Coracoid or Clavicle Fractures Associated With Coracoclavicular Ligament Reconstruction

2021 ◽  
pp. 036354652110367
Author(s):  
Nicholas M. Panarello ◽  
Donald F. Colantonio ◽  
Colin J. Harrington ◽  
Scott M. Feeley ◽  
Tahler D. Bandarra ◽  
...  
Keyword(s):  
Ligament Reconstruction ◽  
Full Range ◽  
Case Series ◽  
Coracoid Process ◽  
Distal Clavicle ◽  
Ligament Repair ◽  
Ac Joint ◽  
Index Procedure ◽  
Fracture Management ◽  
Bone Tunnels

Background: Coracoclavicular (CC) ligament reconstruction is a commonly performed procedure for high-grade acromioclavicular (AC) joint separations. Although distal clavicle and coracoid process fractures represent potential complications, they have been described in only case reports and small case series. Purpose: To identify the incidence and characteristics of clavicle and coracoid fractures after CC ligament reconstruction. Study Design: Case series; Level of evidence, 4. Methods: The US Military Health System Data Repository was queried for patients with a Current Procedural Terminology code for CC ligament repair or reconstruction between October 2013 and March 2020. The electronic health records, including patient characteristics, radiographs, operative reports, and clinical notes, were evaluated for intraoperative or postoperative clavicle or coracoid fractures. Initial operative technique, fracture management, and subsequent clinical outcomes were reviewed for these patients. Results: A total of 896 primary CC ligament repairs or reconstructions were performed during the study period. There were 21 postoperative fractures and 1 intraoperative fracture in 20 patients. Of these fractures, 12 involved the coracoid and 10 involved the clavicle. The overall incidence of fracture was 3.81 fractures per 1000 person-years. In 5 patients who sustained a fracture, bone tunnels were not drilled in the fractured bone during the index procedure. A total of 17 fractures were ultimately treated operatively, whereas 5 fractures had nonoperative management. Of the 16 active-duty servicemembers who sustained intraoperative or postoperative fractures, 11 were unable to return to full military duty after their fracture care. Conclusion: Fracture of the distal clavicle or coracoid process after CC ligament repair or reconstruction is a rare but serious complication that can occur independent of bone tunnels created during the index procedure. Fractures associated with CC ligament procedures occurred at a rate of 2.46 per 100 cases. Most patients were ultimately treated surgically with open reduction and internal fixation or revision CC ligament reconstruction. Although the majority of patients with intraoperative or postoperative fractures regained full range of motion, complications such as anterior shoulder pain, AC joint asymmetry, and activity-related weakness were common sequelae resulting in physical limitations and separation from military service.

scholarly journals Safety and Performance of Titanium Suture Anchors Used in Knee Ligament Repair Procedures

Medicina ◽  
2021 ◽  
Vol 57 (3) ◽  
pp. 287
Author(s):  
Antonio Maestro ◽  
Iván Pipa ◽  
Nicolás Rodríguez ◽  
Carmen Toyos ◽  
Marcelino Torrontegui-Duarte ◽  
...  
Keyword(s):  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Young Patients ◽  
Case Series ◽  
Invasive Technique ◽  
Ligament Repair ◽  
Knee Ligament ◽  
And Performance

Injuries to the knee ligaments can be particularly disabling in young patients, given the risk of long-term disability if adequate fixation is not achieved during initial repair. The TWINFIX™ titanium (Ti) suture anchor with ULTRABRAID™ Suture (Smith and Nephew, London, UK) was designed to secure tendon and ligament reconstructions with increased boney ingrowth at the anchor site with minimal invasive technique. This retrospective analysis looked at 33 patients (41 implants) operated with this device between 2015 and 2019 at a single institution. The average age of patients was 33.18 years (standard deviation [SD], 15.26), with an average body mass index of 24.88 (SD, 3.49). The indications were lateral extra-articular tenodesis during anterior cruciate ligament reconstruction, medial patellofemoral ligament reconstruction, quadriceps or patellar tendon repair and medial collateral ligament repair. After an average follow up of 24.3 + 6.53 months, there was no reports of clinical failure or radiographic evidence of implant failure or loosening. One patient experienced a complication unrelated to the study device, requiring manipulation under anesthesia with resolution of symptoms. This case series supports the safety and performance of this implants for the knee procedures in which its use is indicated. Additional follow-up will be required to determine whether these effects are sustained at medium- and long-term durations.

scholarly journals Cruciate Ligament Repair with Nitinol Wire Synthetic Allograft

