Arthroscopically assisted stabilization of acute high-grade acromioclavicular joint separations in a coracoclavicular Double-TightRope technique: V-shaped versus parallel drill hole orientation

Kraus, Natascha; Haas, Norbert; Scheibel, Markus; Gerhardt, Christian

doi:10.1007/s00402-013-1804-8

Cited by 58 publications

(74 citation statements)

References 10 publications

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“…Two articles were subsequently excluded during data analysis as they utilized the same subset of prospectively collected data already included in this review. 21 , 24 The final 12 articles identified for inclusion as outlined above are listed in Table 1 .…”

Section: Resultsmentioning

confidence: 99%

Complications following arthroscopic fixation of acromioclavicular separations: a systematic review of the literature

Woodmass¹,

Esposito²,

Y³

et al. 2015

OAJSM

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PurposeOver the past decade, a number of arthroscopic or arthroscopically assisted reconstruction techniques have emerged for the management of acromioclavicular (AC) separations. These techniques provide the advantage of superior visualization of the base of the coracoid, less soft tissue dissection, and smaller incisions. While these techniques have been reported to provide excellent functional results with minimal complications, discrepancies exist within the literature. This systematic review aims to assess the rate of complications following these procedures.MethodsTwo independent reviewers completed a search of Medline, Embase, PubMed, and the Cochrane Library entries up to December 2013. The terms “Acromioclavicular Joint (MeSH)” OR “acromioclavicular* (text)” OR “coracoclavicular* (text)” AND “Arthroscopy (MeSH)” OR “Arthroscop* (text)” were used. Pooled estimates and 95% confidence intervals were calculated assuming a random-effects model. Statistical heterogeneity was quantified using the I2 statistic.Level of evidenceIVResultsA total of 972 abstracts met the search criteria. After removal of duplicates and assessment of inclusion/exclusion criteria, 12 articles were selected for data extraction. The rate of superficial infection was 3.8% and residual shoulder/AC pain or hardware irritation occurred at a rate of 26.7%. The rate of coracoid/clavicle fracture was 5.3% and occurred most commonly with techniques utilizing bony tunnels. Loss of AC joint reduction occurred in 26.8% of patients.ConclusionArthroscopic AC reconstruction techniques carry a distinct complication profile. The TightRope/Endobutton techniques, when performed acutely, provide good radiographic outcomes at the expense of hardware irritation. In contrast, graft reconstructions in patients with chronic AC separations demonstrated a high risk for loss of reduction. Fractures of the coracoid/clavicle remain a significant complication occurring predominately with techniques utilizing bony tunnels.

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Section: Resultsmentioning

confidence: 99%

Complications following arthroscopic fixation of acromioclavicular separations: a systematic review of the literature

Woodmass¹,

Esposito²,

Y³

et al. 2015

OAJSM

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show abstract

“…[18][19][20] Reconstruction using 2 adjustableeloop-length suspensory fixation devices showed greater vertical strength and horizontal strength compared with the native ligament in a cadaveric biomechanical study. Hosseini et al 21 suggested that simultaneous use of both the coracoacromial ligament transfer and the CC fixation technique using the single adjustableeloop-length suspensory fixation device can be effective for the treatment of AC joint dislocation.…”

Section: Discussionmentioning

confidence: 98%

Complications After Arthroscopic Coracoclavicular Reconstruction Using a Single Adjustable–Loop-Length Suspensory Fixation Device in Acute Acromioclavicular Joint Dislocation

Shin

Kim

2015

Arthroscopy: The Journal of Arthroscopic & Related Surgery

104

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“…Present study showed, that mini-open operative ACLC treatment was required in 21.5 % of acute ACJ dislocations to achieve anatomical reduction. This finding might at least partly explain the high rates of horizontal ACJ instability following closed techniques of acute ACJ reconstruction [13, 17, 24, 28, 30, 33]. Additional operative ACLC repair might support anatomical ACLC healing, if sufficient biomechanical augmentation is provided during the phase of healing [10].…”

