Acromioclavicular joint reconstruction: a comparative biomechanical study of three techniques

Lädermann, Alexandre; Gueorguiev, Boyko; Štimec, Bojan; Fasel, Jean; Rothstock, Stephan; Hoffmeyer, Pierre

doi:10.1016/j.jse.2012.01.020

Cited by 98 publications

(75 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The inclusion criteria of the patients were as follows: (1) radiographically confirmed closed Rockwood type III (with horizontal instability observed in manual/overhead workers or athletes) or higher AC dislocation; (2) surgery within 2 weeks of trauma (it is known that after this period, CC ligaments lack healing potential 22) ); (3) primary treatment using a clavicular HP (Synthes, Bettlach, Switzerland) or TR (Arthrex, Naples, FL, USA) devices; (4) age of ≥18 years; (5) mono trauma; and (6) minimum follow-up of 24 months after surgery. The exclusion criteria were as follows: (1) polytrauma, including associated nerve and/or vessel injury; (2) previous injury to the injured shoulder; and (3) disease processes that would preclude accurate evaluation of the outcomes (e.g., neuromuscular, rheumatic, or significant psychiatric or metabolic disorders).…”

Section: Patient Selectionmentioning

confidence: 99%

“…CC displacement during cyclic loading has been shown to occur more frequently in HP fixations. 22) Despite these biomechanical disadvantages, clinical studies comparing patients managed using HP with those managed using CC non-rigid fixations have shown that there are no differences in the remaining vertical instability. 9) In the present study, the loss of reduction after HP fixation did not differ significantly from that following the single TR technique with an untouched AC joint and without an implant removal.…”

Section: )mentioning

confidence: 99%

See 1 more Smart Citation

Clinical and Radiological Outcomes of Acute Acromioclavicular Joint Dislocation: Comparison of Hook Plate Fixation with Single Tight Rope Technique

Lee¹,

Kim²,

Kook³

2017

Clinics in Shoulder and Elbow

View full text Add to dashboard Cite

Background: This study was conducted to compare the clinical and radiological outcomes of the locking hook plate fixation (HP) technique and the single tight rope (TR) technique applied for acute high-grade acromioclavicular (AC) joint separations. Methods: Between 2009 and 2014, 135 consecutive patients with acute AC joint separation Rockwood types III, IV, and V were subjected to surgical reconstruction. One hundred fourteen patients (84.4%) were available for retrospective evaluation. Of them, 62 and 52 were treated using the single TR group and clavicular HP group techniques, respectively. The visual analogue scale, Constant, American Shoulder and Elbow Surgeons (ASES), and Taft scores were used for clinical assessment. Postoperative shoulder range of motion was also assessed. An anteroposterior radiograph of the coracoclavicular distance (CCD) was obtained to evaluate the radiographic signs of recurrence. Results: The TR group patients had better Constant, ASES, and Taft scores than the HP group patients. The loss of reduction in terms of the CCD did not differ between groups. Subacromial osteolysis was observed in 34.6% of the cases in the HP group. However, there were no significant differences in the clinical outcomes between the patients with and without osteolysis in the HP group. Subcoracoid osteolysis, drill tunnel widening, and metal displacement were observed in 3.2%, 22.6%, and 4.8% of the cases in the TR group, respectively. Conclusions: The single TR technique was relatively more effective at treating acute high-grade AC joint injuries than the HP fixation technique (level of evidence: therapeutic; retrospective comparative study, Level III). (Clin Shoulder Elbow 2017;20(3):153-161)

show abstract

Section: Patient Selectionmentioning

confidence: 99%

Section: )mentioning

confidence: 99%

Clinical and Radiological Outcomes of Acute Acromioclavicular Joint Dislocation: Comparison of Hook Plate Fixation with Single Tight Rope Technique

Lee¹,

Kim²,

Kook³

2017

Clinics in Shoulder and Elbow

View full text Add to dashboard Cite

show abstract

“…Many of the described repair options offer biomechanically robust reconstructions; however, they often require multiple drill holes through the clavicle, which can create stress risers or result in suture cutout (or both). The TightRope device has been described both biomechanically [2][3][4][5] and clinically 6-8 as a viable reconstruction option requiring only a single drill hole through the clavicle; however, concerns over suture failure through bony cutout remain. Allograft augmentation of this fixation construct helps to eliminate the stress risers potentially created by the device while increasing overall repair construct stability.…”

Section: Discussionmentioning

confidence: 99%

“…9 Several authors have evaluated the biomechanical properties of the TightRope system for AC joint reconstruction. [2][3][4][5] Most often, these studies have reported high vertical stiffness loads with the TightRope construct but more physiological axial stiffness with other techniques such as hook plates, bone anchors, and cerclage wires. 2,4 Similarly, clinical investigations have examined the clinical application of the TightRope device for AC joint reconstruction, with encouraging outcomes.…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic-Assisted Acromioclavicular Joint Reconstruction Using the TightRope Device With Allograft Augmentation: Surgical Technique

