Finite element analysis of different reconstruction methods of coracoclavicular ligament for acromioclavicular joint dislocation / 中国骨伤

OBJECTIVE@#This study aims to examine the biomechanical effects of different reconstruction methods, including single-bundle, double-bundle anatomical reconstruction, and double-bundle truly anatomical reconstruction of the coracoclavicular ligament on the acromioclavicular joint using finite element analysis, to provide a theoretical basis for the clinical application of truly anatomical coracoclavicular ligament reconstruction.@*METHODS@#One volunteer, aged 27 years old, with a height of 178 cm and a weight of 75 kg, was selected for CT scanning of the shoulder joint. Three-dimensional finite element models of single-bundle reconstruction, double-bundle anatomical reconstruction, and double-bundle truly anatomical reconstruction of coracoclavicular ligament were established by using Mimics17.0, Geomagic studio 2012, UG NX 10.0, HyperMesh 14.0 and ABAQUS 6.14 software. The maximum displacement of the middle point of the distal clavicle in the main loading direction and the maximum equivalent stress of the reconstruction device under different loading conditions were recorded and compared.@*RESULTS@#The maximum forward displacement and the maximum backward displacement of the middle point of the distal clavicle in the double-bundle truly anatomic reconstruction were the lowest, which were 7.76 mm and 7.27 mm respectively. When an upward load was applied, the maximum displacement of the distal clavicle midpoint in the double-beam anatomic reconstruction was the lowest, which was 5.12 mm. Applying three different loads forward, backward, and upward, the maximum equivalent stress of the reconstruction devices in the double-beam reconstruction was lower than that in the single-beam reconstruction. The maximum equivalent stress of the trapezoid ligament reconstruction device in the double-bundle truly anatomical reconstruction was lower than that in the double-bundle anatomical reconstruction, which was 73.29 MPa, but the maximum equivalent stress of the conoid ligament reconstruction device was higher than that of the double-bundle anatomical reconstruction.@*CONCLUSION@#The truly anatomical reconstruction of coracoclavicular ligament can improve the horizontal stability of acromioclavicular joint and reduce the stress of the trapezoid ligament reconstruction device. It can be a good method for the treatment of acromioclavicular joint dislocation.

Restablecimiento de la estabilidad horizontal en luxaciones acromioclaviculares III-V mediante la reconstrucción anatómica de los ligamentos coracoclaviculares y acromioclaviculares; técnica quirúrgica / Restoring horizontal stability in III-V acromioclavicular dislocations by anatomic reconstruction of the coracoclavicular and acromioclavicular ligaments; surgical technique

Resumen: Introducción: la luxación de la articulación acromioclavicular (AC) es una lesión frecuente que se observa en adultos jóvenes. El objetivo es describir una técnica quirúrgica que pueda restablecer la estabilidad horizontal y vertical de la articulación AC. Material y métodos: se describe una técnica quirúrgica utilizando un aloinjerto para la reconstrucción anatómica de los ligamentos coracoclaviculares (CC) y AC para luxaciones AC grado III-V de acuerdo con la clasificación de Rockwood. Resultados: es una técnica quirúrgica con reconstrucción anatómica y biológica de los ligamentos CC y AC con injerto. Se realizan dos túneles óseos en la clavícula pasando el cabo lateral del injerto por debajo del acromion; posteriormente se fijan los dos cabos con dos tornillos bioabsorbibles, restaurando de esta manera la estabilidad vertical y horizontal. Conclusión: este procedimiento permite restablecer la estabilidad vertical y horizontal de la articulación AC. Se requieren estudios de seguimiento para reportar resultados funcionales y radiológicos con el fin de poder asegurar ventajas en comparación con las técnicas existentes.

Abstract: Introduction: dislocation of the acromioclavicular (AC) joint is a common injury seen in young adults. The objective is to describe a surgical technique that can restore the horizontal and vertical stability of the AC joint. Material and methods: we describe a surgical technique that can restore horizontal and vertical stability using an allograft for the anatomical reconstruction of the CC and AC ligaments, for AC grade III-V dislocations according to the Rockwood classification. Results: this is a surgical technique with anatomical and biological reconstruction of the CC and AC ligaments, using an allograft. Two bone tunnels are made in the clavicle, passing the lateral end of the graft below the acromion; then the two ends are fixed with two bioabsorbable screws, restoring vertical and horizontal stability. Conclusion: this procedure allows to restore the vertical and horizontal stability of the AC joint. Follow up studies are required to report functional and radiological results, in order to ensure advantages compared to existing techniques.

