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

Abstract

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.

The Relationship Between the Clinical and Radiological Findings and the Outcomes of Early Surgical Treatment After Tossy Type III Acromioclavicular Joint Dislocation

“…All clinical tests were negative in 12 patients, seven had one positive test, three had two positive tests, and one had three positive tests. The mean CS result at the follow-up was 93.44 ± 4.90 (range, 84-100), and the mean SST result was 10.78 ± 1.51 (range, [6][7][8][9][10][11][12]. There was no statistically significant association between the CS results and either shoulder tests or radiological findings.…”

“…The pattern of this trauma is a direct force to the acromion with the arm in an adducted position [7]. ACJ dislocations were classified for the first time in 1963 by Tossy from type I to type III according to the injury pattern of the acromioclavicular (AC) and coracoclavicular (CC) ligaments [8,9]. Later, the classification was expanded by Rockwood and Green to types I to VI [4,[9][10][11].…”

“…ACJ dislocations were classified for the first time in 1963 by Tossy from type I to type III according to the injury pattern of the acromioclavicular (AC) and coracoclavicular (CC) ligaments [8,9]. Later, the classification was expanded by Rockwood and Green to types I to VI [4,[9][10][11]. It is widely accepted that type I-II injuries should be treated conservatively, and type IV-VI surgically [3][4][5][12][13][14][15].…”

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

“…2 A possible explanation for this finding could be the fact that the healed CC elongated ligaments provide enough stability to relieve symptoms. 27 The failure rate after fixation in the chronic setting using only tendon graft has been described to be around 50% or more 28,29 ; while the failure rate after management in the acute setting has been described to be around 26.8%. 28 In our study, there were no significant differences between groups.…”

Manejo de la inestabilidad acromioclavicular crónica

“…En cuanto a la tasa de infecciones, una revisión sistemática de la literatura describe que la tasa global de infecciones superficiales oscila en torno a un 3,8% para los procedimientos artroscópicos 41 , en contraste con una tasa de hasta un 5% para procedimientos realizados mediante cirugía abierta 41 ; y hasta un 8% en aquellos procedimientos en los que se empleó un injerto tendinoso 18,42 . La tasa de fracasos de fijación tras el manejo con injerto tendinoso de la inestabilidad AC crónica se ha descrito que ronda el 50% o más 41,43 ; mientras que la tasa de fracaso de la fijación tras el manejo de la inestabilidad AC aguda oscila en torno al 26,8% 41 . Se ha reportado que estas diferencias pueden obedecer al hecho de que las plastias tendinosas tienden a elongarse con el paso del tiempo, además de que tienden a emular un efecto «parabrisas» a nivel Figura 5 -A.-Visión simple de la cara superior de la clavícula, en la que se aprecia la plastia emergiendo por ambos túneles tras haber sido introducida de forma retrógrada.…”