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

Metzlaff, Sebastian; Roßlenbroich, Steffen; Forkel, Philipp; Schliemann, Benedikt; Arshad, Homa; Raschke, Michael J.; Petersen, Wolf

doi:10.1007/s00167-014-3294-9

Cited by 65 publications

(77 citation statements)

References 36 publications

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“…Several studies have shown significant association of horizontal instability with inferior clinical outcome following arthroscopically-assisted and open acute ACJ reconstruction [13, 19, 30]. Scheibel et al [30] reported inferior Taft (9.2 versus 11.4. points) and ACJI scores (92.3 versus 63.3 points) compared to patients without residual horizontal instability following double TightRope ACJ reconstruction.…”

Section: Discussionmentioning

confidence: 99%

“…Insufficient superior ACLC healing may contribute to persistent horizontal ACJ instability, which is reported in up to 50 % of cases following both arthroscopic and open reconstruction of acute ACJ dislocations [13, 17, 24, 33]. Horizontal ACJ instability represents a clinically relevant issue, since several studies showed an association with inferior functional outcome [13, 19, 30]. Therefore, modern techniques of acute ACJ reconstruction employ additional synthetic acromioclavicular stabilization consisting of absorbable or non-absorbable high-strength suture cerclages [10, 12, 30].…”

Section: Introductionmentioning

confidence: 99%

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Injury patterns of the acromioclavicular ligament complex in acute acromioclavicular joint dislocations: a cross-sectional, fundamental study

Maier

Jaeger

Reising

et al. 2016

BMC Musculoskelet Disord

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BackgroundHorizontal instability impairs clinical outcome following acute acromioclavicular joint (ACJ) reconstruction and may be caused by insufficient healing of the superior acromioclavicular ligament complex (ACLC). However, characteristics of acute ACLC injuries are poorly understood so far. Purposes of this study were to identify different ACLC tear types, assess type-specific prevalence and determine influencing cofactors.MethodsThis prospective, cross-sectional study comprised 65 patients with acute-traumatic Rockwood-5 (n = 57) and Rockwood-4 (n = 8) injuries treated operatively by means of mini-open ACJ reduction and hook plate stabilization. Mean age at surgery was 38.2 years (range, 19–57 years). Standardized pre- and intraoperative evaluation included assessment of ACLC tear patterns and cofactors related to the articular disc, the deltoid-trapezoidal (DT) fascia and bony ACJ morphology. Articular disc size was quantified as 0 = absent, 1 = remnant, 2 = meniscoid and 3 = complete.ResultsAll patients showed complete ruptures of the superior ACLC, which could be assigned to four different tear patterns. Clavicular-sided (AC-1) tears were observed in 46/65 (70.8 %), oblique (AC-2) tears in 12/65 (18.5 %), midportion (AC-3) tears in 3/65 (4.6 %) and acromial-sided (AC-4) tears in 4/65 (6.1 %) of cases. Articular disc size manifestation was significantly (P < .001) more pronounced in patients with AC-1 tears (1.89 ± 0.57) compared to patients with AC-2 tears (0.67 ± 0.89). Other cofactors did not influence ACLC tear patterns. ACLC dislocation with incarceration caused mechanical impediment to anatomical ACJ reduction in 14/65 (21.5 %) of cases including all Rockwood-4 dislocations. Avulsion “in continuity” was a consistent mode of failure of the DT fascia. Type-specific operative strategies enabled anatomical ACLC repair of all observed tear types.ConclusionsAcute ACLC injuries follow distinct tear patterns. There exist clavicular-sided (AC-1), oblique (AC-2), midportion (AC-3) and acromial-sided (AC-4) tears. Articular disc size was a determinant factor of ACLC tear morphology. Mini-open surgery was required in Rockwood-4 and a relevant proportion of Rockwood-5 dislocations to achieve both anatomical ACLC and ACJ reduction. Type-specific operative repair of acute ACLC tears might promote biological healing and lower rates of horizontal ACJ instability following acute ACJ reconstruction.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Injury patterns of the acromioclavicular ligament complex in acute acromioclavicular joint dislocations: a cross-sectional, fundamental study