Frank

Trenhaile

2015

Arthroscopy Techniques

View full text Add to dashboard Cite

Surgical management of acromioclavicular (AC) joint separations remains challenging, especially in the revision setting. Most commonly, Rockwood type I and II injuries are managed nonoperatively whereas type IV, V, and VI injuries are managed with surgery. Type III separations are more controversial, with evidence supporting both nonoperative and operative treatment options. Multiple different arthroscopic techniques have been described; however, there is no current gold standard. AC joint reconstruction with the TightRope device (Arthrex, Naples, FL) with the patient in the lateral decubitus position is a method of restoring joint stability that allows for a minimally invasive, low-profile fixation construct using a single drill hole through the clavicle. Allograft augmentation of this fixation construct helps to eliminate the stress risers potentially created by this device while increasing overall repair construct stability. The purpose of this article is to describe the surgical technique for arthroscopic AC joint reconstruction using a TightRope device with allograft augmentation.

show abstract

“…Ziel aller dieser Techniken ist die Wiederherstellung der korrekten Gelenkstellung und der mechanischen Stabilität des Schultereckgelenks, um beste Voraussetzungen für eine stabile Narbenheilung zu erreichen [14].…”

Section: Verfahrenunclassified

Hakenplatte noch Standard bei Akromioklavikulargelenksprengung?

Bökeler

Felenda

Liener

2014

Trauma Berufskrankh

View full text Add to dashboard Cite

Verletzungen des Akromioklavikulargelenks (ACG) sind mit 9% aller Läsionen in diesem Bereich die häufigste Verletzung des Schultergürtels. Betroffen sind in erster Linie junge, sportlich aktive Män-ner zwischen dem 20. und 40. Lebensjahr [12,19]. Unfallmechanismus ist in erster Linie ein Sturz auf die superolaterale Region der Schulter, wobei die akromio-und korakoklavikularen Bänder verletzt werden [18].In der Literatur liegt weitgehend Einigkeit darüber vor, dass Verletzungen der Schweregrade Rockwood IV, V und VI operativ zu behandeln sind [4,26]. Uneinigkeit besteht weiterhin über die Therapie von Verletzungen des Grads Rockwood III [2,4,5,24], wobei hier in den letzten Jahren ein Trend zur konservativen Behandlung zu verzeichnen war [30].Wird eine operative Versorgung angestrebt, sollte diese frühelektiv durchgeführt werden, da bei verspäteter Versorgung die biologische Potenz des Gewebes abnimmt und dadurch schlechtere klinische Ergebnisse beobachtet wurden [26,32]. Die Zeitspanne zwischen dem Trauma und der Operation sollte daher mög-lichst kurz sein und 3 Wochen nicht über-schreiten [23]. Klinik und Diagnostik Hakenplatte vs. fadenbasierte StabilisierungZiel der folgenden Ausführung ist ein Vergleich der in Deutschland überwie-gend zum Einsatz kommenden Versorgung mittels Hakenplatte und der fadenbasierten Stabilisierung von ACG-Sprengungen.Bezüglich der reinen Implantatkosten sind beide Verfahren vergleichbar, reine Implantatkosten bei den Hakenplattenimplantationen lagen 2013 bei etwa 350,00 €, für eine TightRope®-Implantation (Firma Arthrex) bei etwa 305,00 €.In aktuellen Arbeiten wurden geringe Komplikations-und Reoperationsrate für die Versorgung mit "tight rope" angegeben, es fanden sich jedoch z. T. hohe Raten an heterotropen Ossifikationen, sekundärem Repositionsverlust und Implantatmigrationen (. Abb. 4,[9,22,27,28]). Zu beachten ist auch, dass die arthroskopisch gestützten anatomischen Verfahren nur in Spezialkliniken für Schulterchirurgie in nennenswerter Weise zum Einsatz kommen und innerhalb dieser Kliniken zudem auf wenige Operateure beschränkt sind.Der operative Aufwand ist zudem bei arthroskopischen Verfahren, im Vergleich zur Verwendung der Hakenplatte, deutlich erhöht. Diese Tatsachen stehen einem breiten klinischen Einsatz entgegen, der für die Behandlung dieser häu-

show abstract

Acromioclavicular joint reconstruction: a comparative biomechanical study of three techniques

Cited by 98 publications

References 26 publications

Clinical and Radiological Outcomes of Acute Acromioclavicular Joint Dislocation: Comparison of Hook Plate Fixation with Single Tight Rope Technique

Clinical and Radiological Outcomes of Acute Acromioclavicular Joint Dislocation: Comparison of Hook Plate Fixation with Single Tight Rope Technique

Arthroscopic-Assisted Acromioclavicular Joint Reconstruction Using the TightRope Device With Allograft Augmentation: Surgical Technique

Hakenplatte noch Standard bei Akromioklavikulargelenksprengung?

Contact Info

Product

Resources

About