Disorders of the Acromioclavicular Joint

Purpose The optimal (SBJI) surgical treatment for acute acromioclavicular (AC) joint disruption remains controversial. What is being presented is the long-term functional outcomes of a double cross-looped coracoclavicular (CC) suture technique with the intention of restoring both anteroposterior and superior displacement of the clavicle. Methods Between 2007 and 2016, 81 patients underwent surgical reconstruction for acute acromioclavicular joint (AC) disruption in two orthopaedic centers. Two patients died for reasons unrelated to the treatment, and seven missed the inal follow-up appointment, leaving 72 patients (67 males; 5 females; age 37 ± 12.4; range 15-64 years) for clinical and radiological assessments. All cases were classiied according to the Rockwood classiication as type III (n = 34), IV (n = 14) or V (n = 24). The dislocation was repaired with double cross-looped CC ixation using four Ethibond sutures passing underneath the coracoid and through a 4.5 mm drill hole in the clavicle in opposing directions to control both anteroposterior and vertical displacement. Radiological investigation preoperatively and at the last follow-up included anteroposterior and/or Zanca views, axillary or Alexander views, and comparative stress radiography of both AC joints. Patients were evaluated clinically with the Constant-Murley score (CMS) and Acromio Clavicular Joint Instability Score (ACJIS). Loss of reduction, subluxation, CC ligament ossiication, post-traumatic arthritis, and peri-implant fractures were also recorded. Results Seventy-two patients were available for the last clinical and radiological evaluations. At a median follow-up period of 6.3 ± 2.1 years (range 3-12 years), the CMS and ACJIS were 92.1 ± 7.2 (range 60-100 points) and 90.4 ± 8.6 (range 45-100 points), respectively. Complications included 9 (12.5%) patients with slight loss of reduction, 2 (1.7%) with dislocation recurrence, 1 (1.3%) with supericial infection, 1 (1.3%) with a fracture of the lateral end of the clavicle, and 2 (1.7%) with persistent tenderness in the AC joint. The incidence of periarticular ossiication was 22.4% and did not afect the inal outcome. Conclusions This technique represents an efective and low-cost treatment for acute AC joint separations. Level of evidence IV.

Section: Methodsmentioning

confidence: 99%

Long-term stability of coracoclavicular suture fixation for acute acromioclavicular joint separation

Panagopoulos

Fandridis

Rose

et al. 2020

“…Injuries of the ACJ are among the most common injuries of the shoulder girdle, with an estimated incidence of 1.8 per 1000 per year [7]. The Rockwood classification is the most widely used system for classifying the severity of such injuries and deciding which treatment option should be used [25]. Grade IV–VI injuries require surgical intervention; however, the management of grade III injuries is debatable.…”

Section: Introductionmentioning

confidence: 99%

No correlation exists between coracoid tunnel widening and loss of reduction after arthroscopic acromioclavicular fixation using tightrope system

Elkalyoby

Waly

Abdelrazek

et al. 2023

Purpose To detect the widening of the tunnel of the coracoid process after arthroscopic fixation of acute acromioclavicular joint (ACJ) dislocation using the TightRope system and its correlation with loss of reduction and functional scores. Methods From 2016 to 2018, a prospective study was performed on twenty-three patients with acute grade III–V ACJ dislocation. Arthroscopic TightRope repair of the ACJ was performed. Coracoid tunnel widening was measured by CT, and the coracoclavicular distance was measured on the radiographs immediately postoperatively and at 12 months. The Constant Shoulder Score, Oxford Shoulder Score, Nottingham Clavicle Score and Visual analog scale were used as outcome measures at 12 months. Results The coracoid tunnel diameter to horizontal coracoid diameter ratio increased from 22.8 ± 3.7% immediately postoperatively to 38.5 ± 5.5% at 12 months (p < 0.001). The coracoclavicular (CC) distance showed an increase from a mean of 10.8 ± 1.7 mm to a mean of 11.8 ± 2.5 at 12 months (p < 0.001). There was no correlation between the increase in the coracoclavicular distance and the patients’ functional clinical scores or coracoid tunnel widening. Conclusion Coracoid tunnel widening and radiological loss of reduction occur after arthroscopic fixation of acute ACJ dislocation with the TightRope system. However, they do not correlate with each other or with the functional scores of the patient. Level of evidence Level IV.

“…Acromioclavicular (AC) joint injuries represents 9% of all shoulder girdle injuries and are most often associated with direct blows to the shoulder or axially directed forces onto the ipsilateral extremity [1]. There is a consensus that type I and II injuries, according to Rockwood’s classification [24], should be treated non‐operatively, whereas the vast majority of acute type IV, V and VI injuries should be treated surgically. Considering type III injuries, in literature algorithms have suggested that scapula plays a role and that rapid progression in function excludes surgery as an option for quick recovery [2, 19, 26, 27].…”

Section: Introductionmentioning

confidence: 99%

The Kite technique: a new all-arthroscopic technique for the treatment of acute acromioclavicular joint dislocation

Campagna¹,

Piccinni²,

Rotundo³

et al. 2020

PurposeAlthough many open techniques have been developed, no all‐arthroscopic technique has been introduced to reduce acute acromioclavicular joint dislocation (ACJD) and augment both coracoclavicular (CC) ligaments. The Kite technique is the first all arthroscopic technique with this aim. MethodsForty‐one consecutive patients [35M–6F; median: 29.2 years (range 23–36)] with acute type III and V acromioclavicular joint dislocation were treated with the Kite technique: it consists of positioning three titanium buttons connected by heavy sutures in an 8‐strand configuration between clavicle and coracoid to restore the anatomy of CC ligaments. Patients were followed up for a median of 35 months (range 30–43 months). ResultsMedian operation time was 70.6 min (range 58–82), with no cases of intra‐operative complications. At the final follow‐up, the median post‐operative Constant Score and SST were 94.1 (range 89–98) and 11.6 (range 10–12), respectively. At the final follow‐up reduction maintenance was present in 39 patients; in one patient, signs of acromioclavicular joint dislocation recurrence were present 3 months post‐op. In another patient, medial suture ruptures occurred 4 months after surgery with type II acromioclavicular joint dislocation recurrence but with scarce symptoms and full recovery to sport activity. Clavicle osteolysis was observed in four patients. Cosmetics of the arm were judged as excellent in 39/41. All patients, except two, were satisfied with the final result. ConclusionsThe kite technique is a safe and reproducible arthroscopic procedure to treat acute ACJD. In daily clinical practice, due to the excellent results and the low complication rate, this technique might be considered by surgeons when operative treatment of an acute acromioclavicular joint dislocation is planned. Level of evidenceIV.