Department of Orthopaedics and Traumatology, Helsinki University Central Hospital and University of Helsinki,Centre for Health and Social Economics, Institute for Health and Welfare, Helsinki, Finland
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Beitzel K, Cote MP, Apostolakos J, Solovyova O, Judson CH, Ziegler CG, Edgar CM, Imhoff AB, Arciero RA, Mazzocca AD. Current concepts in the treatment of acromioclavicular joint dislocations. Arthroscopy 2013; 29:387-97. [PMID: 23369483 DOI: 10.1016/j.arthro.2012.11.023] [Citation(s) in RCA: 261] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 11/19/2012] [Accepted: 11/27/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE To conduct a systematic review of the literature in relation to 3 considerations in determining treatment options for patients with acromioclavicular (AC) joint dislocations: (1) operative versus nonoperative management, (2) early versus delayed surgical intervention, and (3) anatomic versus nonanatomic techniques. METHODS The PubMed database was searched in October 2011 using the single term acromioclavicular and the following search limits: any date, humans, English, and all adult (19+). Studies were included if they compared operative with nonoperative treatment, early with delayed surgical intervention, or anatomic with nonanatomic surgical techniques. Exclusion criteria consisted of the following: Level V evidence, laboratory studies, radiographic studies, biomechanical studies, fractures or revisions, meta-analyses, and studies reporting preliminary results. RESULTS This query resulted in 821 citations. Of these, 617 were excluded based on the title of the study. The abstracts and articles were reviewed, which resulted in the final group of 20 studies that consisted of 14 comparing operative with nonoperative treatment, 4 comparing early with delayed surgical intervention, and 2 comparing anatomic with nonanatomic surgical techniques. The lack of higher level evidence prompted review of previously excluded studies in an effort to explore patterns of publication related to operative treatment of the AC joint. This review identified 120 studies describing 162 techniques for operative reconstruction of the AC joint. CONCLUSIONS There is a lack of evidence to support treatment options for patients with AC joint dislocations. Although there is a general consensus for nonoperative treatment of Rockwood type I and II lesions, initial nonsurgical treatment of type III lesions, and operative intervention for Rockwood type IV to VI lesions, further research is needed to determine if differences exist regarding early versus delayed surgical intervention and anatomic versus nonanatomic surgical techniques in the treatment of patients with AC joint dislocations. LEVEL OF EVIDENCE Level III, systematic review of Level II and Level III studies and one case series.
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Affiliation(s)
- Knut Beitzel
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
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