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Radiological examination. Green line shows the distance between the acromion and lateral clavicle (ACD); red line shows the distance between the coracoid process and clavicle (CCD).
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Background
The management of acute Rockwood type III acromioclavicular joint (ACJ) dislocation remains controversial, and the debate about whether patients should be conservatively or surgically treated continues. This study aims to compare conservative and surgical treatment of acute type III ACJ injuries in active sport participants (<35 years of...
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Background
Os acromiale can be potentially missed or misdiagnosed as acromion fracture, and this can affect treatment determination if it is complicated with an ipsilateral shoulder injury. The clavicle hook plate is a widely used technique for distal clavicle injuries, leading to transacromial erosion, particularly when in the presence of os acrom...
Acromioclavicular (AC) joint arthropathy remains one of the most common causes of shoulder pain. In the case of AC joint arthropathy resistant to conservative treatment, most authors have recognized distal clavicle resection as the gold-standard treatment. However, some challenges remain to be solved. One is the difficulty in visualization of the s...
Citations
... Though a variety of surgical procedures exist, a gold standard has not yet been established. Findings of the studies conducted to analyze the various surgical techniques show comparable clinical as well as radiological results in the medium term [2,[6][7][8][9][10][11][12][13][14][15][16]. Significant advances have been made to optimize minimally invasive surgery in recent years. ...
... Studies on the return to sporting activities after twintailed coracoclavicular stabilization using comparable implants show an average recovery rate of the previous level of sports activity of 80.4% (62-92%) [11,[31][32][33][34]. In the MO group, a similar outcome was achieved. ...
... Radiograph demonstrating a complete re-dislocation after double TightRope stabilization Content courtesy of Springer Nature, terms of use apply. Rights reserved.TightRope procedure and the PDS cerclage technique show good-to-excellent clinical results[2,[6][7][8][9][10][11][12][13][14][15][16]. Likewise, the surgical techniques observed in the course of this study show comparable excellent results in the evaluation of the Constant Murley Score (ASK: 91.2 points, MO: 91.6 points), as well as very good results in the Taft Score and the Simple Shoulder Test (Taft: ASK: 10.3 points, MO: 10.5 points; SST: ASK: 11.7 points, MO: 11.7 points). ...
Introduction
In athletes, acromioclavicular joint disruptions account for up to 50% of all shoulder injuries. In high-grade injuries, surgery is favored to ensure a correct restoration of the joint, especially in young athletes. The aim of this study was to compare the clinical, radiological and sport related outcomes of the arthroscopic stabilization with the fixation of the AC joint in a mini-open approach.
Materials and methods
19 patients treated arthroscopically (ASK) and 26 patients with an acute AC-joint dislocation Rockwood V who had undergone the mini-open (MO) surgery were included. Constant Murley Score (CMS), Taft Score (TS) and the Simple Shoulder Tests (SST) were evaluated. The sports activity level was determined according to Valderrabano and the athlete’s recovery of their athletic activity level after surgery according to Rhee. Furthermore, all available X-ray images were analyzed.
Results
Patients in the ASK group achieved an average score of 11.7 ± 0.6 points in the SST, 10.3 ± 1.8 points in the TS and 91.2 ± 11.8 points in the CMS. On average, patients in the MO group achieved results of 10.5 ± 1.4 points in the SST, 11.7 ± 0.7 points in the TS and 91.6 ± 9.8 points in the CMS. The ASK group showed significant difference regarding the CC distance in side comparison (Δ = 3.6 mm), whereas no significant difference was found in the MO group (Δ = 0.8 mm). In comparison of both groups, the posterior as well as the combined translation were significantly greater in the ASK group than in the MO group (posterior: ASK: 24.8 mm, MO: 19.3 mm, combined: ASK: 29.1 mm, MO: 20.9 mm). Residual horizontal instability was greater in the ASK group (43%) than in the MO group (32%). Similar results were achieved in sports activity and the recovery of athletic activity (Valderrabano: ASK: 2.8, MO: 2.6; Rhee: ASK: 1.6, MO: 1.5).
