Arthroscopic Reconstruction of the Coracoclavicular Ligaments Using a Coracoid Cerclage Technique

Parnes, Nata; Blevins, Maryellen; Carey, Paul; Carr, B. I.

doi:10.1016/j.eats.2015.12.002

Cited by 8 publications

(17 citation statements)

References 15 publications

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“…Several scores were used to report functional outcomes among studies. The most common were: Constant score [13] in 27 studies [2, 5, 6, 10, 11, 18, 25, 27, 28, 31–33, 36, 37, 40, 44, 46, 50, 51, 54, 59, 62–65, 67, 70], Visual Analogic Scale (VAS) for pain in 10 studies [10, 15, 22, 24, 25, 27, 46, 50, 64, 67], American Shoulder and Elbow Surgeons (ASES) society standardised shoulder assessment form [52] in seven studies [11, 22, 31, 39, 59, 62, 63], Subjective Shoulder Value (SSV) [21] in seven studies [8, 10, 15, 25, 32, 50, 63] and Disabilities of the Arm, Shoulder and Hand (DASH) score [26] in six studies [15, 29, 46, 54, 64, 65].…”

Section: Resultsmentioning

confidence: 99%

“…Among biologic, synthetic and internal fixation techniques, synthetic reconstruction provided better functional outcomes; whereas, internal fixation provided lower loss of reduction rate. However, it must be highlighted that 30 studies [2, 5, 8, 10, 11, 14–16, 22, 24, 27, 29–34, 36, 39, 44, 46, 47, 50, 54, 58, 62–64, 68, 69] out of 44 [1, 2, 5, 6, 8, 10, 11, 14–16, 18, 19, 22, 24, 25, 27–34, 36, 37, 39, 40, 43, 44, 46, 47, 50, 51, 54, 58, 59, 62–65, 67–70] focused on biologic reconstruction techniques. Therefore, further subgroup analysis was deemed necessary.…”

Section: Discussionmentioning

confidence: 99%

“…No LOE-I studies could be found. Seventeen studies [1,6,8,11,15,18,34,37,39,43,47,50,54,62,63,69] were Fig. 1…”

Section: Study Characteristicsmentioning

confidence: 99%

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Anatomic reconstruction of the acromioclavicular joint provides the best functional outcomes in the treatment of chronic instability

Sircana

Saccomanno

Mocini

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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Purpose To systematically review the outcomes of surgical treatments of chronic acromioclavicular joint dislocation. Methods Studies were identified by electronic databases (Ovid, PubMed). All studies reporting functional and radiological outcomes of surgical treatments of chronic acromioclavicular joint dislocations were included. Following data were extracted: authors and year, study design, level of evidence, number of patients, age, classification of acromioclavicular joint dislocation, time to surgery, surgical technique, follow-up, clinical and imaging outcomes, complications and failures. Descriptive statistics was used, when a data pooling was not possible. Comparable outcomes were pooled to generate summary outcomes reported as frequency-weighted values. Quality appraisal was assessed through the MINORS checklist. Results Fourty-four studies were included for a total of 1020 shoulders. Mean age of participants was 38 years. Mean followup was 32.9 months. Arthroscopic techniques showed better results than open approach (p < 0.0001). Synthetic reconstructions demonstrated better functional outcomes compared to internal fixation and biologic techniques (p < 0.0001). Among biologic techniques, combined coracoclavicular and acromioclavicular ligaments reconstruction showed better Constant (p = 0.0270) and ASES (p = 0.0113) scores compared to isolated coracoclavicular ligaments reconstruction; anatomic biologic non-augmented graft reconstruction showed better Constant (p < 0.0001), VAS (p < 0.0001) and SSV (p = 0.0177) results compared to augmented techniques. No differences in functional outcomes could be found between anatomic biologic nonaugmented graft versus synthetic reconstructions. Overall, methodological quality of the included studies was low. Conclusion Anatomic reconstructions, both synthetic and biologic, showed the best functional results. Level of evidence IV.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Anatomic reconstruction of the acromioclavicular joint provides the best functional outcomes in the treatment of chronic instability

Sircana

Saccomanno

Mocini

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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“…Although long-term clinical evidence is limited, Caroino et al reported high subjective satisfaction rates among patients along with pain release and functional improvement in the short term [9]. These indings have been conirmed by other studies evaluating the short-to mid-term clinical and radiographic outcomes of ACCR procedures using free tendon grafts [6,17,24,28,33,34,37].…”

Section: Introductionmentioning

confidence: 87%

Anatomic coracoclavicular ligament reconstruction (ACCR) using free tendon allograft is effective for chronic acromioclavicular joint injuries at mid-term follow-up

