Comparison of Hook Plate Fixation Versus Arthroscopic Coracoclavicular Fixation Using Multiple Soft Anchor Knots for the Treatment of Acute High-Grade Acromioclavicular Joint Dislocations

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.

Download Full-text

Risk of Clavicle Fracture Following Coracoclavicular Ligament Reconstruction for High Grade Acromioclavicular Joint Dislocations

Volume 2: Biomedical and Biotechnology ◽

10.1115/imece2012-88109 ◽

2012 ◽

Author(s):

Peter A. Gustafson ◽

Mark Omwansa ◽

Andrew G. Geeslin ◽

Vani J. Sabesan

Keyword(s):

Acromioclavicular Joint ◽

Clavicle Fracture ◽

Axial Loading ◽

Reconstruction Technique ◽

High Grade ◽

Qualitative Comparison ◽

Three Point Bending ◽

Four Point Bending ◽

Joint Dislocations ◽

Cantilever Bending

Finite element models are used for qualitative comparison of the risk of fracture associated with clavicle tunnels in reconstruction of the coracoclavicular ligaments for treatment of high-grade acromioclavicular joint (ACJ) injury. The two-tunnel reconstruction technique is found likely to have higher fracture risk than the less anatomic single tunnel reconstruction. The models suggest that four point bending is more likely than three point bending, cantilever bending, or axial loading to differentiate the reconstruction techniques in a laboratory experiment. The results must be narrowly interpreted only in a laboratory context due to the limitations of the study.

Download Full-text

Arthroscopic-assisted hook plate fixation for acromioclavicular joint dislocation

International Orthopaedics ◽

10.1007/s00264-012-1691-6 ◽

2012 ◽

Vol 37 (1) ◽

pp. 77-82 ◽

Cited By ~ 11

Author(s):

Justus Gille ◽

Gerhard Heinrichs ◽

Andreas Unger ◽

Helge Riepenhof ◽

Jan Herzog ◽

...

Keyword(s):

Acromioclavicular Joint ◽

Plate Fixation ◽

Hook Plate ◽

Acromioclavicular Joint Dislocation ◽

Joint Dislocation

Download Full-text

Clinical and Radiological Results of Hook Plate Fixation in Acute Acromioclavicular Joint Dislocations and Distal Clavicle Fractures

Clinics in Shoulder and Elbow ◽

10.5397/cise.2018.21.2.95 ◽

2018 ◽

Vol 21 (2) ◽

pp. 95-100

Author(s):

Joo Han Oh ◽

Seunggi Min ◽

Jae Wook Jung ◽

Hee June Kim ◽

Jae Yoon Kim ◽

...

Keyword(s):

Plate Fixation ◽

Clavicle Fracture ◽

Hook Plate ◽

Distal Clavicle ◽

Ac Joint ◽

Joint Dislocation ◽

Group I ◽

Joint Dislocations ◽

Ac Joint Dislocation ◽

Group Ii

BACKGROUND: The purpose of this study was to evaluate the clinical outcomes and complications of hook plate fixation in acromioclavicular (AC) joint dislocations and distal clavicle fractures.METHODS: We retrospectively reviewed a series of 60 consecutive patients with hook plate fixation for AC joint dislocation (group I) and distal clavicle fracture (group II). Groups I and II had 39 and 21 patients, respectively. Clinical results were evaluated using the pain visual analogue scale (VAS), simple shoulder test, and Constant-Murley scores. In addition, subacromial erosion and stiffness were evaluated as complications.RESULTS: At the removal, the pain VAS was 2.69 ± 1.30 and 4.10 ± 2.14 in groups I and II, respectively, which were significantly different (p=0.003). The simple shoulder test score was 9.59 ± 1.60 and 7.81 ± 2.67 in groups I and II, respectively, which were also significantly different (p=0.002). Subacromial erosion was significantly more frequent in group II (14/21 patients, 66.7%) than in group I (15/39 patients, 38.5%) (p=0.037), and stiffness was also higher in group II (17/21 patients, 81.0%) than in group I (22/39 patients, 56.4%), but it was not significant.CONCLUSIONS: Hook plate fixation showed good clinical and functional results for the treatment of acute unstable AC joint dislocation and distal clavicle fracture. But, in distal clavicle fractures, there are more subacromial erosion and stiffness compare with acute unstable AC joint dislocation.

Download Full-text