The surgical treatment of acromioclavicular joint injuries

Boffano, Michele; Mortera, Stefano; Wafa, Hazem; Piana, Raimondo

doi:10.1302/2058-5241.2.160085

Cited by 33 publications

(38 citation statements)

References 47 publications

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“…For secondary surgery, flexible implants were often combined with a Weaver-Dunn procedure [27]. The array of implants used in the Netherlands is in line with previous publications [5][6][7]. Boffano et al concluded that there is no consensus on the implant use, but suggest to treat young patients with high-grade ACJ injuries in the early stages using synthetic devices with open or arthroscopic procedures aiming to obtain a stable joint [5].…”

Section: Discussionmentioning

confidence: 75%

“…A difficulty in many published studies is that no standardized surgical techniques were compared. Besides autograft techniques such as of Weaver-Dunn and other autologous tendon reconstructions, a diversity of implants have been used: acromioclavicular k-wire fixation, Bosworth screw (rigid coracoclavicular fixation), clavicle hook plate, and different coracoclavicular suture techniques [5][6][7]. Many of these implants cause pain despite correct implantation.…”

Section: Electronic Supplementary Materialsmentioning

confidence: 99%

“…Concerning fully ligamentous injuries with severe dislocation (Rockwood type IV-VI) there is consensus that operative treatment is the best option [1]. Whether or not Rockwood type III injuries should be treated operatively remains subject to debate [3][4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

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Current practice in the management of acromioclavicular joint dislocations; a national survey in the Netherlands

Rooij

Lieshout

Schurink

et al. 2020

Eur J Trauma Emerg Surg

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The aim of this study was to investigate current practice in the management of acromioclavicular joint dislocations in the Netherlands. Methods A 36-item literature-based and expert consensus survey was developed. If available, one orthopaedic and one trauma surgeon for every hospital (n = 82) in the Netherlands was asked to complete the online questionnaire. Only complete data sets were included in the analysis. Descriptive analysis was performed using SPSS. Results Of 149 invited surgeons, 106 (71%) fully completed the survey. The diagnosis of ACJ injury was mainly based on physical examination (91%) and radiographs (95%). The vast majority of patients with ACJ injuries was treated non-operatively. The decision for operative treatment was mainly based on the surgeon's experience and available literature. Patientrelated factors that contributed most to the decision to operate or not, were mainly functional needs and age. Cosmesis and gender contributed less to this decision. Rockwood II and III ACJ injuries were usually treated non-operatively, whereas Rockwood IV and V ACJ injuries were usually treated operatively. For primary and secondary operative treatment, a flexible implant was preferred over rigid fixation techniques. All respondents agreed that nonoperative treatment of Rockwood II ACJ injuries leads to satisfactory results and that secondary operative treatment is only rarely required. Also the majority of patients with Rockwood III ACJ injuries is treated non-operatively, although failure rates are considered higher. Conclusion This survey showed a significant individual variation on diagnosis and treatment strategies among surgeons in the Netherlands. The majority of the Dutch surgeons concern a flexible implant the best available technique for patients who require operative treatment.

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Section: Discussionmentioning

confidence: 75%

Section: Electronic Supplementary Materialsmentioning

confidence: 99%

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Current practice in the management of acromioclavicular joint dislocations; a national survey in the Netherlands

Rooij

Lieshout

Schurink

et al. 2020

Eur J Trauma Emerg Surg

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“…After repairing the AC ligament and capsule, the stability was then assessed by passively moving the shoulder. The deltotrapezial fascia was carefully repaired, and a routine wound closure was performed (a typical case is shown in Figs 5,6,7,8,9).…”

Section: Horizontal Stability Reconstructionmentioning

confidence: 99%

“…Although the incidence of high-grade ACJ injuries requiring surgery is low, indications for the conservative versus surgical treatment of type III and V injuries produce controversy 1,1,[3][4][5][6] . This disagreement has encouraged the development of multiple surgical techniques and may reflect a general dissatisfaction with treatment options and outcomes 3,4,[6][7][8] .…”

Section: Introductionmentioning

confidence: 99%

Acromioclavicular Joint Separation: Repair Through Suture Anchors for Coracoclavicular Ligament and Nonabsorbable Suture Fixation for Acromioclavicular Joint

Liu

Bao

Jiang

et al. 2020

Orthopaedic Surgery

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Objective: To evaluate the clinical and radiographic outcomes of patients undergoing coracoclavicular (CC) ligament repair by two suture anchors and acromioclavicular (AC) joint (ACJ) fixation using heavy nonabsorbable sutures for the treatment of types III-V ACJ injuries with a minimum of 1-year follow-up. Methods: The clinical and radiographic outcomes of 36 consecutive patients (26 men and 10 women) who underwent anatomic reduction for acute ACJ dislocation using two suture anchors for CC ligament reconstruction and two strands of non-absorbable stitches for ACJ fixation between December 2013 and December 2018 were reviewed. Two 3.5 mm suture anchors with double-loaded sutures were separately inserted into the anterolateral and posteromedial portions of the coracoid process. The suture strands were passed through the hole created in the clavicle using 2.0 mm drill and tied over the clavicle. Additional ACJ augmentation using two strands of non-absorbable heavy sutures was performed in all patients. At 3, 6, and 12 months and last follow-up visit, the scores on the visual analog scale (VAS), the American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score, and simple shoulder test (SST) questionnaires were used to provide a final evaluation of shoulder function. Comparison between baseline and treatment results was performed. Radiographic analysis included vertical displacement and horizontal shift. Results: A total of 29 patients (20 men and nine women) were included in the study. A total of seven, six, and 16 patients had Rockwood type III, type IV, and type V ACJ dislocations, respectively. The mean patient age was 42.8 AE 13.5 years, with a mean follow-up of 28 months (range, 12-56 months). At the 12-month follow-up, the mean ASES score was 92.1 AE 3.5, with a mean pain score of 0.5 AE 0.7 on the VAS and mean Constant-Murley score of 93.0 AE 2.4. The new number of positive answers on the SST was 11.5 AE 0.6. Compared with the baseline, the clinical results improved significantly (P < 0.05). No significant difference could be found between the 6-and 12-month follow-up evaluations (P > 0.05). Radiographs showed two partial loss of reduction, whereas no horizontal displacement was found in all patients. One patient developed a superficial wound infection 3 weeks postoperation. The wound healed after routine wound care. No neurovascular complications were recorded. Conclusions: CC ligament reconstruction using two suture anchors and ACJ augmentation using two strands of nonabsorbable heavy sutures on high-grade AC dislocation is a reliable technique for restoring stability to the ACJ and can obtain good to excellent clinical results.

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