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Albishi W, AlShayhan F, Alfridy A, Alaseem A, Elmaraghy A. Acromioclavicular joint separation: Controversies and treatment algorithm. Orthop Rev (Pavia) 2024; 16:94037. [PMID: 38404928 PMCID: PMC10891146 DOI: 10.52965/001c.94037] [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: 04/02/2023] [Accepted: 02/05/2024] [Indexed: 02/27/2024] Open
Abstract
In this article, we present an uptodate outline of acromioclavicular (AC) joint separation. A clear understanding of acromioclavicular joint injury in terms of the mechanism of injury, clinical picture, diagnostic imaging, and most updated surgical techniques used for the treatment can provide the best care for those patients. This article describes updated treatment strategies for AC separation, including type III AC separation which is known most controversial. Finally, we present a proposed treatment algorithm that can aid in the treatment of AC separation from the most updated evidence.
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Affiliation(s)
- Waleed Albishi
- Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Fahad AlShayhan
- Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Afnan Alfridy
- Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulrahman Alaseem
- Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Amr Elmaraghy
- Department of Orthopedic Surgery, University of Toronto; and St Joseph's Health Centre, Toronto, ON, Canada. University of Toronto
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Gawel RJ, D'Amore T, Otlans PT, Rao S, Cohen SB, Ciccotti MG. Criteria for return to play after operative management of acromioclavicular joint separation: a systematic review. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:140-148. [PMID: 37587962 PMCID: PMC10426690 DOI: 10.1016/j.xrrt.2021.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background Acromioclavicular (AC) joint separation is a common cause of shoulder injury among athletes. High-grade injuries may require operative fixation, and comprehensive return-to-play guidelines have not yet been established. The purpose of this study was to summarize criteria for return to play after operative management of AC joint separation. Methods A systematic review of the literature was performed from January 1999 to April 2020 to evaluate clinical evidence regarding criteria for return to play after operative management of isolated AC joint separation. Results Sixty-three studies with at least 1 explicitly stated return-to-play criterion were identified out of an initial database search of 1253 published articles. Eight separate categories of return-to-play criteria were identified, the most common of which was time from surgery (95.2%). Return-to-play timelines ranged from 2 to 12 months, the most common timeline being 6 months (37.8%). Only 4 (6.3%) studies used conditional criteria to guide return to play, which included range of motion, strength, clinical stability, radiographic stability, functional assessment, safety assessment, and hardware removal. Conclusion Most published studies use only time-based criteria for return to play after surgery for AC joint separation, and only a small number of studies use additional subjective or objective criteria. While this systematic review helps provide a foundation for developing a comprehensive return-to-play checklist, further investigation is needed to establish safe and effective guidelines that will enable athletes to safely return to sport and minimize the recurrence of injury.
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Affiliation(s)
- Richard J. Gawel
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Taylor D'Amore
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Peters T. Otlans
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Somnath Rao
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Steven B. Cohen
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Michael G. Ciccotti
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
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Saccomanno MF, Marchi G, Mocini F, Vismara V, Campana V, Salvi AG, Scaini A, Milano G. Anatomic reconstruction of the coracoclavicular and acromioclavicular ligaments with semitendinosus tendon graft for the treatment of chronic acromioclavicular joint dislocation provides good clinical and radiological results. Knee Surg Sports Traumatol Arthrosc 2021; 29:2356-2363. [PMID: 33108527 DOI: 10.1007/s00167-020-06285-x] [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: 03/26/2020] [Accepted: 09/14/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE To evaluate clinical and radiographic outcomes of anatomical reconstruction of the coracoclavicular and acromioclavicular ligaments with single-strand semitendinosus tendon graft for the treatment of chronic acromioclavicular joint dislocation. METHODS Patients affected by chronic type III-V acromioclavicular joint dislocations were included. Exclusion criteria were: age under 18 years, concomitant rotator cuff tears, previous surgery to the same shoulder, degenerative changes of the glenohumeral joint, infections, neurologic diseases, patients with a previous history of ligament reconstruction procedures that had required harvesting of the semitendinosus tendon from the ipsilateral or contralateral knee. All patients underwent the same surgical