Arthroscopic reconstruction of coracoclavicular ligament by suspensory fixation for management of acute acromioclavicular joint dislocation and MRI follow-up study / 中南大学学报(医学版)

OBJECTIVES@#To explore the safety and effectiveness of arthroscopic reconstruction of coracoclavicular ligament by suspensory fixation to manage the acute acromioclavicular joint dislocation.@*METHODS@#From January 2016 to December 2017, 18 cases of acute acromioclavicular joint dislocation were carried out with arthroscopic reconstruction of coracoclavicular ligament by double Endobutton plate suspensory fixation. Anteroposterior view X-ray plain radiographs were obtained on the second day, 6 months and 12 months after the surgery, MRI was performed in 1 year after operation. Meanwhile, subjective and objective scoring were obtained by Vsual Analogue Scale (VAS), Rating Scale of the American Shoulder and Elbow Surgeons (ASES) and University of California at Los Angeles Shoulder Rating Scale (UCLA).@*RESULTS@#All patients were followed up for 12 to 30 months (an average of 18 months). There was no patient with infection, neurovascular injury, loosening and breakage of internal fixation, re-dislocation of acromioclavicular joint, clavicular fracture, coracoid process fracture, etc. Postoperative X-ray showed that all acromioclavicular joints were completely relocated. The follow-up of MRI after 1 year showed no obvious dislocation of acromioclavicular joint and good recovery of acromioclavicular space. Postoperative shoulder joint function, VAS, ASES, UCLA and acromioclavicular distance were significantly improved compared with those before surgery, with statistically significant differences (all <0.05).@*CONCLUSIONS@#Arthroscopic reconstruction of coracoclavicular ligament by suspensory fixation to manage the acute acromioclavicular joint dislocation has the advantages of minimal invasive, rapid functional recovery and less complications and satisfactory early clinical results.

Manejo quirúrgico de la luxación acromioclavicular grado III con sistema de anclaje doble botón / Acromioclavicular dislocation management with use of Tight Rope luxation acromioclavicular con Tight Rope

Resumen: Introducción: La articulación acromioclavicular es parte importante del complejo articular del hombro, formada por el extremo lateral de la clavícula y el borde medial del acromion. Tiene un alto índice de lesión en grados asociados a actividad física y accidentes laborales. Predomina en jóvenes laboralmente activos. Objetivo: Analizar la funcionalidad a un año en pacientes con luxación acromioclavicular grado III, operados con sistema anclaje doble botón. Material y métodos: Estudio descriptivo, prospectivo, longitudinal, unicéntrico, durante Marzo de 2015 a Julio de 2016, en pacientes con luxación acromioclavicular grado III en el Hospital de Traumatología y Ortopedia de Puebla. Se incluyeron pacientes con edad de 18 a 45 años, trabajadores, con evolución mayor de siete días. La estadística fue descriptiva. Resultados: Fueron 17 pacientes; 14 (82.4%) hombres y tres (17.6%) mujeres. Edad promedio: 29.5 (19 a 44 años) ± 7.475 años; nueve (52.9%) pacientes en el hombro derecho y ocho (47.1%) en el izquierdo. Promedio de evolución: 2.88 (1 a 7) ± 2.147 días. Incapacidad promedio: 42.06 días. Conclusiones: La reducción abierta y estabilización dinámica mediante el sistema anclaje doble botón (Tight Rope) ofrece estancia intrahospitalaria corta, poco tiempo de incapacidad, reintegración rápida a la actividad laboral y resultados funcionales adecuados a un año de evolución.

Abstract: Introduction: The acromioclavicular joint, important part of the shoulder complex is formed by clavicular lateral end and acromial medial border, with high index of injury in different grades, associated to physical activity and work accidents, most commonly in active young adults. Objective: To analyze functional outcomes in patients with acromioclavicular dislocation with use of tight rope in one year. Material and methods: Descriptive, prospective, longitudinal, unicentric study, from March 2015 and July 2016 in post-operated patients with diagnosis of acromioclavicular dislocation grade III in Hospital de Traumatología y Ortopedia de Puebla. Patients aged 18 to 45 years were included, active workers, with evolution time < 7 days. Results: 17 patients with diagnosis of acromioclavicular dislocation, fourteen (82.4%) male and 3 (17.6%) female. Average age: 29.5 (19 to 44 years) ± 7.475 years; lesion occurred 9 (52.9%) patients in right shoulder and 8 (47.1%) in left side. Average time of the injury: 2.88 (1-7) ± 2,147 days. Average inability granted: 42.06 days. Conclusions: The open reduction technique and dynamic stabilization of the joint with Tight Rope offers short hospital stay, short time of inability and rapid reintegration to work activity, at 1 year of evolution.

