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Ruiz Ibán MA, Moreno Romero MS, Diaz Heredia J, Ruiz Díaz R, Muriel A, López-Alcalde J. The prevalence of intraarticular associated lesions after acute acromioclavicular joint injuries is 20%. A systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2021; 29:2024-2038. [PMID: 32179968 DOI: 10.1007/s00167-020-05917-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 02/24/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE To synthesise the evidence on the prevalence of associated intraarticular lesions in subjects with acute acromioclavicular joint (ACJ) dislocations. METHODS A search in two electronic databases (PUMBMED and EMBASE) was performed from 1985 to 2019. Two independent reviewers selected studies that complied with the following inclusion criteria: (1) the study included data on surgically treated ACJ dislocation grade III-V in the Rockwood classification, (2) the ACJ injuries were acute (the surgery was performed less than 6 weeks after injury), (3) an arthroscopic evaluation of the glenohumeral joint was performed during surgery. The quality of the studies included was assessed using the tool of the Joanna Briggs Institute. RESULTS A total of 47 studies with acute ACJ injuries met the initial inclusion criteria. Of these, 21 studies (9 retrospective case series, 9 prospective case series and 3 retrospective cohort studies) presented data on associated intraarticular lesions amenable for use in the meta-analysis. The meta-analysed studies included a total of 860 subjects with acute ACJ dislocations with a male/female ratio of 6.5 and a mean age of 32 years. The meta-analysis showed a prevalence of associated intraarticular lesions in subjects with acute ACJ of 19.9% (95% confidence interval [CI] 14.0-26.4%; 21 studies, 860 analysed participants; P = 0.000; I2: 74.5% random-effects model; low risk of bias). CONCLUSION One in five subjects with surgically treated acute ACJ dislocations will have an associated intraarticular lesion that requires further intervention. The case for a customary arthroscopic evaluation of the joint, even when an open procedure is performed to deal with the ACJ dislocation, is strong. Level of evidence IV Trial registry Systematic review registration number: PROSPERO CRD42018090609.
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Affiliation(s)
- Miguel Angel Ruiz Ibán
- Unidad de Hombro Y Codo, Hospital Universitario Ramón Y Cajal, Cta Colmenar km 9,100, Madrid, Spain.
| | | | - Jorge Diaz Heredia
- Unidad de Hombro Y Codo, Hospital Universitario Ramón Y Cajal, Cta Colmenar km 9,100, Madrid, Spain
| | - Raquel Ruiz Díaz
- Unidad de Hombro Y Codo, Hospital Universitario Ramón Y Cajal, Cta Colmenar km 9,100, Madrid, Spain
| | - Alfonso Muriel
- Unidad de Bioestadística Clínica, Hospital Ramón Y Cajal, IRYCIS, CIBERESP, Madrid, Spain.,Departamento de Enfermería, Universidad de Alcalá, Madrid, Spain
| | - Jesus López-Alcalde
- Unidad de Bioestadística Clínica, Hospital Ramón Y Cajal, IRYCIS, CIBERESP, Madrid, Spain.,Faculty of Health Sciences, Universidad Francisco de Vitoria (UFV)-Madrid, Madrid, Spain.,Cochrane Associate Centre of Madrid, Madrid, Spain
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Biologic and synthetic ligament reconstructions achieve better functional scores compared to osteosynthesis in the treatment of acute acromioclavicular joint dislocation. Knee Surg Sports Traumatol Arthrosc 2021; 29:2175-2193. [PMID: 32797247 DOI: 10.1007/s00167-020-06217-9] [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: 03/31/2020] [Accepted: 08/06/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE To systematically review the outcomes of surgical treatments of acute acromioclavicular joint dislocation. METHODS Studies were identified by electronic databases (Ovid, PubMed). All studies reporting functional and radiological outcomes of surgical treatments of acute 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 One hundred and thirty-three studies were included for a total of 4473 shoulders. Mean age of participants was 36.9 years. Mean follow-up was 42.06 months. Arthroscopy showed better ASES (p < 0.0001) and lower VAS pain score (p = 0.0249) compared to an open approach. Biologic and synthetic reconstructions demonstrated better results over osteosynthesis techniques. Biologic techniques showed overall better Constant (p = 0.0001) and DASH (p = 0.0215) scores, while synthetic reconstruction showed better UCLA score (p = 0.0001). Among suture buttons, triple button showed overall better results in Constant (p = 0.0001) and VAS (p = 0.0001) scores, while better results in DASH score (p = 0.0003) were achieved by 2 double button techniques. Overall, the level of evidence was low. CONCLUSION Biological and synthetic reconstructions achieved better functional scores compared to osteosynthesis. Among suture buttons, the triple button showed better functional performance. LEVEL OF EVIDENCE IV.
