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.

Factors Predicting the Outcome After Arthroscopically Assisted Stabilization of Acute High-Grade Acromioclavicular Joint Dislocations

2019 ◽  
Vol 47 (11) ◽  
pp. 2670-2677 ◽  
Author(s):  
Nina Maziak ◽  
Laurent Audige ◽  
Carmen Hann ◽  
Marvin Minkus ◽  
Markus Scheibel
Keyword(s):  
Clinical Outcome ◽  
Acromioclavicular Joint ◽  
High Grade ◽  
Radiological Outcome ◽  
Ac Joint ◽  
Level Of Evidence ◽  
Outcome Parameters ◽  
Joint Dislocations ◽  
Anatomic Reduction ◽  
Arthroscopically Assisted

Background: Factors influencing the outcome after arthroscopically assisted stabilization of acute high-grade acromioclavicular (AC) joint dislocations remain poorly investigated. Purpose: To identify determinants of the radiological outcome and investigate associations between radiological and clinical outcome parameters. Study Design: Cohort study; Level of evidence, 3. Methods: The authors performed a retrospective analysis of patients who underwent arthroscopically assisted stabilization for acute high-grade AC joint dislocations. The following potential determinants of the radiological outcome were examined using univariable and multivariable regression analyses: timing of surgery, initial AC joint reduction, isolated coracoclavicular (CC) versus combined CC and AC stabilization, ossification of the CC ligaments, age, and overweight status. In addition, associations between radiological (ie, CC difference, dynamic posterior translation [DPT]) and clinical outcome parameters (Subjective Shoulder Value, Taft score [TS] subjective subcategory, and Acromioclavicular Joint Instability Score [ACJI] pain subitem) were evaluated using univariable analysis. Results: One hundred four patients with a mean (±SD) age of 38.1 ± 11.5 years were included in this study. The mean postoperative follow-up was 2.2 ± 0.9 years. Compared with patients with an overreduced AC joint after surgery, the CC difference was 4.3 mm (95% CI, 1.3-7.3; P = .006) higher in patients with incomplete reduction. Patients with anatomic reduction were 3.1 times (95% CI, 1.2-7.9; P = .017) more likely to develop DPT than those with an overreduced AC joint. An incompletely reduced AC joint was 5.3 times (95% CI, 2.1-13.4; P < .001) more likely to develop DPT versus an overreduced AC joint. Patients who underwent isolated CC stabilization were 4.8 times (95% CI, 1.1-21.0; P = .039) more likely to develop complete DPT than patients with additional AC stabilization. Significantly higher CC difference values were noted for patients who reported pain on the subjective TS ( P = .025). Pain was encountered more commonly in patients with DPT ( PTS = .049; PACJI = .038). Conclusion: Clinicians should consider overreduction of the AC joint because it may lead to favorable radiological results. Because of its association with superior radiographic outcomes, consideration should also be given to the use of additional AC cerclage.

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 Treatment of acute high-grade acromioclavicular joint dislocation

2020 ◽  
Vol 23 (3) ◽  
pp. 159-165
Author(s):  
Jeung Yeol Jeong ◽  
Yong-Min Chun
Keyword(s):  
Standard Procedure ◽  
High Energy ◽  
Acromioclavicular Joint Dislocation ◽  
High Grade ◽  
Shoulder Injuries ◽  
Ac Joint ◽  
Joint Injury ◽  
Joint Dislocation ◽  
Treatment Type ◽  
Joint Dislocations

Acromioclavicular (AC) joint dislocations account for about 9% of shoulder injuries. Among them, acute high-grade injury following high-energy trauma accounts for a large proportion of patients requiring surgical treatment. However, there is no gold standard procedure for operative treatment of acute high-grade AC joint injury, and several different procedures have been used for this purpose in clinical practice. This review article summarizes the most recent and relevant surgical options for acute high-grade AC joint dislocation patients and the outcomes of each treatment type.

