The Treatment of Chronic Acromio-Clavicular Dislocation

Dewar, F. P.; Barrington, T W

doi:10.1302/0301-620x.47b1.32

Cited by 76 publications

(34 citation statements)

References 5 publications

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“…The aim of each type of procedure is to stabilize the clavicle by substitution of the ruptured coracoclavicular ligaments. Some authors advocate use of the coracoacromial ligament [6,7,12,15,16,20,21,23,24,28,29], the long [25] or short [1,9] head of the biceps tendon, or the autogenous fascia lata [13]. Others use synthetic materials such as Dacron [14], polytetrafluoroethylene (Gore-Tex) [19], polydioxanone sulfate [13], or carbon fibers [5] to maintain reduction.…”

Section: Introductionmentioning

confidence: 99%

Surgical treatment of chronic acromioclavicular joint dislocation by modified Weaver-Dunn procedure

Pavlik

Csépai

Hidas

2001

Knee Surg Sports Traumatol Art

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We present our technique for surgically treating Tossy III acromioclavicular joint dislocation, discuss the indications for various procedures, and evaluate our postoperative results. We operated on 17 patients suffering from chronic acromioclavicular instability after such dislocation using a modified Weaver-Dunn procedure, in which there is no lateral clavicular end resection, the coracoacromial ligament graft is sutured to the inferior part of the clavicle by transosseal sutures, and a Bosworth coracoclavicular screw is used to protect the graft postoperatively for 8 weeks. After a mean of 37 months we evaluated shoulder function by the Constant score and the subjective and radiological results. Mean Constant score was 91.9% (74-100%); it was 80-90% in 5 patients and above 90% in 11. One patient had screw loosing after the operation and suffered partial loss of reduction and discomfort during shoulder loading. All patients but one returned to work, and all but one have returned to their preoperative activity at the same level. Subjectively, there were 11 excellent and 6 good results. Compared to the contralateral uninjured side, radiography showed anatomical reposition in the vertical plane in 9 cases, slight loss of reduction in 6 (difference in the distance between the inferior border of the acromion and the clavicle is 2-4 mm), and partial loss of reduction in 2 (4-8 mm). We recommend the modified Weaver-Dunn procedure for surgical treatment of chronic, Tossy grade III acromioclavicular joint dislocations as it provides good functional and subjective results. Our modification is indicated mainly for young patients because posttraumatic arthrosis occurs more frequently in elderly patients, making clavicular end resection necessary.

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Section: Introductionmentioning

confidence: 99%

Surgical treatment of chronic acromioclavicular joint dislocation by modified Weaver-Dunn procedure

Pavlik

Csépai

Hidas

2001

Knee Surg Sports Traumatol Art

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“…Since a 100% excellent, good or fair results cannot be obtained with conservative treatment, a small number of patients will have persistent complaints serious enough to consider late operation. Most reports are not of recent date [46][47][48], and the only technique properly evaluated seems to be the one of Weaver & Dunn [39,40], which apparently turns out to be appropriate with 94.5% excellent or good results after late operation [21].…”

Section: Resultsmentioning

confidence: 99%

Acromioclavicular Dislocations Type III

Broos¹,

Lauwers²

2002

European Journal of Trauma

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Background: In contrast to acromioclavicular (AC) dislocations types I, II and types IV, V, VI according to Rockwood, traumatologists greatly dissent about the treatment of AC dislocation type III. Before choosing an operative technique, the first question is, whether there is a surgical indication. Material and Methods: A review of literature was done through Medline, Medscape and DynaMed. Results: When conservative treatment was compared to surgical treatment, no clear benefit could be shown for the latter. This is partially due to small series and the fact that nonoperative treatment is generally associated with a favorable outcome. It has never been proven that operative treatment improves the final result. Operative techniques with a high rate of anatomic successes do not guarantee good final results. So, anatomic restoration does not equal a good result, but if dislocation reappears, there is a high risk of a fair or poor result. Additionally, anatomic reduction can sometimes only be obtained at the cost of considerable iatrogenic damage to the AC joint, the clavicle or the subclavicular region. Operative treatment is associated with numerous complications. And last, but certainly not least: operative treatment is not associated with a shorter time period of return to work or to sports activities nor with better muscle strength. Conclusions: Considering the pros and cons of operative treatment, we feel one should initially treat AC dislocations type III conservatively and keep surgery for those few patients with severe, persistent complaints.

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“…This creates a dynamic stabilization of the lateral clavicle. It has been used for the treatment of acute and chronic injuries, with better results in younger patients [18] . But the procedure carries the risk of over-tightening of the coracoclavicular space, subsequent fracture of coracoid [13] , nonunion of transferred coracoid, loss of fixation or screw breakage and injury of musculocutanous nerve [16,23] .…”

Section: Discussionmentioning

confidence: 99%

“…The conjoint tendon is not as strong as the native CCL, but it is stronger than the commonly used coracoacromial ligament [25] . Dewar and Barington procedure (1965) had transferred the conjoint tendon to the lateral clavicle creating a dynamic stabilization of the lateral clavicle [18] . But the long-term outcomes were poor [19] .…”

Section: Introductionmentioning

confidence: 99%

Conjoint tendon transfer: Tenodesis for coracoclavicular ligaments reconstruction in acute high grade acromioclavicular dislocation

Selim¹

2018

Int. J. Orthop. Sci.

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Poor long-term outcomes after Dewar and Barington technique (1965) in the treatment of acromioclavicular joint (ACJ) dislocation were reported. Its modification by conjoint tendon transfertenodesis may yield stable and anatomic reduction. The purpose of this study is to evaluate the clinical and radiological results of patients with acute high-grade acromioclavicular joint (ACJ) dislocation treated with conjoint tendon transfer -tenodesis. Thirty-two patients were operated in the period between March 2012 and June 2015 and could be recruited and evaluated at the final follow-up. Preoperative documentation of coracoclavicular distance, VAS (visual analogue scale) for pain, ASES (American Shoulder and Elbow Surgeons) score and Constant score was done. Reconstruction was performed using conjoint tendon transfer -tenodesis. Statistical analysis was done using the statistical package for social science (SPSS) program version 20.0. At a median follow-up of 34.4 (range 24.3-60.2) months after the procedure, the coracoclavicular distance decreased significantly from a mean of 21.5 mm preoperatively to a mean of 11.5 mm postoperatively (P < 0.001). The VAS for pain improved significantly from an average of 8.5 points preoperatively to 1.2 at the last follow-up (P < 0.001). Constant score and ASES score improved significantly from 70.69 and 65 preoperatively to 95.25 and 96.4 respectively at the last follow-up (P < 0.001). A deep infection affected one patient. The study concluded that, coracoclavicular ligaments reconstruction by conjoint tendon transfer -tenodesis technique achieves excellent results and could be considered a valid surgical option of management in acute high grade acromioclavicular dislocations.

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The Treatment of Chronic Acromio-Clavicular Dislocation

Cited by 76 publications

References 5 publications

Surgical treatment of chronic acromioclavicular joint dislocation by modified Weaver-Dunn procedure

Surgical treatment of chronic acromioclavicular joint dislocation by modified Weaver-Dunn procedure

Acromioclavicular Dislocations Type III

Conjoint tendon transfer: Tenodesis for coracoclavicular ligaments reconstruction in acute high grade acromioclavicular dislocation

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