Prognostic factors to succeed in surgical treatment of chronic acromioclavicular dislocations

Barth, Johannes; Duparc, Fabrice; Baverel, L.; Bahurel, J; Toussaint, B.; Bertiaux, Simon; Clavert, Philippe; Gastaud, Olivier; Brassart, Nicolas; Beaudouin, Emmanuel; Mourgues, P De; Berne, D.; Duport, M.; Najihi, N.; Boyer, Patrick; Faivre, B.; Meyer, Alain; Nourissat, Geoffroy; Poulain, S; Bruchou, F; Ménard, J. F.

doi:10.1016/j.otsr.2015.09.002

Cited by 33 publications

(26 citation statements)

References 28 publications

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“…Rahm et al [ 11 ], Gastaud et al [ 38 ] and others [ 10 , 39 – 41 ] have all shown that despite standardized protocols, classic axillary views are not recommended to assess posterior translation. Our assessment of the effect of projectional variation on our novel quantitative parameters demonstrated that even with 10° and 20° of malpositioning in various planes included, AC–DC and GC–PC continuously increased with increasing severity of ACJ separation.…”

Section: Discussionmentioning

confidence: 99%

New quantitative radiographic parameters for vertical and horizontal instability in acromioclavicular joint dislocations

Zumstein

Schiessl

Ambuehl

et al. 2017

Knee Surg Sports Traumatol Arthrosc

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PurposeThe aim of this study was to identify the most accurate and reliable quantitative radiographic parameters for assessing vertical and horizontal instability in different Rockwood grades of acromioclavicular joint (ACJ) separations. Furthermore, the effect of projectional variation on these parameters was investigated in obtaining lateral Alexander view radiographs.MethodsA Sawbone model of a scapula with clavicle was mounted on a holding device, and acromioclavicular dislocations as per the Rockwood classification system were simulated with the addition of horizontal posterior displacement. Projectional variations for each injury type were performed by tilting/rotating the Sawbone construct in the coronal, sagittal or axial plane. Radiographic imaging in the form of an anterior–posterior Zanca view and a lateral Alexander view were taken for each injury type and each projectional variation. Five newly defined radiographic parameters for assessing horizontal and vertical displacement as well as commonly used coracoclavicular distance view were measured. Reliability, validity and the effect of projectional variation were investigated for these radiographic measurements.ResultsAll radiographic parameters showed excellent intra- and interobserver reliability. The validity was excellent for the acromial centre line to dorsal clavicle (AC–DC) in vertical displacement and for the glenoid centre line to posterior clavicle (GC–PC) in horizontal displacement, whilst the remaining measurements showed moderate validity. For AC–DC and GC–PC, convergent validity expressed strong correlation to the effective distance and discriminant validity demonstrated its ability to differentiate between various grades of ACJ dislocations. The effect of projectional variation increased with the degree of deviation and was maximal (3 mm) for AC–DC in 20° anteverted malpositioning and for GC–PC in 20° retroverted malpositioning.ConclusionsAC–DC and the GC–PC are two novel quantitative radiographic parameters of vertical and horizontal instability in ACJ dislocations that demonstrate excellent reliability and validity with reasonable inertness to malpositioning. The use of AC–DC for assessing vertical displacement and GC–PC for assessing horizontal displacement in a single Alexander view is recommended to guide the appropriate management of ACJ dislocations. A better appreciation of the degree of horizontal instability, especially in lower Rockwood grades (II, III) of ACJ dislocations, may improve management of these controversial injuries.

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Section: Discussionmentioning

confidence: 99%

New quantitative radiographic parameters for vertical and horizontal instability in acromioclavicular joint dislocations

Zumstein

Schiessl

Ambuehl

et al. 2017

Knee Surg Sports Traumatol Arthrosc

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“…No single procedure has proven to be superior to another, and the techniques developed to date still present a considerable failure rate. 3 , 13 , 67 The AC joint is the part of the shoulder girdle that transfers the load of the upper extremity to the core of the body. The CC ligaments are the main ligaments responsible for vertical stability (2 strong connections between the clavicle and the coracoid), 18 whereas the AC ligaments are responsible for horizontal stability (AC joint has 4 thin capsular ligaments all around, the superior and posterior parts being the most important).…”

Section: Discussionmentioning

confidence: 99%

“… 30 , 48 The latest trends advocate the need to use an autograft associated with a fixation system to solve these lesions, given the poor healing capacity of the native ligaments, especially when the injury has long time of evolution. 3 , 20 …”

