Clinical and Radiological Outcomes of Modified Phemister Operation with Coracoclavicular Ligament Augmentation Using Suture Anchor for Acute Acromioclavicular Joint Dislocation

BACKGROUND: Modified Phemister operation has been widely used for the treatment of acute acromioclavicular (AC) joint dislocation. Additionally, the use of suture anchor for coracoclavicular (CC) fixation has been reported to provide CC stability. This study was conducted to evaluate the clinical and radiological results of a modified Phemister operation with CC ligament augmentation using suture anchor for acute AC joint dislocation. METHODS: Seventy-four patients underwent the modified Phemister operation with CC ligament augmentation using suture anchor for acute AC joint dislocation and were followed-up for an average of 12.3 months. The visual analogue scale (VAS), range of motion, Constant score, and Korean shoulder scoring system (KSS) were used for clinical assessment. Acromioclavicular interval (ACI), coracoclavicular distance (CCD), and acromioclavicular distance (ACD) were obtained to evaluate the radiological assessments. RESULTS: At the last follow-up, the mean VAS Score was 1.7 points, the mean joint range of the forward flexion was 164.6°, external rotation at the side was 61.2°, and internal rotation to the posterior was a level of T12. The mean Constant score and the mean KSS was 82.7 points and 84.2 points, respectively. At the mean ACI, CCD, and ACD, significant differences were found preoperatively and at the last follow-up. When the ACI, CCD, and ACD were compared with the contralateral unaffected shoulder at the last follow-up, the affected shoulders had significantly higher values. CONCLUSIONS: The modified Phemister operation with CC ligament augmentation using suture anchor is clinically and radiologically effective at acute AC joint dislocation.

The Modified Phemister Operation with the Suture Anchor Added for the Augmentation of Conoid Ligament in Acute Acromioclavicular Dislocation

PURPOSE: The purpose of this study was to present methods and results for the modified Phemister operation, with a suture anchor added for augmentation of the conoid ligament in cases of acute dislocation of the acromioclavicular joint. MATERIALS AND METHODS: We evaluated 14 cases of acute dislocation of the acromioclavicular joint. This included 11 cases of Rockwood type 3, and 3 cases of type 5. The mean age of patients was 45.2 years. We operated on them using an anchor for augmentation of the conoid ligament in the modified Phemister operation. The average follow-up period was 14 months and post-operative clinical analysis was conducted using the Weitzman classification, VAS Score, Constant Score and KSS Score. RESULTS: According to Weitzman scores, 13 cases were evaluated as excellent, and one case was good. They had mean joint ranges of forward elevation of 170.7degrees, lateral elevation of 166.4, external rotation of 68.2, and internal rotation to the level of T7. The mean VAS Score was 1.9, mean Constant Score 90.8, and the mean KSS Score 91. Radiologic analysis indicated that all cases had a good result. CONCLUSION: The modified Phemister operation with a suture anchor added for augmentation of the conoid ligament is very effective clinically in acute dislocations of the acromioclavicular joint.

Modified Phemister Technique with Tension Band Wiring in Acromioclaviculr Joint Dislocation

PURPOSE: To evaluate the clinical and radiological result of surgical treatment of acromioclavicular joint dislocation, using modified Phemister technique with tension band wiring. MATERIALS AND METHODS: We chose 17 patients who were able to follow up 1 year or more among the patients who were diagnosed as acromioclavicular joint dislocation in our hospital through January 2000 to Feburary 2005 and took modified Phemister technique with tension band wiring. Evaluation of the surgical results was done with the condition of pain, activity of daily living, range of motion, muscle tone by constant score system, and with preoperative, postoperative and last follow up radiographs. RESULTS: Clinical evaluation was average 92 point by Constant score system from 84 point to 100 point. Subjective evaluation was 11 excellent (65%), 6 good (35%). Radiological evaluation was 9 excellent (54%), 6 good (38%), 2 fair (12%), and no poor group. On the final follow up, two cases showed inflammatory reaction at where pins were inserted, but after the removal of the pins, the inflammation was subsided. CONCLUSION: The modified Phemister surgery for acromioclavicular dislocation is one of effective techniques, we can obtain firm fixation, exercise full range of motion early and there is no complication of re-dislocation.

