AC Joint Separation

2018 ◽  
pp. 29-30
Author(s):  
Jonathan Hodax
Keyword(s):  
Ac Joint ◽  
Joint Separation

Stabilization of Acute High-Grade Acromioclavicular Joint Separation: A Prospective Assessment of the Clavicular Hook Plate Versus the Double Double-Button Suture Procedure

2018 ◽  
Vol 46 (11) ◽  
pp. 2725-2734 ◽  
Author(s):  
Thomas Stein ◽  
Daniel Müller ◽  
Marc Blank ◽  
Yana Reinig ◽  
Tim Saier ◽  
...  
Keyword(s):  
Constant Score ◽  
Outcome Data ◽  
Hook Plate ◽  
Plate Versus ◽  
High Grade ◽  
Ac Joint ◽  
Level Of Evidence ◽  
Clinical Scores ◽  
Clavicular Hook Plate ◽  
Joint Separation

Background: The stabilization strategy for acute high-grade acromioclavicular (AC) joint separations with AC-stabilizing clavicular hook plate (cHP) or coracoclavicular (CC)–stabilizing double double-button suture (dDBS) is still under consideration. Hypothesis: The CC-stabilizing dDBS is superior to the cHP according to an AC-specific radiologic assessment and score system. Study Design: Cohort study; Level of evidence, 2. Methods: Seventy-three consecutive patients with acute high-grade AC joint separation were prospectively followed in 2 treatment groups (64.4% randomized, 35.6% patient-selected treatment): open reduction and cHP (cHP group) or arthroscopically assisted dDBS (dDBS group) performed within 14 days of injury. Patients were prospectively analyzed by clinical scores (Taft, Constant score [CS], numeric analog scale for pain) and AC-specific radiographs (AC distance, CC distance [CCD], relative CCD [rCCD; 100 / AC distance × CCD]) at points of examination (preoperative and 6, 12, and 24 months). The minimal clinically important differences (MCIDs) were assessed by the anchor-based method. Results: Twenty-seven of 35 patients (mean age ± SD: 37.7 ± 9.7 years) after cHP implantation and 29 of 38 patients (34.2 ± 9.7 years) after dDBS implantation were continuously followed until the 24-month follow-up. All patients showed significantly increased scores after surgery as compared with preoperative status (all P < .05). As compared with GI, GII had significantly better outcomes at 24 months (Taft: cHP = 9.4 ± 1.7 vs dDBS = 10.9 ± 1.1, P < .05, MCID = 2.9; CS: cHP = 90.2 ± 7.8 vs dDBS = 95.3 ± 4.4, P < .02, MCID = 16.6) and at 24 months for Rockwood IV/V (Taft: cHP = 9.4 ± 1.7 vs dDBS = 11.1 ± 0.8, P < .0005; CS: cHP = 90.1 ± 7.7 vs dDBS = 95.5 ± 3.1, P < .04). Clinically assessed horizontal instability persisted in 18.52% (GI) and 6.89% (GII; P = .24). The rCCD showed equal loss of reduction at 24 months (GII = 130.7% [control = 111%] vs GI = 141.8% [control = 115%], MCID = 11.1%). Conclusion: This prospective study showed significantly superior outcomes in all clinical scores between GII and GI. The subanalysis of the high-grade injury type (Rockwood IV/V) revealed that these patients showed significant benefits from the dDBS procedure in the clinical assessments. The cHP procedure resulted in good to excellent clinical outcome data and displayed an alternative procedure for patients needing less restrictive rehabilitation protocols.

scholarly journals Operative fixation of type IV-VI acromioclavicular joint separation: an internal splint technique

2020 ◽  
Vol 6 (6) ◽  
pp. 1291
Author(s):  
Ritwik Ganguli
Keyword(s):  
Sagittal Plane ◽  
Full Range ◽  
Drill Hole ◽  
Fixation Strength ◽  
Type I ◽  
Ac Joint ◽  
Gold Standard Method ◽  
Female Ratio ◽  
Type Iv ◽  
Joint Separation

<p class="abstract">Treatment of acromioclavicular (AC) joint separation is controversial. Rockwood type I, II, III AC joint injuries generally treated conservatively. In the literature there is various treatment options described for treating type IV - VI injuries with good and poor outcome but no single gold standard method. Rockwood type IV - VI AC joint separation treated with internal splint technique by passing Merselene tape through drill hole at lateral end clavicle, passing it under coracoid process and tied it after reducing vertical displacement of AC joint. Simultaneously horizontal displacement corrected and Merselene tape passed through drill hole of acromian process and tied. Endobuttn supports Merselene tape at superior aspect of clavicle. This study was conducted between April 2015 to March 2019 in KPC Medical College and hospital, Kolkata after taking ethical committee permission. 20 patients undergo surgical fixation of type IV-VI AC joint separation within 3 weeks of injury. Outcome of clinical and radiological parameter assessment was at 6, 12, 24 weeks. Male female ratio was 7:3. Mean age 38.2 years, abduction was less than 100 degree in 2 patients at 6 months follow up due to inadequate compliance to physiotherapy. Other patients develop full Range of motion (ROM) and power of shoulder muscle 5/5. No cosmetic deformity except one painful scar. No postoperative displacement in alignment in Anteroposterior (AP) and axillary lateral view. This technique of interal spilint construct reduces need for rigid implant and biological procedure for acute AC joint dislocation though having excellent fixation strength, good reduction in both coronal and sagittal plane for proper healing of AC and Coracoclavicular (CC) ligaments.</p>

