Arthroscopic-Assisted Coracoclavicular Ligament Reconstruction for Acute Acromioclavicular Dislocation Using 2 Clavicular and 1 Coracoid Cortical Fixation Buttons With Suture Tapes

Shin, Sang-Jin; Jeon, Young-Chan; Kim, Rag Gyu

doi:10.1016/j.arthro.2017.02.003

Cited by 27 publications

(36 citation statements)

References 23 publications

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“…As an open surgical technique, Choi et al9) used an autograft tendon instead of sutures for CC ligament reconstruction and found that reduction loss occurred in 47% of the cases, which indicated that frequency of reduction loss was high regardless of the material used in reconstruction. However, a recent study by Shin et al5) that used the same material as the present study reported much better outcomes with reduction loss occurring in only one of 21 patients. Such results may be attributed to creating two tunnels rather than just one in the clavicle, while allowing fixation with reconstruction of both the conoid and trapezoid ligaments that make up the CC ligament.…”

Section: Discussioncontrasting

confidence: 40%

“…This technique has the advantages of being relatively minimally invasive and providing effective fixation of the CC distance without requiring surgery to remove the internal fixture. Its biomechanical excellence has been proven by recent articles, and several actual clinical cases with favorable outcomes have also been reported 2345). Moreover, the indication for this technique is expanding because the technique can be used for not only the AC joint dislocation, but also acute distal clavicle fractures with CC ligament disruption 6).…”

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confidence: 98%

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Intraoperative and Postoperative Complications after Arthroscopic Coracoclavicular Stabilization

Lim

2019

Clin Orthop Surg

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Background Arthroscopic stabilization of torn coracoclavicular (CC) ligaments gained popularity recently. However, loss of reduction after the operation and complications unique to this technique involving tunnel placement through the distal clavicle and coracoid process are concerns. The purpose of this study was to report intraoperative and early postoperative complications associated with this procedure. Methods This study retrospectively evaluated 18 consecutive patients who had undergone arthroscopic stabilization for torn CC ligaments between 2014 and 2015. The indications for surgery were acute or chronic acromioclavicular dislocation and acute fracture of the distal clavicle, associated with CC ligament disruption. Clinical outcomes were evaluated with the American Shoulder and Elbow Surgeons (ASES) and the University of California, Los Angeles (UCLA) scores. Intra- and postoperative complications and reoperations were investigated. Results There were six female and 12 male patients with a mean age of 47 years (range, 22 to 86 years). At a mean follow-up of 17 ± 10 months (range, 10 to 28 months), the mean ASES score was 88.8 ± 19.9 and the mean UCLA score was 30.9 ± 5.2. Intraoperatively, seven complications developed: breach of lateral cortex of the coracoid process in five patients, medial cortex of the coracoid process in one, and anterior cortex of the clavicle in one. Postoperative complications developed in eight patients: four ossifications of the CC interspace, four tunnel widening of the clavicle, one bony erosion on the clavicle, and one superficial infection. A loss of reduction was found in six patients. Reoperation was performed in three patients for loss of reduction in two and superficial infection in the other. Conclusions Arthroscopic CC stabilization resulted in high rates of intraoperative and early postoperative complications. Most of them were related to the surgical technique involving bone tunnel placement in the coracoid process and the clavicle.

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Section: Discussioncontrasting

confidence: 40%

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confidence: 98%

Intraoperative and Postoperative Complications after Arthroscopic Coracoclavicular Stabilization

Lim

2019

Clin Orthop Surg

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“…Even so, to truly demonstrate the change in reduction after surgery, preoperative films should be compared with the immediately postoperative films, followed by a comparison at the latest follow-up, as only few studies have done. 9,71,73,75,93,102 The overall failure rate for reconstruction was high: 20.8%. However, it is evident that not all losses of reduction may be clinically relevant because only about half were symptomatic and required revision (9.5% revision rate vs 20.8% loss of reduction).…”