scholarly journals Functional and Radiographic Outcomes of Intraoperatively Decreasing the Coracoclavicular Distance to 50% of the Unaffected Side in Stabilization of Acute Acromioclavicular Joint Injury: A Retrospective Evaluation

2021 ◽  
Vol 9 (3) ◽  
pp. 232596712098879
Author(s):  
Prapakorn Klabklay ◽  
Chaiwat Chuaychoosakoon
Keyword(s):  
Ac Joint ◽  
Unaffected Side ◽  
Joint Injury ◽  
Radiographic Outcomes ◽  
Tunnel Width ◽  
Capsular Repair ◽  
Anatomic Reduction ◽  
Significant Difference ◽  
The Mean

Background: The postoperative failure rate of acromioclavicular (AC) joint fixation using the coracoclavicular (CC) stabilization technique is high. Studies have reported that compared with normal intraoperative anatomic reduction, intraoperative overreduction of the AC joint is more successful in achieving a satisfactory anatomic radiographic outcome at 1- to 2-year follow-up. Purpose: To evaluate the functional and radiographic outcomes and complications in patients with acute AC joint injury who underwent combined CC stabilization and AC capsular repair in which the CC distance was intraoperatively decreased to 50% of the unaffected side. Study Design: Case series; Level of evidence, 4. Methods: In this retrospective study, we collected and analyzed the data of patients with an acute AC joint injury (Rockwood type 5) who underwent combined CC stabilization and AC capsular repair during which the CC distance was decreased 50% compared with the unaffected side. At 2-year follow-up, we evaluated functional outcomes (American Shoulder and Elbow Surgeons [ASES] score), radiographic outcomes (alignment of the AC joint in the vertical and horizontal planes, tunnel widening), and complications (infection, clavicular fracture). Results: The study included 20 patients with a mean ± SD age of 42.20 ± 10.10 years. The mean follow-up period was 33.75 ± 11.50 months. At the 2-year follow-up, the mean ASES score was 95.13 ± 5.61. The overreduction alignment, anatomic alignment, and loss reduction alignment rates were 0% (0/20 patients), 95% (19/20 patients), and 5% (1/ 20 patients), respectively. No statistically significant difference was found in the mean CC distance between the affected and unaffected sides on radiographic evaluation. The mean medial clavicular tunnel width and lateral clavicular tunnel width were 5.03 ± 0.68 mm and 4.47 ± 0.67 mm, respectively. None of the patients experienced fractures or infections. Conclusion: Excellent functional and radiographic outcomes and no complications were seen at 2-year follow-up in patients with acute AC joint injury who underwent combined CC stabilization and AC capsular repair with the CC distance intraoperatively decreased to 50% of the unaffected side.

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.

AC Joint Separation

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

scholarly journals Clavicle Elevation or Shoulder Girdle Depression in Acromioclavicular Joint Dislocation: A Radiological Investigation

2019 ◽  
Vol 7 (11) ◽  
pp. 232596711987992 ◽  
Author(s):  
Fady Azar ◽  
Christian Pfeifer ◽  
Volker Alt ◽  
Benedikt Pregler ◽  
Isabella Weiss ◽  
...  
Keyword(s):  
Spinal Column ◽  
Shoulder Girdle ◽  
Classification Systems ◽  
Acromioclavicular Joint Dislocation ◽  
Ac Joint ◽  
Level Of Evidence ◽  
Radiological Investigation ◽  
Cross Sectional ◽  
Joint Injury ◽  
Joint Dislocations