Conclusions
Both techniques prove to be effective for the stabilization of high-grade AC-joint disruptions in athletes and showed excellent clinical results. From a radiographic standpoint, the mini-open procedure appears superior to the arthroscopic technique. After mini-open surgery postoperative loss of correction is less common and greater horizontal stability is achieved. The results also suggest the mini-open technique is superior to the arthroscopic procedure when aiming to restore the athlete’s original level of sports activity.
Level of evidence
1.
... After screening titles/abstracts for satisfying inclusion/exclusion criteria, 177 abstracts were further excluded, leaving 34 unique studies for full-text review. Finally, 14 studies that reported outcomes after the surgical management of acute Rockwood grade III acromioclavicular dislocations were included in this systematic review ( Figure 1) [12,19,[26][27][28][29][30][31][32][33][34][35][36][37]. ...
Injuries of the acromioclavicular joint (ACJ) occur frequently in young and active people. The best management of acute grade III injuries has been a source of controversy and extensive debate. When surgery is indicated, there is still no gold standard surgical technique for treating acute grade III ACJ injuries.
The methodology of this review was a comprehensive search of PubMed, Medline, Cochrane, and EMBASE databases using various combinations of the keywords “Rockwood,” “type III,” “grade III,” “treatment,” “surgery,” “acromioclavicular joint,” and “dislocation,” since the inception of the databases to December 2020. Surgical techniques were divided into two groups. In group 1 were ACJ fixation techniques using hardware such as the hook plate, Kirschner wires, and wire cerclage; group 2 included coracoclavicular (CC) ligament fixation/reconstruction techniques using double buttons, TightRope®, suture anchors, Endobuttons, the Infinity-LockTM Button System, etc. Fourteen studies were selected for the final review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
This review showed better outcome scores in group 2. Overall, complication rates were higher in group 1 compared to group 2. The results of this review show that CC fixation, using suspensory or loop devices, of Rockwood grade III injuries, has better outcomes and fewer complications than fixation of the ACJ with hardware.
... After reviewing the title and abstract of these studies, 793 studies were excluded resulting in 19 eligible studies. These studies were subjected to a full-text evaluation for eligibility, and according to the exclusion and inclusion criteria, five studies [11][12][13][14][15] were selected for qualitative and quantitative analysis. The included studies directly compared clinical and radiological outcomes of patients with acute Rockwood III ACJ dislocation who underwent a conservative or surgical approach. ...
... De Carli et al., in their retrospective study, evidenced no significant differences between the two groups in the UCLA and American Shoulder and Elbow Surgeons (ASES) Scale. On the contrary, statistically significant higher results were observed in the operated patients regarding the Acromioclavicular Joint Instability (ACJI) Scoring System [15] . ...
... Finally, Esen et al. [13] treated patients with an acromioclavicular bandage. Regarding surgical treatments, a modified Phemister procedure [11] , a modified Weaver-Dunn technique [13] , a tightrope tensioning system technique [15] , a hook plate synthesis, and a Kirschner wire synthesis [ 12 , 14 ] were performed. No quantitative analysis of the different surgical and conservative procedures was possible because the treatment protocols differed among the studies analyzed. ...
Background: The most appropriate approach, surgical or conservative, for acute Rockwood type III acromioclavicular joint (ACJ) dislocation is still under debate. In literature, similar results have been reported with both treatments. This review aims to analyze the operative and conservative outcomes of acute Rockwood type III ACJ dislocation to guide orthopedics in daily practice.
Material/methods: A systematic review and meta-analysis were performed according to PRISMA guidelines. A PICOS template was developed. Four databases (Pubmed, Scopus, Embase, and Medline) were searched, and eligible articles were evaluated according to the Levels of Evidence. The methodological quality of the articles was assessed through the ROBINS-I and the RoB-2. This review was registered in PROSPERO.