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

2011 ◽  
Vol 6 (4) ◽  
pp. 624 ◽  
Author(s):  
Jasjeet Bindra ◽  
James VanDenBogaerde ◽  
John C Hunter
Keyword(s):  
Ac Joint ◽  
Joint Dislocation ◽  
Ac Joint Dislocation ◽  
Joint Separation

Clinical Outcome of a Modified Coracoid Tunnel-Free Coracoclavicular Sling Technique With Remnant Preservation for the Treatment of High-Grade Acromioclavicular Joint Separation: A Report of 48 Cases With 2 to 5 Years of Follow-up

2021 ◽  
pp. 036354652110021
Author(s):  
Fenglong Li ◽  
Yue Li ◽  
Yi Lu ◽  
Yiming Zhu ◽  
Chunyan Jiang
Keyword(s):  
Los Angeles ◽  
Surgical Techniques ◽  
Case Series ◽  
Complication Rates ◽  
High Grade ◽  
Ac Joint ◽  
Level Of Evidence ◽  
Remnant Preservation ◽  
Joint Separation

Background: High-grade acromioclavicular (AC) joint separation injuries (Rockwood type IV or V) are surgically indicated because of complete disruption of the AC and coracoclavicular (CC) ligaments, leading to instability and pain. In surgical techniques that require a suspensory system, coracoid tunnel-related complications are not uncommon. Purpose: To report subjective and objective clinical outcomes and complication rates of a modified coracoid tunnel-free CC sling technique combined with CC ligament remnant preservation for a minimum 2-year follow-up. Study Design: Case series; Level of evidence, 4. Methods: Between January 2014 and January 2017, we prospectively enrolled patients who underwent a modified CC sling technique performed by 1 senior surgeon using the AC TightRope System in a coracoid tunnel-free fashion. The CC distance (CCD) and Rockwood AC joint classification were evaluated on radiographs preoperatively, immediately postoperatively, and at the final follow-up. The visual analog pain score, range of motion, American Shoulder and Elbow Surgeons score, Constant-Murley score, and University of California Los Angeles score were recorded preoperatively and at the final follow-up. Results: In total, 48 of 54 patients (88.9%) were included for the evaluation with a mean ± SD follow-up of 39.3 ± 8.9 months (range, 24.7-64.3 months). The CCD was significantly decreased from 22.7 ± 4.2 to 9.8 ± 2.3 mm ( P < .01) immediately after surgery and to 11.2 ± 1.8 mm ( P < .01) at final follow-up. At the final follow-up, the side-to-side difference of CCD was 3.5 ± 0.6 mm. Compared with the preoperative level, all subjective evaluations were significantly improved at the final follow-up. We observed that 4 of the 48 patients (8.3%) had a loss of reduction at the final follow-up, but no pain or instability was documented. Further, no coracoid-related complication or other complications were recorded. Conclusion: The coracoid tunnel-free CC sling technique using the AC TightRope System combined with CC ligament remnant preservation demonstrated significant improvement regarding both clinical and radiological outcomes, with a reduction loss rate of 8.3%. It is a safe method that could achieve satisfactory result without any coracoid drilling-related complications.

Horizontal Instability of the Acromioclavicular Joint: A Systematic Review

2019 ◽  
Vol 48 (2) ◽  
pp. 504-510 ◽  
Author(s):  
Gianna M. Aliberti ◽  
Matthew J. Kraeutler ◽  
Jeffrey D. Trojan ◽  
Mary K. Mulcahey
Keyword(s):  
Systematic Review ◽  
Patient Outcomes ◽  
Operative Management ◽  
Complication Rates ◽  
Ac Joint ◽  
Horizontal Instability ◽  
Joint Injuries ◽  
Meta Analyses ◽  
Joint Separation ◽  
Ac Joint Injuries

