Primary versus revision arthroscopically-assisted acromio- and coracoclavicular stabilization of chronic AC-joint instability

Kraus, Natascha; Hann, Carmen; Minkus, Marvin; Maziak, Nina

doi:10.1007/s00402-019-03153-3

Cited by 19 publications

(22 citation statements)

References 26 publications

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“…When considering revision cases, controversy exists on how to best address recurrent AC joint instability, with only limited data regarding clinical and radiographic outcomes having been published. 12,20,25,45,49 In 2007, Tauber et al 45 demonstrated good clinical and radiographic outcomes in 12 patients undergoing revision AC joint reconstruction with arthroscopically assisted CC ligament reconstruction using a semitendinosus tendon autograft and additional cerclage or Bosworth screw fixation. Kraus et al 25 investigated a series of 14 patients undergoing revision AC joint reconstruction with arthroscopic AC and CC ligament stabilization using a gracilis tendon autograft and TightRope augmentation, with good clinical and radiographic outcomes after a median follow-up of 28.8 months.…”

Section: Discussionmentioning

confidence: 99%

“…12,20,25,45,49 In 2007, Tauber et al 45 demonstrated good clinical and radiographic outcomes in 12 patients undergoing revision AC joint reconstruction with arthroscopically assisted CC ligament reconstruction using a semitendinosus tendon autograft and additional cerclage or Bosworth screw fixation. Kraus et al 25 investigated a series of 14 patients undergoing revision AC joint reconstruction with arthroscopic AC and CC ligament stabilization using a gracilis tendon autograft and TightRope augmentation, with good clinical and radiographic outcomes after a median follow-up of 28.8 months. In patients with previously failed ligament transfer (eg, Weaver-Dunn), Kany et al 23 proposed all-arthroscopic augmented transposition of the conjoined tendons (eg, Vargas technique) as a salvage procedure in 2 patients, with no loss of reduction at final follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…11,12 However, the effect of previous AC joint stabilization on postoperative outcomes in revision surgery is still lacking in the current literature or limited to short follow-up periods and small case series. 12,23,25,45,49 When considering revision cases, a higher rate of complications may be expected because of bony disorders, such as bone loss at the distal clavicle or large bone tunnels created in the clavicle and/or coracoid. 12,13,25,28,29,47,48,50 Thus, performing a detailed failure analysis is of great importance to reduce failure rates and adequately restore native joint biomechanics for ensuring an optimal healing environment.…”

mentioning

confidence: 99%

“…12,23,25,45,49 When considering revision cases, a higher rate of complications may be expected because of bony disorders, such as bone loss at the distal clavicle or large bone tunnels created in the clavicle and/or coracoid. 12,13,25,28,29,47,48,50 Thus, performing a detailed failure analysis is of great importance to reduce failure rates and adequately restore native joint biomechanics for ensuring an optimal healing environment. 12 The purpose of this study was to investigate the longterm clinical and radiographic outcomes of patients undergoing revision ACCR after previously failed AC joint reconstruction of type III through V injuries.…”

mentioning

confidence: 99%

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Minimum 10-Year Outcomes After Revision Anatomic Coracoclavicular Ligament Reconstruction for Acromioclavicular Joint Instability

Berthold

Muench

Beitzel

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Revision surgery in cases of previously failed primary acromioclavicular (AC) joint stabilization remains challenging mainly because of anatomic alterations or technical difficulties. However, anatomic coracoclavicular ligament reconstruction (ACCR) has been shown to achieve encouraging biomechanical, clinical, and radiographic short-term to midterm results. Purpose: To evaluate the clinical and radiographic long-term outcomes of patients undergoing revision ACCR after failed operative treatment for type III through V AC joint injuries with a minimum 10-year follow-up. Study Design: Case series; Level of evidence, 4. Methods: A retrospective chart review was performed on prospectively collected data within an institutional shoulder registry. Patients who underwent revision ACCR for type III through V AC joint injuries between January 2003 and December 2009 were analyzed. Clinical outcome measures included the American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test (SST), and Single Assessment Numeric Evaluation (SANE). The coracoclavicular distance (CCD) was measured for radiographic analysis immediately postoperatively and at last postoperative follow-up. Results: A total of 8 patients with a mean age at the time of surgery of 44.6 ± 10.6 years and a mean follow-up of 135.0 ± 17.4 months (range, 120-167 months) were eligible for inclusion in the study. The time from initial AC joint stabilization until revision surgery was 10.2 ± 12.4 months (range, 0.5-36 months); 62.5% of the patients had undergone more than 2 previous AC joint surgical procedures. The ASES score improved from 43.9 ± 22.4 preoperatively to 80.6 ± 28.8 postoperatively ( P = .012), the SST score improved from 4.4 ± 3.6 preoperatively to 11.0 ± 2.2 postoperatively ( P = .017), and the SANE score improved from 31.4 ± 27.3 preoperatively to 86.9 ± 24.1 postoperatively ( P = .018) at final follow-up. There was no significant difference in the CCD ( P = .08) between the first (7.6 ± 3.0 mm) and final (10.6 ± 2.8 mm) radiographic follow-up (mean, 50.5 ± 32.7 months [range, 18-98 months]). Conclusion: Patients undergoing revision ACCR after failed operative treatment for type III through V AC joint injuries maintained significant improvement in clinical outcomes at a minimum 10-year follow-up.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Minimum 10-Year Outcomes After Revision Anatomic Coracoclavicular Ligament Reconstruction for Acromioclavicular Joint Instability