Section: Discussionmentioning

confidence: 99%

“…The superior ACLC functions as the major horizontal stabilizer of the ACJ [3, 5, 8, 16]. Insufficient superior ACLC healing may contribute to persistent horizontal ACJ instability, which is reported in up to 50 % of cases following both arthroscopic and open reconstruction of acute ACJ dislocations [13, 17, 24, 33]. Horizontal ACJ instability represents a clinically relevant issue, since several studies showed an association with inferior functional outcome [13, 19, 30].…”

Section: Introductionmentioning

confidence: 99%

Injury patterns of the acromioclavicular ligament complex in acute acromioclavicular joint dislocations: a cross-sectional, fundamental study

Maier

Jaeger

Reising

et al. 2016

BMC Musculoskelet Disord

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BackgroundHorizontal instability impairs clinical outcome following acute acromioclavicular joint (ACJ) reconstruction and may be caused by insufficient healing of the superior acromioclavicular ligament complex (ACLC). However, characteristics of acute ACLC injuries are poorly understood so far. Purposes of this study were to identify different ACLC tear types, assess type-specific prevalence and determine influencing cofactors.MethodsThis prospective, cross-sectional study comprised 65 patients with acute-traumatic Rockwood-5 (n = 57) and Rockwood-4 (n = 8) injuries treated operatively by means of mini-open ACJ reduction and hook plate stabilization. Mean age at surgery was 38.2 years (range, 19–57 years). Standardized pre- and intraoperative evaluation included assessment of ACLC tear patterns and cofactors related to the articular disc, the deltoid-trapezoidal (DT) fascia and bony ACJ morphology. Articular disc size was quantified as 0 = absent, 1 = remnant, 2 = meniscoid and 3 = complete.ResultsAll patients showed complete ruptures of the superior ACLC, which could be assigned to four different tear patterns. Clavicular-sided (AC-1) tears were observed in 46/65 (70.8 %), oblique (AC-2) tears in 12/65 (18.5 %), midportion (AC-3) tears in 3/65 (4.6 %) and acromial-sided (AC-4) tears in 4/65 (6.1 %) of cases. Articular disc size manifestation was significantly (P < .001) more pronounced in patients with AC-1 tears (1.89 ± 0.57) compared to patients with AC-2 tears (0.67 ± 0.89). Other cofactors did not influence ACLC tear patterns. ACLC dislocation with incarceration caused mechanical impediment to anatomical ACJ reduction in 14/65 (21.5 %) of cases including all Rockwood-4 dislocations. Avulsion “in continuity” was a consistent mode of failure of the DT fascia. Type-specific operative strategies enabled anatomical ACLC repair of all observed tear types.ConclusionsAcute ACLC injuries follow distinct tear patterns. There exist clavicular-sided (AC-1), oblique (AC-2), midportion (AC-3) and acromial-sided (AC-4) tears. Articular disc size was a determinant factor of ACLC tear morphology. Mini-open surgery was required in Rockwood-4 and a relevant proportion of Rockwood-5 dislocations to achieve both anatomical ACLC and ACJ reduction. Type-specific operative repair of acute ACLC tears might promote biological healing and lower rates of horizontal ACJ instability following acute ACJ reconstruction.

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Arthroscopically assisted stabilization of acute high-grade acromioclavicular joint separations in a coracoclavicular Double-TightRope technique: V-shaped versus parallel drill hole orientation

Cited by 58 publications

References 10 publications

Complications following arthroscopic fixation of acromioclavicular separations: a systematic review of the literature

Complications following arthroscopic fixation of acromioclavicular separations: a systematic review of the literature

Complications After Arthroscopic Coracoclavicular Reconstruction Using a Single Adjustable–Loop-Length Suspensory Fixation Device in Acute Acromioclavicular Joint Dislocation

Injury patterns of the acromioclavicular ligament complex in acute acromioclavicular joint dislocations: a cross-sectional, fundamental study

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