technique and rehabilitation. Primary outcome was the normalized Constant score. Secondary outcomes were: DASH score, radiographic evaluation of loss of reduction and acromioclavicular joint osteoarthritis. RESULTS Thirty patients with a mean age of 28.9 ± 8.3 years were included. Mean time to surgery was 12.8 ± 10 months. Mean follow-up was 28.1 ± 2.4 months (range: 24-32). Comparison between pre- and postoperative functional scores showed significant clinical improvement (p < 0.001). Time to surgery was independently associated with a poorer Constant score (p < 0.0001). On radiographs, 4 patients (13.3%) showed asymptomatic partial loss of reduction. CONCLUSION Anatomic reconstruction of coracoclavicular and acromioclavicular ligaments using a semitendinosus tendon graft for the treatment of chronic acromioclavicular joint dislocation provided good clinical and radiological results at minimum 2-year follow-up. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
| | - Giacomo Marchi
- Department of Bone and Joint Surgery, Spedali Civili, Brescia, Italy
| | - Fabrizio Mocini
- Orthopaedics Institute, Fondazione Policilinico A. Gemelli IRCCS, Rome, Italy
| | - Valeria Vismara
- Orthopaedics Institute, Fondazione Policilinico A. Gemelli IRCCS, Rome, Italy
| | - Vincenzo Campana
- Orthopaedics Institute, Fondazione Policilinico A. Gemelli IRCCS, Rome, Italy
| | | | | | - Giuseppe Milano
- University of Brescia, Brescia, Italy.,Department of Bone and Joint Surgery, Spedali Civili, Brescia, Italy
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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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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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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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Return to sport after surgical treatment for high-grade (Rockwood III-VI) acromioclavicular dislocation. Knee Surg Sports Traumatol Arthrosc 2019; 27:3803-3812. [PMID: 31089792 PMCID: PMC6874623 DOI: 10.1007/s00167-019-05528-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 04/29/2019] [Indexed: 12/23/2022]
Abstract
PURPOSE Acromioclavicular (AC) joint dislocations are common in a young and active population, especially in people performing contact sports. Full recovery with a fast and high rate of return to sport is desirable. This systematic review aims to combine patient outcomes in order to help surgeons in addressing patient expectations regarding the return to sport after surgical intervention for AC dislocations. METHODS To conduct this systematic review, the PRISMA guidelines were followed. Articles were included if written in English or Dutch and evaluated return to sport after any type of surgical intervention for Rockwood types III to VI AC dislocations in patients practicing sports. Outcome parameters were return to sport, time to return to sport, level of sport, functional outcome scores and complications. RESULTS Twelve studies involving 498 patients were included, of which 462 patients practiced sports. 432 (94%) patients returned to sport. The weighted mean time to return to sport was 4.0 months. 338 out of 401 patients (84%) returned to the same level of pre-injury sport and 35 patients (9%) lowered their level of sport. The weighted mean Constant score was 92 out of 100. CONCLUSION The rate of return to sport after surgical intervention for Rockwood (RW) III-VI AC dislocations is high. However, the level of evidence was low and due to the methodological heterogeneity between studies, subgroup analyses of return to sport outcomes were not feasible. LEVEL OF EVIDENCE Systematic review of level I-IV studies, level IV.
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Li G, Liu T, Shao X, Liu Z, Duan J, Akileh R, Cao S, Jin D. Fifteen-degree clavicular hook plate achieves better clinical outcomes in the treatment of acromioclavicular joint dislocation. J Int Med Res 2018; 46:4547-4559. [PMID: 30092651 PMCID: PMC6259358 DOI: 10.1177/0300060518786910] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 05/25/2018] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Clavicular hook plate application is one of the most commonly used treatment methods for acromioclavicular (AC) joint dislocation, although it may cause multiple postoperative complications. We modified the regularly used 0° hook plate to 15° and compared the clinical outcomes of these two hook plates for treatment of AC joint dislocation. METHODS Forty-three patients with acute AC joint dislocation were randomly enrolled (0° hook plate, 20 patients; 15° hook plate, 23 patients). The American Shoulder and Elbow Surgeons (ASES) and visual analog scale for pain (VASP) scores were evaluated preoperatively and at 3 days and 1, 2, 3, and 6 months postoperatively and compared between the two groups. RESULTS Compared with the preoperative scores, the 6-month postoperative ASES score gradually increased but the VASP score decreased in both groups. Furthermore, the ASES and VASP scores were significantly different between the two groups at every postoperative time point. CONCLUSION The 15° hook plate is superior to the 0° hook plate in reducing shoulder pain and improving postoperative recovery in the treatment of AC joint dislocation. LEVEL OF EVIDENCE Level III; Treatment study (retrospective comparative study).
