Keywords
How to Cite
Abstract
Summary. Acute acromioclavicular (AC) joint dislocation is still a challenging task for orthopedic surgeons. Objective: to compare the clinical and radiological results of treatment of patients with acute dislocation of the acromial end of the clavicle who were treated with a dynamic stabilization system with and without suture of acromioclavicular ligaments under arthroscopic control.
Materials and Methods. A retrospective analysis of the treatment of 44 patients with acute AC joint dislocations type III and type V by Rockwood classification was performed. The patients were divided into 2 groups: group I – 18 patients (40.9%) who underwent stabilization of the dislocation and fixation of the acromial end of the clavicle using a dynamic stabilization system and suture of the ligaments of the acromioclavicular joint under arthroscopic control; group II – 26 patients (59.1%) who underwent stabilization of the dislocation and fixation of the acromial end of the clavicle using a dynamic stabilization system without suture of the ligaments of the acromioclavicular joint under arthroscopic control. There were 40 male (90.9%) and 4 female (9.1%) patients aged 18–58 years (mean age 32.9±10.1 years). The mean time from injury to surgical treatment was 8.3±3.2 days (from 3 to 17 days). Clinical observation was carried out at an average time of 20.1±3.9 months after surgery (from 12 to 28 months). Clinical outcomes were assessed using the Oxford Shoulder scale, the Constant-Murley scale, and the Acromioclavicular Joint Instability Scoring System.
Results. The mean Oxford Shoulder score at the final follow-up on the injured side was 45.8±1.3 points and 46.2±1.3 points (p=0.422) in groups I and II, respectively. The mean Constant-Murley score at the final follow-up on the injured side was 94.6±2.4 points and 91.7±4.2 points (p=0.0134) in groups I and II, respectively. The mean score on the Acromioclavicular Joint Instability Scoring System at the final follow-up on the injured side was 83.8±7.1 points and 78.1±11.8 points (p=0.075) in groups I and II, respectively. No significant complications were observed in both groups.
Conclusions. The combination of the arthroscopically assisted technique of reconstruction of the acromioclavicular ligaments using high-strength sutures and fixation of the coracoclavicular ligaments using a dynamic stabilization system provides good long-term clinical results.
References
van Bergen CJA, van Bemmel AF, Alta TDW, van Noort A. New insights in the treatment of acromioclavicular separation. World J Orthop. 2017 Dec 18;8(12):861-873. DOI: 10.5312/wjo.v8.i12.861; PMID: 29312844; PMCID: PMC5745428.
Allemann F, Halvachizadeh S, Waldburger M, Schaefer F, Pothmann C, Pape HC, et al. Different treatment strategies for acromioclavicular dislocation injuries: a nationwide survey on open/minimally invasive and arthroscopic concepts. Eur J Med Res. 2019 Mar 23;24(1):18. DOI: 10.1186/s40001-019-0376-7; PMID: 30904018; PMCID: PMC6431035.
Maier D, Jaeger M, Reising K, Feucht MJ, Südkamp NP, Izadpanah K. Injury patterns of the acromioclavicular ligament complex in acute acromioclavicular joint dislocations: a cross-sectional, fundamental study. BMC Musculoskelet Disord. 2016 Sep 6;17(1):385. DOI: 10.1186/s12891-016-1240-3. PMID: 27600992; PMCID: PMC5012011.
Wylie JD, Johnson JD, DiVenere J, Mazzocca AD. Shoulder Acromioclavicular and Coracoclavicular Ligament Injuries: Common Problems and Solutions. Clin Sports Med. 2018 Apr;37(2):197-207. DOI: 10.1016/j.csm.2017.12.002; PMID: 29525023.
Saier T, Venjakob AJ, Minzlaff P, Föhr P, Lindell F, Imhoff AB, et al. Value of additional acromioclavicular cerclage for horizontal stability in complete acromioclavicular separation: a biomechanical study. Knee Surg Sports Traumatol Arthrosc. 2015 May;23(5):1498-505. DOI: 10.1007/s00167-014-2895-7; PMID: 24554242.
