Horizontal and Vertical Stabilization of Acute Unstable Acromioclavicular Joint Injuries Arthroscopy-Assisted

Natera, Luis; Reiriz, Juan Sarasquete; Besalduch, M.; Petrica, Alexandru Mihai; Escolà, A.; Rodriguez, Joaquim; Fallone, Jan Carlo

doi:10.1016/j.eats.2015.07.014

Cited by 12 publications

(11 citation statements)

References 20 publications

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“…For the superior suture configuration, we used a modified version of the technique described by Cisneros et al 7 Two vertical tunnels were placed into the anterior acromion 10 mm apart from each other and 10 mm lateral to AC joint. The 2 limbs of the suture tape were passed inferior to superior into the tunnels, creating a U-sling.…”

Section: Methodsmentioning

confidence: 99%

“…The purpose of this study was to biomechanically evaluate currently published methods of AC reconstruction alone and in combination with standardized CC reconstruction in resisting translations and rotations. 6,7,13,23 It was hypothesized that techniques that reconstruct the anterior capsular structures would restore native stability against rotations and translations.…”

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confidence: 99%

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Primary Stability of an Acromioclavicular Joint Repair Is Affected by the Type of Additional Reconstruction of the Acromioclavicular Capsule

et al. 2018

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Background: The synergistic effect of the acromioclavicular (AC) capsule and coracoclavicular (CC) ligaments on AC joint stability has gained recent recognition for its importance. Biomechanical and clinical studies have shown the benefit of combined reconstruction with multiple variations of surgical techniques for AC capsule augmentation. The ideal configuration remains unknown for such capsular repair aimed at achieving optimal stability with anatomic reconstruction. Hypothesis: Primary AC joint stability can be restored by AC capsule augmentation, while position of the additional suture construct is critical. It was hypothesized that techniques that reconstruct the anterior capsular structures would restore native stability against rotations and translations. Study Design: Controlled laboratory study. Methods: Thirty fresh-frozen human cadaveric shoulders were used. Each sample was tested in the native state and served as its own control. After complete capsulotomy, 1 of 5 AC capsular repair configurations was performed: anterior, superior, posterior, O-frame, and X-frame. After testing of the AC capsular repair configurations, the tests were repeated after dissection of the CC ligaments and after CC ligament reconstruction with a suture button system. AC joint stability was immediately tested after each step under rotation and horizontal translation. To accomplish this, the AC joints were anatomically positioned on a custom fixture linked to a servohydraulic testing system. A 3-dimensional optical measuring system was used to evaluate the 3-dimensional joint motion. Clavicle posterior translation in relation to the acromion, rotation around the long axis of the clavicle, and displacement of the lateral clavicle in relation to the center of rotation were measured. The torques and forces required to rotate and translate the clavicle were recorded. Results: In terms of translational testing, after the complete capsulotomy, a significant reduction of resistance force was found across all groups, with a mean 13% to 20% remaining ( P < .05). All AC suture augmentations were able to significantly increase the average resistance force as compared with the native ( P = .01) against posterior translation. Subsequent cutting of the CC ligaments did not result in a significant change in any of the groups ( P = .23). The synergistic effect of AC capsule augmentation and CC ligament reconstruction could be demonstrated without exception. In terms of rotational testing, the complete capsulotomy resulted in a significant reduction of resistance torque in all groups ( P < .05), with a remaining torque ranging between 2% and 11% across the groups. However, all AC suture constructs significantly increased the resistance torque as compared with the capsulotomy ( P = .01). The subsequent cutting of the CC ligaments resulted in a significant change in 2 of the 5 groups (O-frame, P = .01; X-frame, P = .02) and an overall remaining torque reduction ranging from 3% and 42%. The combined reconstruction of the AC capsule and CC ligaments achieved the highest percentage of regained resistance torque but remained significantly weaker than the native specimen ( P = .01). Conclusion: Native translational stability could be restored by the addition of AC capsule augmentation, while partial rotational instability remained. The tested constructs revealed no significant individual differences. Clinical Relevance: Combined stabilization of the AC capsule and CC ligaments demonstrated the greatest capacity to restore the native stability against translational and rotational loads, with the specific configuration of the AC capsule repair to be chosen according to the personal preferences of the surgeon.

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Section: Methodsmentioning

confidence: 99%

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confidence: 99%

Primary Stability of an Acromioclavicular Joint Repair Is Affected by the Type of Additional Reconstruction of the Acromioclavicular Capsule

et al. 2018

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“…This technique has been previously described adding an ACJ horizontal augmentation. 12 In the series of patients of this study, no horizontal augmentation was performed.…”

Section: Acute-groupmentioning

confidence: 99%

“…In summary, indications were based on the radiological magnitude of displacement between the clavicle and the acromion, which at the end is the indicator of a tear or not in the CC ligaments with affection or not of the deltotrapezial fascia, 10,11 which also plays a determinant role in the vertical and horizontal stability of the ACJ. 12 Once the diagnosis unstable ACJ injury was established, patients were informed about the different treatment options. The timeline between acute and chronic injuries, as well as the surgical technique, were established according to current international consensus.…”

Section: Management Decision-makingmentioning

confidence: 99%

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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“…Other studies considered that the remaining horizontal instability is the only factor that may lead to an adverse effect on final clinical outcome 51 . Several scholars explored stabilization methods in the horizontal plane to address this important issue 14,[52][53][54] . In this study, we exposed the ACJ, debrided and removed the damaged cartilage disc, reduced the dislocated joint under direct vision, and performed reliable fixation by two strands of heavy nonabsorbable sutures.…”

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confidence: 99%

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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Horizontal and Vertical Stabilization of Acute Unstable Acromioclavicular Joint Injuries Arthroscopy-Assisted

Cited by 12 publications

References 20 publications

Primary Stability of an Acromioclavicular Joint Repair Is Affected by the Type of Additional Reconstruction of the Acromioclavicular Capsule

Primary Stability of an Acromioclavicular Joint Repair Is Affected by the Type of Additional Reconstruction of the Acromioclavicular Capsule

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

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

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