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Affiliation(s)
- Guanghui Li
- Department of Orthopedic Surgery, The Third Affiliated Hospital, Southern Medical University, Guangzhou, Guangdong, China
- Department of Orthopedic Surgery, The First Traditional Chinese Medical Hospital of Hunan Changde, Changde, Hunan, China
| | - Tuoen Liu
- Department of Biomedical Sciences, West Virginia School of Osteopathic Medicine, Lewisburg, WV, United States
| | - Xianfang Shao
- Department of Orthopedic Surgery, The First Traditional Chinese Medical Hospital of Hunan Changde, Changde, Hunan, China
| | - Zhijun Liu
- Department of Orthopedic Surgery, The First Traditional Chinese Medical Hospital of Hunan Changde, Changde, Hunan, China
| | - Jianhui Duan
- Department of Orthopedic Surgery, The First Traditional Chinese Medical Hospital of Hunan Changde, Changde, Hunan, China
| | - Raji Akileh
- Department of Biomedical Sciences, West Virginia School of Osteopathic Medicine, Lewisburg, WV, United States
| | - Shousong Cao
- Department of Pharmacology, School of Pharmacy, Southwest Medical University, Luzhou, Sichuan, China
| | - Dadi Jin
- Department of Orthopedic Surgery, The Third Affiliated Hospital, Southern Medical University, Guangzhou, Guangdong, China
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Kay J, Memon M, Alolabi B. Return to Sport and Clinical Outcomes After Surgical Management of Acromioclavicular Joint Dislocation: A Systematic Review. Arthroscopy 2018; 34:2910-2924.e1. [PMID: 30173912 DOI: 10.1016/j.arthro.2018.04.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 03/18/2018] [Accepted: 04/16/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the rate at which athletes return to sport after surgical management of acute and chronic acromioclavicular (AC) joint dislocations. METHODS Three databases-PubMed, MEDLINE, and EMBASE-were searched from database inception until October 28, 2017, by 2 reviewers independently and in duplicate. The inclusion criteria were English language studies that reported return to sport outcomes in patients undergoing surgical management of AC joint dislocations. RESULTS Overall, 12 studies with a combined total of 315 patients met the inclusion criteria, with a mean age of 33.8 years (range, 18-65 years) and a mean follow-up of 34.9 months (range, 6-126 months). Of the 12 included studies, 1 was a prospective comparative study (Level II), 1 was a retrospective comparative study (Level III), 1 was a prospective case series (Level IV), and 9 were retrospective case series (Level IV). The rates of return to any level of sport ranged from 94% to 100% (I2 = 0%), whereas the rates of return to the preinjury level of sport ranged from 62% to 100% (I2 = 61%). The pooled rate of return to preinjury level of sport in type V AC joint separations was 86.2% (95% confidence interval = 68.1%-98.0%), whereas that after type III or IV AC joint injuries was 89.6% (95% confidence interval = 79.9%-96.9%). CONCLUSIONS An almost perfect rate of return to sport participation after surgical management of AC joint dislocations have been reported, with most returning to their preinjury level of sport. The rates of return to sport were comparable across the different types of injuries and surgical procedures. LEVEL OF EVIDENCE Level IV, systematic review of Level II, III, and IV investigations.
