Acromioclavicular joint separations

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Acromioclavicular (AC) joint injuries are common injuries, especially in the young and active, male population. AC joint injuries account for 12% of all injuries of the shoulder girdle in the overall population. Although conservative treatment is recommended for Rockwood type I and type II injuries, there is controversial debate about optimal treatment for type III injuries. High-grade injuries are typically treated operatively to avoid painful sequelae. A vast number of different surgical methods have been described over the past few decades. Recent advances in arthroscopic surgery have enabled the shoulder surgeon to treat acute and chronic AC lesions arthroscopically assisted. Clinical studies have already shown good and reliable results. Although surgeons agree that a biological augmentation is required to minimize the risk of recurrent instability in chronic cases, a gold standard still needs to be defined. We present an arthroscopically assisted biological augmentation technique to reconstruct the AC and coracoclavicular ligaments, protected by a button-suture tape construct for chronic AC joint instability. The presented arthroscopic biological augmentation technique uses less and/or smaller drill holes in the clavicle and coracoid than previously described, thus reducing weakening of the bony structures. At the same time it enhances both horizontal and vertical stability.

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Arthroscopically Assisted Acromioclavicular and Coracoclavicular Ligament Reconstruction for Chronic Acromioclavicular Joint Instability

Martetschläger

Tauber

Habermeyer³

et al. 2016

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“…1,2 Although the treatment of Rockwood grade III AC joint injuries is controversial, a recently described subclassification may have helped solve the treatment algorithm with evidence supporting nonoperative treatment of Rockwood grades I, II, and IIIA (horizontally stable) whereas Rockwood grades IIIB (horizontally unstable), IV, V, and VI should be treated with surgical reconstruction. 3 Historically, open procedures have been the dominant surgical treatment strategy, although more recently, arthroscopically assisted techniques have become more popular because of the minimally invasive operation, the enhanced visualization, and the ability to diagnose and treat concomitant glenohumeral pathologies, which are common in higher-grade injuries.…”

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confidence: 99%

“…9 Additional soft-tissue grafts to reconstruct the CC ligaments are advocated by most investigators for chronic cases, 3,10 whereas others advocate soft-tissue graft reconstruction of the CC ligaments in all cases of surgical AC joint reconstruction, with the goal of achieving improved primary stability. 1,6 Techniques that obviate drill holes in which the softtissue graft is looped around the coracoid and clavicle were developed to decrease the risk of clavicle or coracoid fracture. 9 Despite the advantage of single bone tunnels with a lower fracture risk, these newer techniques had the disadvantage of having a thicker knot stack on top of the clavicle.…”

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confidence: 99%

Arthroscopic Acromioclavicular Joint Reconstruction Using Knotless Coracoclavicular Fixation and Soft-Tissue Anatomic Coracoclavicular Ligament Reconstruction

Menge

Tahal

Katthagen

et al. 2017

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Acromioclavicular joint injuries are one of the most common shoulder injuries, and there are a variety of treatment options. Recently, there have been newer arthroscopic techniques that have addressed coracoid and clavicle fracture risk by using a knotted suture-button fixation through a single, small bone tunnel with additional looped softtissue graft stabilization. Although clinical outcomes have been good to excellent, there have still been instances of knot and hardware irritation. The described technique builds on the latest advances and achieves an anatomic coracoclavicular (CC) reconstruction through a single knotless CC fixation device with additional soft-tissue allograft reconstruction of the CC ligaments. This technique minimizes the risks of coracoid and clavicle fractures and knot and hardware irritation while maintaining excellent stability.

“…The ideal management of grade III injuries remains controversial, with many surgeons performing surgery acutely in highlevel athletes and manual laborers. [3][4][5] The original Weaver-Dunn method of AC joint reconstruction has been modified over the past 4 decades, most recently with anatomic coracoclavicular ligament reconstruction with soft-tissue grafts, which have shown superiority on biomechanical testing. 6 Bone tunnels through the clavicle are commonly used to reconstruct the coracoclavicular ligaments; however, they have been associated with a significant decrease in clavicle strength with a subsequent increase in the risk for postoperative fracture.…”

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confidence: 99%

Arthroscopically Assisted Anatomic Coracoclavicular Ligament Reconstruction Technique Using Coracoclavicular Fixation and Soft-Tissue Grafts

Millett

Warth

Greenspoon

2015

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Acromioclavicular joint injuries are common and are often seen in contact athletes. Good to excellent clinical results have been reported using soft-tissue grafts to reconstruct the coracoclavicular ligaments; however, complications remain. Some complications are unique to the surgical technique, particularly clavicle and coracoid fractures that are associated with drilling large or multiple bone tunnels. The described technique allows for an anatomic coracoclavicular reconstruction using a large soft-tissue graft while minimizing the risk of clavicle fracture by avoiding large bone tunnels.