Single tunnel technique versus coracoid sling technique for arthroscopic treatment of acute acromioclavicular joint dislocation

Abstract

To evaluate and compare the efficacy of two techniques for the treatment of acute acromioclavicular joint dislocation, the charts of 60 patients diagnosed with acute Rockwood type IV and V acromioclavicular joint dislocation that undergone arthroscopic fixation procedure with single tunnel technique (N = 30, 30.7 ± 5.7 years old) or coracoid sling technique (N = 30, 30.1 ± 5.4 years old) fixation were retrospectively reviewed. The Visual Analog Scale pain score, Constant shoulder functionality score, Karlsson acromioclavicular joint score, the time of return to sports and activity, and plain radiographs of the affected shoulder at different time points of follow-up were recorded for a minimum of 2 years post-op. The majority of the patients recovered to their preoperative activity levels with few complications. The average postoperative acromioclavicular and coracoclavicular distances were significantly narrower than preoperative measurements in both groups without significant difference between the two groups at 2 years post-op (P < 0.05). The coracoid sling technique group had reduced operative time, shorter time of recovery of shoulder movements, higher Constant functionality scores and Karlsson acromioclavicular joint scores, and fewer complications than the single tunnel technique group at the last follow-up (P < 0.05). Therefore, coracoid sling technique achieved superior clinical outcomes with fewer complications compared to the traditional single tunnel technique in arthroscopic treatment of acute acromioclavicular joint dislocation.

Comparison of Surgical Techniques Used in Treating Acromioclavicular Dislocation in Patients Participating in Sports: A Systematic Review

“…In addition, 25 of the 30 patients who underwent the single tunnel technique returned to their activities within 4.2 months [14]. However, 19 patients who underwent the coracoid sling technique were able to return to normal activities in 5.1 months [14].…”

“…In addition, the duration of patients' follow-ups differed significantly among the studies, ranging from 3 to 50.1 months [3] [12]. Regarding the surgical procedures used, 49 patients were treated using titanium plates fixation [3] [13], 24 underwent arthroscopically-assisted techniques to stabilize the coracoclavicular joint [12], 30 were treated using the single tunnel technique [14] and another 30 were treated using the coracoid sling technique [14]. Open Journal of Orthopedics There was a decrease on the visual analog scale (VAS) and an increase on the Constant-Murley scores among patients who were treated with fixation of clavicular titanium plates [13].…”

“…In this systematic review, 22 complications after surgical treatment were identified, including: six cases of infection [13] [14], two algodystrophies [12], two osteolysis [12], three device failures [12], one fracture [12], three patients reported deficit in lateral rotation [12], two cases of loss of displacement reduction [14] and three grade II dislocations [14]. Table 1 presents a summary of the characterization of these studies.…”

“…The new methods of minimally invasive surgery offer a great variety of methods to choose from. In addition, the arthroscopic approach reduces damage in noble and interconnected structures [14]. However, the amount of intra and postoperative problems resulting from this technique is noteworthy, especially with regard to loss of reduction, infections, dislocations and osteolysis, regardless of the maneuver used [20] [29].…”

Arthroscopic-Assisted Acromioclavicular Joint Reconstruction

“…Biomechanical studies show that decreasing the hole size with the coracoid would decrease the risk of fracture [ 7 ]. Regardless of the size of the coracoid tunnel, it is reported in the literature that using a coracoid sling technique and avoiding bony tunnels result in fewer complications [ 8 ].…”