Conversion to anatomic coracoclavicular ligament reconstruction (ACCR) shows similar clinical outcomes compared to successful non-operative treatment in chronic primary type III to V acromioclavicular joint injuries

2020 ◽  
Author(s):  
Lukas N. Muench ◽  
Daniel P. Berthold ◽  
Colin Uyeki ◽  
Cameron Kia ◽  
Mark P. Cote ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Operative Treatment ◽  
Ligament Reconstruction ◽  
Acromioclavicular Joint ◽  
Coracoclavicular Ligament ◽  
Type Iii ◽  
Joint Injuries ◽  
Coracoclavicular Ligament Reconstruction ◽  
Primary Type

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

2020 ◽  
Vol 8 (9) ◽  
pp. 232596712094703
Author(s):  
Daniel P. Berthold ◽  
Lukas N. Muench ◽  
Knut Beitzel ◽  
Simon Archambault ◽  
Aulon Jerliu ◽  
...  
Keyword(s):  
Operative Treatment ◽  
Revision Surgery ◽  
Ligament Reconstruction ◽  
Coracoclavicular Ligament ◽  
Ac Joint ◽  
Type Iii ◽  
Joint Injuries ◽  
Coracoclavicular Ligament Reconstruction ◽  
Ac Joint Injuries

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.

scholarly journals Functional and Radiographic Outcomes After Anatomic Coracoclavicular Ligament Reconstruction for Type III/V Acromioclavicular Joint Injuries

2019 ◽  
Vol 7 (11) ◽  
pp. 232596711988453 ◽  
Author(s):  
Lukas N. Muench ◽  
Cameron Kia ◽  
Aulon Jerliu ◽  
Matthew Murphy ◽  
Daniel P. Berthold ◽  
...  
Keyword(s):  
Ligament Reconstruction ◽  
Coracoclavicular Ligament ◽  
Ac Joint ◽  
Type Iii ◽  
Radiographic Outcomes ◽  
Joint Injuries ◽  
Coracoclavicular Ligament Reconstruction ◽  
Significant Difference ◽  
Ac Joint Injuries

Background: Acromioclavicular (AC) joint separation is a common injury. The anatomic coracoclavicular ligament reconstruction (ACCR) technique is a viable treatment option, designed to restore the native joint anatomy. Purpose: To evaluate the clinical and radiographic outcomes of patients undergoing ACCR for the treatment of type III and V AC joint injuries with a minimum 2-year follow-up. Study Design: Case series; Level of evidence, 4. Methods: A retrospective chart review was performed on prospectively collected data. Patients who underwent ACCR for type III or V AC joint injuries between January 2003 and December 2015 were analyzed. Clinical outcome measures included the American Shoulder and Elbow Surgeons (ASES) score, Rowe score, Simple Shoulder Test (SST), and Constant-Murley (CM) score. To determine the clinical relevance of the ASES score, the minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) were used. The pre- and postoperative coracoclavicular distance (CCD) and side-to-side difference in the CCD were measured for radiographic analysis. Results: A total of 43 patients (22 acute, 21 chronic) were included in the study. The mean patient age was 43.4 ± 11.4 years, with a mean follow-up of 3.4 years (range, 2.0-7.5 years). With regard to the ASES score, 92% of patients achieved the MCID, 81% achieved the SCB, and 49% reached or exceeded the PASS. There was no significant difference when stratifying by type (III vs V) or chronicity (acute vs chronic) of injury (both P > .05). The Rowe score improved from 66.6 ± 15.9 preoperatively to 88.6 ± 12.3 postoperatively, the CM score from 61.6 ± 18.8 to 87.4 ± 15.1, and the SST score from 6.2 ± 3.6 to 9.4 ± 3.7 (all P < .001). The postoperative side-to-side difference in the CCD was 3.1 ± 2.7 mm, with type III injuries (2.4 ± 1.9 mm) showing significantly lower measurements compared with type V (4.2 ± 3.4 mm) ( P = .02). No significant trend was found between joint reduction and the improvement in clinical outcomes ( P > .05). Conclusion: Patients undergoing ACCR for acute and chronic type III and V AC joint injuries maintained significant improvement in clinical and radiographic outcomes at a minimum 2-year follow-up. Additionally, 81% of patients reached the SCB after surgical reconstruction.

scholarly journals Functional outcome following coracoclavicular ligament reconstruction using a gracilis tendon graft for acute type III acromioclavicular dislocation: a case report

2018 ◽  
Vol 6 (8) ◽  
pp. 2836
Author(s):  
Made Tusan Sidharta ◽  
I. Gusti Ngurah Wien Aryana ◽  
I. B. Arimbawa
Keyword(s):  
Ligament Reconstruction ◽  
Acromioclavicular Joint ◽  
Tendon Graft ◽  
Left Shoulder ◽  
Acute Type ◽  
Coracoclavicular Ligament ◽  
Gracilis Tendon ◽  
Type Iii ◽  
Coracoclavicular Ligament Reconstruction ◽  
Gracilis Tendon Graft

The acromioclavicular joint is stabilized by two ligaments: the acromioclavicular ligaments and coracoclavicular ligaments. AC joint dislocations account for 9% to 10% of all shoulder injuries. Tossy and Allman classified acromioclavicular dislocations into three types (I, II and III). This classification was modified by Rockwood (types IV, V, and VI). Type I and II dislocations are treated conservatively. Surgery is indicated for certain Rockwood type III and for all type IV, V, and VI injuries. A 45 years old man yoga trainer presented to our emergency department with a chief complaint of pain over his left shoulder after had traffic accident 3 hours prior to admission. Physical examination revealed left lateral clavicular end prominent and tenderness over the left shoulder with limited range of motion due to pain. A Zanca view X-Ray of left shoulder was performed and revealed dislocation of acromioclavicular joint. The patient was diagnosed with suspect Left AC joint disruption grade III. We performed coracoclavicular ligament reconstruction using a gracilis tendon graft 2 days after the accident. Before the surgery, constant score of the patient left shoulder was 25 (Fair). The constant score measured was 63 after 10 month follow up. Coracoclavicular ligament reconstruction with an autogenous gracilis tendon graft was feasible and safe in physically active patients with acute type-III acromioclavicular joint dislocation.

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