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Overview of operating site. Left shoulder, lateral decubitus position. Standard posterior, anterolateral, and anterior portals and an additional skin incision over the distal clavicle are used.
Source publication
Acromioclavicular (AC) joint dislocation is a common injury, particularly among active young individuals. Numerous surgical procedures for treating acute, high-grade AC joint dislocation have been reported. However, no standard surgical procedure that restores the normal kinematics of the AC joint is available. Among the available coracoclavicular...
Context in source publication
Context 1
... pillow at the head of the patient is removed because it can interfere with subsequent clavicle drilling. Three (posterior, anterolateral, and anterior) or two (anterolateral and anterior) standard arthroscopic portals are created (Fig 1). The posterior portal is only the initial introductory portal that helps identify the anterolateral and anterior portals. ...
Citations
... Fixation failures have been found to be due to hardware breakage or migration, suture abrasion and breakage, or bone erosion because of the potential sawing action of the sutures through the clavicle or the coracoid. [22] Some suturing techniques are also reported in the literature. Huang et al [23] suspended suture augmentation through the drill holes in the clavicle, but they did not reconstruct the AC ligament. ...
The objective of this report was to introduce a new suture augmentation of coracoclavicular (CC) and acromioclavicular ligament reconstruction for acute Rockwood grade III to V acromioclavicular dislocations.
From January 2015 to January 2019, 43 patients with Rockwood III to VI acute acromioclavicular dislocations were retrospectively reviewed. For comparison, another series of 28 patients treated with double Endobutton technique from January 2011 to December 2014 were reviewed. A P < .05 was considered statistical significance.
The mean follow-up period of the 2 series were 39.69 ± 7.42 months (range, 24–54 months) and 37.86 ± 8.23 months (range, 26–48 months) (P > .05), respectively. There were significant differences regarding CC space (11.62 ± 2.54 mm vs 16.78 ± 5.53 mm; P < .05), CC reduction loss (5.56 ± 4.73 mm vs 26.25 ± 4.42 mm; P < .05), and acromioclavicular space (6.89 ± 1.87 mm vs 7.95 ± 2.37 mm; P < .05). There were significant differences regarding the disabilities of the arm, shoulder, and hand questionnaire (3.3 ± 2.8 vs 5.32 ± 4.37; P < .05) and University of California–Los Angeles shoulder rating scale (31.19 ± 2.48 vs 29.24 ± 2.48; P < .05). The excellent to good percentages were 100% (n = 32) and 85% (n = 23), respectively.
In conclusion, the suture augmentation of acromioclavicular and CC ligament reconstruction is a reliable technique for acute acromioclavicular dislocation with minimal complications.
Type of study/level of evidence: Therapeutic IIa.
... Possible failures with recurrent clavicular subluxation or dislocation have been reported after some of these procedures, with failure rates up to 50%. Fixation failures have been found to be due to hardware breakage or migration, suture abrasion and breakage, or bone erosion because of the potential sawing action of the sutures through the clavicle or the coracoid23 . ...
PurposeThe objective of this report was to introduce a new suture augmentation of coracoclavicular and acromioclavicular ligament reconstruction for acute Rockwood grade III to V acromioclavicular dislocations.Methods
From January 2015 to January 2019, 43 patients with Rockwood III to VI acute acromioclavicular dislocations were retrospective reviewed. The outcome evaluations included coracoclavicular space, loss of reduction, and acromioclavicular space. The Disabilities of the Arm, Shoulder, and Hand questionnaire was used to assess the limb function. Clinical evaluation of patients was performed using the University of California-Los Angeles scoring systems. For comparison, another series of 28 patients treated with double Endobutton technique from January 2011 to December 2014 was reviewed. A P<0.05 was considered statistical significance.ResultsThe mean follow-up period of the two series were 39.69±7.42 months (range, 24–54 months) and37.86±8.23 months (range, 26–48 months) (P>0.05), respectively. There were significant differences regarding coracoclavicular space (11.62±2.54 mm vs 16.78±5.53 mm; P<0.05), coracoclavicular reduction loss (5.56±4.73 mm vs 26.25±4.42 mm; P<0.05), and acromioclavicular space (6.89±1.87 mm vs 7.95±2.37 mm; P<0.05). There were significant differences regarding the Disabilities of the Arm, Shoulder, and Hand questionnaire (3.3±2.8 vs 5.32±4.37; P<0.05) and University of California-Los Angeles Shoulder rating scale (31.19±2.48 vs 29.24±2.48; P<0.05). The excellent to good percentages were 100 % (n=32) and 85% (n=23), respectively. Conclusions
In conclusion, the suture augmentation of acromioclavicular and coracoclavicular ligament reconstruction is reliable technique for acute acromioclavicular dislocation with minimal complications.Type of study/level of evidenceTherapeutic IIa.