Results: Five studies were included, with 73 and 110 patients treated with conservative and surgical approaches, respectively. Three outcomes, Constant Score (CS), coracoclavicular distance (CCD), and acromioclavicular distance (ACD) were analyzed. Only the acromioclavicular distance was statistically significant in the surgical group over the conservative one (p < 0.05); instead, the other two outcomes demonstrated no statistical difference between the two groups.
Conclusions: This study demonstrated statistically significant superiority of the mean ACD score in the radiological follow-up of the surgical group compared to the conservative one. A tendency for better radiological and clinical results, mean CCD and CS scores, respectively, although non statically significant, was reported in the surgical group. High-quality randomized controlled clinical trials should help determine the most appropriate treatment for acute Rockwood type III ACJ dislocations.
... The Tightrope system is a commonly used flexible internal device, which has been successfully used in the treatment of acromioclavicular joint dislocation and anterior cruciate ligament reconstruction. In the previous experiments, most of the patients returned to their sport/recreational athletic activities and their work smoothly [7][8][9][10]. This paper describes a technique of reconstructing Lisfranc ligament with the Tightrope system for the treatment of purely ligamentous Lisfranc injuries. ...
Background
Purely ligamentous Lisfranc injuries are mainly caused by low energy damage and often require surgical treatment. There are several operative techniques for rigid fixation to solve this problem clinically. This study evaluated the effect of using the Tightrope system to reconstruct the Lisfranc ligament for elastic fixation.
Methods
We retrospectively analyzed 11 cases with purely ligamentous Lisfranc injuries treated with the Tightrope system from 2016 to 2019, including 8 male and 3 female. X-ray was performed regularly after operation to measure the distance between the first and second metatarsal joint and the visual analogue scale (VAS) score was used to evaluate pain relief. American orthopedic foot & ankle society (AOFAS) and Maryland foot score were recorded at the last follow-up.
Results
The average follow-up time was 20.5 months (range, 17–24). There was statistically significant difference in the distance between the first and second metatarsal joint and VAS score at 3 months, 6 months, and the last follow-up when compared with preoperative values ( P < 0.05).Mean of postoperative AOFAS mid-foot scale and Maryland foot score were 92.4 ± 4.3, 94.1 ± 3.5, respectively. The Tightrope system was not removed and the foot obtained better biomechanical stability. No complications occurred during the operation.
Conclusion
Tightrope system in the treatment of purely ligamentous Lisfranc injuries can stabilize the tarsometatarsal joint and achieve satisfactory effect.
... 9 Many researchers have measured the satisfaction of the patients by the appearance of their shoulder, subjectively. 10,11 In most of the commonly used shoulder outcome scores, deformity or cosmetic satisfaction of the patients are not considered. Recently, Barwood et al. suggested a new scoring system called "Specific AC Score" (SACS). ...
... All of these questionnaires were adapted and validated in Turkish language. [11][12][13][14] The OSS is a PROM consisting of 12 questions, and each question consists of points ranging from 1 to 5. The questionnaire ranged from 12 to 60. Maximum points (60) represent the worst outcome and minimum points the best outcome. 14 The ASES consists of two sections in which the first section is self-reported and the second part is completed by the physician. ...
Objective:
The Specific Acromioclavicular Score (SACS) is a questionnaire that assesses functional outcomes for Acromioclavicular Joint (ACJ) pathologies. The aim of this study was to evaluate the ease of use, reliability, and validity of the Turkish-translated and culturally adapted form of the SACS.
Methods:
The SACSwas translated into Turkish according to Beaton's recommendations. Seventy-eight patients were included in this study (67 with acute or chronic AC instability and 11 with symptomatic ACJ arthritis). The mean interval between test and retestwas 13.2 ± 4.6 days. The reliability of the tools was measured with the intraclass correlation coefficient. External validity was evaluated using correlations between the SACS,Oxford Shoulder Score (OSS), Shoulder Pain and Disability Index (SPADI), American Shoulder and Elbow Surgeons (ASES) Shoulder score, and the SF-36 version 2 (SF-36v2). Floor and ceiling effects were also analyzed.