Arthroscopic Twin Tail TightRope combined with distal joint capsule repair technique for acute acromioclavicular dislocation / 中国修复重建外科杂志

Objective: To investigate arthroscopic treatment for acute acromioclavicular dislocation by using Twin Tail TightRope combined with distal joint capsular repair. Methods: The clinical data of 40 patients with acromioclavicular dislocation treated between February 2016 and December 2017 were retrospectively analyzed. The patients were divided into arthroscopic group (20 cases, using arthroscopic Twin Tail TightRope combined with distal joint capsular repair for anatomical repair of stable structure of acromioclavicular joint) and control group (20 cases, treated with clavicular hook plate internal fixation) according to different surgical methods. There was no significant difference in gender, age, cause of injury, Rockwood classification, time from injury to operation, preoperative visual analogue scale (VAS) score and Constant score between the two groups ( P>0.05), which were comparable. Postoperative VAS score and Constant score were used to assess shoulder function and re-dislocation was also observed. Results: The incisions of the two groups healed by first intention, and no early postoperative complications occurred. All patients were followed up 12-18 months (mean, 13.5 months). Postoperative X-ray films showed good anatomical reduction in both groups, but the clavicular hook had a presense in the subacromial space in control group. All patients in arthroscopic group achieved satisfactory shoulder function and returned to work after operation; there was no obvious pain, no complications such as exposure of implant after operation, and no need to remove the implant. In the control group, 4 patients had obvious subacromial impingement pain after operation, and 1 patient had re-dislocation after removal of internal fixator at 1 year after operation; the rest had no complications related to internal fixation, and the internal fixators were removed at 1.0-1.5 years after operation, without re-dislocation. The VAS score and Constant score at 3 months and 1 year after operation in both groups significantly improved when compared with those before operation, and further improved at 1 year after operation ( P<0.05). The VAS score and Constant score at 3 months and 1 year after operation in arthroscopic group were significantly better than those in control group ( P<0.05). Conclusion: Arthroscopic treatment for acute acromioclavicular joint dislocation by using Twin Tail TightRope combined with distal capsular repair is more effective than traditional incision surgery and can obtain more satisfactory results in patient compliance and function recovery because of minimally invasive surgery.

A combined technique for acromioclavicular reconstruction after acute dislocation - technical description and functional outcomes / Técnica combinada para reconstrução acromioclavicular após luxação aguda - descrição técnica e resultados funcionais

ABSTRACT Objective: This study aims to describe the surgical approach to such injuries and to present the clinical and functional outcomes obtained in a cohort of patients. Methods: This is an observational retrospective study that included 153 patients with acute acromioclavicular joint dislocation, operated between 1999 and 2015. Clinical evaluation included the following outcomes: Constant functional scale, development of complications, time to return to previous work/sport activities, and satisfaction index. The contra-lateral (uninjured) shoulder was used as control in subjective outcomes. Radiological evaluation was performed in order to monitor signs of loss of reduction, degenerative joint changes, and coracoclavicular calcifications. Results: The mean age was 29.20 ± 9.53 (16-71), with a large male predominance (91.5%). Follow-up lasted 55.41 ± 24.87 (12-108) months. The mean Constant score attained was 96.45 ± 4.00 (84-100) on operated shoulders and 98.28 ± 1.81 (93-100) on contralateral ones. Almost all patients (98.69%) were satisfied with the surgical results. Worse outcomes were observed in acromioclavicular joint dislocations of increasing grade (from type III to V, but worse for type IV), both concerning the Constant score and return to work or sport. The overall incidence of complications was considered low, with the most prevalent being Kirschner wire failure and isolated coracoclavicular ligament calcifications. Conclusion: The surgical technique described is an excellent option in the treatment of acute acromioclavicular joint dislocations of Rockwood grades III to V. This is corroborated by the excellent clinical and functional outcomes and the low rate of complications.

RESUMO Objetivo: Descrever a abordagem cirúrgica das luxações acromioclaviculares agudas e apresentar os desfechos clínicos e funcionais obtidos em uma coorte de pacientes. Métodos: Estudo observacional retrospectivo que incluiu 153 pacientes com luxação aguda da articulação acromioclavicular operados entre 1999 e 2015. A avaliação clínica incluiu os seguintes desfechos: escala funcional de Constant, surgimento de complicações, tempo até o retorno ao trabalho ou atividades esportivas e índice de satisfação. O ombro contralateral (não lesionado) foi usado como controle nos resultados subjetivos. Foi feita avaliação radiológica para monitorar sinais de perda de redução, alterações articulares degenerativas e calcificações coracoclaviculares. Resultados: A média de idade foi de 29,20 ± 9,53 (16 a 71), com grande predominância masculina (91,5%). O seguimento durou 55,41 ± 24,87 (12 a 108) meses. A média no escore Constant foi de 96,45 ± 4,00 (84 a 100) nos ombros operados e 98,28 ± 1,81 (93 a 100) nos contralaterais. Quase todos os pacientes (98,69%) ficaram satisfeitos com os resultados da cirurgia. Luxações de articulação acromioclavicular de grau crescente (do tipo III para V, mas principalmente no tipo IV) apresentaram resultados piores, tanto no que diz respeito ao escore de Constant quanto ao retorno ao trabalho ou esporte. A incidência global de complicações foi considerada baixa, as mais prevalentes foram falha do fio de Kirschner e calcificações isoladas do ligamento coracoclavicular. Conclusão: A técnica cirúrgica descrita é uma excelente opção no tratamento de luxações agudas de articulações acromioclaviculares classificadas como graus III a V na escala de Rockwood. Essa conclusão é corroborada pelos excelentes resultados clínicos e funcionais e pela baixa taxa de complicações.