Background
A coracoclavicular (CC) fixation technique using an all-suture anchor with the assistance of fluoroscopy can prevent iatrogenic anterior deltoid detachment from the clavicle; however, soft anchor pullout has been reported as a complication.
Purpose
To compare the biomechanical properties of conventional metallic and all-suture anchors for CC suture fixation.
Study Design
Controlled laboratory study.
Methods
A total of 24 fresh-frozen cadaveric specimens were divided into 2 groups: metal anchor group (group M) and all-suture anchor group (group A). In group M, 5.0-mm metallic suture anchors were used for CC fixation, whereas 2.8-mm all-suture anchors were used in group A. The prepared specimens were mounted on a materials testing machine. After preconditioning at 0 to 20 N for 10 cycles, the specimens were subjected to cyclic loading from 20 to 70 N for 1000 cycles. Finally, all the specimens were loaded to failure. Cyclic elongation, linear stiffness, ultimate load, and failure modes were recorded, and the Mann-Whitney U test was used to compare nonparametric parameters between the 2 groups.
Results
All of the specimens completed the cyclic loading test. The elongation after cyclic loading in group M (1.6 ± 0.6 mm) was significantly smaller compared with that in group A (2.5 ± 1.2 mm) ( P = .02). No between-group differences were found in linear stiffness (42 ± 17 N/mm in group M and 41 ± 17 N/mm in group A). The ultimate failure load in group M (263 ± 66 N) was significantly greater than that in group A (177 ± 76 N) ( P = .02). All specimens failed because of suture anchor pullout.
Conclusion
The use of all-suture anchors in CC fixation resulted in significantly greater cyclic displacement and smaller ultimate failure load than that of metallic anchors.
Clinical Relevance
Understanding the most biomechanically sound suture anchor may assist in lowering the risk of clinical failure in CC fixation and repair.
Purpose
To compare the clinical and radiologic outcomes of arthroscopically assisted coracoclavicular (CC) fixation using multiple soft anchor knots versus hook plate fixation in patients with acute high-grade Rockwood type III and V acromioclavicular (AC) joint dislocations.
Methods
This retrospective study included 22 patients with acute Rockwood type III and V AC joint dislocations who underwent arthroscopic fixation or hook plate fixation surgery between February 2016 and March 2018. Patients were categorized into two groups: arthroscopically assisted CC fixation using multiple soft anchor knots group (AR, n =12) and hook plate fixation group (HO, n =10). We measured the CC distances (CCDs) and CCD ratio at 6 months, 1 year, and last follow-up postoperatively to compare the radiological results between the groups. Clinical outcomes were assessed at 1 year postoperatively and at the last follow-up using the visual analog scale (VAS), American Shoulder and Elbow Surgeons scores (ASES), and Shoulder Pain And Disability Index (SPADI) scores and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Magnetic resonance imaging (MRI) after hook plate removal was used to evaluate the healing ligaments and tendon–bone interface.
Results
The AR group patients had better ASES, SPADI, and Quick DASH scores than the HO group patients at 1 year postoperatively and at last follow-up. The CCD and CCD ratio were significantly better in the AR group than in the HO group at the last follow-up period (P = .007/0.029). MRI findings showed grade I in 60% of patients in the AR group and grade III in 60% of patients in the HO group. AC joint arthritic change was observed in 40% of the HO group.
Conclusion
The CC fixation method using multiple soft anchor knots showed satisfactory results and had superior CC ligament healing ability and maintenance of CC distance compared to hook fixation.
Level of evidence
Level III, retrospective therapeutic comparative investigation