2014 ◽  
Vol 2 (11_suppl3) ◽  
pp. 2325967114S0019
Author(s):  
Ökkeş Bilal ◽  
Mustafa Kınaş ◽  
Ahmet Güney ◽  
Fatih Doğar
Keyword(s):  
Anterior Cruciate Ligament ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Full Range ◽  
Joint Space ◽  
Synthetic Graft ◽  
Ligament Repair ◽  
Nitinol Wire ◽  
Anterior Cruciate ◽  
Synthetic Grafts

Objectives: To present two cases who underwent cruciate ligament repair by nitinol wire synthetic allograft and to discuss outcomes. Methods: Although definitive incidence of anterior cruciate ligament injuries is unknown, it is estimated that annual 200.000 rupture occurs with 100.000 reconstructions in United States [1]. Therapeutic options include medical treatment, isolated or augmented anterior cruciate ligament repair and reconstruction with autograft, allograft and synthetic grafts. Debates on the treatment of such injury focus on selection of graft rather than need for surgery. Once anterior cruciate ligament reconstruction was decided, surgeon should have to select a graft. In general, an autograft is preferred. There are also allograft and synthetic grafts. Autograft have advantages of low risk for cross-inflammatory response and lack of risk for disease transmission. Nitinol is a material produced from nickel and titanium. It is more often used in vascular stents, orthodontic wires, implants used in mandible surgery and some orthopedic implants [2]. We presented 2 patients who underwent reconstruction with synthetic grafts produced from flexible nitinol wire. Results: Case 1: A 31-year old man presented to our clinic with pain at right knee. The patient underwent cruciate ligament surgery 10 years ago at another facility. His right knee was sprained again 12 months ago; thus, he was re-operated ad anterior cruciate reconstruction was performed in a facility. The patient had pain after surgery. On the physical examination, there was limitation in knee flexion by 100 degree and in knee extension by 10 degree at the right. It was seen that there was painful knee movements. It was found that there was tenderness at medial joint space and patellofemoral grind test was positive while Lachman and anterior drawer tests were negative. On the plain radiographs, it was observed that reconstruction was performed by using flexible nitinol wire synthetic graft and that occasional fractures in nitinol wire existed. The patient accepted removal of graft when he was informed. Thus, we removed flexible nitinol wire synthetic graft and interference screw. In the arthroscopic examination, it was seen that there was grade 4 cartilage defect in patellofemoral joint with occasional fracture in flexible nitinol wire synthetic graft. Endo-button was localized at suprapatellar pouch and removed via artrhroscopy. Micro-fracture procedure was performed for cartilage defect. The patient was scheduled for physical therapy after surgery. After 3 months, it was seen that complaints were resolved and he had almost full range of motion without instability signs. Case 2: A 23-year old man presented to our clinic with pain at right knee. He reported that his knee was injured during sports 9 months ago and he underwent anterior cruciate ligament reconstruction in another facility. However, he had persistent pain. On the physical examination, it was seen that there was full range of motion at knee but diffuse knee pain in hyperflexion. It was seen that medial McMurray test was positive and there was tenderness at medial joint space while Lachman and anterior drawer tests were negative. On the plain radiographs, it was observed that reconstruction was performed by using flexible nitinol wire synthetic graft and that occasional fractures in nitinol wire existed. Revision surgery was recommended but the patient didn’t attend control visit. Conclusion: Orthopedic surgeons tend to have appreciation against novel instruments; however, novel techniques should be adopted by meticulously considering outcomes without fascinating. It is clear that use of synthetic grafts without sufficient experimental and biomechanical in vivo and in vitro studies will result in some complications.

scholarly journals Severe and Rapid Post-Traumatic Osteolysis of the Distal Clavicle in a College Athlete: A Case Report and Review of the Literature

2020 ◽  
pp. 1-3
Author(s):  
Katharine Schuyler Nissen ◽  
Brian M. Grawe ◽  
Katharine Schuyler Nissen ◽  
Yehia H. Bedeir
Keyword(s):  
Case Report ◽  
Surgical Management ◽  
Ligament Reconstruction ◽  
Sagittal Plane ◽  
Significant Activity ◽  
Distal Clavicle ◽  
College Athlete ◽  
Ac Joint ◽  
Horizontal Instability ◽  
Post Traumatic

Case Report: A 21-year-old female college athlete presented with continually worsening distal clavicle osteolysis. After conservative management and significant activity modification failed to resolve pain, surgical management was considered. Instability in the sagittal plane was believed to contribute to her persistent pain. Surgical management included acromioclavicular (AC) ligament reconstruction, in addition to the standard distal clavicle excision. Conclusion: Horizontal instability in the AC joint may contribute to the failure of conservative treatment in patients with distal clavicle osteolysis. If surgical management is considered, AC ligament reconstruction, in addition to the standard distal clavicle excision, may provide additional benefit in functional outcomes.