Background: Injuries to the acromioclavicular (AC) joint are common and should be suspected in patients who have shoulder pain in the region of the acromion and clavicle. Injuries to the AC ligament can cause horizontal instability and are often neglected or underdiagnosed, which can lead to poor patient outcomes. Purpose: To perform a systematic review of the literature on the diagnosis and treatment of horizontal instability of the AC joint. Study Design: Systematic review. Methods: The authors performed a systematic review using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed and EMBASE were searched for studies that investigated diagnosis, treatment, and failure of operative management of acute and chronic AC separations. Studies that did not specifically evaluate AC joint injuries, were not written in English, or were specific only to vertical instability of the AC joint were excluded. Results: Overall, 23 articles met the inclusion criteria and were therefore included in this systematic review. Diagnosing horizontal AC instability is difficult using plain radiographs; dynamic views were shown in some cases to better detect horizontal instability than with static views. More than 60 procedures for treating AC joint injuries have been published, but many focus on vertical rather than horizontal instability. Modifications to current surgical procedures to incorporate reconstruction of the horizontal component showed improved patient outcomes. Such modifications included additional AC joint suture cord cerclage, combined AC and coracoclavicular ligament reconstruction, and the Twin Tail TightRope triple button technique. Failure after surgical stabilization of AC joint separation has been reported to occur in 15% to 80% of cases. Conclusion: No consensus is available regarding the best practices for diagnosis, evaluation, and treatment of acute or chronic horizontal instability of the AC joint. Moreover, horizontal instability injuries are often neglected or poorly understood, making diagnosis difficult, which may lead to high complication rates and failure after surgical stabilization.

scholarly journals Physical Therapist Examination, Evaluation, and Intervention Following the Surgical Reconstruction of a Grade III Acromioclavicular Joint Separation

2006 ◽  
Vol 86 (6) ◽  
pp. 857-869 ◽  
Author(s):  
Lisa B Culp ◽  
William A Romani
Keyword(s):  
Acromioclavicular Joint ◽  
Physical Therapist ◽  
Exercise Program ◽  
Neuromuscular Control ◽  
Surgical Reconstruction ◽  
Ac Joint ◽  
College Professor ◽  
Shoulder Strength ◽  
Joint Separation ◽  
Grade Iii

Abstract Background and Purpose. This case report describes the examination, intervention, and outcome of a patient following the surgical reconstruction of a grade III acromioclavicular (AC) joint separation. Detailed postoperative interventions have not previously been described in the literature. Case Description. The patient was a 34-year-old male college professor with a left grade III AC joint separation and no prior restrictions of upper-extremity function. After 12 weeks of presurgical treatment, the patient’s complaints included crepitus and the inability to push open heavy doors. Intervention. Surgical reconstruction of the AC joint and a 4-month graded exercise program were used. Outcome. The patient returned to preinjury levels of function 5 months after surgery with scores of 3.33/100 and 0/100 on the Disabilities of the Arm, Shoulder and Hand questionnaire and optional Sport/Music or Work Module, respectively. Discussion. An intervention focusing on restoring shoulder strength, range of motion, flexibility, and neuromuscular control of the shoulder following a surgical reconstruction of the AC joint can lead to a successful functional outcome. [Culp LB, Romani WA. Physical therapist examination, evaluation, and intervention following the surgical reconstruction of a grade III acromioclavicular joint separation.Phys Ther.2006;86:857 – 869.]

scholarly journals Can an acute high-grade acromioclavicular joint separation be reduced and stabilized without surgery? A surgeon’s experience

2020 ◽  
Vol 140 (12) ◽  
pp. 2021-2027
Author(s):  
Tazio Maleitzke ◽  
Nina Maziak ◽  
Fabian Plachel ◽  
Tobias Winkler ◽  
Philipp Moroder
Keyword(s):  
High Grade ◽  
Joint Stability ◽  
Ac Joint ◽  
Joint Injury ◽  
Cosmetic Appearance ◽  
Anatomic Reduction ◽  
Valuable Treatment ◽  
Joint Separation ◽  
Type V ◽  
Rockwood Type Iii

Abstract Introduction While the management of Rockwood type III injuries is still a topic of debate, high-grade Rockwood type V injuries are mostly treated surgically, to anatomically reduce the acromioclavicular (AC) joint and to restore functionality. In this case report, we present a method for non-operative reduction and stabilization of a high-grade AC joint injury. Case A 31-year-old male orthopaedic resident sustained a Rockwood type V injury during a snowboarding accident. His AC joint was reduced and stabilized with an AC joint brace for six weeks. The brace provided active clavicle depression and humeral elevation. After removal of the brace the AC joint showed a nearly anatomic reduction. Six-month follow-up weighted X-ray views showed an AC joint which had healed in a Rockwood type II position and the patient returned to full pre-injury function with a satisfying cosmetic appearance. Conclusion Non-operative reduction and stabilization of high-grade AC joint separations seems to be a valuable treatment option. A “closed reduction and external fixation” approach with the aid of a dedicated AC joint brace can reduce the AC joint and keep it in place until ligamentous consolidation occurs, thus improving AC joint stability and cosmetic appearance without surgical intervention.

The author responds: pain control in AC joint separation

2020 ◽  
Vol 38 (5) ◽  
pp. 1038-1039
Author(s):  
John Gelber ◽  
Arun Nagdev ◽  
Carlos Mikell
Keyword(s):  
Pain Control ◽  
Ac Joint ◽  
Joint Separation
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