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Affiliation(s)
- Jeffrey Kay
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
| | - Muzammil Memon
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Bashar Alolabi
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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Xue C, Song LJ, Zhang H, Tang GL, Li X, Fang JH. Truly anatomic coracoclavicular ligament reconstruction with 2 Endobutton devices for acute Rockwood type V acromioclavicular joint dislocations. J Shoulder Elbow Surg 2018; 27:e196-e202. [PMID: 29352695 DOI: 10.1016/j.jse.2017.12.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Revised: 11/23/2017] [Accepted: 12/03/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Truly anatomic coracoclavicular ligament reconstruction (TACCR) according to the original insertions is a creative new method for the treatment of severe acromioclavicular separation. This research analyzed the clinical and radiologic results of TACCR in 25 patients with at least 2-year follow-up. METHODS The study enrolled 25 patients with Rockwood type V acromioclavicular joint dislocations who underwent TACCR using 2 Endobutton (Smith & Nephew Inc., Andover, MA, USA) devices from May 2013 to October 2015. Patients were assessed with clinical and radiologic follow-up at 3, 6, 12, 18, and 24 months postoperatively. The clinical assessments consisted of the visual analog scale and the Constant score. The radiographic evaluations were performed by measurements of the coracoclavicular distance. RESULTS The mean follow-up was 34 ± 6.8 months (range, 24-48 months). The visual analog scale and Constant scores revealed significant advancements from 5 ± 0.9 (range, 4-7) and 45 ± 5.6 (range, 30-54) scores preoperatively to 0 ± 0.5 (range, 0-2) and 95 ± 2.9 (range, 91-98) scores at 24 months postoperatively, respectively. The coracoclavicular distance significantly decreased from 23 ± 5.4 mm (range, 16-34 mm) preoperatively to 8 ± 0.9 mm (range, 7-10 mm) at the final follow-up. CONCLUSIONS TACCR represents a safe, reliable and creative surgical technique that yields good to excellent clinical and radiologic outcomes in the treatment of severe acromioclavicular separation.
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Affiliation(s)
- Cheng Xue
- Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
| | - Li-Jun Song
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Hao Zhang
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Guo-Long Tang
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Xiang Li
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China.
| | - Jia-Hu Fang
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China.
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López-Alameda S, Fernández-Santás T, García-Villanueva A, Varillas-Delgado D, Garcia de Lucas F. Results of surgical treatment of acromioclavicular dislocations type III using modified Weaver Dunn technique. Rev Esp Cir Ortop Traumatol (Engl Ed) 2018. [DOI: 10.1016/j.recote.2018.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Results of surgical treatment of acromioclavicular dislocations type III using modified Weaver Dunn technique. Rev Esp Cir Ortop Traumatol (Engl Ed) 2018; 62:93-99. [PMID: 29428418 DOI: 10.1016/j.recot.2017.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 09/25/2017] [Accepted: 11/12/2017] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To evaluate the clinical and radiological results of the surgical treatment of type III acromioclavicular dislocations using the Weaver-Dunn technique in the delayed phase. MATERIAL AND METHOD A non-randomised controlled retrospective observational study of 38 patients operated between January 2006 and December 2014. We excluded 10 patients due to death or non-localisation. We collected demographic data, time to intervention, complications, analysing the Visual Analog Scale, DASH and Oxford Shoulder Score and the updated radiological result. RESULTS mean age of patients with right-dominant shoulder affected in 71% of cases predominantly by non-level falls was 35. 70% of the cases had subjective perception of both recovery of strength and disappearance of deformity. Full radiological reduction was observed in 95% of the cases with the appearance of mild osteoarthritis in 44% and moderate osteoarthritis in 5.6%. The results of the DASH presented values of 12,939 (±16,851) and the OSS of 42,736 (±7,794), indicating satisfactory articular function. DISCUSSION The data from this study shows similar results to previous studies regarding subjective recovery of strength, maintenance of anatomical reduction, functional test results and efficacy of the Weaver-Dunn technique. CONCLUSIONS The modified Weaver-Dunn technique provided good clinical and radiological results with patient reincorporation to their usual activities and maintenance over time.
