Associated Lesions Requiring Additional Surgical Treatment in Grade 3 Acromioclavicular Joint Dislocations

Arrigoni, Paolo; Brady, Paul C.; Zottarelli, L.; Barth, Johannes; Narbona, Pablo; Huberty, David P.; Koo, Samuel; Adams, Christopher R.; Parten, Peter M.; Denard, Patrick J.; Burkhart, Stephen S.

doi:10.1016/j.arthro.2013.10.006

Cited by 52 publications

(41 citation statements)

References 12 publications

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“…Recently, De Carli et al 17) reported similar results following single suture-button procedures with TightRope for Rockwood type III AC joint dislocations after a minimum followup of 24 months. In contrast to Arrigoni et al, 18) who showed an overall rate of 29.5% associated pathologic lesions requiring additional surgical treatment in patients with type III AC joint dislocation, we did not find any concomitant pathology. Many studies evaluating the treatment of AC joint injuries have focused on different treatment modalities in acute and chronic cases; however, no studies have addressed the effects of surgical timing on clinical outcomes.…”

Section: Discussioncontrasting

confidence: 55%

All-arthroscopic, Guideless Single Suture-button Fixation of Acute Acromioclavicular Joint Dislocation: A Description of the Technique and Early Treatment Results

Altıntaş

Yıldız

Uzer

et al. 2017

Clinics in Shoulder and Elbow

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Background: The purpose of this study was to examine the clinical and radiological results of the all-arthroscopic, suture-button fixation technique to treat acute acromioclavicular (AC) joint separations. Methods: All patients with acute AC joint separations received all-arthroscopic, single suture-button (TightRope) procedure without a special guide. Postoperative Constant score (CS), pain level according to visual analogue scale, and range of motion (ROM) were evaluated. For radiological evaluation, coracoclavicular distances were measured bilaterally. Results: Between December 2010 and June 2012, 18 consecutive patients (4 women and 14 men; mean age, 29.3 years) with acute AC joint separations underwent surgical treatment after 6.4 days (range, 2-20 days) following the initial trauma. The average postoperative follow-up was 16.9 months. The mean CS was 92.4 (range, 84-96). The mean external rotation, forward flexion, and abduction were 75.8° (range, 50°-90°), 170° (range, 150°-180°), and 163.8° (range, 140°-180°), respectively. Five patients exhibited coracoclavicular ossifications. In two patients, superficial wound infections were successfully treated with antibiotic therapy. In one patient, a coracoid fracture was observed. No significant differences were found regarding pain, ROM, or strength parameters between both sides. The coracoclavicular distance was discovered to be approximately 2.8 mm greater on the affected side; however, this minimal reduction loss did not affect the functional results. Conclusions: The findings of this study suggests that all-arthroscopic treatment of AC joint separations using the single suture-button technique without a drill guide is safe, yielding good to excellent clinical results. (Clin Shoulder Elbow 2017;20(2):59-67)

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Section: Discussioncontrasting

confidence: 55%

All-arthroscopic, Guideless Single Suture-button Fixation of Acute Acromioclavicular Joint Dislocation: A Description of the Technique and Early Treatment Results

Altıntaş

Yıldız

Uzer

et al. 2017

Clinics in Shoulder and Elbow

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“…17 Diagnosis and treatment of concomitant glenohumeral injuries and no mandatory implant removal are the main advantages of arthroscopy-assisted techniques among open procedures. 17,18 As far as we have knowledge, this is the first comparative report in regards to associated intraarticular injuries in the acute and chronic setting.…”

Section: Discussionmentioning

confidence: 85%

Unstable acromioclavicular joint injuries: Is there really a difference between surgical management in the acute or chronic setting?

Natera

Reiriz

2017

Journal of Orthopaedics

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“…The nuanced indications for operative intervention, such as the presence of associated lesions were not captured by our survey. 25 While most team physicians cited functional limitations as their most common reason for offering surgery, several MLB orthopedic surgeons also commented on evaluating the stability of the AC joint after a grade III injury, akin to the consensus statement from the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) Upper Extremity Committee 26 in 2014 that diversified the Rockwood Grade III AC joint separation into its IIIA and IIIB classifications. The ISAKOS recommendations include initial conservative management and a second evaluation (both clinical and radiographic) for grade III lesions 3 to 6 weeks after the injury.…”

Section: 18mentioning

confidence: 99%

Treatment of Grade III Acromioclavicular Separations in Professional Baseball Pitchers: A Survey of Major League Baseball Team Physicians

Liu

Garcia²,

Weeks³

et al. 2018

Am J Orthop

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Despite advancements in surgical technique and understanding of throwing mechanics, controversy persists regarding the treatment of grade III acromioclavicular (AC) joint separations, particularly in throwing athletes. Twenty-eight major league baseball (MLB) orthopedic team physicians were surveyed to determine their definitive management of a grade III AC separation in the dominant arm of a professional baseball pitcher and their experience treating AC joint separations in starting pitchers and position players. Return-to-play outcomes were also evaluated. Twenty (71.4%) team physicians recommended nonoperative intervention compared to 8 (28.6%) who would have operated acutely. Eighteen (64.3%) team physicians had treated at least 1 professional pitcher with a grade III AC separation; 51 (77.3%) pitchers had been treated nonoperatively compared to 15 (22.7%) operatively. No difference was observed in the proportion of pitchers who returned to the same level of play (P = .54), had full, unrestricted range of motion (P = .23), or had full pain relief (P = .19) between the operatively and nonoperatively treated MLB pitchers. The majority (53.6%) of physicians would not include an injection if the injury was treated nonoperatively. Open coracoclavicular reconstruction (65.2%) was preferred for operative cases; 66.7% of surgeons would also include distal clavicle excision as an adjunct procedure. About 90% of physicians would return pitchers to throwing >12 weeks after surgery compared to after 4 to 6 weeks in nonoperatively treated cases. In conclusion, MLB team physicians preferred nonoperative management for an acute grade III AC joint separation in professional pitchers. If operative intervention is required, ligament reconstruction with adjunct distal clavicle excision were the most commonly performed procedures.

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Associated Lesions Requiring Additional Surgical Treatment in Grade 3 Acromioclavicular Joint Dislocations

Cited by 52 publications

References 12 publications

All-arthroscopic, Guideless Single Suture-button Fixation of Acute Acromioclavicular Joint Dislocation: A Description of the Technique and Early Treatment Results

All-arthroscopic, Guideless Single Suture-button Fixation of Acute Acromioclavicular Joint Dislocation: A Description of the Technique and Early Treatment Results

Unstable acromioclavicular joint injuries: Is there really a difference between surgical management in the acute or chronic setting?

Treatment of Grade III Acromioclavicular Separations in Professional Baseball Pitchers: A Survey of Major League Baseball Team Physicians

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