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ISSN 2992-8036 (Electronic)
ISSN 2306-4102 (Print)
Órgano Oficial del Colegio Mexicano de Ortopedia y Traumatología

2016, Number 1

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Acta Ortop Mex 2016; 30 (1)

Acromioclavicular instability: arthroscopic and mini-open combined treatment

Slullitel D, Galán H, Della VF, Ibañez F

Language: Spanish
References: 26
Page: 2-6
PDF size: 245.33 Kb.


ABSTRACT

Introduction: The surgical treatment of acromioclavicular dislocation remains controversial. We describe herein a combined two-stage technique that includes an arthroscopic approach followed by a mini-invasive approach. Material and methods: 41 patients with acromioclavicular dislocation grades III, IV and V. Acute and chronic lesions and revision surgeries were included during the follow-up. Patients with other shoulder conditions were excluded. Mean age was 28.6 years. Patients were assessed preoperatively with the UCLA and Constant scores, and the pain visual analog scale. The 6- and 12-month postoperative evaluation included X-rays to assess coronal and axial stability, coracoclavicular ossifications, signs of acromioclavicular arthrosis and/or distal clavicular osteolysis. Results: The Constant scores were as follows: 41.3 preoperatively; 89.4 at 6 months; 92.3 at 12 months. The UCLA scores were as follows: 21.7 preoperatively; 29.1 at 6 months; 31.4 at 12 months. The VAS scores were 8.4, 2.3 and 1.2, for the same periods respectively. Two cases had repeated injury due to trauma and one case was dissatisfied with the cosmetic appearance of the scar. The X-ray assessment showed two cases of loss of stability and one case of distal clavicular osteolysis. Conclusion: The combination of two reduction methods, a synthetic one and a biological one allows for a solid anatomical reconstruction that is stable in the coronal and axial planes and good medium-term results.


REFERENCES

  1. Mardani-Kivi M, Mirbolook A, Salariyeh M, Hashemi-Motlagh K, Saheb-Ekhtiari K: The comparison of Ethibond sutures and semitendinosus autograft in the surgical treatment of acromioclavicular dislocation. Acta Orthop Traumatol Turc. 2013; 47(5): 307-10.

  2. Mazzocca AD, Arciero RA, Bicos J: Evaluation and treatment of acromioclavicular joint injuries. Am J Sports Med. 2007; 35(2): 316-29.

  3. Beitzel K, Cote MP, Apostolakos J, Solovyova O, Judson CH, Ziegler CG, et al: Current concepts in the treatment of acromioclavicular joint dislocations. Arthroscopy. 2013; 29(2): 387-97.

  4. Weaver JK, Dunn HK: Treatment of acromioclavicular injuries, especially complete acromioclavicular separation. J Bone Joint Surg Am. 1972; 54: 1187-94.

  5. 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.

  6. Thomas K, Litsky A, Jones G, Bishop JY. Biomechanical comparison of coracoclavicular reconstructive techniques. Am J Sports Med. 2011; 39: 804-10.

  7. Cooper ES: New method of treating long standing dislocations of the scapula-clavicle articulation. Am J Med Sci. 1861; 1: 389-92.

  8. Beitzel K, Obopilwe E, Chowaniec D, Nowak M, Hanypsiak B, Guerra J: Biomechanical properties of repairs for dislocated AC joints using suture button systems with integrated tendon augmentation. Knee Surg Sports Traumatol Arthrosc. 2012; 20: 1931-8.

  9. Tischer T, Vogt S, Imhoff AB: Arthroscopic stabilization of the shoulder with suture anchors with special reference to the deep anterior-inferior portal (5.30 o’clock). Oper Orthop Traumatol. 2007; 19(2): 133-54.

  10. Rockwood CA Jr, Williams GR, Young CD: Injuries of the acromioclavicular Joint. In: Rockwood CA Jr, et al: (eds) Fractures in adults. Lippincott-Raven, Philadelphia, 1996; 134-1431.

