Concomitant Acromioclavicular and Coracoclavicular Ligament Reconstruction with a Duo-Figure-8 Autogenic Graft Wrapping Technique for Treating Chronic Acromioclavicular Separation

Huang, Fu-Ting; Lin, Kai-Cheng; Lin, Chih-Yang; Chang, Wei‐Ning

doi:10.4055/cios20194

Cited by 5 publications

(4 citation statements)

References 30 publications

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“… 4 25) Recently, based on the concept that the CC ligament is a crucial structure for fracture stability and the healing process in type IIB fractures, several studies reported satisfactory clinical and radiographic outcomes after CCS using a suture button device for type IIB fractures. 5 6 7 11 12 13 15 26) …”

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confidence: 99%

Comparison of Locking Plate Osteosynthesis versus Coracoclavicular Stabilization for Neer Type IIB Lateral Clavicle Fractures

Kim

Choi

et al. 2022

Clin Orthop Surg

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Background The best option for the treatment of Neer type IIB lateral clavicle fractures remains controversial. The aim of this study was to compare outcomes and complications between pre-contoured locking plate osteosynthesis (PLPO) and coracoclavicular stabilization (CCS) using a TightRope for the treatment of type IIB fractures. Methods Forty-six consecutive type IIB fractures were treated with PLPO (17 cases) or CCS (29 cases). The mean follow-up period was 33.7 months (range, 12–144 months). Radiographic outcomes were evaluated using serial plain radiographs. Clinical outcomes were evaluated using the University of California, Los Angeles (UCLA) score, the American Shoulder and Elbow Surgeons (ASES) score, and subjective shoulder value (SSV). Results Of the 46 cases, complete bony union within 6 months after surgery was achieved in 42 cases (91.3%). The union rate was 100% (17/17) in the PLPO group and 86.2% (25/29) in the CCS group, showing a statistically significant difference ( p = 0.043). No significant differences in terms of UCLA score (32.8 vs. 32.1), ASES score (93.2 vs. 90.8), or SSV (89.1% vs. 90.3%) were observed between the PLPO and CCS groups. The complication rates were 17.6% (3/17; 2 cases of screw breakage and 1 case of stiffness) in the PLPO group and 37.9% (11/29; 4 cases of nonunion, 3 cases of stiffness, 2 cases of skin irritation, 1 case of superficial infection, and 1 case of coracoid button migration) in the CCS group, showing no statistically significant difference ( p > 0.05). Four cases with nonunion after CCS did not require reoperation because they had good to excellent clinical outcomes without radiographic progression. Conclusions Although a higher nonunion rate was observed in the CCS group compared with the PLPO group, satisfactory clinical outcomes were obtained for both groups. Both techniques can be regarded as useful options for the treatment of Neer type IIB lateral clavicle fractures.

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confidence: 99%

Comparison of Locking Plate Osteosynthesis versus Coracoclavicular Stabilization for Neer Type IIB Lateral Clavicle Fractures

Kim

Choi

et al. 2022

Clin Orthop Surg

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“…Virtanen et al reviewed 25 patients after a mean of 4.2 years after ligament reconstruction with autogenous semitendinosus and gracilis; mean CS was 83 and mean DASH was 14 [14]. In the past, the combination of coracoclavicular (CC) and acromioclavicular (AC), ligament reconstruction has become popular in the hope of decreasing complication rates and improving patient outcomes associated with non‐anatomic repairs [15, 16]. The successful outcomes of anatomic CC ligament reconstruction rely on graft choice, bone tunnels and horizontal stability.…”

Section: Discussionmentioning

confidence: 99%

Hybrid coracoclavicular and acromioclavicular reconstruction in chronic acromioclavicular joint dislocations yields good functional and radiographic results