Background: The side-comparative coracoclavicular (CC) distance is used to describe the vertical instability component of acute acromioclavicular (AC) joint dislocations. Elevation of the clavicle or a depression of the shoulder girdle can lead to an increased CC distance. The dislocation direction has not yet been investigated and is not included in common classification systems. Hypothesis: Clavicle elevation is primarily responsible for vertical dislocation in AC joint separation. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Weighted and nonweighted bilateral plain anteroposterior views of the shoulder girdles of patients with AC joint dislocations (Rockwood [RW] types III and V), diagnosed in our trauma department between 2001 and 2018, were included in this study. After determining the CC distance, a side-comparative determination of the positions of both the clavicle and shoulder girdle, with reference to the spinal column, was conducted. Results: In total, 245 bilateral plain anteroposterior views were evaluated (RW III, n = 116; RW V, n = 129). All patients showed a side-comparative clavicle elevation (mean ± SD: RW III, 5 ± 14 mm; RW V, 11 ± 17 mm) in weighted and nonweighted views. While no depression of the shoulder girdle was measured in RW III injuries (weighted and nonweighted views, 0 ± 11 mm), dropping of the shoulder girdle in RW V lesions on nonweighted views was observed (–5 ± 11 mm). Conclusion: Vertical dislocation is mostly associated with clavicle elevation in RW III injures, while in high-grade AC joint dislocations (RW V), a combination of clavicle elevation and shoulder girdle depression is present. A significantly greater superior displacement of the clavicle in RW V injuries was seen in weighted views, while a depression of the shoulder girdle could be detected in nonweighted views. For the first time, these results include the dislocation direction in the classification of an AC joint injury. Further studies are needed to investigate the extent to which dislocation types differ in optimal therapy and outcome.

scholarly journals Grade 3 AC joint injury: A survey of current practice in the United Kingdom

2019 ◽  
Vol 27 (1) ◽  
pp. 230949901882522
Author(s):  
Ravindra H Mahajan ◽  
Sachin Kumar ◽  
Bhanu Pratap Mishra
Keyword(s):  
United Kingdom ◽  
Current Practice ◽  
Ac Joint ◽  
Joint Injury ◽  
The United Kingdom ◽  
Grade 3

scholarly journals Study of Pattern of the Talar Articular Facets in 150 Dried Adult Human Calcanei of North Karnataka Population

2021 ◽  
Vol 9 (3.1) ◽  
pp. 8040-8044
Author(s):  
Taqdees Fatima ◽  
◽  
Deepalaxmi S ◽  
Jaishree H ◽  
◽  
...  
Keyword(s):  
Subtalar Joint ◽  
Type I ◽  
Joint Stability ◽  
Type Iv ◽  
Tarsal Bones ◽  
Superior Surface ◽  
Hind Foot ◽  
Characteristic Features ◽  
Type V ◽  
Genetically Determined

Introduction: Calcaneus and talus are bones of the hind foot. Calcaneus being the largest of tarsal bones has three facets on its superior surface for articulation with the talus namely anterior, middle and posterior talar facets. Proper alignment of these two bones is essential for maintenance of the arches of foot. Variations in the talar facets of calcanei are important because they influence subtalar joint stability. In many diseases of foot such as the talocalcaneal arthritis and coalition, intra-articular fracture etc, the size, shape and relation of talus and calcaneus with each other and other bones of the foot must be considered for the external and internal fixation and for other surgical procedures. Objectives: The present work is intended to study different patterns of talar articular facets on the calcaneum to have a better understanding of anatomical elements contributing to subtalar joint stability and to correlate findings of the present study with existing literature. Materials and Methods: 150 dry adult undamaged and non-pathological human calcanei of unknown sex were obtained from museum section of department of Anatomy of various medical colleges in North Karnataka. The pattern of talar articular facets with reference to their shape and number was studied and interfacet distance between anterior and middle talar facets was measured using sliding vernier callipers. The data was subjected for statistical analysis. Results: Based on notable characteristic features, calcanei were grouped into five types:73.3% of calcanei belonged to Type I, 22% to Type II, 2% to Type III, 2% to Type IV and 0.7% to type V. Conclusion: Unique feature of the present study was that all the five types of calcanei were found. Type I being the commonest(73.3%) and Type V which is the rarest type and has been scarcely reported in the literature was also seen in one calcaneum. Pattern of talar articular facets on calcaneum exhibits racial differentiation which could be probably genetically determined. KEY WORD: Articular, Calcaneus, Facets, Talus.

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