Trapezius Rotation-plasty for Complicated Acromioclavicular Joint Ganglion Cysts

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.

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A comparative study of acute and chronic acromioclavicular joint dislocation managed with the modified weaver-Dunn procedure and Hook plate reinforcement

Injury Extra ◽

10.1016/j.injury.2011.06.254 ◽

2011 ◽

Vol 42 (9) ◽

pp. 114

Author(s):

S. Robinson ◽

P. Ralte ◽

A. Sinha ◽

S. Morapudi ◽

J. Fischer ◽

...

Keyword(s):

Comparative Study ◽

Acromioclavicular Joint ◽

Hook Plate ◽

Acromioclavicular Joint Dislocation ◽

Joint Dislocation ◽

Chronic Acromioclavicular Joint Dislocation

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Acromioclavicular joint reconstruction implants have differing ability to restore horizontal and vertical plane stability

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-021-06700-x ◽

2021 ◽

Author(s):

Mohamed Alkoheji ◽

Hadi El-Daou ◽

Jillian Lee ◽

Adrian Carlos ◽

Livio Di Mascio ◽

...

Keyword(s):

Repeated Measures ◽

Acromioclavicular Joint ◽

Vertical Plane ◽

Testing System ◽

Bonferroni Correction ◽

Joint Reconstruction ◽

Fresh Frozen ◽

Robotic Testing ◽

Robotic Testing System ◽

Anterior Posterior

Abstract Purpose Persistent acromioclavicular joint (ACJ) instability following high grade injuries causes significant symptoms. The importance of horizontal plane stability is increasingly recognised. There is little evidence of the ability of current implant methods to restore native ACJ stability in the vertical and horizontal planes. The purpose of this work was to measure the ability of three implant reconstructions to restore native ACJ stability. Methods Three groups of nine fresh-frozen shoulders each were mounted into a robotic testing system. The scapula was stationary and the robot displaced the clavicle to measure native anterior, posterior, superior and inferior (A, P, S, I) stability at 50 N force. The ACJ capsule, conoid and trapezoid ligaments were transected and the ACJ was reconstructed using one of three commercially available systems. Two systems (tape loop + screw and tape loop + button) wrapped a tape around the clavicle and coracoid, the third system (sutures + buttons) passed directly through tunnels in the clavicle and coracoid. The stabilities were remeasured. The data for A, P, S, I stability and ranges of A–P and S–I stability were analyzed by ANOVA and repeated-measures Student t tests with Bonferroni correction, to contrast each reconstruction stability versus the native ACJ data for that set of nine specimens, and examined contrasts among the reconstructions. Results All three reconstructions restored the range of A–P stability to that of the native ACJ. However, the coracoid loop devices shifted the clavicle anteriorly. For S–I stability, only the sutures + buttons reconstruction did not differ significantly from native ligament restraint. Conclusions Only the sutures + buttons reconstruction, that passed directly through tunnels in the clavicle and coracoid, restored all stability measures (A, P, S, I) to the native values, while the tape implants wrapped around the bones anteriorised the clavicle. These findings show differing abilities among reconstructions to restore native stability in horizontal and vertical planes. (300 words)

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Masses of the Sternoclavicular Area: Case Series and Review of the Literature

Clinical Medicine Insights Pediatrics ◽

10.1177/11795565211021600 ◽

2021 ◽

Vol 15 ◽

pp. 117955652110216

Author(s):

Parisa Oviedo ◽

Morgan Bliss

Keyword(s):

English Language ◽

Pediatric Patients ◽

Tertiary Care ◽

Case Series ◽

Review Of The Literature ◽

Incision And Drainage ◽

Surgical Interventions ◽

Ganglion Cysts ◽

Icd 10 ◽

Bronchogenic Cysts

Objective: Masses of the sternoclavicular area are rare, and are not well described in the literature. We aim to present a series of patients with masses in this location and to review all reported English language cases of sternoclavicular masses in pediatric patients. Methods: This is a case series of pediatric patients with masses of the sternoclavicular area presenting to a tertiary care pediatric hospital from 2010 through 2017. Data was collected by using ICD-9 and ICD-10 codes to query the electronic medical record. Chart review included age at presentation, mass characteristics, medical and surgical interventions, and pathology results. A review of the literature was then performed. Results: Ten patients with masses overlying the sternoclavicular area were identified. Four patients presented with abscess and were treated with incision and drainage. Three of these patients were then treated with staged excision once infection cleared. Two additional patients were treated with primary excision. Four patients were treated with observation. The most common histopathologic finding was epidermoid. One patient was found to have a dermoid cyst, and 1 had a congenital cartilaginous rest. Conclusion: Epidermoids and dermoids are the most common masses overlying the sternoclavicular area. Controversy remains regarding the embryologic origin of sternoclavicular masses. The differential for masses in this area also includes branchial remnants, bronchogenic cysts, ganglion cysts, or septic arthritis.

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