Cerciello

Berthold

Uyeki

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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Purpose To evaluate the clinical and radiographic outcomes of patients undergoing anatomic coracoclavicular ligament reconstruction (ACCR) using free tendon allografts for the treatment of chronic acromioclavicular joint (ACJ) injuries with a minimum 1-year follow-up. Methods Patients who underwent ACCR for chronic ACJ injuries between 2003 and 2017 were analyzed. Clinical outcome measures included American Shoulder and Elbow Surgeons (ASES), Constant-Murley (CM), Simple Shoulder Test (SST), and Single Assessment Numerical Evaluation (SANE) scores. Radiographic loss of reduction during follow-up was evaluated by calculating the diference (mm) in the coracoclavicular distance (CCD) of the involved side immediately postoperatively and at terminal follow-up. Results Forty-two patients (mean age: 42.7 ± 12.8 years) were included in the study with an average follow-up of 3.8 ± 3.1 years (range: 1.1-11.5 years). Patients achieved signiicant improvement in ASES (50.2 ± 20.1 pre to 85.2 ± 16.3 post), CM (60.2 ± 18.5 pre to 88.2 ± 9.1 post), SST (6.1 ± 3.2 pre to 9.5 ± 3.7 post), and SANE (24.0 ± 25.7 pre to 89.0 ± 12.7 post) scores (P < 0.001, respectively). There were no signiicant diferences in functional improvement when comparing type III and V injuries (n.s.). Mean increase in CCD of the involved side from immediately postoperative to inal radiographic follow-up was 4.1 ± 3.9 mm, with no signiicant correlation to clinical outcomes scores. Complications occurred in 33.3% of cases, with postoperative heterotopic ossiication being most frequent (14.3%). Conclusion Patients undergoing ACCR using free tendon allografts for chronic ACJ injuries achieved signiicant improvement in shoulder function at a mean follow-up of 3.8 years. No correlation was observed between the amount of loss of reduction and clinical outcome scores. Free tendon allografts may be a reliable alternative to autografts in the treatment of chronic ACJ dislocations.

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“…Instead of drilling a bone tunnel in the coracoid process that is small in size, the method loops the suture around the inferior coracoid process and fixes it on the clavicle. Such method has been suggested,12) but, there are concerns about a decrease in fixation force of the suture when movement of the suture in the subcoracoid occurs. The method of fixation with insertion of a suture anchor on the coracoid process for fixation on the coracoid process side can also be an alternative.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative and Postoperative Complications after Arthroscopic Coracoclavicular Stabilization

Lim

2019

Clin Orthop Surg

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Background Arthroscopic stabilization of torn coracoclavicular (CC) ligaments gained popularity recently. However, loss of reduction after the operation and complications unique to this technique involving tunnel placement through the distal clavicle and coracoid process are concerns. The purpose of this study was to report intraoperative and early postoperative complications associated with this procedure. Methods This study retrospectively evaluated 18 consecutive patients who had undergone arthroscopic stabilization for torn CC ligaments between 2014 and 2015. The indications for surgery were acute or chronic acromioclavicular dislocation and acute fracture of the distal clavicle, associated with CC ligament disruption. Clinical outcomes were evaluated with the American Shoulder and Elbow Surgeons (ASES) and the University of California, Los Angeles (UCLA) scores. Intra- and postoperative complications and reoperations were investigated. Results There were six female and 12 male patients with a mean age of 47 years (range, 22 to 86 years). At a mean follow-up of 17 ± 10 months (range, 10 to 28 months), the mean ASES score was 88.8 ± 19.9 and the mean UCLA score was 30.9 ± 5.2. Intraoperatively, seven complications developed: breach of lateral cortex of the coracoid process in five patients, medial cortex of the coracoid process in one, and anterior cortex of the clavicle in one. Postoperative complications developed in eight patients: four ossifications of the CC interspace, four tunnel widening of the clavicle, one bony erosion on the clavicle, and one superficial infection. A loss of reduction was found in six patients. Reoperation was performed in three patients for loss of reduction in two and superficial infection in the other. Conclusions Arthroscopic CC stabilization resulted in high rates of intraoperative and early postoperative complications. Most of them were related to the surgical technique involving bone tunnel placement in the coracoid process and the clavicle.

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Arthroscopic Reconstruction of the Coracoclavicular Ligaments Using a Coracoid Cerclage Technique

Cited by 8 publications

References 15 publications

Anatomic reconstruction of the acromioclavicular joint provides the best functional outcomes in the treatment of chronic instability

Anatomic reconstruction of the acromioclavicular joint provides the best functional outcomes in the treatment of chronic instability

Anatomic coracoclavicular ligament reconstruction (ACCR) using free tendon allograft is effective for chronic acromioclavicular joint injuries at mid-term follow-up

Intraoperative and Postoperative Complications after Arthroscopic Coracoclavicular Stabilization

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