Acromioclavicular joint dislocation treated with Bosworth screw and additional K-wiring: results after 7.8 years – still an adequate procedure?

Abstract

BackgroundThe acromioclavicular (AC) joint dislocation is a major reason for shoulder instability. Different concepts of treatment and surgical methods are described in the literature. Thus, the purpose of this study was to present our data of long-term follow-up of patients having undergone treatment of acromioclavicular (AC) joint dislocation using the Bosworth Screw with additional K-wiring.MethodsThis study was conducted as a retrospective single centre data analysis. All patients treated operatively for AC joint dislocation with a Bosworth screw and additional K-wire fixation at our Department were asked to participate in this study.ResultsThe study population consisted of 22 patients, 20 male and 2 female, with a mean age of 40 years ±15.6 years. Three grade-II lesions, 13 grade-III lesions, four grade-IV lesions and two grade-V lesions according to the Rockwood classification were found. The overall mean clinical outcome at the latest follow up was: Constant 95, DASH 6.4, ASES 94.6, SST 99.02, UCLA 33.1, ACJI 91.82 and VAS 0.29 – representing a good-to-excellent long-term outcome in all patients after at least 2 years follow-up (range; 2 - 19 years). Overall, 19 patients (86%) reported to be very satisfied with the achieved result, 15 patients (68%) reported to be able to participate in every sports activity and 16 patients (73%) reported to be able to perform their daily work without limitations. Overall, complications occurred in three patients (14%). Only one patient remained unsatisfied with the achieved result.ConclusionSummarizing, our reported results showed that surgical fixation of acute AC joint dislocation with a Bosworth screw and additional K-wire fixation leads to good-to-excellent functional outcome and highly satisfactory results in the majority of patients. Despite its complications, in accordance with our results, Bosworth screw fixation with additional K-wiring in AC joint dislocation represents an adequate surgical procedure.Level of Evidence: Level IV, retrospective study.

Different treatment strategies for acromioclavicular dislocation injuries: a nationwide survey on open/minimally invasive and arthroscopic concepts

“…While Bosworth screws are no longer used in isolation, they are still sometimes combined with other treatment modalities. Tiefenboeck et al [ 23 ] showed that Bosworth screw fixation with additional K-wire stabilization offers good-to-excellent functional outcomes and was well tolerated.…”

Primary Acromioclavicular-Coracoclavicular Reconstruction Using 2 Allografts, TightRope, and Stabilization to the Acromion

“…performed biomechanical tests, which demonstrated the superiority of an anatomic CC ligament reconstruction over the modified Weaver-Dunn technique. Numerous modifications of the Weaver-Dunn technique and anatomic CC reconstruction have been reported including both open and arthroscopic options 7, 8, 9, 12, 13. Despite these efforts, up to 80% of patients following AC reconstruction have been reported to lose radiographic reduction, and between 20% and 30% of patients treated surgically are reported to have complications leading to reoperation 14, 15.…”

“…Numerous modifications of the Weaver-Dunn technique and anatomic CC reconstruction have been reported including both open and arthroscopic options. 7 , 8 , 9 , 12 , 13 Despite these efforts, up to 80% of patients following AC reconstruction have been reported to lose radiographic reduction, and between 20% and 30% of patients treated surgically are reported to have complications leading to reoperation. 14 , 15 The goal of the presented technique is to use the biomechanical data available to create a construct that minimizes failure and provides anatomic restoration of the AC joint using a reinforced biologic construct.…”

“…Since the Weaver-Dunn procedure was first described, numerous modifications and new open and arthroscopic techniques have emerged. Despite these many surgical techniques, no gold standard surgical technique is agreed on 7, 8, 9. Nevertheless, specific criteria are recommended when treating AC joint dislocations surgically: (1) biologic augmentation, namely, tendon graft, should be used, and (2) anatomic techniques for surgical reconstruction should be favored 5 .…”

“…Despite these many surgical techniques, no gold standard surgical technique is agreed on. 7 , 8 , 9 Nevertheless, specific criteria are recommended when treating AC joint dislocations surgically: (1) biologic augmentation, namely, tendon graft, should be used, and (2) anatomic techniques for surgical reconstruction should be favored. 5 The objective of this Technical Note is to describe an anatomic AC and CC ligament reconstruction technique using 2 tendon grafts, an AC TightRope (Arthrex, Naples, FL), and 2 precontoured Dog Bone Buttons (Arthrex) for primary surgical treatment of symptomatic primary AC joint instability.…”