Functional Assessment Following Treatment of Acromioclavicular Joint Dislocation by Screw and Tension Band Wiring

Background: The acromioclavicular (AC) joint is commonly involved in traumatic injuries in male athletic population. Treatment of acute complete AC dislocation is controversial in literature. Both conservative and surgical treatment has been reported with similar results. Methods: We report a prospective study of 17 patients of Acromioclavicular dislocations (Type III) managed with screw and tension band wiring and were followed up for a period of 3 years. Repair of Coracoclavicular Ligament was performed if found completely torn. Results: Patients were assessed on basis of pain relief, tenderness, functional ability, range of motion at shoulder and cosmosis. Conclusion:Fixation with screw and Tension band wiring is a simple, easy, less time consuming surgical technique allowing faster rehabilitation in young and adult active patients to achieve a stable, pain free shoulder with no serious intra-operative or post-operative complications.

Ligament reconstruction by getting tendon palmaris longus for treating acromioclavicular joint dislocation under arthroscopically assisted Endobutton steel plate fixation / 重庆医学

Objective To investigate the clinical effect of coracoclavicular ligament reconstruction by getting tendon palmaris longus for treating acromioclavicular joint dislocation under arthroscopically assisted Endobutton steel plate fixation.Methods Eighteen patients with acute closed acromioclavicular joint dislocation treated in this hospital from January 2013 to March 2015 were selected and treated by coracoclavicular ligament reconstruction by getting tendon palmaris longus and double Endobutton steel plate fixation under arthroscopy.The visual analogue scale(VAS) was adopted before and after operation.The Karlsson treatment effect score was adopted at the end of follow up period.The patients satisfaction was investigated.Results The wounds in 18 cases were stage Ⅰ first grade healing and the reduction of acromioclavicular joint dislocation was good.The postoperative VAS score was(0.56±0.62) points,which was significantly decreased compared with(2.44± 1.20) points before operation(t=5.945,P＜0.01).During the follow-up visit,1 case appeared dislocation recurrence and treated by adopting clavicle hook plate fixation;average follow up time was 17.72 months,the Karlsson score at the end stage was excellent in 12 cases,good in 5 cases and poor in 1 case,the excellent and good rate was 94.44 ％,the patient satisfaction degree was 88.89 ％.Conclusion Arthroscopically assisted Endobutton steel plate fixation combined with ligament reconstruction by tendon palmaris longus for treating acromioclavicular joint dislocation has small trauma and reliable fixation,and promotes the joint function recovery.

Identificación del ligamento coracoclavicular medial o de Caldani en imágenes de resonancia magnética: Protocolo original y aplicaciones clínicas / Identification of medial coracoclavicular (Caldani's) ligament by magnetic resonance imaging. Original protocol and clinical applications

Introducción: El ligamento de Caldani o coracoclavicular medial ha sido estudiado anatómicamente, pero no hemos hallado mención alguna sobre su identificación imagenológica. El objetivo de este trabajo es presentar una técnica original de resonancia magnética que hemos desarrollado para identificarlo, y describir las imágenes correspondientes. Materiales y Métodos: Se incluyó a siete voluntarios sin patología de hombro conocida. Se utilizó un resonador magnético Philips Ingenia de una intensidad de campo magnético de 1.5 T, versión 4.1, diámetro de Gantry de 70 cm, bobina específica para hombro de 8 canales con imágenes de alta resolución. Se realizaron las secuencias de búsqueda del ligamento en tres planos. Resultados: El ligamento coracoclavicular medial fue identificado en todos los casos, se extendía oblicuamente desde la apófisis coracoides hasta la clavícula, lo que coincide con las descripciones de la bibliografía anatómica consultada. Tuvo una señal hipointensa en todas las secuencias, lo que indica el poco espacio entre fibras y que corresponde a tejido colágeno compacto. Su longitud promedio fue de 41,15 mm (rango 34-47 mm, desviación estándar 4,40). El espesor promedio fue de 2,11 mm (rango 1,3-3,2 mm, desviación estándar 0,66). Conclusiones: El ligamento coracoclavicular medial se puede observar en imágenes de resonancia magnética mediante la técnica original que describimos. La capacidad de localizarlo y observarlo con este estudio por imágenes abre las puertas a futuras investigaciones sobre su posible papel no solo en las compresiones neurovasculares, sino también en las lesiones traumáticas acromioclaviculares, especialmente en las de tipo V de Rockwood. Nivel de Evidencia: II