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Murphy RJ, Ambuehl B, Schaer MO, Weihs J, Moor BK, Zumstein MA. BiPOD arthroscopically assisted bidirectional stabilisation technique for high-grade acromioclavicular joint injury: two-year clinical and radiological outcomes. Arch Orthop Trauma Surg 2021; 141:1559-1565. [PMID: 33555404 PMCID: PMC8354922 DOI: 10.1007/s00402-021-03768-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 01/01/2021] [Indexed: 01/07/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the intermediate-term clinical and radiological outcomes for acute, unstable acromioclavicular joint (ACJ) injuries treated with the arthroscopically assisted BiPOD stabilisation technique. METHODS Twenty-three patients who sustained acute, unstable ACJ injuries were included in this prospective study. We recorded demographics, injury classification, time to surgery, clinical scores, radiological outcomes and complications; each patient completed a minimum of 2 years post-operative observation. RESULTS Mean follow-up was 26 months (range, 24-34). Clinical outcomes scores demonstrated good 2-year results: relative Constant score, 97.9/100; ACJ Index, 89.4/100; Subjective Shoulder Value, 92.4/100 and Taft = 11.1/12. Final C-C distance showed a mean of 0.7 mm (SD ± 1.8 mm) at 2 years. Complication rate was 9%. CONCLUSION The BiPOD technique shows excellent, reliable intermediate-term results with a favourable complication rate compared to existing techniques; it provides a comprehensive surgical option for the stabilisation of acute ACJ injuries restoring both vertical and horizontal stability.
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Affiliation(s)
- Richard J. Murphy
- Shoulder, Elbow and Orthopaedic Sports Medicine, Orthopaedics Sonnenhof, 3006 Bern, Switzerland ,grid.411656.10000 0004 0479 0855Shoulder, Elbow and Orthopaedic Sports Medicine, Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Benedikt Ambuehl
- grid.411656.10000 0004 0479 0855Shoulder, Elbow and Orthopaedic Sports Medicine, Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Michael O. Schaer
- grid.411656.10000 0004 0479 0855Shoulder, Elbow and Orthopaedic Sports Medicine, Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Johannes Weihs
- grid.411656.10000 0004 0479 0855Shoulder, Elbow and Orthopaedic Sports Medicine, Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Beat K. Moor
- grid.418149.10000 0000 8631 6364Centre Hospitalier du Valais Romand, Hôpital du Valais (RSV), Hôpital de Martigny, av. de la Fusion 27, 1920 Martigny, Switzerland
| | - Matthias A. Zumstein
- Shoulder, Elbow and Orthopaedic Sports Medicine, Orthopaedics Sonnenhof, 3006 Bern, Switzerland ,grid.411656.10000 0004 0479 0855Shoulder, Elbow and Orthopaedic Sports Medicine, Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland ,Stiftung Lindenhof I Campus SLB, Swiss Institute for Translational and Entrepreneurial Medicine, Freiburgstrasse 3, 3010 Bern, Switzerland