Berthold

Muench

Beitzel

et al. 2020

Orthopaedic Journal of Sports Medicine

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“…In the initially described technique, three transclavicular, two transcoracoidal, and one transacromial drill hole was made. Postoperative tunnel widening in the transclavicular graft holes was detected but did not lead directly to negative clinical results, al-though dynamic posterior translation was observed in some cases [4]. Multiple drill holes may weaken the bone and lead to fractures of the coracoid and clavicle postoperatively.…”

Section: Introductionmentioning

confidence: 92%

Arthroscopically assisted stabilization of chronic bidirectional acromioclavicular joint instability using a low-profile implant and a free tendon graft

et al. 2020

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Clavicular tunnel widening in chronic acromioclavicular joint instabilities after primary versus revision arthroscopically‐assisted acromio‐ and coracoclavicular stabilization

Vetter,

Bellmann,

Eckl

et al. 2024

J. exp. orthop.

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PurposeTo evaluate joint reduction (loss of reduction [LOR]; dynamic posterior translation [DPT]) and clavicular tunnel widening (cTW) in patients treated with arthroscopically‐assisted acromioclavicular joint (ACJ) stabilization after previously failed nonoperative versus surgical treatment.MethodsPatients undergoing arthroscopically‐assisted ACJ stabilization (bidirectional tendon allograft with a low‐profile TightRope) after previously failed nonoperative versus surgical treatment were included retrospectively. Bilateral anteroposterior stress views served for evaluating LOR (side‐comparative coracoclavicular distance [CCD]) and cTW at a 6‐weeks‐ and 6‐months‐follow‐up (FU) and for evaluating the filling ratio (FR, vertical device insertion depth relative to clavicle height) at the 6‐weeks‐FU. Postoperative DPT was assessed on Alexander's views.ResultsTwenty‐seven patients (20 male, mean age 46.1 ± 14.8 years) were included (prior treatment: nonoperative: n = 15; surgical: n = 12). There were no differences in LOR, DPT or cTW between groups postoperatively. Initial CCD‐symmetry at the 6‐weeks‐FU (CCD: −0.1 mm [95% confidence interval, CI, −2 to 1.4 mm]) was followed by LOR at the 6‐months‐FU (CCD: −3.5 mm [95% CI, −5.2 to −1.9 mm]; p < 0.001). cTW increased towards the inferior cortex, compared to the superior cortex and the intermediate level (p < 0.001, respectively). cTW at the inferior cortex was associated with more LOR (r = −0.449; p = 0.024) and DPT (r = 0.421; p = 0.036), dependent on a smaller FR (r = −0.430; p = 0.032).ConclusionPatients undergoing arthroscopically‐assisted ACJ stabilization for chronic bidirectional ACJ instabilities showed comparable radiologic results after previous nonoperative versus surgical treatment. cTW increased towards the inferior cortex and was associated with recurrent vertical and horizontal instability, related to a smaller FR. More research into reduced cTW, for example, by a more filling device, should be performed.Level of EvidenceLevel III, retrospective comparative study.

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Primary versus revision arthroscopically-assisted acromio- and coracoclavicular stabilization of chronic AC-joint instability

Cited by 19 publications

References 26 publications

Minimum 10-Year Outcomes After Revision Anatomic Coracoclavicular Ligament Reconstruction for Acromioclavicular Joint Instability

Minimum 10-Year Outcomes After Revision Anatomic Coracoclavicular Ligament Reconstruction for Acromioclavicular Joint Instability

Arthroscopically assisted stabilization of chronic bidirectional acromioclavicular joint instability using a low-profile implant and a free tendon graft

Clavicular tunnel widening in chronic acromioclavicular joint instabilities after primary versus revision arthroscopically‐assisted acromio‐ and coracoclavicular stabilization

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