Introduction: Although Caldani´s ligament or medial coraco-clavicular ligament has been anatomically studied, we have not found any publication regarding its identification in imaging studies. The aim of this research is to present an original technique to locate the medial coraco-clavicular ligament on magnetic resonance imaging, as well as to describe the pertinent findings. Methods: Seven volunteers without any known shoulder pathology were studied by means of this original protocol. A Philips Ingenia magnetic resonance equipment was used, with a magnetic field intensity of 1,5 T, Gantry diameter: 70 cm, and an 8-channel coil for shoulder study. The sequences to locate the ligament were performed in three planes. Results: This ligament was observed in all cases. Its arrangement was similar to that described in previous anatomical studies. Its origin was at the coracoid process, with an oblique path to reach its insertion at the clavicle. The mean length was 41.14 (range 34-47 mm, standard deviation 4.40). The mean thickness was 2.11 mm (range 1.3-3.2 mm, standard deviation: 0.66). Conclusions: The medial coraco-clavicular ligament can be observed in magnetic resonance images using this original procedure. The ability to display this ligament in magnetic resonance images allows for future investigations on its possible role in both thoracic outlet syndrome and traumatic acromioclavicular dislocations, especially the Rockwood type V. Level of Evidence: II

A modified closed-loop double-endobutton technique for the treatment of Rockwood type Ⅲ acromioclavic-ular joint dislocation / 医学研究生学报

Objective Double-endobutton technique , as a widely accepted strategy for the treatment of acromioclavicular joint dislocation ( ACD ) , is undergoing constant improvement .This study was to assess the clinical effect of a modified closed-loop double-endobutton technique ( CDT) in the fixation of Rockwood type Ⅲ ACD . Methods This retrospective study included 60 cases of Rockwood type Ⅲ ACD treated between January 2010 and December 2015, 30 by modified CDT (MCDT) and the other 30 by conventional CDT (CCDT).We recorded and compared the operation time, incision length , intraoperative blood loss , pre-and post-opera-tive scores in the Constant-Murley Scale ( CMS ) , UCLA Shoulder Rating Scale ( SRS) , American Shoulder and Elbow Surgeons Rating Scale ( ARS) and Oxford Shoulder Score ( OSS), and the vertical distance from the supraclavian to subcoracoid plane ( CC-Dist ) be-tween the two groups of patients . Results Compared with the CCDT group, the MCDT group showed a significantly shorter operation time ([78.33±11.47] vs [52.33±8.48] min, P<0.05) and less intraoperative blood loss ([103.00±7.38] vs [79.17±9.75] mL, P<0.05).In comparison with the baseline, the patients of MCDT group achieved markedly improved scores at 12 months after surgery in CMS (46.60±2.09 vs 97.67±0.88, P<0.05), SRS (14.70±1.24 vs 32.17±1.21, P<0.05), ARS (44.23±2.40 vs 91.83±1.62, P<0.05), OSS (45.07±3.10 vs 15.80±1.81, P<0.05), and CC-Dist ([16.76±0.88] vs [7.57±0.73] mm, P<0.05). Conclusion MCDT, with the advantages of easier , tighter, and fas-ter reduction and fixation , is obviously superior to CCDT in the treatment of Rockwood type Ⅲ ACD .

A modified closed-loop double-endobutton technique for the treatment of Rockwood type Ⅲ acromioclavic-ular joint dislocation / 医学研究生学报

Objective Double-endobutton technique , as a widely accepted strategy for the treatment of acromioclavicular joint dislocation ( ACD ) , is undergoing constant improvement .This study was to assess the clinical effect of a modified closed-loop double-endobutton technique ( CDT) in the fixation of Rockwood type Ⅲ ACD . Methods This retrospective study included 60 cases of Rockwood type Ⅲ ACD treated between January 2010 and December 2015, 30 by modified CDT (MCDT) and the other 30 by conventional CDT (CCDT).We recorded and compared the operation time, incision length , intraoperative blood loss , pre-and post-opera-tive scores in the Constant-Murley Scale ( CMS ) , UCLA Shoulder Rating Scale ( SRS) , American Shoulder and Elbow Surgeons Rating Scale ( ARS) and Oxford Shoulder Score ( OSS), and the vertical distance from the supraclavian to subcoracoid plane ( CC-Dist ) be-tween the two groups of patients . Results Compared with the CCDT group, the MCDT group showed a significantly shorter operation time ([78.33±11.47] vs [52.33±8.48] min, P<0.05) and less intraoperative blood loss ([103.00±7.38] vs [79.17±9.75] mL, P<0.05).In comparison with the baseline, the patients of MCDT group achieved markedly improved scores at 12 months after surgery in CMS (46.60±2.09 vs 97.67±0.88, P<0.05), SRS (14.70±1.24 vs 32.17±1.21, P<0.05), ARS (44.23±2.40 vs 91.83±1.62, P<0.05), OSS (45.07±3.10 vs 15.80±1.81, P<0.05), and CC-Dist ([16.76±0.88] vs [7.57±0.73] mm, P<0.05). Conclusion MCDT, with the advantages of easier , tighter, and fas-ter reduction and fixation , is obviously superior to CCDT in the treatment of Rockwood type Ⅲ ACD .