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Takase K, Hata Y, Morisawa Y, Goto M, Tanaka S, Hamada J, Hayashida K, Fujii Y, Morihara T, Yamamoto N, Inui H, Shiozaki H. Treatment of acromioclavicular joint separations in Japan: a survey. JSES Int 2020; 5:51-55. [PMID: 33554164 PMCID: PMC7846705 DOI: 10.1016/j.jseint.2020.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Treatment options for acromioclavicular joint (ACJ) separations are highly dependent on severity, as well as the patient’s background. Furthermore, some patients can be switched from conservative to surgical treatment. In this study, we conducted a mail-based questionnaire survey of members of the Japan Shoulder Society on the administration of treatments for ACJ separations. Methods A questionnaire survey with 5 categories was mailed to all 1655 members of the Japan Shoulder Society (including 59 councilors): initial treatment, whether surgery was performed, indications for surgery based on severity, switching from conservative to surgical treatment, and surgical methods. Results Altogether, 183 members, including 56 councilors, responded. Regarding the initial treatment, 17 respondents opted for treatment without immobilization or fixation and 166 opted for immobilization or fixation. Of the members, 11 opted for only conservative treatment whereas 172 chose surgery depending on the case; of the latter, 9 considered it for patients with a Rockwood classification of type 2 or higher; 120, for patients with type 3 or higher; and 172, for patients with types 4-6. Furthermore, 75 of 172 members had experience switching to surgical treatment during conservative treatment. For 64 of 172 members, the modified Cadenat method was the most common surgical method. Conclusions Only 11 members opted for conservative treatment of ACJ separations, and approximately 95% of physicians chose surgery. Furthermore, >70% of physicians considered surgery for an injury classified as type 3 or higher, and 37% of members performed the modified Cadenat method. However, the popularization of arthroscopic surgery may affect the selection of surgical methods in the future.
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Affiliation(s)
- Katsumi Takase
- Corresponding author: Katsumi Takase, MD, PhD, Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku Shinjuku-ku, Tokyo, 160-0023, Japan.
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Cochrane in CORR®: Surgical Versus Conservative Interventions For Treating Acromioclavicular Dislocation of The Shoulder in Adults. Clin Orthop Relat Res 2020; 478:462-468. [PMID: 31990713 PMCID: PMC7145055 DOI: 10.1097/corr.0000000000001143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Arenas-Miquelez A, Karargyris O, Olariu R, Zumstein M. Free Vascularized Fibular Graft for Reconstruction of the Lateral Clavicle: A Case Report and Review of the Literature. JBJS Case Connect 2019; 9:e0330. [PMID: 31609747 DOI: 10.2106/jbjs.cc.18.00330] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 50-year-old female patient presented with significant (40%) bone loss of the lateral clavicle extending to the acromioclavicular (AC) joint, as a result of multiple, failed revision surgeries following a fracture-dislocation. She was treated with a free vascularized fibular graft and biplanar stabilization of the AC joint. At 4 years of follow-up, the patient had experienced resolution of painful symptoms with a Constant-Murley score of 72. CONCLUSIONS Reconstruction of large, lateral clavicle defects with a free vascularized fibular graft and biplanar stabilization of the AC joint may provide a satisfactory clinical outcome.