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confidence: 99%

Chronic acromioclavicular dislocations: multidirectional stabilization without grafting

Cano-Martínez¹,

Nicolás-Serrano²,

Bento-Gerard³

et al. 2020

JSES International

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Objective Clinical and radiological evaluation of the surgical treatment of chronic acromioclavicular (AC) dislocations with triple button device and AC joint augmentation. Materials and Methods This retrospective study included 21 patients with chronic AC dislocations. All patients underwent bilateral-weighted Zanca and Alexander views as well as the Constant score (CS) and Acromioclavicular Joint Instability Scoring System (ACJI). Results A total of 21 patients (19 men and 2 women) with the mean age of 30.7 ± 11.7 years (range, 19-62 years) were able to participate in clinical and radiographic follow-up. After a mean follow-up of 49.7 ± 17.1 months (range, 13-60 months), the results of the CS were 95.2 ± 5.5 (range, 85-100) and ACJI test 89.7 ± 7.9 (range, 75-100), showing no significant differences with the uninjured shoulder (CS, 96.2 ± 3.9; range, 85-100; ACJI, 95.7 ± 4.1; range, 85-100). At the final review, we observed that the preoperative coracoclavicular distance (Zanca view) improved from 12.8 ± 1.5 mm to 8.5 ± 1.3 mm and the AC distance (Alexander view) from 7.8 ± 2.3 mm to 0.99 ± 0.91 mm. Compared with healthy shoulder, these differences were not significant. Osteoarthritis or radiological calcifications were not associated with worse clinical outcomes. Conclusion The triple button device is an acceptable alternative surgical method for chronic AC joint dislocations. The surgical technique is simple; it does not need a graft, nor does it present major complications, and material extraction is unnecessary.

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confidence: 99%

“…Chronic acromioclavicular joint (ACJ) instability is considered when resorption and progressive retraction of the coracoclavicular (CC) and acromioclavicular (AC) ligaments are present such that spontaneous healing becomes impossible and biological augmentation becomes mandatory 1, 2. Most authors have reported that ACJ injuries with a duration of more than 3 weeks should be considered chronic; however, others have minimized this time interval to only 10 days from injury 1, 2, 3. Failure of conservative or surgical treatment in the acute phase results in chronic ACJ instability; periscapular muscle fatigue, scapular dyskinesia, a subjective sensation of heaviness of the injured upper limb, painful horizontal adduction, and failure to return to high-level sports or manual work develop in about 15% to 40% of patients with complete acromioclavicular joint dislocations (ACJDs) 1, 4, 5…”

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confidence: 99%

Arthroscopic Coracoacromial Ligament Transfer Augmented With Suspensory V-Shaped Fixation System for Chronic Acromioclavicular Joint Dislocation

Kany¹,

Selim

2019

Arthroscopy Techniques

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Chronic acromioclavicular joint dislocations (ACJDs) develop when there is failure of conservative treatment, failed surgical treatment of acute ACJD, or simply missing the treatment in the acute healing phase. There is wide agreement that mechanical fixation alone in chronic ACJD is not sufficient and biological augmentation is necessary. Various arthroscopic techniques for reconstruction of the coracoclavicular ligament have been described, but allografts are expensive, are not available in all centers, carry the risk of disease transmission, and are “dead tissue” with a poor capacity for healing. Autografts are associated with donor-site morbidity and avascular structures. Moreover, these grafts are associated with a high risk of clavicular or coracoid fractures owing to large tunnels. We present an arthroscopic technique to transfer the coracoacromial ligament to the inferior surface of the lateral part of the clavicle in chronic ACJD, augmented with 2 clavicular buttons and a single coracoid button in a V-shaped configuration. The technique has various advantages including better stabilization, anatomic reconstruction, and a minimal risk of fracture of the coracoid and clavicle with small tunnels, using a vascularized graft with arthroscopic control of reduction.

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Prognostic factors to succeed in surgical treatment of chronic acromioclavicular dislocations

Abstract: Level II prospective non-randomized comparative study.

Cited by 33 publications

References 28 publications

New quantitative radiographic parameters for vertical and horizontal instability in acromioclavicular joint dislocations

New quantitative radiographic parameters for vertical and horizontal instability in acromioclavicular joint dislocations

Chronic acromioclavicular dislocations: multidirectional stabilization without grafting

Arthroscopic Coracoacromial Ligament Transfer Augmented With Suspensory V-Shaped Fixation System for Chronic Acromioclavicular Joint Dislocation

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