scholarly journals Anatomic Medial Patellofemoral Ligament Reconstruction Without Bone Tunnels or Anchors in the Patella

2018 ◽  
Vol 7 (6) ◽  
pp. e611-e615 ◽  
Author(s):  
Yehia H. Bedeir ◽  
Melissa A. Summers ◽  
Dhavalkumar J. Patel ◽  
Brian M. Grawe ◽  
Angelo J. Colosimo
Keyword(s):  
Ligament Reconstruction ◽  
Medial Patellofemoral Ligament ◽  
Medial Patellofemoral Ligament Reconstruction ◽  
Bone Tunnels

scholarly journals Combined Anterior Cruciate Ligament Repair and Anterolateral Ligament Reconstruction

2019 ◽  
Vol 8 (1) ◽  
pp. e23-e29 ◽  
Author(s):  
Jean-Romain Delaloye ◽  
Jozef Murar ◽  
Thais Dutra Vieira ◽  
Adnan Saithna ◽  
Johannes Barth ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Anterolateral Ligament ◽  
Ligament Repair ◽  
Anterolateral Ligament Reconstruction ◽  
Anterior Cruciate Ligament Repair ◽  
Anterior Cruciate

scholarly journals Treatment of chronic acromioclavicular joint dislocation in a paraplegic patient with the Weaver-Dunn procedure and a hook-plate

2016 ◽  
Vol 8 (2) ◽  
Author(s):  
Holger Godry ◽  
Mustafa Citak ◽  
Matthias Königshausen ◽  
Thomas A. Schildhauer ◽  
Dominik Seybold
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Weight Bearing ◽  
Full Range ◽  
Hook Plate ◽  
Acromioclavicular Joint Dislocation ◽  
Ac Joint ◽  
Joint Dislocation ◽  
Ac Joint Dislocation ◽  
Cord Injury

Abstract In case of patients with spinal cord injury and concomitant acromioclavicular (AC) jointdislocation the treatment is challenging, as in this special patient group the function of the shoulder joint is critical because patients depend on the upper limb for mobilization and wheelchair-locomotion. Therefore the goal of this study was to examine, if the treatment of chronic AC-joint dislocation using the Weaver- Dunn procedure augmented with a hook-plate in patients with a spinal cord injury makes early postoperative wheelchair mobilization and the wheelchair transfer with full weightbearing possible. In this case the Weaver- Dunn procedure with an additive hook-plate was performed in a 34-year-old male patient with a complete paraplegia and a posttraumatic chronic AC-joint dislocation. The patient was allowed to perform his wheelchair transfers with full weight bearing on the first postoperative day. The removal of the hook-plate was performed four months after implantation. At the time of follow-up the patient could use his operated shoulder with full range of motion without restrictions in his activities of daily living or his wheel-chair transfers.

scholarly journals Patient and Surgeon Expectations Prior to Anterior Cruciate Ligament Reconstruction

2018 ◽  
Vol 14 (3) ◽  
pp. 282-285 ◽  
Author(s):  
Mahmoud Michael Khair ◽  
Hassan Ghomrawi ◽  
Sean Wilson ◽  
Robert G. Marx
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Case Series ◽  
Patient Expectations ◽  
Activity Level ◽  
Cruciate Ligament Reconstruction ◽  
Special Surgery ◽  
Anterior Cruciate

Abstract Background When discussing potential treatment with patients choosing to undergo surgery for disruption of the anterior cruciate ligament (ACL) and their families, surgeons spend considerable time discussing expectations of the short- and long-term health of the knee. Most of the research examining patient expectations in orthopedic surgery has focused largely on arthroplasty. Questions/Purposes The purpose of this study was to quantitatively assess the differences between the patient’s and the surgeon’s expectations before primary anterior cruciate ligament reconstruction (ACLR). Methods In this case series, we prospectively enrolled 93 patients scheduled for primary ACLR between 2011 and 2014. Expectations were measured using the Hospital for Special Surgery 23-item Knee Expectations Survey; scores were calculated for each subject. Results In all but six categories, patients had expectations that either aligned with their surgeons’ or were lower. The largest discordance between surgeon and patient expectations in which the patient had lower expectations was employment; 75% of patients had similar expectations to the surgeon when asked if the knee would be “back to the way it was before the problem started,” less than 1% had higher expectations, and 17% had lower expectations. Conclusion In general, patient expectations align well with surgeon expectations. Patients who are older, have a lower activity level, and who have selected allograft over autograft for ACLR could also be at risk for greater discordance. Understanding these differences, and their predictors, will help guide physicians when they are counseling patients about ACLR and also help them interact with patients after surgery as they assess outcomes.

Sign in / Sign up

Export Citation Format

Share Document