Modified Phemister Technique with Mersilene Tape Augmentation in the Acute Acromioclavicular Joint Dislocation

PURPOSE: To find out the consequences of the surgical treatment of acromioclavicular joint dislocation, using modified Phemister technique with Mersilene tape augmentation. MATERIALS AND METHODS: We chose 26 patients who were able to follow up 1 year or more among the patients who were diagnosed as acromioclavicular joint dislocation in our hospital through February 2001 to March 2003 and took modified Phemister surgery with Mersilene tape augmentation. Patients with clavicle fracture were excluded. Evaluation of the surgical results was done with the condition or pain, function, range of motion by using Imatani evaluation system, and preoperative, postoperative and last follow up radiographs. RESULTS: Most of the cases showed satisfactory result. Clinical evaluations were 16 excellent (62%), 10 good (38%), radiological evaluations were 14 excellent (54%), 10 good (38%), 2 fair (8%), and no poor group. On the final follow up six cases showed vertical translation, but none had clinical symptoms. Seven cases showed a little inflammation at where pin were inserted, but after the removal of the pin, the inflammation was gone. CONCLUSION: The modified Phemister surgery for acromioclavicle dislocation is simple, but we can obtain strong fixation, and there is no burden of the removal of the metal plate, or complication of re- dislocation after the removal of the pin, so it is thought as a very effective surgery.

Treatment of Acromioclavicular Dislocation with Modified Phemister Method / 대한정형외과학회잡지

The method of treatment of acromioclavicular dislocation is controversial, and conservative and surgical treatment have been reported to be both successful. Recently, many surgeons tend to treat the acromioclavicular dislocation with anatomical reduction of acromioclavicular joint and rigid internal fixation because of many disadvantages of conservative methods. We report 24 cases of acute acromioclavicular dislocation treated with modified Phemister method from March 1989 to December 1992. The follow-up ranged from 12 months to 31 months with 16.5 months on average. The results are as follows. l. Among 24 cases, 21 cases are males and 20 cases are in 3rd decade to 5th decade. 2. The most common cause of injuries is falling down, followed by traffic accident. 3. Associated injuries are fractures in 5 cases, spleen rupture in 1 case. 4. Except 1 case with spleen rupture, 23 cases were treated within 2 weeks after injury. 5. Preoperative difference in C-C distance on stress view is 8.6mm on average, ranged from 6mm to 18mm. 6. Clinical results were excellent in 11 cases, good in 10 cases, fair in 2 case, and poor in 1 case. 7. Complications were pin migration in 1 case and symptomatic acromioclavicular arthritis in 1 case.

A Clinical Result of Modified Phemister Method for Acute Acromioclavicular Dislocation / 대한정형외과학회잡지

There are many procedures for the treatment of acute A-C injury which have many complications such as limitation of shoulder motion, post traumatic arthritis, recurrence of dislocation etc. From September 1985 to February 1992 at Haesung Hospital, Ulsan, 62 patients with grade I complete A-C dislocation had been treated surgically by modified Phemister method. We report 42 cases with at least 1 year follow up. The following results are obtained. 1. There are no limitation of shoulder motion in all cases. 2. The comparision of coraco-clavicular interval after surgery(1.43mm) with that of follow up (2.13mm) shows no significant difference. 3. We experience 15 cases who have resorption of distal clavicle or arthritic change in x-ray film. 4. Clinical results shows that excellent in 20 cases, good in 10 cases, fair in 11 cases, poor in 1 case. From the above result, we suggest the modified phemister method is good procedure in the treatment of acute A-C dislocation.