Keywords
chronic dislocation
How to Cite
Abstract
Relevance. Treatment of chronic acromioclavicular joint dislocations remains a controversial issue and ranges from conservative treatment to extensive reconstruction.
Objective: to compare clinical and radiographic results of surgical treatment of patients with chronic acromioclavicular joint dislocation.
Materials and Methods. A retrospective analysis of 41 patients with chronic acromioclavicular joint dislocation was performed (time from the injury was more than 3 weeks). The patients were divided into two groups: group I (19 patients, 46.3%), which underwent arthroscopically assisted dynamic type of acromioclavicular joint dislocation stabilization with acromioclavicular and coracoclavicular ligaments augmentation, and group II (22 patients, 53.7%), which underwent fixation of acromioclavicular joint dislocation with Hook-plate and acromioclavicular and coracoclavicular ligaments augmentation. The mean age at surgery was 34.1±11.2 years (range 18-70 years). Most of the patients were males – 36 patients (87.8%). Clinical outcomes were assessed using the Oxford Shoulder Score, Constant – Murley Score, and Acromioclavicular Joint Instability Scoring System.
Results. The mean Oxford Shoulder score before surgical treatment was 31.5±7.7 points and 33.3±4.2 points (p=0.347), and at the final follow-up 46±2.6 points and 46.1±1.6 points – in group I and group II, respectively. The mean Constant – Murley score before surgical treatment was 68.9±12.4 points and 69.7±14.5 points (p=0.863), and at the final follow-up 94.2±7.7 points and 96.5±3.9 points (p=0.291). The mean Acromioclavicular Joint Instability Scoring System score before surgical treatment was 31.3±9.5 points and 25.1±8.2 points (p=0.087), and at the final follow-up 79.9±16.7 points and 75.7±9.1 points (p=0.422), respectively. Concomitant intra-articular injuries of the shoulder joint were diagnosed in 68.4% of patients; the most common injuries were SLAP injury and long head of biceps tendonitis. Complications of treatment were noted in both groups, but there were no complications that would require additional reconstructive.
Conclusions. Arthroscopic assisted dynamic fixation techniques or open fixation techniques with a specialized plate in combination with the reconstruction of acromioclavicular ligaments and coracoclavicular ligaments by tendon autografts provides good long-term functional results.
References
Garcia AV, Castillo FS, Giordani ME, Mura J. Anteroinferior bundle of the acromioclavicular ligament plays a substantial role in the joint function during shoulder elevation and horizontal adduction: A finite element model. J Orthop Surg Res. 2022 Feb 5;17(1):73. DOI: 10.1186/s13018-022-02966-0. PMID: 35123523; PMCID: PMC8818233
Keener JD. Acromioclavicular joint anatomy and biomechanics. Oper Tech Sports Med. 2014 Sep; 22(3): 210-13. DOI: 10.1053/j.otsm.2014.02.018.
Scheibel M, Dröschel S, Gerhardt C, Kraus N. Arthroscopically assisted stabilization of acute high-grade acromioclavicular joint separations. The Am J Sports Med. 2011 Jul;39(7):1507-16. DOI: 10.1177/0363546511399379.
Faria RS, Ribeiro FR, Amin BO, Tenor Junior AC, Costa MP, Filardi Filho CS, et al. Acromioclavicular dislocation: postoperative evaluation of the coracoclavicular ligaments using magnetic resonance. Rev Bras Ortop. 2015 Apr 24;50(2):195-9. DOI: 10.1016/j.rboe.2015.04.007. PMID: 26229916; PMCID: PMC4519617.
Cano-Martínez JA, Nicolás-Serrano G, Bento-Gerard J, Marín FP, Grau JA, Antón ML. Chronic acromioclavicular dislocations: multidirectional stabilization without grafting. JSES Int. 2020 May 26;4(3):519-531. DOI: 10.1016/j.jseint.2020.04.014. PMID: 32939479; PMCID: PMC7479045.
Weinstein DM, McCann PD, McIlveen SJ, Flatow EL, Bigliani LU. Surgical Treatment of Complete Acromioclavicular Dislocations. Am J Sports Med. 1995 May-Jun;23(3):324-31. DOI: 10.1177/036354659502300313. PMID: 7661261.
Carbone S, Postacchini R, Gumina S. Scapular dyskinesis and SICK syndrome in patients with a chronic type III acromioclavicular dislocation. Results of rehabilitation. Knee Surg Sports Traumatol Arthrosc. 2015 May;23(5):1473-80. DOI: 10.1007/s00167-014-2844-5. Epub 2014 Jan 24. PMID: 24458335.
Murena L, Canton G, Vulcano E, Cherubino P. Scapular dyskinesis and SICK scapula syndrome following surgical treatment of type III acute acromioclavicular dislocations. Knee Surg Sports Traumatol Arthrosc. 2013 May;21(5):1146-50. DOI: 10.1007/s00167-012-1959-9. Epub 2012 Mar 30. PMID: 22461014.
