Acromioclavicular third degree dislocation: surgical treatment in acute cases

Abstract

BackgroundThe management of acute Rockwood type III acromioclavicular joint (ACJ) dislocation remains controversial, and the debate about whether patients should be conservatively or surgically treated continues. This study aims to compare conservative and surgical treatment of acute type III ACJ injuries in active sport participants (<35 years of age) by analysing clinical and radiological results after a minimum of 24 months follow-up.MethodsThe records of 72 patients with acute type III ACJ dislocations who were treated from January 2006 to December 2011 were retrospectively evaluated. Patients were categorised into two groups. group A included 25 patients treated conservatively, and group B included 30 patients treated surgically with the TightRope™ system. Seventeen patients were lost to follow-up.All patients were evaluated at final follow-up with these clinical scores: Constant, University of California Los Angeles scale (UCLA), American Shoulder and Elbow Surgeons Scale (ASES) and Acromioclavicular Joint Instability (ACJI) and with a subjective evaluation of the patient satisfaction, aesthetic results and shoulder function. The distance between the acromion and clavicle and between the coracoid process and clavicle were evaluated radiographically and compared with preoperative values. Δ, the difference in mm between the distance at the final follow-up and at T0 in the injured shoulder, and α, the side-to-side difference in mm at follow-up, were calculated. Heterotopic ossification and postoperative osteolysis were evaluated in both groups.ResultsThere were no major intraoperative complications in the surgical group. The subjective parameters significantly differed between the two groups. Constant, ASES and UCLA scores were similar in both groups (P > 0.05), whereas ACJI results favoured the surgical group (group A, 72.4; group B, 87.9; P < 0.05). All measurements of radiographic evaluation were significantly reduced in the surgical group compared with the conservative group. In group A, we detected calcifications in 30% of patients; in group B we detected two cases of moderate osteolysis and calcifications in 70% of patients.ConclusionAlthough better subjective and radiographic results were achieved in surgically treated patients, traditional objective scores did not show significant differences between the two groups. Our results cannot support routine use of surgery to treat type III ACJ dislocations.

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

“…De Carli et al compared the functional results of patients with double-button fixation and conservative treatment of 3rd degree AC joint dislocations. According to this study, although there was no difference in terms of non-AC joint-specific objective scores in the surgical group, a statistically significant difference was found in the AC joint-specific objective measurements, subjective evaluation of patients and aesthetic satisfaction [28]. In our study, although there was no difference in non-AC joint-specific objective scores in the group without loss of reduction, a statistically significant difference was found in AC joint-specific objective scores, subjective assessment and aesthetic satisfaction.…”

All-arthroscopic, Guideless Single Suture-button Fixation of Acute Acromioclavicular Joint Dislocation: A Description of the Technique and Early Treatment Results

“…Further follow-up will determine the results of the singleimplant technique described in this article; however, because the ligament healing will be completed within the first year after surgery, we do not expect any future complications regarding implant failure. Recently, De Carli et al 17) reported similar results following single suture-button procedures with TightRope for Rockwood type III AC joint dislocations after a minimum followup of 24 months. In contrast to Arrigoni et al, 18) who showed an overall rate of 29.5% associated pathologic lesions requiring additional surgical treatment in patients with type III AC joint dislocation, we did not find any concomitant pathology.…”

Arthroscopic Reconstruction of the Coracoclavicular Ligaments Using a Coracoid Cerclage Technique

“…1,3 Types IV to VI are typically treated surgically, whereas type III injuries are still being debated for a consensus on optimal treatment. 4,5 A wide variety of CC ligament reconstruction techniques have been developed in an effort to identify an optimal approach to this challenging shoulder injury. The current techniques described are both arthroscopic and open using either allograft or autograft tissue.…”