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Affiliation(s)
| | | | - Radu Olariu
- Plastic Surgery, Inselspital, Bern, Switzerland
| | - Matthias Zumstein
- Shoulder and Elbow, Orthopaedics, Inselspital, Bern, Switzerland.,Shoulder, Elbow and Orthopaedic Sports Medicine, Orthopaedics Sonnenhof, Bern, Switzerland
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Bedeutung und Behandlung der horizontalen Instabilitätskomponente bei Verletzungen des Akromioklavikulargelenks. ACTA ACUST UNITED AC 2019. [DOI: 10.1007/s11678-019-0525-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Schär MO, Jenni S, Fessel G, Snedeker JG, Scheibel M, Zumstein MA. Biomechanical comparison of two biplanar and one monoplanar reconstruction techniques of the acromioclavicular joint. Arch Orthop Trauma Surg 2019; 139:779-786. [PMID: 30739190 DOI: 10.1007/s00402-019-03137-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The purpose of this proof-of-concept study was to investigate the biomechanical performance of two surgical techniques, namely (1) the double Tight-Rope fixation with an additional acromioclavicular FiberTape fixation (DTRC) and (2) the fixation of the clavicle to the acromion and coracoid in a bipodal manner (Bipod) using a Poly-Tape and FiberTape. Both techniques intend to address vertical and horizontal instability after acromioclavicular dislocation. They were compared with the commonly used (3) double Tight-Rope (DTR) technique, which only stabilizes the clavicle to the coracoid. MATERIALS AND METHODS The acromioclavicular joint (ACJ) of 18 composite Sawbone shoulder specimens (6 per reconstruction group) were tested for posterosuperior elongation (70N cyclical load, 1500 cycles), load-to-failure and stiffness. RESULTS After 1500 cycles, the DTRC, Bipod and DTR group showed an elongation of 0.45 mm (SD 0.14 mm), 1.19 mm (SD 0.54 mm), and 0.46 mm (SD 0.15 mm), respectively. Although the elongation of the Bipod group was increased when compared to the other two groups (Bipod versus DTRC p = 0.008; Bipod versus DTR p = 0.006), the difference was less than 0.7 mm. The DTRC showed a higher load-to-failure of 656.1N (SD 58.1 N) compared to the Bipod [531.1 N (SD 108.2N) (p = 0.039)] and DTR group [522.8 N (SD 32.8 N) (p = 0.033)]. CONCLUSION The DTRC and the DTR group resulted in similar low elongation, while the elongation in the Bipod technique was slightly higher. Even though this difference of 0.7 mm shows statistical significance, it most likely has no clinical relevance. When testing in posterosuperior direction, which is the clinically relevant load vector, an additional fixation of the clavicle to the acromion did not reduce elongation in this study. It is, furthermore, questionable if the benefit of an increased load-to-failure in combination with no improvement in elongation and stiffness as seen in the DTRC group outweighs the possible risks and increased costs coming with the DTRC refixation.
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Affiliation(s)
- Michael O Schär
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University of Bern, Inselspital, Freiburgstrasse, Bern, Switzerland.
| | - Stefanie Jenni
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University of Bern, Inselspital, Freiburgstrasse, Bern, Switzerland
| | - Gion Fessel
- Department of Orthopaedics, University of Zurich, Balgrist, Switzerland
| | - Jess G Snedeker
- Department of Orthopaedics, University of Zurich, Balgrist, Switzerland
| | - Markus Scheibel
- Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité- Universitaetsmedizin Berlin, Berlin, Germany
| | - Matthias A Zumstein
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University of Bern, Inselspital, Freiburgstrasse, Bern, Switzerland
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Abel J, Zumstein MA, Bolliger L, Schär MO. [Current aspects and new techniques in dislocation of the shoulder joint]. DER ORTHOPADE 2018; 47:158-167. [PMID: 29335760 DOI: 10.1007/s00132-017-3517-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
With 12% of all injuries concerning the shoulder, acromioclavicular (AC) joint dislocations are a common injury especially in young and active patients. The Rockwood classification is widely accepted, which differentiates between six types depending on the degree of injury and the vertical dislocation. Because the classification does not adequately address the horizontal instability, its benefits are questionable and there is currently no consensus. For this reason, the classification and the therapy of these injuries are increasingly becoming the subject of scientific investigations. Whereas conservative treatment for type I and II injuries and operative treatment for type IV-VI injuries are widely accepted, there is still no agreement in treating type III lesions. The goal of this review article is to present the current evidence for the diagnostics, different classifications and therapeutic possibilities.
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Affiliation(s)
- J Abel
- Universitätsklinik für Orthopädische Chirurgie und Traumatologie, Inselspital, Universität Bern, 3010, Bern, Schweiz
| | - M A Zumstein
- Universitätsklinik für Orthopädische Chirurgie und Traumatologie, Inselspital, Universität Bern, 3010, Bern, Schweiz.
| | - L Bolliger
- Universitätsklinik für Orthopädische Chirurgie und Traumatologie, Inselspital, Universität Bern, 3010, Bern, Schweiz
| | - M O Schär
- Universitätsklinik für Orthopädische Chirurgie und Traumatologie, Inselspital, Universität Bern, 3010, Bern, Schweiz
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