Martetschläger F, Horan MP, Warth RJ, Millett PJ. Complications after anatomic fixation and reconstruction of the coracoclavicular ligaments. Am J Sports Med. 2013 Dec;41(12):2896-903. DOI: 10.1177/0363546513502459; PMID: 24007761.
Clavert P, Meyer A, Boyer P, Gastaud O, Barth J, Duparc F; SFA. Complication rates and types of failure after arthroscopic acute acromioclavicular dislocation fixation. Prospective multicenter study of 116 cases. Orthop Traumatol Surg Res. 2015 Dec;101(8):313-6. DOI: 10.1016/j.otsr.2015.09.012; PMID: 26545944.
Thangaraju S, Tauber M, Habermeyer P, Martetschläger F. Clavicle and coracoid process periprosthetic fractures as late post-operative complications in arthroscopically assisted acromioclavicular joint stabilization. Knee Surg Sports Traumatol Arthrosc. 2019 Dec;27(12):3797-802. DOI: 10.1007/s00167-019-05482-7; PMID: 30900030.
Rockwood CJ, Wirth MA, Fehringer EV, Matsen FA, Sperling JW, Lippitt SB. Rockwood and matsen’s the shoulder, fifth edition 5th ed. Philadelphia, PA: Elsevier; 2018. 379-398 p.
Hobusch GM, Fellinger K, Schoster T, Lang S, Windhager R, Sabeti-Aschraf M. Ultrasound of horizontal instability of the acromioclavicular joint: A simple and reliable test based on a cadaveric study. Wien Klin Wochenschr. 2019 Feb;131(3-4):81-86. DOI: 10.1007/s00508-018-1433-x; PMID: 30617708; PMCID: PMC6394808.
Faruch Bilfeld M, Lapègue F, Chiavassa Gandois H, Bayol MA, Bonnevialle N, Sans N. Ultrasound of the coracoclavicular ligaments in the acute phase of an acromioclavicular disjonction: Comparison of radiographic, ultrasound and MRI findings. Eur Radiol. 2017 Feb;27(2):483-90. DOI: 10.1007/s00330-016-4413-4; PMID: 27236814.
Dawson J, Rogers K, Fitzpatrick R, Carr A. The Oxford shoulder score revisited. Arch Orthop Trauma Surg. 2009 Jan;129(1):119-23. DOI: 10.1007/s00402-007-0549-7; PMID: 18183410.
Constant CR, Gerber C, Emery RJ, Søjbjerg JO, Gohlke F, Boileau P. A review of the Constant score: modifications and guidelines for its use. J Shoulder Elbow Surg. 2008 Mar-Apr;17(2):355-61. DOI: 10.1016/j.jse.2007.06.022; PMID: 18218327.
Scheibel M, Dröschel S, Gerhardt C, Kraus N. Arthroscopically assisted stabilization of acute high-grade acromioclavicular joint separations. Am J Sports Med. 2011 Jul;39(7):1507-16. DOI: 10.1177/0363546511399379; PMID: 21436458.
Minkus M, Maziak N, Moroder P, Scheibel M. Arthroscopic low-profile reconstruction for acute acromioclavicular joint instability. Obere Extremität. 2019 Feb;14(6):60-65. DOI: 10.1007/s11678-019-0506-4.
Lafosse T, Fortané T, Lafosse L. All-Endoscopic Treatment of Acromioclavicular Joint Dislocation: Coracoclavicular Ligament Suture and Acromioclavicular Ligament Desincarceration. Arthrosc Tech. 2020 Sep 25;9(10):e1485-e1494. DOI: 10.1016/j.eats.2020.06.011; PMID: 33134050; PMCID: PMC7587138.
Hachem AI, S RR, Costa G, Verdalet I, Ezzeddine H, Rius X. Arthroscopically Assisted Comprehensive Double Cerclage Suture Fixation Technique for Acute Acromioclavicular Joint Separation. Arthrosc Tech. 2020 Sep 15;9(10):e1495-e1504. DOI: 10.1016/j.eats.2020.06.012; PMID: 33134051; PMCID: PMC7587229.
This work is licensed under a Creative Commons Attribution 4.0 International License.