Results:
The mean time to complete the Turkish SACS was 3 min 18 s (range, 1 min 40 s to 7 min 9 s). The test-retest reliability was excellent (ICC, 0.988). There was a very good correlation between SACS,OSS, SPADI, and ASES scores (r = 0.645, 0.645, and -0.682, respectively, P < 0.05). A poor correlationwas observed between SACS and subscales of SF-36v2 (P > 0.05). No floor or ceiling effects were detected.
Conclusion:
The Turkish version of the SACS is a reliable and valid tool tomeasure outcomes after various types of acromioclavicular joint pathologies.
Level of evidence:
Level IV, Diagnostic Study.
... Types III-VI are higher energy injuries that result in significant displacement of the AC joint representing complete disruption of the CC ligament complex causing considerable pain, disability, and deformity [1,3]. Types IV-VI are typically treated surgically while the optimal treatment for type III injuries is still hotly debated regarding consensus on optimal treatment [4][5]. ...
A female patient who underwent successful reconstruction of an acute high-grade acromioclavicular (AC) joint separation with hook plate presented with failure of the reduction eight weeks after removal of the hardware. Surgeons and patients should be aware of the risk of late failure of acromioclavicular reconstruction after removal of the hook plate.
... The rate of return to work, if provided, was also collected. 36 2 0 0 2 0 1 0 0 5o f1 6 Beris et al. 18 2 0 0 2 0 1 0 0 5o f1 6 Bhingraj et al. 29 2 0 0 2 0 1 0 0 5o f1 6 Chaudhary et al. 37 2 0 0 1 0 1 0 0 4o f1 6 Chouhan et al. 38 0 0 1 2 0 1 0 0 4o f1 6 Darabos et al. 34 2 40 2 0 0 2 0 2 1 0 1 1 1 0 1 0o f2 4 Gangary and Meena 44 2 ...
... 12, Six outcome measures were reported in these 20 studies. The CS was the most common outcome measure reported (17 studies), 12,[18][19][20][21][22][23]25,26,29,31,[33][34][35][36][37][38][39][40][41][42] followed by the Disabilities of the Arm, Shoulder and Hand score (7 studies), 12,18,28,31,32,34,36 visual analog scale score (7 studies), 18,27,29,32,33,36,38 American Shoulder and Elbow Surgeons score (3 studies), [38][39][40] Oxford Shoulder Score (3 studies), 22,32,34 and return to work (2 studies). 29,37 The range of CSs in patients undergoing acute reconstructions was 84.4 to 98.2, whereas patients undergoing chronic reconstructions had a range of 80.8 to 94.1. ...
... 12, Six outcome measures were reported in these 20 studies. The CS was the most common outcome measure reported (17 studies), 12,[18][19][20][21][22][23]25,26,29,31,[33][34][35][36][37][38][39][40][41][42] followed by the Disabilities of the Arm, Shoulder and Hand score (7 studies), 12,18,28,31,32,34,36 visual analog scale score (7 studies), 18,27,29,32,33,36,38 American Shoulder and Elbow Surgeons score (3 studies), [38][39][40] Oxford Shoulder Score (3 studies), 22,32,34 and return to work (2 studies). 29,37 The range of CSs in patients undergoing acute reconstructions was 84.4 to 98.2, whereas patients undergoing chronic reconstructions had a range of 80.8 to 94.1. ...
Purpose
To perform a systematic review comparing clinical outcomes, radiographic outcomes, and complication rates after acute (surgery ≤6 weeks from injury) versus chronic (surgery >6 weeks from injury) acromioclavicular joint reconstructions for grade III injuries using modern suspensory fixation techniques.
Methods
We performed a systematic review of the literature examining acute versus chronic surgical treatment of Rockwood grade III acromioclavicular joint separations using the Cochrane registry, MEDLINE database, and Embase database over the past 10 years according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. The inclusion criteria included techniques using suspensory fixation, a minimum study size of 3 patients, a minimum follow-up period of 6 months, human studies, and English-language studies. The methodology of each study was evaluated using the Methodological Index for Non-randomized Studies (MINORS) tool for nonrandomized studies and the revised Cochrane risk-of-bias (RoB 2) tool for randomized controlled trials.
