Evaluation of the Surgical Treatment of Acromioclavicular Joint Dislocation With a New Option for Temporary Fixation of the Acromioclavicular Joint

Abstract

The purpose of this paper is to evaluate the results of surgical treatment of acute acromioclavicular joint (ACJ) dislocation using coracoclavicular cerclage, coracoacromial ligament transfer to the distal third of the clavicle, and a new option for strengthening the temporary stabilization of the ACJ using a Kirschner wire between the clavicle and scapula. We evaluated 21 patients who underwent surgical treatment for ACJ dislocation. The average follow-up period was 18 months and varied from 13 to 23 months. Postoperative results, graded by the UCLA scoring system, were satisfactory in 20 patients. Using radiographic evaluation, 18 patients did not show loss of reduction. Among 21 patients who underwent surgical treatment, only 2 complications related to a new method of temporary ACJ stabilization were reported, neither of which appeared to influence the final outcome. The authors concluded that the surgical treatment of acute ACJ dislocation provides good functional and radiographic outcomes and that a new method of temporary ACJ stabilization described herein is an easy-toperform and low-cost procedure with a low complication rate.

Prefered Surgical Technique Used by Orthopedists in Acute Acromioclavicular Dislocation

“…This is not an established technique as Phemister's, but it has been described by surgeons in charge of specialized services on our midst. 13 These findings reinforce the influence of academic training in surgical preference.…”

“…Both specialists and generalists who used Phemister's modified techniques, or coracoclavicular repair technique and anterior to posterior temporary fixation with Kirschner wire toward the scapula, 13 mostly used two clavicular tunnels to repair coracoclavicular ligaments. ( Table 4 ) There was no difference between the proportion of specialists and generalists regarding the number of tunnels used.…”

“…In cases where the acromioclavicular joint was temporarily fixated with intramedullary Kirschner wire (Phemister's technique and its modifications) or anteroposterior toward the scapula, 13 no difference regarding burying or not the Kirschner wire into the patient's subcutaneous tissue was observed between specialists and generalist, as well as the time of permanence of Kirschner wire. ( Table 5 ) However, most surgeons, specialists or generalists, preferred to remove the Kirschner wire after six to eight weeks.…”

Resultados funcionais e radiológicos do tratamento cirúrgico da luxação acromioclavicular aguda com âncoras e fixação clavículo-escapular

“…Fixation of the clavicle to the coracoid process with suture anchors and the use of a temporary metal pin between the clavicle and the scapular spine presents an alternative to avoid complications and simplify temporary fixation. 15 In the patients of the present study, CC anchors were used as the main procedure, and temporary clavicle and scapula fixation, as an auxiliary method. According to Tamaoki et al, 23 in a cross-sectional study with Brazilian orthopedic surgeons regarding the treatment of ACD, in surgical cases of grade III, 63% of the respondents use CC fixation in their patients, while 51% prefer the AC transarticular fixation technique.…”

“…Through dissection, the base of the coracoid process was exposed, enabling the insertion of two 4-mm metallic anchors, each with 1 or 2 non-absorbable suture threads, adapted according to the technique of Dal Molin et al 6 The sutures were inserted into 2 holes made in the clavicle with a 2.0-mm drill to reproduce the anatomical insertion of the coracoclavicular ligaments: a posteromedial orifice for the conoid ligament and, 1 cm laterally, an anterolateral orifice of the same size, for the trapezoid, at a distance of 1 cm from the ACJ. Prior to the CC approach with the anchor sutures, the ACJ was anatomically reduced: while the assistant performed the retracting scapula stabilization maneuver and the clavicle reduction, the surgeon performed clavicle-spinal fixation by directing a 2.5-mm Kirschner wire from the anterior superior edge of the lateral third of the clavicle to the base of the scapular spine, according to the technique described by Carrera et al 15 ( Figure 2 ). The anchor sutures previously inserted into the holes in the collarbone were tied, and the CA ligament, when transferred, was tensioned.…”