Surgical Outcome Following Arthroscopic Fixation of Acromioclavicular Joint Disruption With the TightRope Device

Abstract

The objective of this study was to evaluate the preliminary radiographic and clinical results of grade IV and V acromioclavicular joint disruption repair using the arthroscopic Arthrex acromioclavicular TightRope (Naples, Florida) fixation technique. Numerous procedures have been described for surgical management of acromioclavicular joint disruption. The TightRope device involves an arthroscopic technique that allows nonrigid anatomic fixation of the acromioclavicular joint. A cohort of 10 men and 2 women with a mean age of 43 years (range, 25-61 years) underwent the acromioclavicular joint TightRope procedure between April 2007 and October 2009. Eleven patients had either Rockwood grade IV or V disruptions and 1 sustained a distal third clavicle fracture with acromioclavicular joint disruption. Data was collected from a chart review. Patients were evaluated clinically, radiographically, by the simple shoulder test, and by overall satisfaction. There were 2 failures of reduction and 1 loss of reduction at final radiographic follow-up. The rate of fixation failure was 16.6%. All patients had >110° of total elevation. The majority of patients obtained satisfactory functional results according to the Simple Shoulder Test averaging 11 of 12 questions answered positively (range, 7-12; standard deviation, 1.50) and 11 of 12 patients were satisfied with the procedure. At final phone interview at approximately 2 years postoperatively, 6 patients were lost to follow-up. The remaining patients were all satisfied with the procedure and no patients reported subjective loss of reduction or deterioration of function. Simple Shoulder Test average was maintained with 11 of 12 positively answered questions (range, 7-12; standard deviation, 2.0) This case series revealed a high rate of fixation failure with the TightRope system. Still, most patients were satisfied with the procedure and achieved high functional shoulder results.

Recommendations for Optimizing Acromioclavicular Fixation Success with the Tight Rope Device

“…The subjective improvement in all subjects seen in this study, regardless of reduction loss, has been reported by others [17].…”

“…Thiel et al [17] proposed using two TightRope devices (Arthrex, Naples, FL) to minimize reduction loss. This approach could potentially increase the risk of fracture; especially if biologic healing does not occur.…”

“…Other advantages are that it is a non-rigid device and does not require removal. There have been reported high rates of failure with this device [16][17].…”

Acromioclavicular joint dislocations

“…Failure could present as Lateral end clavicle osteolysis, hardware failure, or even fracture of coracoid or clavicle [16][17][18][19]. There have been reports of high failure of mechanical devices [20]. …”

Acromioclavicular joint separations

“…While most injuries can be managed non-operatively, high-grade separations may result in persistent pain or functional decline and require surgical intervention [4][5][6][7][8][9]. Many surgical techniques have been described to stabilize the AC joint, however, the utility of many of these techniques are limited secondary to reported failure and complication rates [8,[10][11][12][13]. More recently, open or arthroscopically-assisted anatomic reconstruction of the coracoclavicular (CC) ligaments have been introduced and early follow-up appears encouraging [14][15][16].…”