Coracoid fracture with recurrent AC joint separation after Tightrope repair of AC joint dislocation

Background Acromioclavicular (AC) separations are commonly seen shoulder injuries. Numerous surgical reconstruction techniques have been described. In this study, we present a series of patients who underwent an anatomic reconstruction using a synthetic ligament and allograft construct. Methods We performed a retrospective review of patients with type IV or V AC separations who underwent primary or revision AC reconstruction with a luggage-tag synthetic ligament and a semitendinosus allograft placed through the anatomic insertion sites of the coracoclavicular ligaments. Patient-reported outcomes, as well as complication rates, were recorded at a minimum 2-year follow-up. Results Ten patients with a mean age of 44.2 ± 14.9 years were included in the study. The mean Disabilities of the Arm, Shoulder and Hand score was 15.5 ± 15.4; mean Single Assessment Numeric Evaluation score, 81.8 ± 12.1; mean Simple Shoulder Test score, 11.4 ± 1.1; mean American Shoulder and Elbow Surgeons score, 84.6 ± 15.7; mean Constant score, 82.5 ± 11.6; and mean visual analog scale score, 2 ± 2.6. Conclusion The technique using a luggage-tag synthetic ligament along with an anatomic allograft coracoclavicular ligament reconstruction is a safe, effective alternative to other techniques described in the literature.

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“…Fractures after AC reconstructions involving transcoracoid drilling have been reported in the literature. 6 , 10 …”

Section: Discussionmentioning

confidence: 99%

Anatomic reconstruction of acromioclavicular joint dislocations using allograft and synthetic ligament

et al. 2020

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“…Second, in order to prevent clavicle fractures at the suture hole, it is essential to avoid excessive drilling of the suture hole during ACJ reconstruction and pay attention to the widening of suture holes at radiography images. Over-tensioning of the sutures [14, 16], osteolysis from a soft tissue reaction [15], technical factors due to the operator such as multiple entry-point drilling or suture holes that are not located in the center of the bone [1, 9], and poor adherence of the patients [7] are considered to be the mechanisms that can cause fractures near the suture hole. In the present case, multiple drilling holes were observed near the suture-button entry-point during the present surgery.…”

Section: Discussionmentioning

confidence: 99%

Clavicle fracture at the suture hole after acromioclavicular joint reconstruction using a suture-button: a case report

Inoue

Furuhata

Kaneda

et al. 2019

BMC Musculoskelet Disord

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Background Intraosseous suture-button devices have been used for acromioclavicular joint reconstruction due to its relative simplicity compared with other procedures. However, the complications of acromioclavicular joint reconstruction using a suture-button are not fully understood. Here, we describe a case of a clavicle fracture at the suture hole following acromioclavicular joint reconstruction using a suture-button and hook plate. Case presentation A 28-year-old man presented at our hospital after a fall from his bicycle. The patient had a history of acromioclavicular joint reconstruction with a suture-button and a hook plate for right acromioclavicular joint dislocation, seven months ago at another hospital. The hook plate had been removed four months ago, while X-ray radiography before removal had shown the widening of a suture hole. In the current fall from the bicycle, X-ray radiography revealed a clavicle fracture through the previous drill hole for suture-button. We removed the suture-button and performed an open reduction and internal fixation for the clavicle fracture. Conclusion The present case indicated that a clavicle fracture at the suture hole, although rare, is one of the complications after an acromioclavicular joint reconstruction using a suture-button. This case suggested that drilling to the necessary minimum when making suture holes and paying attention to the widening of suture holes are important to prevent a postoperative clavicle fracture.

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“…[10][11][12] More recently, as use of the arthroscopic transcoracoid technique has increased, several reports of associated coracoid fracture have emerged. [13][14][15] Both Gerhardt et al 13 and Bindra et al 14 reported isolated fractures after the use of different types of coracoid buttons. More worrisome is a report by Milewski et al 15 that retrospectively reviewed a case series of different anatomic reconstruction techniques.…”

Section: Discussionmentioning

confidence: 99%

Coracoclavicular Ligament Reconstruction: Coracoid Tunnel Diameter Correlates With Failure Risk

Rylander¹,

Baldini²,

Mitchell³

et al. 2014

Orthopedics

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The current study compared tunnel diameter as an independent risk factor for fixation failure from the coracoid after transcoracoid coracoclavicular reconstruction. The effect of variation in coracoid size and scapular bone density on fixation failure was also studied. Sixty-two cadaveric scapulae were randomized into 1 of 4 groups: a control group with no coracoid hole, a group with a 4-mm transcoracoid tunnel, a group with a 6-mm transcoracoid tunnel, and a group with a socket technique using a 6-mm hole superiorly with a 4-mm hole inferiorly. Bone density measures for all specimens were performed. Coracoid dimensions were quantified. Using a cortical button device, all specimens were loaded to failure with an Instron servohydraulic testing machine (Instron Corp, Canton, Massachusetts). All drilled specimens failed by button pullout, and all control specimens failed by coracoid fracture. Average pullout strength for each tunnel subgroup was as follows: 4 mm, 296.9 N; 6 mm, 146.2 N; 6-4 socket, 261.8 N; control, 762.9 N. No difference was found with respect to tunnel subgroups in base height (P=.25) or bone density (P=.44). Load to failure for the control group was significantly higher than for the other 3 techniques. The 4-mm tunnel load to failure was significantly higher than that for the 6-mm tunnel (P=.006). No difference was found between the 4-mm tunnel and the 6-4 socket technique (P=.853). Although it was not statistically significant, a very strong trend was seen toward increased strength of the 6-4 socket over the 6-mm tunnel (P=.051). The study results show that when employing a transcoracoid reconstruction technique, a 4-mm tunnel technique is significantly stronger than a 6-mm tunnel technique. None of the coracoids drilled with the various tunnels approached the strength of the native coracoid controls using a looped wire technique.

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Coracoid fracture with recurrent AC joint separation after Tightrope repair of AC joint dislocation

Abstract: We present a case of failure of acromioclavicular joint (ACJ) reduction that was performed with low-profile, double-metallic button technique (Tightrope; Arthrex Inc). The patient presented with coracoid fracture and loss of reduction within eight weeks of surgery.

Cited by 14 publications

References 9 publications

Anatomic reconstruction of acromioclavicular joint dislocations using allograft and synthetic ligament

Anatomic reconstruction of acromioclavicular joint dislocations using allograft and synthetic ligament

Clavicle fracture at the suture hole after acromioclavicular joint reconstruction using a suture-button: a case report

Coracoclavicular Ligament Reconstruction: Coracoid Tunnel Diameter Correlates With Failure Risk

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