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confidence: 99%

Current Concepts in the Operative Management of Acromioclavicular Dislocations: A Systematic Review and Meta-analysis of Operative Techniques

et al. 2018

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Background: Acromioclavicular (AC) instability is a frequent injury affecting young and athletic populations. Symptomatic, high-grade dislocations may be managed by a myriad of operative techniques that utilize different grafts to achieve reduction. Comparative data are lacking on the ability of these techniques to achieve excellent patient outcomes and stable AC reduction and to minimize complications. Purpose: To systematically review the outcomes and complications of different techniques of AC joint reconstruction. Study Design: Systematic review and meta-analysis. Methods: The MEDLINE, Scopus, Embase, and Cochrane Library databases were accessed to perform a systematic review of the scientific literature from 2000 to 2018 using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria with the following keywords: “acromioclavicular” and “reconstruction.” Included articles were evaluated for loss of reduction, complication rate, revision rate, and change in coracoclavicular distance. Articles were stratified by graft and surgical material used: suture only, Endobutton with suture, TightRope, GraftRope, synthetic artificial ligament, tendon graft, and Weaver-Dunn coracoacromial ligament transfer. These outcomes were pooled using a random-effects model and stratified by surgical technique and arthroscopic versus open reconstruction. Results: Fifty-eight articles were included in the analysis, with 63 homogeneous populations composed of 1704 patients. The mean age was 37.1 years (range, 15-80 years) with a mean follow-up of 34.3 months (range, 1.5-186 months). The overall failure rate was 20.8% (95% CI, 16.9%-25.2%). The overall pooled complication rate was 14.2% (95% CI, 10.5%-18.8%). The most common complications were infection (6.3% [95% CI, 4.7%-8.2%]), fracture to the coracoid or distal clavicle (5.7% [95% CI, 4.3%-7.6%]), and hardware/button failure (4.2% [95% CI, 3.1%-5.8%]). There were no differences between arthroscopic and open techniques in regard to loss of reduction ( P = .858), overall complication rate ( P = .774), and revision rate ( P = .390). Open surgery had a greater rate of clavicular/coracoid fractures than arthroscopic surgery ( P = .048). Heterogeneity, best assessed from the pooled loss of reduction, was measured as I2 = 64.0%. Conclusion: Open and arthroscopic AC joint reconstruction techniques have no differences in loss of reduction, the complication rate, and the revision rate based on the available literature. Complications are significant, and profiles vary between surgical techniques, which should be evaluated in the decision making of selecting the technique.

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“…This rate of loss of reduction is significantly higher than reported in double-bundle CC ligament reconstructions, which have demonstrated a 4.8% reduction loss after 2 years of follow-up. [2][3][4][5] To evaluate which fixation method was biomechanically superior, the authors used 8 cadaveric specimens and evaluated AC joint transition and rotational stability using a 3-dimensional system, after each of the 4 fixation methods. With regard to AC joint translation, the authors examined native and reconstructed AC joint anteroposterior (AP) and superoinferior translation using 10 and 15 N loads.…”

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confidence: 99%

“…The CC ligaments' footprint on the clavicle is broad, and therefore recreating its footprint with a single point of fixation during CC ligament repair has been associated with loss of reduction and inferior function. 2,6,8,9 Double-bundle AC joint reconstruction provides significantly better restraint to AP translation and trends toward superior rotational control compared with SB reconstruction. 1 There is a broad spectrum of surgical treatments of AC joint instability.…”

Section: See Related Article On Page 2983mentioning

confidence: 99%

Editorial Commentary: Double Bundle the Coracoclavicular Ligaments for Success: The More the Better?

Chahla

Cinque

2018

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Injuries to the acromioclavicular joint are common across all levels of sport and activity. Overall, a consensus exists regarding Rockwood grade I and II injuries (conservative approach) and Rockwood grades IV to VI (best treated surgically). However, grade III injuries are heterogeneous and thus respond differently to nonoperative and operative treatment. Regardless of the acromioclavicular injury grade, these are widely prevalent injuries, and there is a lack a consensus as to which operative fixation methods yield the best outcomes for patients. Although K-wires and plates were historically used to achieve rigid fixation, recent evidence supports the use of soft tissue grafts to reconstruct the coracoclavicular ligaments and restore vertical and anteroposterior and rotational stability with a more biological approach.

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Arthroscopic-Assisted Coracoclavicular Ligament Reconstruction for Acute Acromioclavicular Dislocation Using 2 Clavicular and 1 Coracoid Cortical Fixation Buttons With Suture Tapes

Cited by 27 publications

References 23 publications

Intraoperative and Postoperative Complications after Arthroscopic Coracoclavicular Stabilization

Intraoperative and Postoperative Complications after Arthroscopic Coracoclavicular Stabilization

Current Concepts in the Operative Management of Acromioclavicular Dislocations: A Systematic Review and Meta-analysis of Operative Techniques

Editorial Commentary: Double Bundle the Coracoclavicular Ligaments for Success: The More the Better?

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