Clinical outcomes of arthroscopic and navigation-assisted two tunnel technique for coracoclavicular ligament augmentation of acute acromioclavicular joint dislocations

Background The purpose of this study was to present a navigated image-free augmentation technique for the acromioclavicular joint (ACJ) and coracoclavicular (CC) ligaments and to report the clinical and radiological outcomes. Methods From 2013 to 2018, 35 eligible patients were treated with our navigated image-free ACJ- and CC-augmentation technique. The average follow-up was 3 years. Follow-up evaluations included the Constant-Murley Score, subjective shoulder value, Taft score, and the acromioclavicular joint instability (ACJI) score. The patients’ quality of life was assessed using the EuroQol-5D (EQ-5D) questionnaire. In addition, in accordance with the instability criteria, radiographs were evaluated before surgery, after surgery, and during follow-up. Results Overall, 25 patients (71%) suffered an acute type V disruption, 5 (14%) had a type IV disruption, and 5 (14%) had an acute Rockwood type IIIb injury. The mean Constant-Murley Score was 90 (range: 56–100; p = 0.53) on the injured side, and the mean subjective shoulder value was 92% (range: 80–100%). The mean Taft and ACJI scores were 10 (range: 4–12) and 86 (range: 34–100), respectively and the mean EQ-5D was 86 (range: 2–100). The mean CC difference of the injured side was 4 mm (range: 1.9–9.1 mm) at follow-up, which was not significantly different than that of the healthy side (p = 0.06). No fractures in the area of the clavicle or the coracoid were reported. Conclusions The arthroscopic- and navigation-assisted treatment of high-grade ACJ injuries in an anatomical double-tunnel configuration yields similar clinical and radiological outcomes as the conventional technique using an aiming device. Precise positioning of the navigation system prevents multiple drillings, which avoids fractures.

Treatment of Acute Acromioclavicular Joint Dislocations Type III and Type V by Rockwood Classification Using a Dynamic Stabilization System under Arthroscopic Control with and without Suture of the Ligaments of the Acromioclavicular Joint

Summary. Acute acromioclavicular (AC) joint dislocation is still a challenging task for orthopedic surgeons. Objective: to compare the clinical and radiological results of treatment of patients with acute dislocation of the acromial end of the clavicle who were treated with a dynamic stabilization system with and without suture of acromioclavicular ligaments under arthroscopic control. Materials and Methods. A retrospective analysis of the treatment of 44 patients with acute AC joint dislocations type III and type V by Rockwood classification was performed. The patients were divided into 2 groups: group I – 18 patients (40.9%) who underwent stabilization of the dislocation and fixation of the acromial end of the clavicle using a dynamic stabilization system and suture of the ligaments of the acromioclavicular joint under arthroscopic control; group II – 26 patients (59.1%) who underwent stabilization of the dislocation and fixation of the acromial end of the clavicle using a dynamic stabilization system without suture of the ligaments of the acromioclavicular joint under arthroscopic control. There were 40 male (90.9%) and 4 female (9.1%) patients aged 18–58 years (mean age 32.9±10.1 years). The mean time from injury to surgical treatment was 8.3±3.2 days (from 3 to 17 days). Clinical observation was carried out at an average time of 20.1±3.9 months after surgery (from 12 to 28 months). Clinical outcomes were assessed using the Oxford Shoulder scale, the Constant-Murley scale, and the Acromioclavicular Joint Instability Scoring System. Results. The mean Oxford Shoulder score at the final follow-up on the injured side was 45.8±1.3 points and 46.2±1.3 points (p=0.422) in groups I and II, respectively. The mean Constant-Murley score at the final follow-up on the injured side was 94.6±2.4 points and 91.7±4.2 points (p=0.0134) in groups I and II, respectively. The mean score on the Acromioclavicular Joint Instability Scoring System at the final follow-up on the injured side was 83.8±7.1 points and 78.1±11.8 points (p=0.075) in groups I and II, respectively. No significant complications were observed in both groups. Conclusions. The combination of the arthroscopically assisted technique of reconstruction of the acromioclavicular ligaments using high-strength sutures and fixation of the coracoclavicular ligaments using a dynamic stabilization system provides good long-term clinical results.

High degree of consensus achieved regarding diagnosis and treatment of acromioclavicular joint instability among ESA-ESSKA members

Purpose To develop a consensus on diagnosis and treatment of acromioclavicular joint instability. Methods A consensus process following the modified Delphi technique was conducted. Panel members were selected among the European Shoulder Associates of ESSKA. Five rounds were performed between October 2018 and November 2019. The first round consisted of gathering questions which were then divided into blocks referring to imaging, classifications, surgical approach for acute and chronic cases, conservative treatment. Subsequent rounds consisted of condensation by means of an online questionnaire. Consensus was achieved when ≥ 66.7% of the participants agreed on one answer. Descriptive statistic was used to summarize the data. Results A consensus was reached on the following topics. Imaging: a true anteroposterior or a bilateral Zanca view are sufficient for diagnosis. 93% of the panel agreed on clinical override testing during body cross test to identify horizontal instability. The Rockwood classification, as modified by the ISAKOS statement, was deemed valid. The separation line between acute and chronic cases was set at 3 weeks. The panel agreed on arthroscopically assisted anatomic reconstruction using a suspensory device (86.2%), with no need of a biological augmentation (82.8%) in acute injuries, whereas biological reconstruction of coracoclavicular and acromioclavicular ligaments with tendon graft was suggested in chronic cases. Conservative approach and postoperative care were found similar Conclusion A consensus was found on the main topics of controversy in the management of acromioclavicular joint dislocation. Each step of the diagnostic treatment algorithm was fully investigated and clarified. Level of evidence Level V.

Recurrent acromioclavicular joint dislocation with an associated coracoid fracture following acromioclavicular joint reconstruction

Acromioclavicular joint injuries are common and account for up to 12% of all shoulder girdle injuries and have been reported as being as high as 50% in sports-related shoulder injuries. While the majority of acromioclavicular joint dislocations can be treated non-operatively, there are certain injury configurations, which can include high-grade dislocations in overhead athletes, where surgery may be indicated. The surgical management of acromioclavicular joint instability has moved towards recreating the action of the coracoclavicular ligaments by resuspending the clavicle on to the coracoid. Multiple techniques using high-strength sutures, synthetic ligaments, tendon allografts or autografts passed either around or through the coracoid process have been described. However, an unusual, but significant, complication associated with these techniques is an iatrogenic fracture of the coracoid process. We report the case of a patient with an iatrogenic coracoid fracture following two failed acromioclavicular joint resuspensory reconstructions using a synthetic ligament. This injury was successfully treated with an autologous hamstring graft reconstruction, initially protected with a hook plate.