“…Initial methods to restore AC joint stability described transfer of the coracoacromial ligament to the distal clavicle (i.e., Weaver-Dunn procedure), while more modern techniques focus on more anatomic reconstructions of the coracoclavicular (CC) ligaments through either open or arthroscopic-assisted approaches. 1,2 Results of arthroscopy-assisted CC reconstruction have, thus far, been promising, with high rates of patient satisfaction and improved patientreported outcome scores (PRO scores) after surgery, [3][4][5][6] albeit with residual risk of recurrent deformity due to loss of anatomic reduction.…”
Section: See Related Article On Page 3025mentioning
There are numerous described techniques for surgical management of high-grade acromioclavicular (AC) joint injuries, and the associated clinical outcomes can be quite variable. Contemporary techniques are typically directed at anatomic reconstruction of the coracoclavicular (CC) ligaments through either an arthroscopy-assisted or an open approach. Most patients treated with acute surgery improve, whereas in chronic cases, the majority improve, but a significant number have persistent recurrent deformity due to loss of anatomic reduction. In addition, whether acute or chronic, over one quarter of patients do not have a PASS (patient acceptable symptomatic state). Of interest, PASS may not primarily be related to the final deformity in terms of coracoclavicular distance, and investigation is still required in terms of the effect of anteroposterior or rotational instability of the AC joint after injury and surgery. Finally, PASS values for AC separation are not well established, resulting in a current limitation of the strength of applying threshold values to this pathology.
“…Initial methods to restore AC joint stability described transfer of the coracoacromial ligament to the distal clavicle (i.e., Weaver-Dunn procedure), while more modern techniques focus on more anatomic reconstructions of the coracoclavicular (CC) ligaments through either open or arthroscopic-assisted approaches. 1,2 Results of arthroscopy-assisted CC reconstruction have, thus far, been promising, with high rates of patient satisfaction and improved patientreported outcome scores (PRO scores) after surgery, [3][4][5][6] albeit with residual risk of recurrent deformity due to loss of anatomic reduction.…”
Section: See Related Article On Page 3025mentioning
There are numerous described techniques for surgical management of high-grade acromioclavicular (AC) joint injuries, and the associated clinical outcomes can be quite variable. Contemporary techniques are typically directed at anatomic reconstruction of the coracoclavicular (CC) ligaments through either an arthroscopy-assisted or an open approach. Most patients treated with acute surgery improve, whereas in chronic cases, the majority improve, but a significant number have persistent recurrent deformity due to loss of anatomic reduction. In addition, whether acute or chronic, over one quarter of patients do not have a PASS (patient acceptable symptomatic state). Of interest, PASS may not primarily be related to the final deformity in terms of coracoclavicular distance, and investigation is still required in terms of the effect of anteroposterior or rotational instability of the AC joint after injury and surgery. Finally, PASS values for AC separation are not well established, resulting in a current limitation of the strength of applying threshold values to this pathology.
“…A cromioclavicular (AC) dislocations represent up to 12% of all shoulder injuries 1 and, although no gold standard treatment has been established, there is currently a tendency toward an arthroscopic approach, which has been demonstrated to be extremely safe and reliable. 1,2 However, despite significant evolution in fixation materials and techniques, postoperative loss of reduction is a concern, affecting up to 28% of operated patients. 3 The objective of this technical note is to describe a technique that ensures accurate reduction of the AC joint and minimizes loss of reduction following coracoclavicular (CC) arthroscopic fixation.…”
Loss of reduction is the most common complication following acromioclavicular dislocations treatment, with literature showing greater postoperative coracoclavicular distances associated with worse clinical results. We present a surgical gesture that aims to help surgeons achieve and secure an anatomic acromioclavicular reduction during coracoclavicular fixation. This technique has the possibility to improve radiological and functional results of acromioclavicular dislocation treatment.
“…For this reason, reconstructive strategies must give the same importance to AC reconstruction as to CC reconstruction. This evidence could explain why despite reports of some loss of reduction in the vertical plane after CC reconstruction, patients still have good subjective outcomes, particularly when clinical examination findings show that the ACJ posterior translation test result is negative, as reported by Garofalo et al, 13 as well as the literature review by Gowd et al 14 Lamplot et al 4 failed to show better results in patients in whom reconstruction of the AC capsule and ligaments was associated with CC reconstruction. However, looking at their series shows that the 8% of cases that were not able to resume activity fell into the group that did not receive any associated AC reconstruction.…”
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confidence: 96%
“…In the case series reported by Lamplot et al, 4 the tendon in all cases was passed around the base of the coracoid without any tunnels; however, it was secured in different ways at the level of the clavicle. Although there are some concerns about the possibility of healing of tissue graft around the coracoid base without any fixation, we could eliminate the risk of coracoid complications in this way.…”
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confidence: 99%
“…A last important point regarding the study by Lamplot et al 4 is related to the use of arthroscopy when performing ACJ reconstruction. When we look at outcomes previously reported with open procedures, shifting to arthroscopy does not appear to provide significant improvement.…”
Surgical management of chronic acromioclavicular joint (ACJ) dislocations is a matter of controversy. In the acute setting of high-grade acromioclavicular separation, if a surgical repair of the ACJ capsule and ligaments and deltotrapezial fascia could allow biological healing of the ligaments themselves, this could be enough to restore the functional biomechanics of the joint; unfortunately, this is not true for chronic cases. In the latter situation, a surgical technique using biological augmentation such as autograft or allograft should be preferred. Time is very important for this injury, and a chronic lesion should be considered when treatment is being performed 3 weeks after trauma. The graft should be passed around the base of the coracoid or through a tunnel at the base of the coracoid itself and then at the level of the clavicle as anatomically possible to reproduce the function of the native ligaments. However, some studies have shown that passing the graft at the base of the coracoid and wrapping it around the clavicle could also achieve satisfactory outcomes. An arthroscopic technique, when used in combination, could be great to treat the associated lesions, which have a reported percentage between 30% and 49%. Finally, to restore the biomechanics of the ACJ, however, reconstruction of the acromioclavicular superior and posterior capsules together with the deltotrapezial fascia seems to be very important.
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