Clinical and Radiological Outcomes of Hook Plate Fixation in the Lateral End Fracture of the Clavicle and Acromioclavicular Dislocation

BACKGROUND: The purpose of this study was to identify the clinical and radiological outcomes of hook plate fixation for lateral end fracture of the clavicle and acromioclavicular dislocation. METHODS: There were a total of 20 cases with lateral end fracture of the clavicle and 16 cases with acromioclavicular dislocation. All patients were evaluated for range of motion, functional score by using Constant score, and American Shoulder and Elbow Surgeons shoulder index at just before implant removal and at final follow-up. Coracoclavicular distance was measured in acromioclavicular dislocation and bony union was evaluated in the lateral end fracture of the clavicle. RESULTS: The clinical outcomes and range of motion were increased at the final follow-up compared with just before implant removal in both the lateral end fracture of the clavicle and acromioclavicular dislocation. In acromioclavicular dislocation, all cases—except one—showed maintenance of reduction after implant removal. Moreover, in the lateral end fracture of the clavicle, all cases—except one—showed bony union. CONCLUSIONS: Hook plate fixation in the lateral end fracture of the clavicle and acromioclavicular dislocation resulted in good clinical and radiological results.

Clinical and Radiological Outcomes of Hook Plate Fixation in the Lateral End Fracture of the Clavicle and Acromioclavicular Dislocation

BACKGROUND: The purpose of this study was to identify the clinical and radiological outcomes of hook plate fixation for lateral end fracture of the clavicle and acromioclavicular dislocation. METHODS: There were a total of 20 cases with lateral end fracture of the clavicle and 16 cases with acromioclavicular dislocation. All patients were evaluated for range of motion, functional score by using Constant score, and American Shoulder and Elbow Surgeons shoulder index at just before implant removal and at final follow-up. Coracoclavicular distance was measured in acromioclavicular dislocation and bony union was evaluated in the lateral end fracture of the clavicle. RESULTS: The clinical outcomes and range of motion were increased at the final follow-up compared with just before implant removal in both the lateral end fracture of the clavicle and acromioclavicular dislocation. In acromioclavicular dislocation, all cases—except one—showed maintenance of reduction after implant removal. Moreover, in the lateral end fracture of the clavicle, all cases—except one—showed bony union. CONCLUSIONS: Hook plate fixation in the lateral end fracture of the clavicle and acromioclavicular dislocation resulted in good clinical and radiological results.

Case control study on the treatment of acromioclavicular dislocation with Endobutton plates combined with an anchor / 中国骨伤

<p><b>OBJECTIVE</b>To compare the clinical effect of Endobutton plates combined with an anchor and clavicle hook plate in the treatment of acromioclavicular dislocation.</p><p><b>METHODS</b>From January 2012 to August 2014, 83 patients with Rockwood type III acromioclavicular dislocation underwent surgical treatments. Among them, 34 patients were treated with Endobutton plate and anchor repair(Endobutton group), including 23 males and 11 females, and the mean age was(39.0±6.3) years old (26 to 51 years old); the average time from injury to operation was(4.1±1.3) days(3 to 7 days);the injured side:14 left, 20 right; the dislocation in 28 patients dues to fall, 6 patients dues traffic accident. There were 49 patients treated with clavicular hook plate(hook plate group), including 33 males and 16 females;the mean age was(37.9±6.3) years old (27 to 53 years old); the average time from injury to operation was(4.1±1.1) days (2 to 7 days);the injured side: 18 left, 31 right;the dislication in 36 patients dues to fall, 13 patients dues traffic accidents. The indexes such as intraoperative bleeding volume, operation time, incision size, postoperative complication and postoperative coracoclavicular space, shoulder joint function, and life quality were compared between two groups.</p><p><b>RESULTS</b>In the hook plate group with 49 patients, the plates in 43 patients were removed at the secondary operation, and 32 patients had shoulder pain or limited active range. Thirty four patients in the Endobutton group had no pain symptoms and limited active range. All the patients did not suffer acromioclavicular dislocation again. There was no significant difference between the two groups in operation time, and intraoperative bleeding volume(>0.05). The incision length in the hook plate group was longer than that in Endobutton group(<0.05). The coracoclavicular space of the uninjured and injured side in two groups respectively had no significant differences, and the coracoclavicular space in the injured side between two group had no significant difference(>0.05). There were no significant differences of Constant score and SF-36 between two groups 2 months after operation(>0.05). Sixteen months after operation, the Constant score in the injured side of both groups was higher than that in 2 months postoperative. But the Constant score in the injured side of hook plate group was higher than that in Endobutton group(<0.05). The Constant score in the uninjured side had no significant differences between two group(>0.05). In hook plate group, the Constant score in the uninjured side was higher than that in the injured side. In Endobutton group, there were no significant differences of Constant score between two sides. The 16 month postoperative SF-36 in the injured side of both groups was higher than the 2 month postoperative one, but 16 month postoperative SF-36 in hook plate group was lower than that in Endobutton group (<0.05).</p><p><b>CONCLUSIONS</b>Endobutton plate combined with an anchor can effectively fix Rockwood type III or more acute acromioclavicular dislocation. The method has less complications, avoiding secondary removal of internal fixation.</p>

