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Ji Y, Yang S, Wang Y, Guo B, Xu J. Factors influencing clavicular tunnel widening after single bundle coracoclavicular ligament reconstruction. J Orthop Surg Res 2024; 19:735. [PMID: 39506765 PMCID: PMC11542265 DOI: 10.1186/s13018-024-05201-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Accepted: 10/23/2024] [Indexed: 11/08/2024] Open
Abstract
BACKGROUND The coracoclavicular ligament reconstruction (CLR) technique for the treatment of acromioclavicular joint (ACJ) dislocation has gained immense clinical popularity. However, this technique also has some limitations including complications such as distal clavicle fractures, coracoid fractures, bone tunnel widening, implant failure, and loss of reduction. A study was conducted to analyse the extent of CTW after single-bundle CLR by measuring radiographic parameters to determine its relationship with clinical variables to reduce the risk of clavicular tunnel widening (CTW), thereby providing important insights for clinical practice. METHODS This retrospective analysis was conducted at Affiliated Fuyang People's Hospital of Bengbu Medical University, and data from 96 patients who underwent single-bundle CLR for type III-VI ACJ dislocation between January 2018 and December 2023 were initially collected. Finally, 84 patients met the inclusion criteria (63 male and 21 female, mean age: 49.5 ± 12.36 years). The clavicle tunnel (CT) width and coracoclavicular distance (CCD) was measured immediately postoperatively and at 6 months follow up using radiographic imaging, and the degree of expansion at 6 months was recorded. Preoperative variables including patient sex, age, injury cause, injury side, body mass index (BMI), Rockwood classification, extent of the CCD after surgery, and the CT location were recorded to analyze their correlation with the extent of CTW at 6 months follow up. RESULTS With an average follow-up duration of 10 months (range: 6-18 months). Both the extent of the CCD and CTW measured at 6 months postoperatively were differently enlarged, compared to early postoperative period (EPO) (P < 0.05). The results showed that there were no statistically significant differences in the CTW at 6 months postoperatively with respect to patients' sex, causes of injury, sides of injury, and Rockwood classification types(P > 0.05). However, the location of CT was significantly associated with the extent of CTW at 6 months postoperatively (P < 0.05). CONCLUSIONS The location of CT drilling is a significant factor that affects tunnel widening. When the drilling site is situated closer to the conoid tubercle, the extent of CTW is greater than when the tunnel is located farther from the conoid tubercle.
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Affiliation(s)
- Yuncong Ji
- Department of Orthopedics, Sports Medicine and Arthroscopy, Affiliated Fuyang People's Hospital of Anhui Medical University, Fuyang, China
| | - Siqi Yang
- School of Mathematics and Statistics, Fuyang Normal University, Fuyang, China
| | - Yanbo Wang
- Department of Orthopedics, Sports Medicine and Arthroscopy, Affiliated Fuyang People's Hospital of Anhui Medical University, Fuyang, China
| | - Biao Guo
- Department of Orthopedics, Sports Medicine and Arthroscopy, Affiliated Fuyang People's Hospital of Anhui Medical University, Fuyang, China.
| | - Jian Xu
- Department of Orthopedics, Sports Medicine and Arthroscopy, Affiliated Fuyang People's Hospital of Anhui Medical University, Fuyang, China.