Maier

Jaeger

Reising

et al. 2016

BMC Musculoskelet Disord

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“…Rockwood divided AC dislocations into six types and according to current recommendations; types IV through VI are managed by surgical reconstruction and treatment of type III should be individualized based on the patient's demands, activity level and response to conservative treatment. There are several methods used for fixation like K-wires, hook plate, Bosworth screw, Weaver-Dunn and resection of the lateral end of the clavicle, but there is no gold standard procedure [2][3][4]. Recently, arthroscopic techniques have been successfully proposed to treat AC joint dislocations [5][6][7].…”

Section: (Continued From Previous Page)mentioning

confidence: 99%

The frequency of reduction loss after arthroscopic fixation of acute acromioclavicular dislocations using a double-button device, and its effect on clinical and radiological results

Çarkçı¹,

Polat

Gürpınar³

2020

J Orthop Surg Res

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Background: The aim of this study was to investigate the effect of reduction loss of more than 3 mm on clinical and radiological results after at least 2 years of follow-up after arthroscopic fixation of acute acromioclavicular joint dislocations using a double-button device. Methods: Thirty-six patients who had acute (< 3 weeks old), type III or V acromioclavicular (AC) joint dislocations underwent arthroscopic fixation of the AC joint using a double-button device. Clinical and radiological evaluations were performed at preoperative, postoperative first day, 3 months and last follow-up. When the coracoclavicular (CC) distances of patients at the last follow-up were compared to the early postop CC distances, those with a difference of 3 mm or less were grouped as group A and those with a difference of more than 3 mm were grouped as group B.

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“…The TightRope ® System (Arthrex Medizinische Instrumente GmbH, Germany) is a device originally designed for the reduction and stabilization of tibio-fibular syndesmosis, then redesigned to be used for the stabilization of the acromioclavicular joint (ACJ TightRope ® System) with open or arthroscopic technique (6). This device consists of two metal buttons, one circular and one oval, connected by FiberWire suture (7).…”

Section: Objectivesmentioning

confidence: 99%

New Variant of the Treatment of Acromion-Clavicular Dislocation With TightRope ® System in a Mini - Open Approach: A Preliminary Clinical Study

et al. 2016

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Background: Many different surgical techniques have been described to stabilize the acromion-clavicular (AC) dislocations. So far many of these procedures are performed only in arthroscopy. Objectives: In this study, we describe a new technique that utilizes the tightrope with a mini-invasive open approach for the acute stabilization of the acromion-clavicular joint (ACJ) dislocation. Patients and Methods: We set an prospective study aimed to verify the efficacy of this new surgical technique. We treated 28 patients with acute ACJ dislocation with ACJ TightRope ® System with dual mini access. We retrospectively reviewed the data of 34 patients treated with arthroscopic technique. They were considered as the control group. Results: At 6 month's follow-up, all the 28 patients showed a stable joint during clinical examination and obtained an average Constant score of 98.62/100, with a complete recovery of ROM and strength in abduction. The mean operation time was of 33.7 minutes. The mean recovery duration was 102.8 days. No significant difference was found between the experimental and control groups (P > 0.05). Conclusions: Results of this trial suggest the effectiveness of this new mini-invasive surgical technique in producing clinical and functional recovery in patients with ACJ dislocations.

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

Abstract: III.

Cited by 65 publications

References 36 publications

Injury patterns of the acromioclavicular ligament complex in acute acromioclavicular joint dislocations: a cross-sectional, fundamental study

Injury patterns of the acromioclavicular ligament complex in acute acromioclavicular joint dislocations: a cross-sectional, fundamental study

The frequency of reduction loss after arthroscopic fixation of acute acromioclavicular dislocations using a double-button device, and its effect on clinical and radiological results

New Variant of the Treatment of Acromion-Clavicular Dislocation With TightRope ® System in a Mini - Open Approach: A Preliminary Clinical Study

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