Imaging Study of Acromioclavicular Joint Injury / 实用放射学杂志

Objective To study the imaging findings of the normal acromioclavicular joint and acromioclavicular dislocation.Methods CR films of normal shoulder in 68 cases and normal chest in 400 cases were collected.The distances of the acromioclavicular joint were measured,and the inferior cortex line of the acromioclavicular joint was observed on CR.MRI in 30 cases with normal shoulder,24 cases with acromioclavicular dislocation and 7 cases with shoulder impingement syndrome were also presented.Results The normal distance of the acromioclavicular joint was (3.36±0.44) mm.There was an arch line on the inferior cortex of the acromioclavicular joint for normal subjects.According to the Rockwood classification,acromioclavicular dislocation included type Ⅰ in 7/24 cases,type Ⅱ in 5/24 cases and type Ⅲ in 12 cases.The distances of the acromioclavicular joint were increased(＞4.3 mm) in type Ⅱ and type Ⅲ,and the inferior cortex lines of the acromioclavicular joint were not continual in type Ⅲ.MR imaging showed that the intra-articular fibrocartilaginous disk,the capsular and acromioclavicular ligament structure were ruptured in type Ⅱ,and coracoclavicular ligament torn in type Ⅲ.Conclusion The distance and the inferior cortex line of the acromioclavicular joint are of important value in diagnosis and classification of acromioclavicular dislocation.MRI is the most significant method in diagnosis of acromioclavicular dislocation.

Tratamento artroscópico da luxação acromio-clavicular pelo método "tight rope" (arthrex®) / Arthroscopic treatment of acromioclavicular joint dislocation by tight rope technique (arthrex®)

OBJETIVO: Apresentar a técnica cirúrgica artroscópica pelo método "Tight Rope" e a avaliação dos resultados com esta técnica no tratamento da luxação acrômio-clavicular aguda. MÉTODOS: entre agosto de 2006 e maio de 2007, 10 ombros de 10 pacientes com luxação acrômio-clavicular aguda foram submetidos a tratamento artroscópcio pela técnica Tight Rope-Arthrex®. O seguimento mínimo foi de 12 meses, com média de 15 meses. A idade variou de 26 e 42 anos com média de 34 anos. Todos os pacientes eram do sexo masculino. Todos os pacientes foram atendidos na fase aguda da lesão sendo avaliados por radiologia simples (série trauma). Os pacientes foram acompanhados semanalmente no primeiro mês e a cada três meses após o procedimento artroscópico. A avaliação clínica foi feita por meio dos critérios da University of Califórnia at Los Angeles (UCLA). RESULTADOS: Todos os pacientes operados agudamente encontravam-se satisfeitos com os resultados do tratamento cirúrgico artroscópico com uma média de 32,5 pontos na escala de avaliação da UCLA. CONCLUSÃO: O tratamento artroscópico da luxação acrômio-clavicular aguda pelo método "Tight Rope" é uma técnica cirúrgica minimamente invasiva que mostrou-se eficiente para o tratamento destas lesões.

OBJECTIVE: Presenting the arthroscopic treatment by Tight Rope - Arthrex® system for acute acromioclavicular dislocation and to evaluate results obtained with this procedure. METHODS: Between August 2006 and May 2007, 10 shoulders of 10 patients with acute acromioclavicular dislocation were submitted to arthroscopic repair using the Tight Rope - Arthrex® system. Minimum follow-up was 12 months, with a mean of 15 months. Age ranged from 26 to 42, mean 34 years. All patients were male. Radiology evaluation was made by trauma series x-ray. The patients were assisted in the first month weekly and after three months after the procedure. Clinical evaluation was based on the University of California at Los Angeles (UCLA) criteria. RESULTS: All patients were satisfied after the arthroscopic procedure and the mean UCLA score was 32,5. CONCLUSION: The arthroscopic treatment by Tight Rope - Arthrex® system for acute acromioclavicular dislocation showed to be an efficient technique.

Coracoclavicular Ligaments Reconstruction for Acromioclavicular Dislocation using Two Suture Anchors and Coracoacromial Ligament Transfer

PURPOSE: This study examined the outcomes of reconstruction of the coracoclavicular ligaments with using two suture anchors and performing coracoacromial ligament transfer in patients with acromioclavicular dislocation. MATERIAL AND METHODS: Forty patients with complete acromioclavicular dislocation were included in this study. According to the preoperative radiographs, 5 patients with AC dislocations were diagnosed as type III, 4 patients as type IV and 31 patients as type V. Two 3.5mm suture anchors with four strands of nonabsorbable sutures were separately placed on the anterolateral and posteromedial portion of the base of the coracoid process to stabilize the distal clavicle. The coracoacromial ligament was then transferred to the undersurface of the distal end of the clavicle for augmentation. RESULTS: At a mean follow-up of 28 months, the average Constant score improved to 97 points. All the patients returned to normal life at an average of 3.2 months postoperatively. At the last follow-up, 37 patients achieved anatomical reduction and three patients showed complete redislocation. However, the clinical results of the patients with redislocation were satisfactory. CONCLUSION: Anatomical coracoclavicular reconstruction using two suture anchors and coracoacromial ligament transfer for treating complete acromioclavicular dislocation is a safe, effective procedure for restoring a physiologically stable acromioclavicular joint.