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Senel A, Eren M, Batur OC, Kaya O, Sert S, Key S. The Effect of Clavicular Tunnel Position on Reduction Loss in Patients with Acute Acromioclavicular Joint Dislocations Operated with a Single-Bundle Suspensory Loop Device. Orthop Surg 2024; 16:1622-1630. [PMID: 38766809 PMCID: PMC11216842 DOI: 10.1111/os.14095] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 04/23/2024] [Accepted: 04/26/2024] [Indexed: 05/22/2024] Open
Abstract
OBJECTIVE The treatment of acromioclavicular joint (ACJ) dislocations offers numerous options, and ongoing debates persist regarding their comparative effectiveness. Among these options, the suspensory loop device (SLD) is one of the most favored treatment modalities. Despite the observed high reduction loss rate associated with SLD, the treatment yields favorable clinical outcomes. This study aimed to investigate the clinical outcomes of patients with acute type 3 and 5 ACJ dislocations who underwent open and arthroscopic procedures using a single-bundle SLD, and to evaluate the effect of clavicular tunnel position on reduction loss. METHODS Thirty-seven eligible patients diagnosed with acute type 3 and type 5 ACJ dislocation who underwent open and arthroscopic surgery with a single-bundle SLD between January 2015 and March 2022 were evaluated retrospectively. Demographic data and radiological measurements including coracoclavicular (CC) interval, clavicle length (CL), and implant distance (ID) were recorded. The ID/CL ratio was calculated and a value between 0.17 and 0.24 was considered as "acceptable implant position". Reduction loss and other complications were noted. Patients were divided into two groups: open (Group 1) and arthroscopic (Group 2). Constant Murray Score (CMS) and Visual Analog Scale (VAS) were used for clinical and functional outcomes. Non-parametric tests were used for statistical analysis of variables. RESULTS The study included six females (16.2%) and 31 males (83.8%) with a mean age of 40.2 ± 14.7 years (range: 20-75). The mean follow-up period was 22.3 ± 16.7 months (range: 6-72). The average time from trauma to surgery was 6.3 ± 5.3 days (range: 1-18). At the last follow-up, the CMS was 89.3 ± 8.8 and the VAS score was 2.1 ± 0.9. The mean ID/CL ratio was 0.19 ± 0.1 and 19 patients (51.4%) were between 0.17 and 0.24. Reduction loss was observed in nine patients (24.3%). There were no significant differences between Group 1 and Group 2 regarding operation time (p = 0.998), ID/CL ratio (p = 0.442), reduction loss (p = 0.458), CMS (p = 0.325), and VAS score (p = 0.699). Of the 28 patients without reduction loss, 16 had an ID/CL ratio between 0.17 and 0.24 (p = 0.43). Furthermore, within the 0.17-0.24 interval, CMS was higher with an average of 91.8 ± 5.1 compared to the other intervals (p = 0.559). CONCLUSION The clinical and functional outcomes of acute type 3 and type 5 ACJ dislocation operated open and arthroscopically with single-bundle SLD are similar and satisfactory. A clavicular tunnel position in the range of 0.17-0.24 (ID/CL ratio) is recommended to maintain postoperative reduction.
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Affiliation(s)
- Ahmet Senel
- Orthopedics and Traumatology DepartmentIstanbul Training and Research HospitalIstanbulTurkey
| | - Murat Eren
- Orthopedics and Traumatology DepartmentIstanbul Training and Research HospitalIstanbulTurkey
| | - Omer Cihan Batur
- Orthopedics and Traumatology DepartmentElazig Fethi Sekin City HospitalElazigTurkey
| | - Oguz Kaya
- Orthopedics and Traumatology DepartmentElazig Fethi Sekin City HospitalElazigTurkey
| | - Selman Sert
- Orthopedics and Traumatology DepartmentIstanbul Training and Research HospitalIstanbulTurkey
| | - Sefa Key
- Department of Orthopedics and TraumatologyFirat University Faculty of MedicineElazigTurkey
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Elhalawany MF, Abdalla UG, Shwitter L, ElAttar MS, Fahmy FS. Assessment of Coracoclavicular Ligament Healing on MRI After Arthroscopic TightRope Fixation for Acute Acromioclavicular Joint Dislocation. Orthop J Sports Med 2023; 11:23259671231185749. [PMID: 37840901 PMCID: PMC10568992 DOI: 10.1177/23259671231185749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/13/2023] [Indexed: 10/17/2023] Open
Abstract
Background Arthroscopic-assisted fixation of acute high-grade acromioclavicular (AC) joint dislocation has gained popularity in the last decade. Coracoclavicular (CC) fixation using the TightRope device is a less invasive technique. Purpose To investigate CC ligament healing and functional outcomes after arthroscopic fixation using the TightRope device for acute AC joint disruption. Study Design Case series; Level of evidence, 4. Methods The study retrospectively analyzed the data of patients admitted for arthroscopic surgical treatment of acute AC joint injury using a single TightRope device. The data collection commenced in October 2021. The Constant-Murley (CM) score and University of California, Los Angeles (UCLA) shoulder score were used for functional evaluation. The CC distance (CCD) was measured on plain radiographs, whereas healing of the CC ligament was evaluated on magnetic resonance imaging (MRI). Statistical analyses were conducted with the Mann-Whitney U test, independent t test, or paired t test, as appropriate. Results The analysis included 33 patients with a mean age of 37.7 years (range, 24-49 years) and a minimum follow-up of 24 months. Significant preoperative to postoperative increases were noted in both the CM and UCLA scores (from 34.1 ± 7.6 to 93.3 ± 3.6 and from 8.7 ± 2.1 to 32.9 ± 1.7, respectively; P < .0001 for both). The CCD decreased from 21.8 ± 3.02 mm preoperatively to 10.6 ± 1.2 mm postoperatively (P < .0001). All patients displayed CC ligament healing on MRI. Two patients with superficial infection and 1 case of partial reduction loss were confirmed at the end of this study. Conclusion The arthroscopic TightRope technique was found to be a reliable and less invasive method of fixation for acute AC joint disruptions. The CC ligament healed adequately based on MRI evaluation, and the patients regained their preinjury activities, with favorable functional outcomes and minor comorbidities.
