Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
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Anatomic coracoclavicular ligament reconstruction with triple flip-buttons leads to good functional outcomes and low reduction loss: a case series

  • Raul Aguila (Department of Orthopaedics and Traumatology, Clinica Santa Maria) ;
  • Gonzalo Gana (Department of Orthopaedics and Traumatology, Clinica Santa Maria) ;
  • J Tomas Munoz (Faculty of Medicine, Universidad de los Andes) ;
  • Diego Garcia de la Pastora (Faculty of Science, Universidad de los Andes) ;
  • Andres Oyarzun (Faculty of Medicine, Universidad de Chile) ;
  • Gabriel Mansilla (Research Support Team, Clinica Santa Maria) ;
  • Sebastian Coda (Department of Orthopaedics and Traumatology, Clinica Santa Maria) ;
  • J Tomas Rojas (Department of Orthopaedics and Traumatology, Clinica Santa Maria)
  • Received : 2022.10.14
  • Accepted : 2023.01.18
  • Published : 2023.06.01
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Abstract

Background: The management of acromioclavicular (AC) joint dislocation remains controversial. Recently, anatomic coracoclavicular (CC) fixation with a double clavicular tunnel and three flip-buttons has shown promising results. This study aimed to evaluate functional and radiological outcomes in patients with high-grade AC joint dislocation treated with anatomic CC fixation using double clavicular tunnels and three flip-buttons. Methods: A retrospective, unicentric study was performed. The study included patients with high-grade AC joint dislocation who underwent surgery with anatomic CC fixation using double clavicular tunnels and three flip-buttons. Demographic data were obtained from medical records. A functional evaluation using subjective shoulder value (SSV), visual analog scale (VAS), and disabilities of the arm, shoulder, and hand (DASH) questionnaires was performed, and an evaluation of preoperative and postoperative comparative Zanca view images was performed. Factors associated with functional outcomes and radiological AC reduction were analyzed. Results: A total of 83 patients completed follow-up and were included in the analysis. The mean SSV, VAS, and DASH scores were 92.8, 0.8, and 6.4, respectively. Patients who had complications experienced significantly worse functional outcomes (DASH: P=0.037). Suboptimal final AC reduction was observed in nine patients (11.1%), and significantly more frequently in patients older than 40 years (P=0.031) and in surgeries performed more than 7 days after injury (P=0.034). There were two reoperations (2.4%). Conclusions: Anatomic CC fixation with a double clavicular tunnel and three flip-buttons leads to good functional outcomes, low complication rates, and high rates of optimal AC reduction.

Keywords

Acknowledgement

The authors are grateful to Andrea Canals for statistical analysis, to Maria T. Alliende for manuscript preparation, and to Alejandro Viacava and Hector Carreno for the performed surgeries.

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