Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
권호 표지
DOI QR코드

DOI QR Code

Anatomic reconstruction for acromioclavicular joint injuries: a pilot study of a cost-effective new technique

  • Received : 2021.05.23
  • Accepted : 2021.07.11
  • Published : 2021.12.01
Download PDF
⟨ Previous Next ⟩

Abstract

Background: The treatment for acromioclavicular joint injuries (ACJI) ranges from a conservative approach to extensive surgical reconstruction, and the decision on how to manage these injuries depends on the grade of acromioclavicular (AC) joint separation, resources, and skill availability. After a thorough review of the literature, the researchers adopted a simple cost-effective technique of AC joint reconstruction for acute ACJI requiring surgery. Methods: This was a prospective single-center study conducted between April 2017 and April 2018. For patients with acute ACJI more than Rockwood grade 3, the researchers performed open coracoclavicular ligament reconstruction using synthetic sutures along with an Endobutton and a figure of 8 button plate. This was followed by AC ligament repair augmenting it with temporary percutaneous AC K-wires. Clinical outcomes were evaluated using the Constant Murley shoulder score. Results: Seventeen patients underwent surgery. The immediate postoperative radiograph showed an anatomical reduction of the AC joint dislocation in all patients. During follow-up, one patient developed subluxation but was asymptomatic. The mean follow-up period was 30 months (range, 24-35 months). The mean Constant score at 24 months was 95. No AC joint degeneration was noted in follow-up X-rays. The follow-up X-rays showed significant infra-clavicular calcification in 11 of the 17 patients, which was an evidence of a healed coracoclavicular ligament post-surgery. Conclusions: This study presents a simple cost-effective technique with a short learning curve for anatomic reconstruction of acute ACJI. The preliminary results have been very encouraging.

Keywords

References

  1. Chillemi C, Franceschini V, Dei Giudici L, et al. Epidemiology of isolated acromioclavicular joint dislocation. Emerg Med Int 2013;2013:171609. https://doi.org/10.1155/2013/171609
  2. Folwaczny EK, Yakisan D, Sturmer KM. The Balser plate with ligament suture: a dependable method of stabilizing the acromioclavicular joint. Unfallchirurg 2000;103:731-40. https://doi.org/10.1007/s001130050612
  3. Faraj AA, Ketzer B. The use of a hook-plate in the management of acromioclavicular injuries. Report of ten cases. Acta Orthop Belg 2001;67:448-51.
  4. Zanca P. Shoulder pain: involvement of the acromioclavicular joint. (Analysis of 1,000 cases). Am J Roentgenol Radium Ther Nucl Med 1971;112:493-506. https://doi.org/10.2214/ajr.112.3.493
  5. Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 1987;(214): 160-4.
  6. Walz L, Salzmann GM, Fabbro T, Eichhorn S, Imhoff AB. The anatomic reconstruction of acromioclavicular joint dislocations using 2 TightRope devices: a biomechanical study. Am J Sports Med 2008;36:2398-406. https://doi.org/10.1177/0363546508322524
  7. Rios CG, Arciero RA, Mazzocca AD. Anatomy of the clavicle and coracoid process for reconstruction of the coracoclavicular ligaments. Am J Sports Med 2007;35:811-7. https://doi.org/10.1177/0363546506297536
  8. Willimon SC, Gaskill TR, Millett PJ. Acromioclavicular joint injuries: anatomy, diagnosis, and treatment. Phys Sportsmed 2011;39:116-22. https://doi.org/10.3810/psm.2011.02.1869
  9. Mazzocca AD, Spang JT, Rodriguez RR, et al. Biomechanical and radiographic analysis of partial coracoclavicular ligament injuries. Am J Sports Med 2008;36:1397-402. https://doi.org/10.1177/0363546508315200
  10. Reid D, Polson K, Johnson L. Acromioclavicular joint separations grades I-III: a review of the literature and development of best practice guidelines. Sports Med 2012;42:681-96.
  11. Gorbaty JD, Hsu JE, Gee AO. Classifications in brief: Rockwood classification of acromioclavicular joint separations. Clin Orthop Relat Res 2017;475:283-7. https://doi.org/10.1007/s11999-016-5079-6
  12. Galasso O, Tarducci L, De Benedetto M, et al. Modified Weaver-Dunn procedure for type 3 acromioclavicular joint dislocation: functional and radiological outcomes. Orthop J Sports Med 2020;8:2325967120905022.
  13. Modi CS, Beazley J, Zywiel MG, Lawrence TM, Veillette CJ. Controversies relating to the management of acromioclavicular joint dislocations. Bone Joint J 2013;95:1595-602. https://doi.org/10.1302/0301-620X.95B12.31802
  14. Korsten K, Gunning AC, Leenen LP. Operative or conservative treatment in patients with Rockwood type III acromioclavicular dislocation: a systematic review and update of current literature. Int Orthop 2014;38:831-8. https://doi.org/10.1007/s00264-013-2143-7
  15. Beitzel K, Cote MP, Apostolakos J, et al. Current concepts in the treatment of acromioclavicular joint dislocations. Arthroscopy 2013;29:387-97. https://doi.org/10.1016/j.arthro.2012.11.023
  16. van Bergen CJ, van Bemmel AF, Alta TD, van Noort A. New insights in the treatment of acromioclavicular separation. World J Orthop 2017;8:861-73. https://doi.org/10.5312/wjo.v8.i12.861
  17. Jerosch J, Filler T, Peuker E, Greig M, Siewering U. Which stabilization technique corrects anatomy best in patients with AC-separation? An experimental study. Knee Surg Sports Traumatol Arthrosc 1999;7:365-72. https://doi.org/10.1007/s001670050182
  18. Breslow MJ, Jazrawi LM, Bernstein AD, Kummer FJ, Rokito AS. Treatment of acromioclavicular joint separation: suture or suture anchors. J Shoulder Elbow Surg 2002;11:225-9. https://doi.org/10.1067/mse.2002.123904
  19. Ladermann A, Grosclaude M, Lubbeke A, et al. Acromioclavicular and coracoclavicular cerclage reconstruction for acute acromioclavicular joint dislocations. J Shoulder Elbow Surg 2011; 20:401-8. https://doi.org/10.1016/j.jse.2010.08.007
  20. Najibi S, Banglmeier R, Matta J, Tannast M. Material properties of common suture materials in orthopaedic surgery. Iowa Orthop J 2010;30:84-8.