  11. Milewski MD, Tompkins M, Giugale JM, Carson EW, Miller MD, Diduch DR: Complications Related to Anatomic Reconstruction of the Coracoclavicular Ligaments. Am J Sports Med. 2012; 40(7): 1628-34.

  12. Nüchtern JV, Sellenschloh N, Bishop N, et al: Biomechanical evaluation of 3 stabilization methods on acromioclavicular joint dislocations. Am J Sports Med. 2013; 41: 1387-94.

  13. Beitzel K, Obopilwe E, Apostolakos J, Cote MP, Russell RP, Charette R, et al: Rotational and translational stability of different methods for direct acromioclavicular ligament repair in anatomic acromioclavicular joint reconstruction. Am J Sports Med. 2014; 42: 2141-8.

  14. Ranne JO, Sarimo JJ, Rawlins MI, Heinonen OJ, Orava SY: All-arthroscopic double-bundle coracoclavicular ligament reconstruction using autogenous semitendinosus graft: a new technique. Arthrosc Tech. 2012; 1(1): e11-e4.

  15. Gonzalez R, Damacen H, Nyland J, Ed D, Caborn D: Acromioclavicular joint reconstruction using peroneus brevis tendon allograft. Arthroscopy. 2007; 23(7): 788. e1-e4.

  16. Yoo YS, Tsai AG, Ranawat AS, Bansal M, Fu F, Rodosky M, et al: A biomechanical analysis of the native coracoclavicular ligaments and their influence on a new reconstruction using a coracoid tunnel and free tendon graft. Arthroscopy. 2010; 26(9): 1153-61.

  17. Geaney LE1, Beitzel K, Chowaniec DM, Cote MP, Apostolakos J, Arciero RA, et al: Graft fixation is highest with anatomic tunnel positioning in acromioclavicular reconstruction. Arthroscopy. 2013; 29(3): 434-9.

  18. Tauber M, Eppel M, Resch H, Salzburg A: Acromioclavicular reconstruction using autogenous semitendinosus tendon graft: results of revisions surgery in chronic cases. J Shoulder Elbow Surg. 2007; 16(4): 429-33.

  19. Geaney LE, Miller MD, Ticker JB, Arciero RA, DeBerardino TM, Mazzocca A: Management of the failed ac joint reconstruction: causation and treatment. Sports Med Arthrosc Rev. 2010; 18(3): 167-72.

  20. Bosworth B: Acromioclavicular separation: new method of repair. Surg Gynecol Obstet. 1941; 73: 866-71.

  21. Cadenat F: The treatment of dislocations and fractures of the outer end of the clavicle. Int Clin. 1917; 1: 145-69.

  22. Dewar FP, Barrington TW: The treatment of chronic acromio-clavicular dislocation. J Bone Joint Surg Br. 1965; 47: 32-5.

  23. Chernchujit B, Tischer T, Imhoff AB: Arthroscopic reconstruction of the acromioclavicular joint disruption: surgical technique and preliminary results. Arch Orthop Trauma Surg. 2006; 126(9): 575-81.

  24. Wellmann M, Kempka JP, Schanz S, Zantop T, Waizy H, Raschke M, et al: Coracoclavicular ligament reconstruction: biomechanical comparison of tendon graft repairs to a synthetic double bundle augmentation. Knee Surg Sports Traumatol Arthrosc. 2009; 17(5): 521-8.

  25. Carofino BC, Mazzocca AD: The anatomic coracoclavicular ligament reconstruction: surgical technique and indications. J Shoulder Elbow Surg. 2010; 19: 37-46.

  26. Fauci F, Merolla G, Paladini P, Campi F, Porcellini G: Surgical treatment of chronic acromioclavicular dislocation with biologic graft vs synthetic ligament: a prospective randomized comparative study. J Orthop Traumatol. 2013; 14(4): 283-90.




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