Cerciello

Corona

Morris

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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Purpose Optimal treatment of chronic unstable acromioclavicular (AC) joint dislocations (stage 3-5 according the Rockwood classification) is still debated. Anatomic coracoclavicular (CC) reconstruction is a reliable option in terms of two-dimensional radiographic reduction, clinical outcomes, and return to sports, but there remain concerns regarding anterior-posterior stability of the AC joint with CC ligament reconstruction alone. The aim of the present study was to describe the mid-term results of a new hybrid technique with CC and AC ligament reconstruction for chronic AC joint dislocations. Methods Twenty-two patients surgically treated for chronic AC joint dislocations (grade 3 to 5) were retrospectively reviewed. All patients were assessed before surgery and at final follow-up with the Constant-Murley score (CMS) and the American Shoulder and Elbow Surgeons (ASES) score. The CC vertical distance (CCD) and the CCD ratio (affected side compared to unaffected side) were measured on Zanca radiographs preoperatively, at 6 months postop and at final followup. The same surgical technique consisting in a primary fixation with a suspensory system, coracoclavicular ligaments reconstruction with a double loop of autologous gracilis and acromioclavicular ligaments reconstruction with autologous coracoacromial ligament was performed in all cases. Results Twenty-two shoulders in 22 patients (19 males and 3 females) were evaluated with a mean age of 34.4 ± 9 years at the time of surgery. The mean interval between the injury and surgery was 53.4 ± 36.7 days. The mean duration of postoperative follow-up was 49.9 ± 11.8 months. According to the Rockwood classification, there were 5 (22.6%) type-III and 17 (77.2%) type-V dislocations. Mean preoperative ASES and CMS were 54.4 ± 7.6 and 64.6 ± 7.2, respectively. They improved to 91.8 ± 2.3 (p = 0.0001) and 95.2 ± 3.1 (p = 0.0001), respectively at final FU. The mean preoperative CCD was 22.4 ± 3.2 mm while the mean CCD ratio was 2.1 ± 0.1. At final FU, the mean CCD was 11.9 ± 1.4 mm (p = 0.002) and the mean CCD ratio was 1.1 ± 0.1 (p = 0.009). No recurrence of instability was observed. One patient developed a local infection and four patients referred some shoulder discomfort. Heterotopic ossifications were observed in three patients. Conclusions The optimal treatment of chronic high-grade AC joint dislocations requires superior-inferior and anterior-posterior stability to ensure good clinical outcomes and return to overhead activities or sports. The present hybrid technique of AC and CC ligaments reconstruction showed good clinical and radiographic results and is a reliable an alternative to other reported techniques. Level of evidence Level IV.

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“…Several studies have shown that surgical treatment for AC joint injury is appropriate for patients with high physical needs, such as young people, athletes, and physical workers [ 6 – 8 ]. Various surgical options have been developed to manage AC joint dislocation, including coracoacromial ligament transfer (Weaver–Dunn procedure), CC fixation, and AC or CC reconstruction [ 9 , 10 ]. Among the methods of AC joint fixation, using a hook plate is effective for the treatment of acute AC joint dislocation and has the advantage of being a simple technique that allows early joint motion due to high stability [ 11 – 13 ].…”

Section: Introductionmentioning

confidence: 99%

Risk factors of loss of reduction after acromioclavicular joint dislocation treated with a hook plate

et al. 2023

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Background Acromioclavicular joint fixation using a hook plate is effective for the treatment of acute acromioclavicular joint dislocation. However, several studies have reported some complications including loss of reduction after surgery for acromioclavicular joint dislocation. This study aimed to identify the risk factors associated with the loss of reduction after acromioclavicular joint dislocation surgery using a hook plate. Methods This was a retrospective study that assessed 118 patients with acromioclavicular joint dislocation, who were diagnosed between March 2013 and January 2019 and underwent surgical treatment using the hook plate (reduction loss group: n = 38; maintenance group: n = 80). The mean follow-up period was 29.9 months (range, 24–40 months). We assessed the range of motion, the American Shoulder and Elbow Surgeons score (ASES), visual analog scale score for pain, and a subjective shoulder value. Radiological assessment of coracoid clavicular distance was performed. The risk factors of reduction loss were analyzed using multivariable logistic regression analysis. Results Age (p = 0.049), sex (female, p = 0.03, odds ratio OR = 4.81), Rockwood type V (p = 0.049, OR = 2.20), and time from injury to surgery > 7 days (p = 0.018, OR = 2.59) were statistically significant factors in the reduction loss group. There were no significant differences in the clinical outcomes for range of motion, ASES, subjective shoulder value, and visual analog scale scores between the two groups. In the radiological results, preoperative coracoid clavicular distance (p = 0.039) and ratio (p = 0.001), and over-reduction (p = 0.023, OR = 0.40) were significantly different between the two groups. The multivariate logistic regression analysis identified the female sex (p = 0.037, OR = 5.88), a time from injury to surgery > 7 days (p = 0.019, OR = 3.36), and the preoperative coracoid clavicular displacement ratio of the injured shoulder (p < 0.001, OR = 1.03) as risk factors associated with reduction loss following surgery using a hook plate for acromioclavicular dislocation. Conclusion A delayed timing of surgery > 7 days, preoperative coracoid clavicular displacement ratio of the injured shoulder, and female sex were identified as risk factors for loss of reduction after surgery using a hook plate for acromioclavicular joint dislocation. Level of evidence: Level IV; retrospective comparison; treatment study

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Concomitant Acromioclavicular and Coracoclavicular Ligament Reconstruction with a Duo-Figure-8 Autogenic Graft Wrapping Technique for Treating Chronic Acromioclavicular Separation

Cited by 5 publications

References 30 publications

Comparison of Locking Plate Osteosynthesis versus Coracoclavicular Stabilization for Neer Type IIB Lateral Clavicle Fractures

Comparison of Locking Plate Osteosynthesis versus Coracoclavicular Stabilization for Neer Type IIB Lateral Clavicle Fractures

Hybrid coracoclavicular and acromioclavicular reconstruction in chronic acromioclavicular joint dislocations yields good functional and radiographic results

Risk factors of loss of reduction after acromioclavicular joint dislocation treated with a hook plate

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