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Affiliation(s)
| | - Usama Gaber Abdalla
- Department of Orthopedic Surgery, Faculty of Medicine, AlAzhar University, Cairo, Egypt
| | - Lotfy Shwitter
- Department of Orthopedic Surgery, Faculty of Medicine, AlAzhar University, Cairo, Egypt
| | - Mohammed Said ElAttar
- Department of Orthopedic Surgery, Faculty of Medicine, Zagazig University, Sharkia, Egypt
| | - Fahmy Samir Fahmy
- Department of Orthopedic Surgery, Faculty of Medicine, Zagazig University, Sharkia, Egypt
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Hu F, Han S, Liu F, Wang Z, Jia H, Wang F, Hu L, Chen J, Wang B, Yang Y. A modified single-endobutton technique combined with nice knot for treatment of Rockwood type III or V acromioclavicular joint dislocation. BMC Musculoskelet Disord 2022; 23:15. [PMID: 34980065 PMCID: PMC8725473 DOI: 10.1186/s12891-021-04915-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 11/24/2021] [Indexed: 02/08/2023] Open
Abstract
PURPOSE Double-endobutton technique, as a widely accepted strategy for the treatment of acromioclavicular joint dislocation, is undergoing constant improvement. This study aims to assess the clinical effect of a modified single-endobutton combined with the nice knot in the fixation of Rockwood type III or V acromioclavicular joint dislocation. METHODS From January 2016 to June 2019, 16 adult patients (13 males and 3 females) with Rockwood type III or V acromioclavicular joint dislocation were treated with a modified single-endobutton technique combined with the nice knot in our department. The age ranged from 18 to 64 years old with an average of 32.8 years old. Operative time, intraoperative blood loss, post-operative clinical outcomes and radiographic results were recorded and analyzed. Preoperative and last follow-up scores in the Constant-Murley Scale, Neer score, Rating Scale of the American Shoulder and Elbow Surgeons and VAS scale and complications such as infection, re-dislocation, implant loosening, medical origin fracture and hardware pain were recorded and evaluated. RESULTS Sixteen patients were followed up for 6 to 18 months with an average of 10.3 months. The operative time was 50-90 min with an average of (62.5 ± 3.10) min. The intraoperative blood loss was 30-100 ml, with an average of (55.0 ± 4.28) ml. The complications, such as wound infection, internal fixation failure and fractures, were not found in these cases. According to Karlsson criteria, there were excellent in 14 cases, good in 2 cases at the final follow-up. The mean VAS score of the patients was 5.88 ± 0.26 preoperatively, compared with 0.19 ± 0.14 at the final follow-up evaluation. The difference was statistically significant (P < 0.05). The mean Constant score was 45.5 ± 2.0 preoperatively, compared to 94.0 ± 0.73 at the final follow-up evaluation. The difference was statistically significant (P < 0.05). Patients had statistically significant preoperative and postoperative AC (acromioclavicular distance) and CC (coracoclavicular distance) distances (P < 0.05); 6 months postoperatively the AC(P = 0.412) and CC(P = 0.324) distances were not statistically significant compared to the healthy side. CONCLUSION Nice knot provides a reliable fixation for the single-endobutton technique in the treatment of acromioclavicular dislocations. The modified single-endobutton technique combined with the nice knot can achieve good clinical outcomes in the treatment of Rockwood type III or V acromioclavicular joint dislocation.