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Post-operative outcomes and complications of suspensory loop fixation device versus hook plate in acute unstable acromioclavicular joint dislocation: a systematic review and meta-analysis. J Orthop Traumatol 2017; 18:293-304. [PMID: 28236179 PMCID: PMC5685975 DOI: 10.1007/s10195-017-0451-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 02/09/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Treatment of acute (≤3 weeks) acromioclavicular joint dislocation type III-VI is still controversial. Currently, the two modern techniques that are widely used are hook plate (HP) fixation and coracoclavicular ligament fixation using a suspensory loop device that consists of either a tightrope (single or double), endo-button (single or double), or synthetic ligament and absorbable polydioxansulfate sling. MATERIALS AND METHODS This systematic review was conducted according to the PRISMA guidelines. Relevant studies that reported Constant-Murley score (CMS), Pain Visual Analog score (VAS) and postoperative complications of either technique were identified from Medline and Scopus from inception to 5 October 2015. RESULTS Sixteen studies were included for the analysis of HP fixation, and 25 studies were included for analysis of loop suspensory fixation (LSF). Pooling of mean CMS and VAS scores gave 90.35 (95% CI 87.16, 93.54), 1.51 (95% CI 0.73, 2) in the HP group, and 92.48 (95% CI 90.91, 94.05), 0.32 (95% CI 0, 0.64) in the suspensory loop devices group, respectively. The pooled unstandardized mean differences (UMD) scores of CMS and VAS in LSF were 2.13 (95% CI -1.43, 5.69) and -1.19 (95% CI -2.03, -0.35) when compared to hook plating. The pooled prevalence of LSF and hook plating were 0.08 (95% CI 0.06, 0.10) and 0.05 (95% CI 0.02, 0.08) scores. The chance of having complications in the LSF group was 1.69 (95% CI 1.07, 2.60), which was statistically significantly higher than in the HP group. CONCLUSION LSF have higher shoulder function scores (CMS) and lower postoperative pain when compared to HP fixation; however, there are higher complication rates with LSF when compared to hook plating. LEVEL OF EVIDENCE IV.
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15
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Saier T, Plath JE, Beitzel K, Minzlaff P, Feucht JM, Reuter S, Martetschläger F, Imhoff AB, Aboalata M, Braun S. Return-to-activity after anatomical reconstruction of acute high-grade acromioclavicular separation. BMC Musculoskelet Disord 2016; 17:145. [PMID: 27039293 PMCID: PMC4818932 DOI: 10.1186/s12891-016-0989-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 03/16/2016] [Indexed: 11/16/2022] Open
Abstract
Background To evaluate return-to-activity (RtA) after anatomical reconstruction of acute high-grade acromioclavicular joint (ACJ) separation. Methods A total of 42 patients with anatomical reconstruction of acute high-grade ACJ-separation (Rockwood Type V) were surveyed to determine RtA at a mean 31 months follow-up (f-u). Sports disciplines, intensity, level of competition, participation in overhead and/or contact sports, as well as activity scales (DASH-Sport-Module, Tegner Activity Scale) were evaluated. Functional outcome evaluation included Constant score and QuickDASH. Results All patients (42/42) participated in sporting activities at f-u. Neither participation in overhead/contact sports, nor level of activity declined significantly (n.s.). 62 % (n = 26) of patients reported subjective sports specific ACJ integrity to be at least the same as prior to the trauma. Sporting intensity (hours/week: 7.3 h to 5.4 h, p = .004) and level of competition (p = .02) were reduced. If activity changed, in 50 % other reasons but clinical symptoms/impairment were named for modified behavior. QuickDASH (mean 6, range 0–54, SD 11) and DASH-Sport-Module (mean 6, range 0–56, SD 13) revealed only minor disabilities at f-u. Over time Constant score improved significant to an excellent score (mean 94, range 86–100, SD 4; p < .001). Functional outcome was not correlated with RtA (n.s.). Conclusion All patients participated in sporting activities after anatomical reconstruction of high-grade (Rockwood Type V) ACJ-separation. With a high functional outcome there was no significant change in activity level (Tegner) and participation in overhead and/or contact sports observed. There was no correlation between functional outcome and RtA. Limiting, there were alterations in time spent for sporting activities and level of competition observed. But in 50 % those were not related to ACJ symptoms/impairment. Unrelated to successful re-established integrity and function of the ACJ it should be considered that patients decided not return-to-activity but are very content with the procedure.
