Prevalence of concomitant intraarticular lesions in patients treated operatively for high-grade acromioclavicular joint separations

Abstract

The purpose of this study is to investigate the prevalence of concomitant intraarticular lesions to the glenohumeral joint or to surrounding soft tissue structures with non-randomized prospective case series. High-grade acromioclavicular (AC) joint dislocations result from direct or indirect force impact to the shoulder girdle. Fourty consecutive patients (2 female, 38 male) with high-grade acromioclavicular joint dislocations (Rockwood III: n = 3; IV: n = 3; V: n = 34) who underwent diagnostic arthroscopy at the time of acromioclavicular joint repair were evaluated. Associated pathologic lesions were documented and treated by an all-arthroscopic approach. As a result, traumatic intraarticular lesions were found in 15% (n = 6/40) of cases. Two patients had an isolated partial tear of the subscapularis tendon. One patient had a combined tear of the subscapularis and supraspinatus tendon (PASTA type lesion). Two patients showed a type II SLAP-lesion and one patient had a type VI SLAP-lesion. Arthroscopic treatment included rotator cuff reconstruction in two cases and debridement of the partially torn tendon in one case. Two patients underwent an arthroscopic SLAP-repair and in one patient a debridement of a labral flap tear was performed. Acromioclavicular joint reconstruction was achieved via an open technique using suture anchors in 14 cases and via an all-arthroscopic approach using a double Tight-rope technique in 26 cases. To conclude, in number of cases, high-grade AC-separations may be associated with traumatic concomitant glenohumeral pathologies resulting from the same trauma impact to the shoulder girdle. A combined or an all-arthroscopic approach allows to accurately diagnose and treat associated intraarticular pathologies.

Surgical treatment of acute acromioclavicular joint dislocations: hook plate versus minimally invasive reconstruction

“…To overcome these disadvantages, minimally invasive or arthroscopically assisted CC repairs were developed [26,27,[30][31][32]34]. The main principle of these techniques is to approximate the stubs of the torn CC ligament with the use of a flip buttons assembled with heavy sutures in a liftingblock fashion.…”

Two-Year Outcomes After Primary Anatomic Coracoclavicular Ligament Reconstruction

“…All patients underwent initial diagnostic arthroscopy to identify and address any concomitant intra-articular or subacromial lesions before reconstruction. [21][22][23] Arthroscopic distal clavicle An additional polydioxanone sulfate cable, composed of 9 strands of polydioxanone sulfate suture, is passed beneath the coracoid and tied over the top of the clavicle to help maintain joint reduction. excisions were routinely performed in this cohort to prevent post-traumatic osteoarthritis of the AC joint.…”

Managing and recognizing complications after treatment of acromioclavicular joint repair or reconstruction

“…An understanding of this classification system will assist in guiding patient expectations, discussion of available treatment options, and formulating a proper surgical plan to address the associated injuries. While MRI examinations are not standard for all types of AC injuries, concomitant intraarticular glenohumeral pathologies have been shown to occur from 15 to 18.2 % of patients with type III or greater severity of AC joint injuries [8,9]. Thus, MRI should be considered in patients presenting with high-grade AC injuries or clinical exam suspicious for intraarticular shoulder pathology.…”