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Affiliation(s)
- Fangning Hu
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong Province, China
| | - Shumei Han
- Department of Radiotherapy, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Fanxiao Liu
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong Province, China
| | - Zhuang Wang
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong Province, China
| | - Honglei Jia
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong Province, China
| | - Fu Wang
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong Province, China
| | - Lingfei Hu
- Department of Emergency surgery, Linyi People's Hospital, Shandong First Medical University and Shandong Academy of Medical Sciences, Linyi, Shandong Province, China
| | - Jing Chen
- Department of Emergency surgery, Linyi People's Hospital, Shandong First Medical University and Shandong Academy of Medical Sciences, Linyi, Shandong Province, China
| | - Bomin Wang
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong Province, China.
- Department of Hemodialysis, Linyi People's Hospital, Shandong First Medical University and Shandong Academy of Medical Sciences, Linyi, Shandong Province, China.
| | - Yongliang Yang
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong Province, China.
- Department of Hemodialysis, Linyi People's Hospital, Shandong First Medical University and Shandong Academy of Medical Sciences, Linyi, Shandong Province, China.
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Yongfei F, Chaoyu L, Wenqiang X, Xiulin M, Jian X, Wei W. Clinical outcomes of Tightrope system in the treatment of purely ligamentous Lisfranc injuries. BMC Surg 2021; 21:395. [PMID: 34743702 PMCID: PMC8573989 DOI: 10.1186/s12893-021-01394-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 11/01/2021] [Indexed: 12/15/2022] Open
Abstract
Background Purely ligamentous Lisfranc injuries are mainly caused by low energy damage and often require surgical treatment. There are several operative techniques for rigid fixation to solve this problem clinically. This study evaluated the effect of using the Tightrope system to reconstruct the Lisfranc ligament for elastic fixation. Methods We retrospectively analyzed 11 cases with purely ligamentous Lisfranc injuries treated with the Tightrope system from 2016 to 2019, including 8 male and 3 female. X-ray was performed regularly after operation to measure the distance between the first and second metatarsal joint and the visual analogue scale (VAS) score was used to evaluate pain relief. American orthopedic foot & ankle society (AOFAS) and Maryland foot score were recorded at the last follow-up. Results The average follow-up time was 20.5 months (range, 17–24). There was statistically significant difference in the distance between the first and second metatarsal joint and VAS score at 3 months, 6 months, and the last follow-up when compared with preoperative values (P < 0.05).Mean of postoperative AOFAS mid-foot scale and Maryland foot score were 92.4 ± 4.3, 94.1 ± 3.5, respectively. The Tightrope system was not removed and the foot obtained better biomechanical stability. No complications occurred during the operation. Conclusion Tightrope system in the treatment of purely ligamentous Lisfranc injuries can stabilize the tarsometatarsal joint and achieve satisfactory effect.
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Affiliation(s)
- Fan Yongfei
- Department of Orthopaedic Surgery, Anhui Spinal Deformity and Clinical Medical Research Center, Fuyang Hospital Affiliated to Anhui Medical University, Fuyang People's Hospital, Fuyang, 236000, Anhui, People's Republic of China
| | - Liu Chaoyu
- Department of Orthopaedic Surgery, Anhui Spinal Deformity and Clinical Medical Research Center, Fuyang Hospital Affiliated to Anhui Medical University, Fuyang People's Hospital, Fuyang, 236000, Anhui, People's Republic of China
| | - Xu Wenqiang
- Department of Orthopaedic Surgery, Anhui Spinal Deformity and Clinical Medical Research Center, Fuyang Hospital Affiliated to Anhui Medical University, Fuyang People's Hospital, Fuyang, 236000, Anhui, People's Republic of China
| | - Ma Xiulin
- Department of Orthopaedic Surgery, Anhui Spinal Deformity and Clinical Medical Research Center, Fuyang Hospital Affiliated to Anhui Medical University, Fuyang People's Hospital, Fuyang, 236000, Anhui, People's Republic of China
| | - Xu Jian
- Department of Orthopaedic Surgery, Anhui Spinal Deformity and Clinical Medical Research Center, Fuyang Hospital Affiliated to Anhui Medical University, Fuyang People's Hospital, Fuyang, 236000, Anhui, People's Republic of China
| | - Wang Wei
- Department of Orthopaedic Surgery, Anhui Spinal Deformity and Clinical Medical Research Center, Fuyang Hospital Affiliated to Anhui Medical University, Fuyang People's Hospital, Fuyang, 236000, Anhui, People's Republic of China.
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