Challenges in Treating Acromioclavicular Separations: Current Concepts

Cook, Jay B.; Krul, Kevin P.

doi:10.5435/jaaos-d-16-00776

Cited by 34 publications

(40 citation statements)

References 44 publications

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“…Motion was gradually increased after cessation of sling wear with a goal of full motion at 3 months. Strengthening started at this point, and patients were allowed to return to contact sports at 6 months 5,21 .…”

Section: Postoperative Managementmentioning

confidence: 99%

“…No consensus has been reached regarding the treatment of high-grade AC dislocation despite the prevalence of this injury 3,5,24 . The choice of an adequate surgical procedure is based on various factors, such as the surgeon's preference, the patient's activity level, and biomechanical properties of the surrounding ligaments 25 .…”

Section: Characteristics and Surgical Options Of Acj Dislocationmentioning

confidence: 99%

“…Distal clavicle resection (Mumford procedure) may represent an effective solution to a painful old ACJ injury 5,49 . Various modified Weaver-Dunn procedures which include distal clavicle excision have been widely used 21,25,50 .…”

Section: Technical Characteristics and Key Technologies Of This Studymentioning

confidence: 99%

“…These conditions account for 9% to 12% of shoulder girdle injuries 2 and are more frequent in young adults and athletes, often resulting from a direct fall onto the superior aspect of the shoulder when the arm is adducted 3 , and five times more common in men than in women. Although the incidence of high-grade ACJ injuries requiring surgery is low, indications for the conservative versus surgical treatment of type III and V injuries produce controversy 1,1,[3][4][5][6] . This disagreement has encouraged the development of multiple surgical techniques and may reflect a general dissatisfaction with treatment options and outcomes 3,4,[6][7][8] .…”

Section: Introductionmentioning

confidence: 99%

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Acromioclavicular Joint Separation: Repair Through Suture Anchors for Coracoclavicular Ligament and Nonabsorbable Suture Fixation for Acromioclavicular Joint

Liu

Bao

Jiang

et al. 2020

Orthopaedic Surgery

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Objective: To evaluate the clinical and radiographic outcomes of patients undergoing coracoclavicular (CC) ligament repair by two suture anchors and acromioclavicular (AC) joint (ACJ) fixation using heavy nonabsorbable sutures for the treatment of types III-V ACJ injuries with a minimum of 1-year follow-up. Methods: The clinical and radiographic outcomes of 36 consecutive patients (26 men and 10 women) who underwent anatomic reduction for acute ACJ dislocation using two suture anchors for CC ligament reconstruction and two strands of non-absorbable stitches for ACJ fixation between December 2013 and December 2018 were reviewed. Two 3.5 mm suture anchors with double-loaded sutures were separately inserted into the anterolateral and posteromedial portions of the coracoid process. The suture strands were passed through the hole created in the clavicle using 2.0 mm drill and tied over the clavicle. Additional ACJ augmentation using two strands of non-absorbable heavy sutures was performed in all patients. At 3, 6, and 12 months and last follow-up visit, the scores on the visual analog scale (VAS), the American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score, and simple shoulder test (SST) questionnaires were used to provide a final evaluation of shoulder function. Comparison between baseline and treatment results was performed. Radiographic analysis included vertical displacement and horizontal shift. Results: A total of 29 patients (20 men and nine women) were included in the study. A total of seven, six, and 16 patients had Rockwood type III, type IV, and type V ACJ dislocations, respectively. The mean patient age was 42.8 AE 13.5 years, with a mean follow-up of 28 months (range, 12-56 months). At the 12-month follow-up, the mean ASES score was 92.1 AE 3.5, with a mean pain score of 0.5 AE 0.7 on the VAS and mean Constant-Murley score of 93.0 AE 2.4. The new number of positive answers on the SST was 11.5 AE 0.6. Compared with the baseline, the clinical results improved significantly (P < 0.05). No significant difference could be found between the 6-and 12-month follow-up evaluations (P > 0.05). Radiographs showed two partial loss of reduction, whereas no horizontal displacement was found in all patients. One patient developed a superficial wound infection 3 weeks postoperation. The wound healed after routine wound care. No neurovascular complications were recorded. Conclusions: CC ligament reconstruction using two suture anchors and ACJ augmentation using two strands of nonabsorbable heavy sutures on high-grade AC dislocation is a reliable technique for restoring stability to the ACJ and can obtain good to excellent clinical results.

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Section: Postoperative Managementmentioning

confidence: 99%

Section: Characteristics and Surgical Options Of Acj Dislocationmentioning

confidence: 99%

Section: Technical Characteristics and Key Technologies Of This Studymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Acromioclavicular Joint Separation: Repair Through Suture Anchors for Coracoclavicular Ligament and Nonabsorbable Suture Fixation for Acromioclavicular Joint

Liu

Bao

Jiang

et al. 2020

Orthopaedic Surgery

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“…Acromioclavicular (AC) joint separations are common injuries and account for 3.2% of shoulder injuries 1 . These injuries typically occur among adolescent and young adult athletes during contact sports, such as hockey, wrestling, and rugby 2 .…”

mentioning

confidence: 99%

Anatomic Acromioclavicular Ligament Reconstruction Using Semitendinosus Autograft With Suture Augmentation: Surgical Technique

Sherman

French

Faerber

2019

Arthroscopy Techniques

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Acromioclavicular (AC) joint separations are common injuries and account for 3.2% of shoulder injuries. These injuries typically occur among adolescent and young adult athletes during contact sports, such as hockey, wrestling, and rugby. Low-grade AC joint separations (Rockwood grade I-II) are often successfully treated nonoperatively. High-grade AC joint separations (Rockwood grade IV-VI) have the potential to alter scapular kinematics, causing painful and restricted motion, and are often treated surgically. Over 150 surgical techniques have been described to treat AC joint separations. Techniques vary in the types of implants used (screws, pins), use of anatomic or nonanatomic reconstructions, number of drill holes used, use of arthroscopic or open procedures, use of distal clavicle resection, and types of augmentation (allografts, autografts, sutures). The procedure can be expensive, with the implants and grafts costing varied amounts and, at times, thousands of dollars. The purpose of this Technical Note is to describe an inexpensive method of open anatomic AC joint reconstruction using a single bone tunnel, suture tape, and a semitendinosus autograft.

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Clavicle

Vidal¹,

Riederer²,

Bartley³

et al. 2020

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Challenges in Treating Acromioclavicular Separations: Current Concepts

Cited by 34 publications

References 44 publications

Acromioclavicular Joint Separation: Repair Through Suture Anchors for Coracoclavicular Ligament and Nonabsorbable Suture Fixation for Acromioclavicular Joint

Acromioclavicular Joint Separation: Repair Through Suture Anchors for Coracoclavicular Ligament and Nonabsorbable Suture Fixation for Acromioclavicular Joint

Anatomic Acromioclavicular Ligament Reconstruction Using Semitendinosus Autograft With Suture Augmentation: Surgical Technique

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