Injuries to the acromioclavicular joint

Comparison of single versus double TightRope system in the treatment of acute acromioclavicular joint dislocation

BACKGROUND

Reconstruction of the coracoclavicular (CC) ligament using a single TightRope (ST) system has some complications. We attempted to use a double TightRope (DT) system to reduce complications and obtain the ideal therapeutic effect.

PURPOSE

This investigation aimed to compare the ST and DT systems in terms of efficacy and safety in treating acromioclavicular (AC) joint dislocation.

METHODS

Sixty-six cases of acute AC joint dislocation between January 2013 and January 2018 were retrospectively reviewed. All patients were divided into 2 groups based on treatment with the ST or DT system. Patients were evaluated radiologically and clinically using the Disability of Arm, Shoulder, and Hand, Constant, and visual analog scale scores as clinical outcome measures at 1 day, 3 weeks, 6 weeks, 3 months, 6 months, 1 year, and 2 years after surgery. The CC distance and displacement ratio were assessed radiologically.

RESULTS

The mean follow-up period was 49 months. Satisfactory clinical outcomes were obtained after CC fixation in both groups. No intergroup difference was found regarding the visual analog scale (P = .80), Disability of Arm, Shoulder, and Hand (P = .42), or Constant score (P = .28) at 2 years. However, there was a significant difference in the displacement ratio at 6 weeks (P < .0001), 3 months (P < .0001), 6 months (P < .0001), 1 year (P < .0001), and 2 years (P < .0001) postoperatively between the 2 groups. There were 3 complications in the ST group, including 1 case of secondary coracoid fracture, 1 case of AC joint arthrosis combined with ossification of the CC ligaments, and 1 case of clavicular erosion. All complications occurred in the ST group.

CONCLUSIONS

Both surgical methods are effective in treating AC joint dislocation, but the DT system is more reliable for reduction maintenance.

Epidemiology of isolated acromioclavicular joint dislocation

Background. Acromioclavicular (AC) joint dislocation is a common shoulder problem. However, information about the basic epidemiological features of this condition is scarce. The aim of this study is to analyze the epidemiology of isolated AC dislocation in an urban population. Materials and Methods. A retrospective database search was performed to identify all patients with an AC dislocation over a 5-year period. Gender, age, affected side and traumatic mechanism were taken into account. X-rays were reviewed by two of the authors and dislocations were classified according to the Rockwood's criteria. Results. A total of 108 patients, with a mean age of 37.5 years were diagnosed with AC dislocation. 105 (97.2%) had an isolated AC dislocation, and 3 (2.8%) were associated with a clavicle fracture. The estimated incidence was 1.8 per 10000 inhabitants per year and the male-female ratio was 8.5 : 1. 50.5% of all dislocations occurred in individuals between the ages of 20 and 39 years. The most common traumatic mechanism was sport injury and the most common type of dislocation was Rockwood type III. Conclusions. Age between 20 and 39 years and male sex represent significant demographic risk factors for AC dislocation.

Acromioclavicular joint injuries in sport. Recommendations for treatment

Dislocation of the acromioclavicular joint is a common joint injury in sport, especially those in which there is the risk of falling on to the point of the shoulder. There is controversy regarding the early management of such a dislocation but recent literature strongly favours a conservative approach, because no single surgical procedure has produced results which are consistently better than those achieved following conservative management. In addition the few studies which document late results suggest that in most instances the outcome following conservative treatment is very satisfactory with good power and movement of the shoulder.

Reconstruction for chronic scapuloclavicular instability

Seventeen young patients with chronic scapuloclavicular instability were treated with tendon graft reconstruction. Sixteen patients had sustained a Type III and one sustained a Type II injury according to Allman's classification (Allman, FL: Fractures and ligamentous injuries of the clavicle and its articulation. J Bone Joint Surg 49A: 774-784, 1967). Both the coracoclavicular ligaments and the ligaments of the acromioclavicular joint were reconstructed. The operation was performed an average of 7.6 months after injury. The followup was from 8 months to 18 years, averaging 5.1 years. After surgery, 12 patients returned to heavy or moderately heavy work and eight engaged in athletics. All patients regained normal motion and muscle strength, except for one patient with posttraumatic hemiplegia. None required further surgery. Followup x-ray films showed no instability or degenerative changes.