Results
The systematic review search yielded 20 studies with a total of 253 patients. There were 2 prospective randomized controlled trials, but most of the included studies were retrospective. On comparison of acute surgery (≤6 weeks) and chronic surgery (>6 weeks), individual studies reported a range of Constant scores of 84.4 to 98.2 and 80.8 to 94.1, respectively. The ranges of radiographic coracoclavicular distances reported at final follow-up also favored acute reconstructions, which showed improved reduction (9.2-15.7 mm and 11.7-18.6 mm, respectively). The reported complication rates ranged from 7% to 67% for acute reconstructions and from 0% to 30% for chronic reconstructions.
Conclusions
The ranges in the Constant score may favor acute reconstructions, but because of the heterogeneity in the surgical techniques in the literature, no definitive recommendations can be made regarding optimal timing.
Level of Evidence
Level IV, systematic review of Level I through IV studies.
... It classifies the Acromioclavicular joint dislocation into six types. 5 Type I, II, III are more frequent and type IV, V and VI are rarer. In type I, Acromioclavicular ligament is strained, in type II acromioclavicular joint is disrupted and Coracoclavicular ligament is strained while in type III, Acromioclavicular and Coracoclavicular ligaments both are disrupted, in type IV distal, clavicle is positioned posterior to acromion process, in type V, there is a gross superior dislocation of the acromioclavicular joint with ruptured Acromioclavicular and Coracoclavicular ligaments and joint capsule and in type VI, distal clavicle positioned inferior to coracoid process. ...
Introduction: Acromioclavicular joint dislocation Type III is still controversial for its management, despite of numerous trials and reviews. Aims: To compare and evaluate the functional and surgical outcome of Rockwood Type III acromioclavicular joint dislocation treated surgically with clavicular Hook plate and Tension Band wiring with K-wires. Methods: In a prospective hospital based interventional study comprising of total 22 patients with a mean age of 31.36 ± 7.53 years who presented with Rockwood Type III acromioclavicular joint dislocation were carried between January 2018 to December 2019. They were graded according to Rockwood et al. classification. All 22 patients underwent open reduction and internal fixation. These patients were divided into two groups according to operative procedure; of which 11 patients were treated with clavicular hook plate (CHP) and rest 11 were treated with tension band wiring with K-wires (TBW). Descriptive comparison was tabulated during pre-operative, intra-operative and post-operative periods. The Constant-Murley Shoulder scoring system was applied for evaluating the results. Results: The mean follow up period was 7.6 months. The clavicular hook plate was removed at 10 months in one patient due to severe pain and limited range of motion , and removal of Tension Band wiring with K-wires were done in two patients due to wound dehiscence and Kirschner wire back out at 5 and 6 months. The mean Constant- Murley shoulder score was 82.6 (min. 70 & max. 93) in clavicular hook plate and 74.72 (min 68 & max. 84) in Tension band wiring with K-wires which found to be significantly difference in mean scoring between two groups. Conclusion: Patients treated with Clavicular Hook Plate for Rockwood Type III acromioclavicular joint dislocation had a very good functional and surgical outcome over Tension Band wiring with K-wires.
... For statistical calculations GraphPad Prism version 8.3.1 (GraphPad Software, La Jolla, California, USA, www.graph pad.com) was used. Based on a previous clinical study that evaluated outcome after Rockwood type III ACJ dislocations, assuming a power of 0.80 and a significance level of 5%, at least 18 patients are required for statistical calculations [6]. Testing for normal distribution was performed using the D'Agostino and Pearson omnibus normality test. ...
Purpose: Despite the available classifications, diagnostics and treatment of acute acromioclavicular joint (ACJ) injuries are still vague and challenging for trauma and shoulder surgeons. This study aimed to evaluate the dynamic radiographic as well as clinical outcome of operatively and conservatively treated Rockwood (RW) type III and IV ACJ dislocations.
