Acromioclavicular Joint Reduction, Repair and Reconstruction Using Metallic Buttons-Early Results and Complications

Lim, Yeow Wai; Sood, Anubhuti; Riet, Roger P. van; Bain, Gregory I.

doi:10.1097/bte.0b013e3181578965

Cited by 62 publications

(51 citation statements)

References 17 publications

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“…The addition of CA ligament transfer to distal clavicle in AC joint reconstruction with hamstring allograft did not significantly improve the overall biomechanical strength [8]. Although the WeaverDunn-Chuinard procedure (CA ligament with a bone piece) with double-button fixation of the chronic AC joint dislocation gave encouraging results, the durability of the reconstruction in a series of 10 cases was unproven [20]. The residual subluxation and dislocation in spite of various Weaver-Dunn procedures for AC joint dislocation are reported to be between 29 and 76% [28,32].…”

Section: Discussionmentioning

confidence: 89%

Arthroscopic acromioclavicular joint reconstruction using a synthetic ligament device

Kany¹,

Amaravathi

Guinand³

et al. 2011

Eur J Orthop Surg Traumatol

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Purpose To describe an all-arthroscopic treatment of acromioclavicular joint (ACJ) dislocation and report the clinical results of the procedure. Methods This study consisted of 54 patients of whom 49 were men and 5 were women. The age of the patients averaged 39 years (range 16-69 years). All the symptomatic acute and chronic acromioclavicular joint dislocations classified according to Rockwood type III-IV were included in the study. All of them underwent standard clinical and radiological examination. Result All the patients were regularly followed up at the institute with the average follow-up being 15.09 months (range 5-30 months). The results were assessed using the shoulder subjective value (SSV) and the Modified rating of the University of California Los Angeles (UCLA) for acromioclavicular joint. The mean pre-operative SSV improved from 35.65 to the post-operative value of 88.6. According to the UCLA scale, 40 excellent, 8 good, 4 fair and 2 poor results were achieved. There were few problems encountered with the procedure like failure of ligament, incomplete reduction, capsulitis, and migration of sleeve and fracture clavicle.Conclusion ACJ dislocations can effectively be treated with arthroscopy-assisted procedure. Since this procedure has given uniformly good to excellent results comparable to open reconstructive procedures, it can be a good treatment option for symptomatic ACJ dislocations. Level of evidence IV, therapeutic series.

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Section: Discussionmentioning

confidence: 89%

Arthroscopic acromioclavicular joint reconstruction using a synthetic ligament device

Kany¹,

Amaravathi

Guinand³

et al. 2011

Eur J Orthop Surg Traumatol

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“…A proposed mechanism for failure of the device in the cases that allowed for loss of reduction includes abrasion and disruption of the suture or knot slippage [16]. We are uncertain of the mode of failure since none of the devices showed any signs of migration.…”

Section: Discussionmentioning

confidence: 99%

“…Other advantages are that it is a non-rigid device and does not require removal. There have been reported high rates of failure with this device [16][17].…”

Section: Introductionmentioning

confidence: 99%

Recommendations for Optimizing Acromioclavicular Fixation Success with the Tight Rope Device

Simonian¹

2017

MOJOR

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Purpose: To determine if the TightRope device (Arthrex Naples, FL) for fixation of acromioclavicular (AC) separations can create an environment for biologic healing of the coracoclavicular (CC) ligaments.Methods: Twenty-five male subjects, sustained Grade V AC separations. All patients had AC reconstruction with the TightRope device (Arthrex, Naples, FL). The time from the injury to surgical fixation averaged 13 days.Results: Twenty-one of 25 patients had an anatomic reduction of their AC joint. Four were reduced to a near-anatomic (within 2mm) reduction. At final followup, four (16%) patients maintained their anatomic reduction. These four patients underwent surgery at an average of 11 days after the date of injury and had an average age of 25 years. Thirteen (52%) patients displaced to a grade II level (Rockwood classification). These patients averaged 10 days from the date of injury to the date of surgery and had an average age of 39 years. Eight (32%) of the 25 had displaced back to a grade III level (Rockwood classification). These patients averaged 18 days from the date of injury until date of surgery and had an average age of 35 years. All 25 patients described a subjective improvement regardless of displacement. Conclusion:There is a high rate of loss of reduction when using the TightRope (Arthrex, Naples, FL) device. When this device is employed, it should be done as quickly as possible after injury. When the time from injury to surgery exceeds 11 days, loss of reduction seems to be greater. There may be a correlation between older age and a more significant loss of reduction regardless of the acuity of fixation. Level of evidence:IV.

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“…The presumed advantage of this technique is that it maintains reduction of the CC distance and allows normal movement of the ACJ [30]. Richards and Tennent reported their results in ten patients treated with the TightRope system [51].…”

Section: Tightrope Systemmentioning

confidence: 97%

Management of the Acromioclavicular Joint Problems

Tetik

2011

Sports Injuries

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The acromioclavicular joint (ACJ) is composed of the distal end of the clavicle and the acromion. Its function is to anchor the clavicle to the scapula and to the shoulder girdle. The subcutaneous location of this joint makes it vulnerable to injury. It is approximately 9% of all the shoulder injuries. The majority of the injuries occur in men with a male to female ratio of approximately 5:1, and patients in their 20s are the most affected age group [53]. Because of the high incidence of these injuries, orthopedists, sports medicine doctors, emergency physicians, and physical therapists should be aware of the management of these injuries [56]. AnatomyThe ACJ is subcutaneous and has little protection by soft tissues. It is composed of the distal end of the clavicle and the acromion and serves to anchor the clavicle to the scapula and the shoulder girdle. This is an inherently unstable articulation. ACJ capsule and the strong coracoclavicular (CC) ligaments, conoid ligament medially and trapezoid ligament laterally, support the joint and provide static stability. The dynamic stabilizers are the trapezius and deltoid muscles. The distal ends of the clavicle and the acromion are lined with hyaline cartilage, and there is a meniscal structure intraarticularly. The role of this meniscus is negligible, and generally it is thought to be degenerated during the fourth decade [56].The clavicular origin of the conoid ligament originates an average of 46 mm medial to the ACJ, and the trapezoid ligament originates 26 mm medial to the ACJ. The conoid is more posterior compared with the trapezoid origin at the mid-portion of the inferior surface of the clavicle [52]. The superior, inferior, and posterior acromioclavicular (AC) ligaments insert an average of 16-20 mm medial to the ACJ on the clavicle. The importance of this anatomic observation is that aggressive distal clavicle excision (DCE) can destabilize the ACJ and lead to symptomatic posterior impingement against the acromion if that ranges were exceeded.

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Acromioclavicular Joint Reduction, Repair and Reconstruction Using Metallic Buttons-Early Results and Complications

Cited by 62 publications

References 17 publications

Arthroscopic acromioclavicular joint reconstruction using a synthetic ligament device

Arthroscopic acromioclavicular joint reconstruction using a synthetic ligament device

Recommendations for Optimizing Acromioclavicular Fixation Success with the Tight Rope Device

Management of the Acromioclavicular Joint Problems

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