Luxación acromioclavicular (LAC) aguda. Resultados con técnica de doble Endobutton® sin reconstrucción ligamentaria / Acromio clavicular acute dislocation. Results with double endobutton technique without ligament reconstruction

Introducción Las lesiones de la articulación acromioclavicular (AC) son muy comunes y van en aumento por el incremento de los deportes de contacto y el aumento del número de deportistas. Se presentan en el 9% de todas las lesiones de la cintura escapular. La gran cantidad de técnicas quirúrgicas descritas e ilustradas nos evidencia el hecho de que la técnica ideal para tratar este tipo de lesiones sintomáticas no ha sido desarrollada. El objetivo del estudio es reportar los resultados radiográficos en luxaciones de la AC de tipo V mediante la técnica de doble Endobutton® sin reconstrucción de ligamentos. Materiales y métodos Desde enero de 2011 hasta diciembre de 2013, 15 pacientes con luxación acromioclavicular aguda (<3 semanas) fueron tratados con la técnica de doble Endobutton® sin reconstrucción ligamentaria. Todos los pacientes presentaron luxación de tipo V según clasificación de Rockwood. Entre los pacientes, 12 fueron de sexo masculino y 3 de sexo femenino, con una media de edad de 35 años (rango de 22 a 56 años), evaluados con rayos X en el postoperatorio inmediato, y 1, 3 y 12 meses después. Resultados De los 15 pacientes, 7 presentaron pérdida de reducción radiográfica durante el primer año postoperatorio en comparación con radiografía inicial. Discusión Mediante la técnica de doble Endobutton® en las luxaciones de la AC de tipo V sin asociar una reconstrucción de ligamentos, obtuvimos el 46% de pérdida de reducción en el primer año postoperatorio. Por ello, concluimos que esta técnica presenta un alto porcentaje de pérdida de reducción en este tipo de lesiones. Nivel de evidencia clínica Nivel IV.

Background The acromioclavicular (AC) joint injuries are common, accounting for 9% of all injuries to the shoulder girdle. The multitude of techniques describes and illustrates the fact that the ideal technique to treat a symptomatic AC joint dislocation remains to be found. Materials & methods From January 2011 to December 2013, 15 patients with acute acromioclavicular joint dislocation were surgically immobilized with the double Endobutton® technique without ligament reconstruction. All the patients had type V AC dislocations according to Allman-Rockwood classification. Among the patients, 12 patients were male and 3 patients were female, with an average age of 35 years (ranged from 22 to 56 years). The therapeutic effects were evaluated with postoperative X-ray, at 1, 3 and 12 months. Results From fifteen patients in this study, seven patient lost radiographic reduction during the first year of postoperative procedure compared with the first post-operative Rx. There were no other complications reported. Discussion We obtained with the double Endobutton® AC reduction without ligament reconstruction a 46% of loosening reduction in the first year. This technique has a high percentage of loss of reduction in this type of patient. Evidence level IV.

Study on correlation between reduction loss and fixator moment arm after treatment of acromioclavicular joint dislocation using endobutton technique / 医用生物力学

Objective To study the correlation between the amount of reduction loss and the length of fixator moment arm after treating acrmioclavicular（AC）joint dislocation with the endobutton technique as viewed from mechanics. Methods 24 patients with acute AC joint dislocation were treated with the endobutton technique and made the follow-up from Mar. 2009 to Dec. 2010 in Shanghai Ninth People’s Hospital. The loss of reduction was observed by evaluating the change of distance between the coracoid and clavicle three days and six months after the operation, respectively. Meanwhile, the length from the upper endnobutton midpoint to the proximal end of clavicle (L1) and the whole length of clavicle (L) were measured and the ratio of L1/L as the moment arm of the fixator was calculated to study the correlation between reduction loss and moment arm. Results All the 24 patients received good reduction after the operation, and the distance between the coracoid and clavicle returned to normal. The average distance between the coracoid and clavicle three days and six months after the operation was (28.2±3.9) and (29.5±4.1) mm, respectively. The amount of average reduction loss was (1.3±1.2) mm. The average moment arm was 0.79±0.03. There was a significant negative correlation between the reduction loss and moment arm with the correlation coefficient -0.498(P＜0.05). Conclusions For the treatment of AC joint dislocation using endobutton technique, the position of the endobutton is closely related with the loss of reduction postoperatively. The shorter the moment arm, the greater the loss of reduction would be. The proper moment arm should be around 0.80.