Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
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Long-term clinical and radiographic outcomes of arthroscopic acromioclavicular stabilization for acute acromioclavicular joint dislocation

  • Received : 2023.11.30
  • Accepted : 2024.01.20
  • Published : 2024.06.01
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Abstract

Background: Standard open acromioclavicular (AC) stabilization is associated with increased postoperative complications including deltoid injury, infection, tunnel complications, loss of reduction, and wound/cosmetic concerns. Arthroscopy may offer superior visualization and advantages that limit these risks. The aim of this prospective non-randomized study is to evaluate advantages and long-term reliability of arthroscopic AC stabilization. Methods: Thirty-two patients with acute grade III, IV and V AC dislocations underwent arthroscopic AC reconstruction with long-term assessment by clinical AC examination, Simple Shoulder Test, American Shoulder and Elbow Surgeons scores, visual analog scale, Specific AC Score and Quick Disabilities of the Arm, Shoulder and Hand scores. Radiographs verified conservation of initial reduction and presence of coracoclavicular (CC) ossifications. Complications, revision rate, and satisfaction were assessed and compared to the literature. Results: Mean follow-up time was 67.6 months. All clinical outcome scores improved and differences were statistically significant (P<0.001). Initial postoperative radiographs consistently showed complete reduction. Two patients experienced relapse to grade II AC dislocation without clinical implications. In total, 71.8% showed CC ossifications without functional impairment, and in 31.3% concomitant injuries were observed. Reintervention rate was 9.4%, and 96.9% of patients were satisfied with procedure outcomes. Conclusions: Arthroscopic stabilization for acute AC joint dislocations offers satisfactory clinical and radiographic outcomes, and our results show that the arthroscopic technique is reliable in the long run. We report better reduction in maintenance, fewer complications, and similar reoperation rates compared to other techniques.

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References

  1. Martetschlager F, Kraus N, Scheibel M, Streich J, Venjakob A, Maier D. The diagnosis and treatment of acute dislocation of the acromioclavicular joint. Dtsch Arztebl Int 2019;116:89-95.
  2. Cutbush K, Hirpara KM. All-arthroscopic technique for reconstruction of acute acromioclavicular joint dislocations. Arthrosc Tech 2015;4:e475-81.
  3. Campagna V, Piccinni V, Rotundo G, Candela V, Gumina S. The Kite technique: a new all-arthroscopic technique for the treatment of acute acromioclavicular joint dislocation. Knee Surg Sports Traumatol Arthrosc 2021;29:2055-63.
  4. DeBerardino TM, Pensak MJ, Ferreira J, Mazzocca AD. Arthroscopic stabilization of acromioclavicular joint dislocation using the AC graftrope system. J Shoulder Elbow Surg 2010;19(2 Suppl):47-52.
  5. Gowd AK, Liu JN, Cabarcas BC, et al. Current concepts in the operative management of acromioclavicular dislocations: a systematic review and meta-analysis of operative techniques. Am J Sports Med 2019;47:2745-58.
  6. Martetschlager F, Horan MP, Warth RJ, Millett PJ. Complications after anatomic fixation and reconstruction of the coracoclavicular ligaments. Am J Sports Med 2013;41:2896-903.
  7. Glanzmann MC, Buchmann S, Audige L, Kolling C, Flury M. Clinical and radiographical results after double flip button stabilization of acute grade III and IV acromioclavicular joint separations. Arch Orthop Trauma Surg 2013;133:1699-707.
  8. Carkci E, Polat AE, Gurpinar T. The frequency of reduction loss after arthroscopic fixation of acute acromioclavicular dislocations using a double-button device, and its effect on clinical and radiological results. J Orthop Surg Res 2020;15:136.
  9. Choi NH, Lim SM, Lee SY, Lim TK. Loss of reduction and complications of coracoclavicular ligament reconstruction with autogenous tendon graft in acute acromioclavicular dislocations. J Shoulder Elbow Surg 2017;26:692-8.
  10. Loriaut P, Casabianca L, Alkhaili J, et al. Arthroscopic treatment of acute acromioclavicular dislocations using a double button device: clinical and MRI results. Orthop Traumatol Surg Res 2015;101:895-901.
  11. Warth RJ, Martetschlager F, Gaskill TR, Millett PJ. Acromioclavicular joint separations. Curr Rev Musculoskelet Med 2013;6:71-8.
  12. Markel J, Schwarting T, Malcherczyk D, Peterlein CD, Ruchholtz S, El-Zayat BF. Concomitant glenohumeral pathologies in high-grade acromioclavicular separation (type III - V). BMC Musculoskelet Disord 2017;18:439.
  13. Millett PJ, Horan MP, Warth RJ. Two-year outcomes after primary anatomic coracoclavicular ligament reconstruction. Arthroscopy 2015;31:1962-73.
  14. Woodmass JM, Esposito JG, Ono Y, et al. Complications following arthroscopic fixation of acromioclavicular separations: a systematic review of the literature. Open Access J Sports Med 2015;6:97-107.
  15. Rehbein K, Jung C, Becker U, Bauer G. Treatment of acute AC joint dislocation by transosseal acromioclavicular and coracoclavicular fiberwire cerclage. Z Orthop Unfall 2008;146:339-43.
  16. Scheibel M, Droschel S, Gerhardt C, Kraus N. Arthroscopically assisted stabilization of acute high-grade acromioclavicular joint separations. Am J Sports Med 2011;39:1507-16.
  17. Motta P, Bruno L, Maderni A, Tosco P, Mariotti U. Acromioclavicular motion after surgical reconstruction. Knee Surg Sports Traumatol Arthrosc 2012;20:1012-8.
  18. Gu F, Tan L, Wang T, et al. Comparison of single versus double TightRope system in the treatment of acute acromioclavicular joint dislocation. J Shoulder Elbow Surg 2021;30:1915-23.
  19. Dumont GD, Russell RD, Knight JR, et al. Impact of tunnels and tenodesis screws on clavicle fracture: a biomechanical study of varying coracoclavicular ligament reconstruction techniques. Arthroscopy 2013;29:1604-7.
  20. Milewski MD, Tompkins M, Giugale JM, Carson EW, Miller MD, Diduch DR. Complications related to anatomic reconstruction of the coracoclavicular ligaments. Am J Sports Med 2012;40:1628-34.
  21. Cohen G, Boyer P, Pujol N, Hamida Ferjani B, Massin P, Hardy P. Endoscopically assisted reconstruction of acute acromioclavicular joint dislocation using a synthetic ligament: outcomes at 12 months. Orthop Traumatol Surg Res 2011;97:145-51.
  22. Salzmann GM, Walz L, Buchmann S, Glabgly P, Venjakob A, Imhoff AB. Arthroscopically assisted 2-bundle anatomical reduction of acute acromioclavicular joint separations. Am J Sports Med 2010;38:1179-87.