Natera-Cisneros L, Santiago-Boccolini H, Sarasquete-Reiriz J

Language: Spanish
References: 19
Page: 164-171
PDF size: 559.52 Kb.

ABSTRACT

The purpose of this paper is to assess the results obtained with the arthroscopy-assisted surgical technique for the treatment of chronic acromioclavicular joint instability (CACJI), based on non-rigid coracoclavicular (CC) fixation and anatomical CC reconstruction with a tendinous allograft. Patients with CACJI who underwent surgery between 2008 and 2012 were included in the study. Clinical assessments included SF36, VAS and DASH, applied at the preoperative visit (POV) and at the last follow-up visit (LFUV). The Constant score and the General Satisfaction Score (0-10) were applied at the last follow-up visit. Occurrence of secondary subluxations was assessed. Ten patients were included; mean age was 41 years (range 33-55). Mean follow-up was 25.50 months (range 24-30). Surgical treatment was indicated in all patients after failure of conservative treatment. Questionnaires applied at the POV and the LFUV showed the following results: 1. SF36: physical, POV = 29.60 ± 3.41 and LFUV = 59.58 ± 1.98 (p = 0.000); 2. SF36 mental, POV = 46.57 ± 3.80 and LFUV = 56.62 ± 1.89 (p = 0.000); 3. VAS: POV = 5.17 ± 2.40 and LFUV: 1.67 ± 2.07 (p = 0.022); and 4. DASH: POV = 63.33 ± 23.56 and LFUV = 2.61 ± 1.79 (p = 0.000). The Constant score and the general satisfaction at the LFUV were 95.56 ± 3.28 and 9.22 ± 0.67, respectively. There were no secondary subluxations. Treatment of CACJI with a CC suspension device and arthroscopically-assisted anatomical reconstruction of CC ligaments may provide a significant quality of life improvement to patients. It is a strategy that, upon considering primary mechanical CC fixation, may minimize the chance of failure and occurrence of secondary subluxations.

REFERENCES

1. Mazzocca AD, Arciero RA, Bicos J: Evaluation and treatment of acromioclavicular joint injuries. Am J Sports Med. 2007; 35: 316-29.

2. 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; 21: 1146-50.

3. Lee SJ, Nicholas SJ, Akizuki KH, McHugh MP, Kremenic IJ, Ben-Avi S: Reconstruction of the coracoclavicular ligaments with tendon grafts: a comparative biomechanical study. Am J Sports Med. 2003; 31: 648-54.

4. Rios CG, Arciero RA, Mazzocca AD: Anatomy of the clavicle and coracoid process for reconstruction of the coracoclavicular ligaments. Am J Sports Med. 2007; 35: 811-7.

5. Calvo E, López-Franco M, Arribas IM: Clinical and radiologic outcomes of surgical and conservative treatment of type III acromioclavicular joint injury. J Shoulder Elbow Surg. 2006; 15: 300-5.

6. Gstettner C, Tauber M, Hitzl W, Resch H: Rockwood type III acromioclavicular dislocation: surgical versus conservative treatment. J Shoulder Elbow Surg. 2008; 17: 220-5.

7. Weinstein DM, McCann PD, McIlveen SJ, Flatow EL, Bigliani LU: Surgical treatment of complete acromioclavicular dislocations. Am J Sports Med. 1995; 23: 324-31.

8. Rolla PR, Surace MF, Murena L: Arthroscopic treatment of acute acromioclavicular joint dislocation. Arthroscopy. 2004; 20: 662-8.

9. LaPrade RF, Hilger B: Coracoclavicular ligament reconstruction using a semitendinosus graft for failed acromioclavicular separation surgery. Arthroscopy. 2005; 21: 1277.

10. Rockwood CA Jr, Williams GR Jr, Young DC: Disorders of the acromioclavicular joint. In: Rockwood CA Jr, Matsen FA 3rd, editors. The shoulder. Philadelphia: WB Saunders;1998: 483-553.

11. Rosenorn M, Pedersen EB: A comparison between conservative and operative treatment of acute acromioclavicular dislocation. Acta Orthop Scand. 1974; 45: 50-9.

12. Grutter PW, Petersen SA: Anatomical acromioclavicular ligament reconstruction: a biomechanical comparison of reconstructive techniques of the acromioclavicular joint. Am J Sports Med. 2005; 33: 1723-8.

13. Lafosse L, Baier GP, Leuzinger J: Arthroscopic treatment of acute and chronic acromioclavicular joint dislocation. Arthroscopy. 2005; 21: 1017.

14. Yoo YS, Seo YJ, Noh KC, Patro BP, Kim DY: Arthroscopically assisted anatomical coracoclavicular ligament reconstruction using tendon graft. Int Orthop. 2011; 35: 1025-30.

15. Jerosch J, Filler T, Peuker E, Greig M, Siewering U: Which stabilization technique corrects anatomy best in patients with AC-separation? An experimental study. Knee Surg Sports Traumatol Arthrosc. 1999; 7: 365-72.

16. Guttmann D, Paksima NE, Zuckerman JD: Complications of treatment of complete acromioclavicular joint dislocations. Instr Course Lect. 2000; 49: 407-13.

17. Wellmann M, Zantop T, Petersen W: Minimally invasive coracoclavicular ligament augmentation with a flip button/polydioxanone repair for treatment of total acromioclavicular joint dislocation. Arthroscopy. 2007; 23: 1132.e1-5.

18. Baumgarten KM, Altchek DW, Cordasco FA: Arthroscopically assisted acromioclavicular joint reconstruction. Arthroscopy. 2006; 22: 228.e1-228.e6.

19. Pauly S, Kraus N, Greiner S, Scheibel M: Prevalence and pattern of glenohumeral injuries among acute high-grade acromioclavicular joint instabilities. J Shoulder Elbow Surg. 2013; 22: 760-6.