Minkus M, Hann C, Scheibel M, Kraus N. Quantification of dynamic posterior translation in modified bilateral Alexander views and correlation with clinical and radiological parameters in patients with acute acromioclavicular joint instability. Arch Orthop Trauma Surg. 2017 Jun;137(6):845-852. DOI: 10.1007/s00402-017-2691-1. Epub 2017 Apr 17. PMID: 28417201.
White LM, Ehmann J, Bleakney RR, Griffin AM, Theodoropoulos J. Acromioclavicular Joint Injuries in Professional Ice Hockey Players: Epidemiologic and MRI Findings and Association With Return to Play. Orthop J Sports Med. 2020 Nov 19;8(11):2325967120964474. DOI: 10.1177/2325967120964474. PMID: 33283007; PMCID: PMC7686611.
Cote MP, Wojcik KE, Gomlinski G, Mazzocca AD. Rehabilitation of acromioclavicular joint separations: operative and nonoperative considerations. Clin Sports Med. 2010 Apr;29(2):213-28, vii. DOI: 10.1016/j.csm.2009.12.002. PMID: 20226315.
LeVasseur MR, Mancini MR, Berthold DP, Cusano A, McCann GP, Cote MM, et al. Acromioclavicular Joint Injuries: Effective Rehabilitation. Open Access J Sports Med. 2021 May 28;12:73-85. DOI: 10.2147/OAJSM.S244283. PMID: 34093044; PMCID: PMC8169819.
Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987 Jan;(214):160-4. PMID: 3791738.
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. Epub 2008 Jan 9. PMID: 18183410.
Cooper E. New method of treating long standing dislocations of the scapuloclavicular articulation. Am J Med Sci. 1861;1:389–92.
Mumford EB. Acromioclavicular dislocation A new operative treatment. J Bone Joint Surg. 1941 Oct;23(4):799-802.
Neviaser S. Acromioclavicular dislocation treated by transference of the coraco-acromial ligament. A long-term follow-up in a series of 112 cases. Clin Orthop Relat Res. 1968 May-Jun;58:57-68. PMID: 5666868.
Cadenat F. The treatment of dislocations and fractures of the outer end of the clavicle. Int Clin. 1917; 1: 145-169.
Weaver JK, Dunn HK. Treatment of Acromioclavicular Injuries, Especially Complete Acromioclavicular Separation. J Bone Joint Surg Am. 1972 Sep;54(6):1187-94. PMID: 4652050.
Verstift DE, Somford MP, van Deurzen DF, van den Bekerom MP. Review of Weaver and Dunn on treatment of acromioclavicular injuries, especially complete acromioclavicular separation. J ISAKOS. 2021 Mar;6(2):116-119. DOI: 10.1136/jisakos-2019-000299. Epub 2020 Sep 24. PMID: 33832985.
Boström Windhamre HA, von Heideken JP, Une-Larsson VE, Ekelund AL. Surgical treatment of chronic acromioclavicular dislocations: a comparative study of Weaver-Dunn augmented with PDS-braid or hook plate. J Shoulder Elbow Surg. 2010 Oct;19(7):1040-8 DOI: 10.1016/j.jse.2010.02.006. Epub 2010 May 10. PMID: 20452245.
Jones P, Lemos J, Schepsis. Salvage of failed acromioclavicular joint reconstruction using autogenous semitendinosus tendon from the knee. Am J Sports Med. 2001 Mar-Apr;29(2):234-7. DOI: 10.1177/03635465010290022001. PMID: 11292052.
Motamedi AR, Blevins FT, Willis MC, McNally TP, Shahinpoor M. Biomechanics of the coracoclavicular ligament complex and augmentations used in its repair and reconstruction. Am J Sports Med. 2000 May-Jun;28(3):380-4. DOI: 10.1177/03635465000280031701. PMID: 10843132.
Jensen G, Millett pJ, Tahal DS, Al Ibadi M, Lill H, Katthagen JC. Concomitant glenohumeral pathologies associated with acute and chronic grade III and grade V acromioclavicular joint injuries. Int Orthop. 2017 Aug; 41(8):1633-1640. DOI: 10.1007/s00264-017-3469-3. Epub 2017 Apr 28. PMID: 28455736.
Ruiz Ibán MA, Moreno Romero MS, Diaz Heredia J, Ruiz Díaz R, Muriel A, López-Alcalde J. The prevalence of intraarticular associated lesions after acute acromioclavicular joint injuries is 20%. A systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2021 Jul;29(7):2024-2038. DOI: 10.1007/s00167-020-05917-6. Epub 2020 Mar 16. PMID: 32179968.
This work is licensed under a Creative Commons Attribution 4.0 International License.