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Affiliation(s)
- T Saier
- Department of Orthopedic Sports Medicine, Technische Universität München, Munich, Germany.,Department of Reconstructive Joint Surgery, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Germany
| | - J E Plath
- Department of Orthopedic Sports Medicine, Technische Universität München, Munich, Germany
| | - K Beitzel
- Department of Orthopedic Sports Medicine, Technische Universität München, Munich, Germany
| | - P Minzlaff
- Chirurgische Klinik Dr. Rinecker, Munich, Germany
| | - J M Feucht
- Department Orthopedics and Traumatology University of Freiburg, Freiburg, Germany
| | - S Reuter
- Department of Orthopedic Sports Medicine, Technische Universität München, Munich, Germany
| | - F Martetschläger
- Department of Orthopedic Sports Medicine, Technische Universität München, Munich, Germany.,Center for Shoulder and Elbow Surgery, ATOS Clinic Munich, Munich, Germany
| | - Andreas B Imhoff
- Department of Orthopedic Sports Medicine, Technische Universität München, Munich, Germany.
| | - M Aboalata
- Department of Orthopedic Sports Medicine, Technische Universität München, Munich, Germany.,Department of Orthopaedic Surgery, Mansoura University, Mansoura, Egypt
| | - S Braun
- Department of Orthopedic Sports Medicine, Technische Universität München, Munich, Germany
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Gao YS, Zhang YL, Ai ZS, Sun YQ, Zhang CQ, Zhang W. Transarticular fixation by hook plate versus coracoclavicular stabilization by single multistrand titanium cable for acute Rockwood grade-V acromioclavicular joint dislocation: a case-control study. BMC Musculoskelet Disord 2015; 16:360. [PMID: 26585649 PMCID: PMC4652419 DOI: 10.1186/s12891-015-0820-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 11/16/2015] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Hook plate (HP) is popularly used for acute and severely displaced acromioclavicular (AC) dislocations. However, subacromial impingement and acromion osteolysis induced by transarticular fixation are notorious. The current case-control study was to compare transarticular fixation by HP to coracoclavicular (CC) stabilization by single multistrand titanium cable (MSTC). METHODS Between January 2006 and August 2009, 24 patients with acute AC dislocations were surgically treated by open reduction and transarticular fixation with HP. These patients were matched to a series of 24 patients, who were managed by CC stabilization with MSTC in the same period. All AC dislocations were graded as Rockwood type V. Implant was removed 8-12 months after the primary operation in all patients, and 12 months at least were needed to assess the maintenance of AC joint. Functional results were evaluated before implant removal as well as in the last follow-up based on Constant-Murley criteria. RESULTS There were no differences of demographic data including age, dominant gender and side, injury-to-surgery interval, operation time and follow-up period. In terms of functionality, Constant score was 95.8 ± 4.1 in MSTC group, while 76.7 ± 8.0 in HP group before implant removal (P < 0.001). In detail, MSTC was superior to HP in pain, ROM and activities. Constant score was significantly improved to 86.1 ± 5.7 after hardware removal for patients in HP (P < 0.001). Degenerative change of acromioclavicular joint presented in 16 patients (66.7%) in patients treated by HP, while it was found in only 3 patients (12.5%) treated by MSTC (P < 0.001). CONCLUSIONS MSTC is superior to HP for the treatment of Rockwood type-V acromioclavicular dislocation both before and after removal of the implant. Hardware removal is of great benefits for functional improvement in patients treated by HP.
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Affiliation(s)
- You-Shui Gao
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China.
| | - Yue-Lei Zhang
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China.
| | - Zi-Sheng Ai
- Department of Medical Statistics, Tongji University School of Medicine, Shanghai, 200092, China.
| | - Yu-Qiang Sun
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China.
| | - Chang-Qing Zhang
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China.
| | - Wei Zhang
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China.
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