• Clinics in Shoulder and Elbow
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• v.12 no.2
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• pp.167-172
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• 2009

Purpose: We wanted to evaluate the results of treating acromioclavicular joint dislocation using an AO hook plate. Materials and Methods: Between February 2008 and September 2009, 10 patients underwent implant removal after surgical treatment of acromioclavicular joint dislocation using a AO hook plate. The Constant-Murley scoring system was administered postoperatively for evaluating the clinical results, and simple X-ray was taken for evaluating the state of reduction. Results: All cases showed satisfactory results on the clinical and radiological study. The mean Constant-Murley score at follow-up was 90.5 (range: 84~95). Three patients had some degree of discomfort with the hook plate, but these symptoms were relieved on removal of the plate. The radiological evaluation showed restoration of the vertical displacement of the clavicle in all the patients. No complications occurred such as infection, plate failure or redislocation after removal of the plate. Conclusion: The short term follow-up results of treating acromioclvicular joint dislocation using an AO hook plate were satisfactory both clinically and radiologically.

• Clinics in Shoulder and Elbow
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• v.21 no.2
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• pp.95-100
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• 2018

Background: The purpose of this study was to evaluate the clinical outcomes and complications of hook plate fixation in acromioclavicular (AC) joint dislocations and distal clavicle fractures. Methods: We retrospectively reviewed a series of 60 consecutive patients with hook plate fixation for AC joint dislocation (group I) and distal clavicle fracture (group II). Groups I and II had 39 and 21 patients, respectively. Clinical results were evaluated using the pain visual analogue scale (VAS), simple shoulder test, and Constant-Murley scores. In addition, subacromial erosion and stiffness were evaluated as complications. Results: At the removal, the pain VAS was $2.69{\pm}1.30$ and $4.10{\pm}2.14$ in groups I and II, respectively, which were significantly different (p=0.003). The simple shoulder test score was $9.59{\pm}1.60$ and $7.81{\pm}2.67$ in groups I and II, respectively, which were also significantly different (p=0.002). Subacromial erosion was significantly more frequent in group II (14/21 patients, 66.7%) than in group I (15/39 patients, 38.5%) (p=0.037), and stiffness was also higher in group II (17/21 patients, 81.0%) than in group I (22/39 patients, 56.4%), but it was not significant. Conclusions: Hook plate fixation showed good clinical and functional results for the treatment of acute unstable AC joint dislocation and distal clavicle fracture. But, in distal clavicle fractures, there are more subacromial erosion and stiffness compare with acute unstable AC joint dislocation.

• The Academic Congress of Korean Shoulder and Elbow Society
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• 2007.03a
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• pp.82-83
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• 2007

• Clinics in Shoulder and Elbow
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• v.20 no.2
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• pp.59-67
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• 2017

Background: The purpose of this study was to examine the clinical and radiological results of the all-arthroscopic, suture-button fixation technique to treat acute acromioclavicular (AC) joint separations. Methods: All patients with acute AC joint separations received all-arthroscopic, single suture-button (TightRope) procedure without a special guide. Postoperative Constant score (CS), pain level according to visual analogue scale, and range of motion (ROM) were evaluated. For radiological evaluation, coracoclavicular distances were measured bilaterally. Results: Between December 2010 and June 2012, 18 consecutive patients (4 women and 14 men; mean age, 29.3 years) with acute AC joint separations underwent surgical treatment after 6.4 days (range, 2-20 days) following the initial trauma. The average postoperative follow-up was 16.9 months. The mean CS was 92.4 (range, 84-96). The mean external rotation, forward flexion, and abduction were $75.8^{\circ}$ (range, $50^{\circ}-90^{\circ}$), $170^{\circ}$ (range, $150^{\circ}-180^{\circ}$), and $163.8^{\circ}$ (range, $140^{\circ}-180^{\circ}$), respectively. Five patients exhibited coracoclavicular ossifications. In two patients, superficial wound infections were successfully treated with antibiotic therapy. In one patient, a coracoid fracture was observed. No significant differences were found regarding pain, ROM, or strength parameters between both sides. The coracoclavicular distance was discovered to be approximately 2.8 mm greater on the affected side; however, this minimal reduction loss did not affect the functional results. Conclusions: The findings of this study suggests that all-arthroscopic treatment of AC joint separations using the single suture-button technique without a drill guide is safe, yielding good to excellent clinical results.

• Clinics in Shoulder and Elbow
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• v.25 no.3
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• pp.224-229
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• 2022

Background: Most acromioclavicular joint (ACJ) injuries are caused by direct trauma to the shoulders, and various methods and techniques are used to treat them; however, none of the options can be considered the gold standard. This study examines the horizontal stability of the ACJ after a complete dislocation was repaired using one of two Ethibond suture techniques, the loop technique and the two holes in the clavicle technique. Methods: In this single-blind, randomized clinical trial, 104 patients diagnosed with complete ACJ dislocation type V were treated using Ethibond sutures with either the loop technique or the two holes in the clavicle technique. Horizontal changes in the ACJ were radiographically assessed in the lateral axial view, and shoulder function was evaluated by the Constant (CS) and Taft (TS) scores at intervals of 3, 6, and 12 months after surgery. Results: The horizontal stability of the ACJ was better with the two-hole technique than the loop technique at all measurement times. CS and TS changes showed a significant upward trend over time with both techniques. The mean CS and TS at the final visit were 95.2 and 11.6 with the loop technique and 94.0 and 11.9 with the two-hole technique, respectively. The incidence of superficial infections caused by the subcutaneous pins was the same in the two groups. Conclusions: Due to the improved ACJ stability with the two-hole technique, it appears to be a more suitable option than the loop technique for AC joint reduction.

• Clinics in Shoulder and Elbow
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• v.26 no.4
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• pp.373-379
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• 2023

Background: The purpose of this study was to determine the association between smoking and clinical outcomes of hook plate fixation for acute acromioclavicular (AC) joint injuries. Methods: This study retrospectively investigated 82 patients who underwent hook plate fixation for acute AC joint dislocation between March 2014 to June 2022. The patients were grouped by smoking status, with 49 in group N (nonsmokers) and 33 in group S (smokers). Functional scores and active range of motion were compared among the groups at the 1-year follow-up. Coracoclavicular distance (CCD) was measured, and difference with the uninjured side was compared at initial injury and 6 months after implant removal. Results: No significant differences were observed between the two groups in demographic factors such as age and sex, as well as parameters related to initial injury status, which included time from injury to surgery, the preoperative CCD difference value, and the Rockwood classification. However, the postoperative CCD difference was significantly higher in group S (3.1±2.6 mm) compared to group N (1.7±2.4 mm). Multivariate regression analysis indicated that smoking and the preoperative CCD difference independently contributed to an increase in the postoperative CCD difference. Despite the radiographic differences, the postoperative clinical outcome scores and active range of motion measurements were comparable between the groups. Conclusions: Smoking had a detrimental impact on ligament healing after hook plate fixation for acute AC joint dislocations. This finding emphasizes the importance of smoking cessation to optimize reduction maintenance after AC joint injury. Level of evidence: III.

• Clinics in Shoulder and Elbow
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• v.26 no.2
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• pp.140-147
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• 2023

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.

• Clinics in Shoulder and Elbow
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• v.24 no.4
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• pp.209-214
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• 2021

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.

• The Academic Congress of Korean Shoulder and Elbow Society
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• 2005.03a
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• pp.73-73
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• 2005

• The Academic Congress of Korean Shoulder and Elbow Society
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• 2008.03a
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• pp.109-109
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• 2008