Prospective and comparative study of Atlas titanium cable or clavicular hook plate for total acromioclavicular dislocation / 中国矫形外科杂志

[Objective]To compare the result of treatment with double bands of Atlas Ti-cable and clavicular hook plate for total acromioclavicular dislocation.[Method]Fifty-two total acromioclavicular dislocation were treated with two different fixation.1)by double bands of Atlas cable(DC group,28 cases) and 2)clavicular hook plate(HP group,24 cases).There were 38 males and 14 females,39 acute and 13 chronic,all unilateral.The mean age of patients was 38.5 years(22~65).A sling of double cable was fixed through the base of the coracoid process and the clavicle at 1.5 cm upper medially above coracoid process.All hook plate were 6 holes.Coracoclavicular ligament was reconstructed routinely.[Result]All patients were available for an average duration of follow-up of 18.8 months(range,6~42 months).The results were evaluated by radiographic measurement and clinical recovery(muscle strength in upper arms,pain in shoulder,range of joint motion) by Lazcano standard.In HP group,14 patients were assessed as good,6 as fair and 4 as poor(good and fair 83%).In DC group,22 patients were assessed as good,5 as fair and 1 as poor(good and fair 96%).There was no statistical difference between the two groups.[Conclusion]In the treatment of acromioclavicular dislocation,fixation of double bands of Atlas cable is believed to be as good as hook plate fixation.Meanwhile,Atlas cable is featured with less pain followed operation,which in favor of early exercise.For it's good biocompatibility,titanium cable can be retained in body and does not need to be removed.

Evaluación del manejo quirúrgico en la luxación acromioclavicular grado iii en el hospital obrero n° 2 c n s / Evaluation of surgical management in grade III acromioclavicular dislocation in the workers' hospital n ° 2 cns

Entre Enero 1998 a Abril 2004, en un periodo de 6 años y 4 meses, en el servicio de Ortopedia y Traumatología del hospital Obrero N°2 de la C.N.S, se realizó un estudio de tipo retrospectivo longitudinal en 21 casos con diagnóstico clínico - radiológico de Luxación Acromioclavicular Grado III (LAC III), los cuales son tratados quirúrgicamente Existen una variedad de tratamientos quirurgicos para el manejo de la LAC III, por lo que vemos la necesidad de analizar objetivamente los resultados obtenidos y tratar de estandarizar su manejo para beneficio de los pacientes. La incidencia de la lesión fue 12 (57%) para el lado derecho, y 9 (43%) para el lado izquierdo, 11 (52%) de los pacientes el mecanismo de lesión fue por caída de altura, y en los otros 10 (47%) pacientes el mecanismo de lesión fue caída de vehículo de dos ruedas. Más frecuente en varones con 18(85 %) casos, y en mujeres con 3(14%) casos, y una relación de incidencia de 6:1, con una edad mínima de 26 años y una máxima de 71 años, obteniéndose un promedio de 44.9 años . Los resultados fueron evaluados mediante la escala clínico-radiología de la UCLA modificada; Correspondiendo para el Grupo A (Bueno 55%, Regular 44%), Grupo B (Excelente 60%, Bueno 40%), Grupo C (Bueno 43%, Regular 29%, Malo 29%). De las tres técnicas quirúrgicas los resultados más alentadores son los del Grupo B por las ventajas mencionadas, se debe recalcar que se requiere un amplio conocimiento de la anatomía local para evitar complicaciones.

Between January 1998 and April 2004, (in a 6 year 4 month period), in the Orthopedic and Traumatology service at the Obrero Hospital N°2 that belongs to the C.N.S., a longitudinal retrospective study was done, in 21 cases with clinical - radiology diagnose of Acromioclavicular Dislocation III degree (LAC III), that went throught surgical treatment. There is a Wide variety of surgical treatments to handle the LAC III, therefore, we saw the need to analyze the results we obtained and to try to design a protocol to manage it in order to benefit our patients. The incidence was 12 (57%) for the right side and 9 (43%) for the left side. In 11 patients the mechanism of the injury was a fall from height and in the other 10 (47%) patients the mechanism of injury was a fall from a two-wheeled vehicle. The results were evaluated using the clinical-radiology modified scale from de UCLA, obtaining for Group A (Good 55%, Average 44%), for Group B (Excellent 60%, Good 40%,), and for Group C (Good 43%, Average 29%, Poor 29%). From the three surgical techniques described the most encouraging results were for Group B because of the advantages we discussed. We must emphasize the need to know the local anatomy in order to avoid complications.

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.