Materials and methods: All patients with RW type III and IV ACJ dislocations between 2009 and 2016 (n = 226) were included in this retrospective data analysis with a prospective follow-up examination. According to their injury classification, patients were subdivided in an operative and conservative treatment group. Examiner blinded clinical evaluation including the constant score (CS), American shoulder and elbow surgery (ASES) score, the acromioclavicular joint instability (ACJI) score, visual analog scale (VAS), bilateral force measurements, and posttraumatic/postsurgical sequelae were assessed. Fluoroscopic evaluations including dynamic stability assessment with functional axillary views were performed for every patient.
Results: For follow-up examination (mean 4.8 years ± 0.3 SEM) 56 patients (29 RW type III, 27 RW type IV) were available. In patients with RW type III ACJ dislocations [operative (n = 10); conservative (n = 19)] prolonged duration of treatment was seen in operatively treated patients (p < 0.05). Clear improvement could be shown for the ACJI score (p < 0.05) and coracoclavicular (CC) and acromioclavicular (AC) distance (p < 0.05) in the operative group. In patients with RW type IV ACJ dislocations [operative (n = 18); conservative (n = 9)] superior clinical results were found in operated patients with highly significant differences for the ACJI score (p < 0.001). Radiographic dynamic horizontal analysis showed nearly normalized anteroposterior translation in operated patients (p < 0.05). No differences were found regarding arthroscopic or open procedures.
Conclusion: Accurate diagnostics including sufficient dynamic stability assessment with functional axillary views are strongly advised for patients with ACJ dislocations. Conservative treatment should be recommended for patients with RW type III ACJ dislocations, due to shorter duration of treatment with good clinical results but lacking operative risks. In patients with RW type IV ACJ dislocations, surgical treatment is recommended because of superior clinical and radiological results.
Level of evidence: Level III.
Keywords: Acromioclavicular joint dislocation; Arthroscopically assisted; Conservative; Dynamic radiological analysis; Operative; Rockwood.
... Types I and II injuries are usually treated conservatively [8], whereas types IV, V and VI dislocations, surgically [1,3]. Controversy still exists about the treatment of type III injuries [2,[9][10][11]. Furthermore, in the operative approach, there is no agreement on the best surgical technique to use [12,13]; this comes from a lack of evidence regarding the comparison between different available techniques. The aim of the study is to compare the mini-open approach with the arthroscopic one focusing on the evaluation of the anatomic precision of the coracoid drilling, that is the key to reach biomechanical stabilization and appropriate functional outcomes [12][13][14]. ...
PurposeTreatment of acromioclavicular joint (ACJ) dislocation is not encoded uniquely. Type I and II injuries are usually treated conservatively, while types IV, V and VI surgically. Controversy still exists over the treatment of type III injuries. In the operative approach, there is no agreement on the best surgical technique. Our purpose is to compare the mini-open and arthroscopic approach focusing on the evaluation of the anatomical precision of the coracoid drilling.Methods
This is a controlled laboratory study. Ten fresh-frozen cadaveric shoulders were randomly assigned to the two techniques in order to compare them. We performed essential surgical gestures to drill the tunnel using MINAR® System (mini-open) and Dog-Bone® (ARTHREX, arthroscopic). The anatomical specimens were then subjected to CT-scan investigation. We statistically evaluated the precision of these two techniques analyzing DICOM files using two parameters. Parameter 1 evaluates the tunnel entry area on the superior side of the coracoid. Parameter 2 describes the orientation of the tunnel.ResultsThere are no statistically significant differences (95% confidence level) between arthroscopic and mini-open approach about the precision in the location of the coracoid hole, regarding the entry area (p = 1.00) and the orientation (p = 0.196).Conclusion
The evidences collected enable the orthopedic surgeon to choose equally between the two techniques in the treatment of AC joint dislocation toward precision.
