A modified single-endobutton technique combined with nice knot for treatment of Rockwood type III or V acromioclavicular joint dislocation

Purpose Double-endobutton technique, as a widely accepted strategy for the treatment of acromioclavicular joint dislocation, is undergoing constant improvement. This study aims to assess the clinical effect of a modified single-endobutton combined with the nice knot in the fixation of Rockwood type III or V acromioclavicular joint dislocation. Methods From January 2016 to June 2019, 16 adult patients (13 males and 3 females) with Rockwood type III or V acromioclavicular joint dislocation were treated with a modified single-endobutton technique combined with the nice knot in our department. The age ranged from 18 to 64 years old with an average of 32.8 years old. Operative time, intraoperative blood loss, post-operative clinical outcomes and radiographic results were recorded and analyzed. Preoperative and last follow-up scores in the Constant-Murley Scale, Neer score, Rating Scale of the American Shoulder and Elbow Surgeons and VAS scale and complications such as infection, re-dislocation, implant loosening, medical origin fracture and hardware pain were recorded and evaluated. Results Sixteen patients were followed up for 6 to 18 months with an average of 10.3 months. The operative time was 50–90 min with an average of (62.5 ± 3.10) min. The intraoperative blood loss was 30–100 ml, with an average of (55.0 ± 4.28) ml. The complications, such as wound infection, internal fixation failure and fractures, were not found in these cases. According to Karlsson criteria, there were excellent in 14 cases, good in 2 cases at the final follow-up. The mean VAS score of the patients was 5.88 ± 0.26 preoperatively, compared with 0.19 ± 0.14 at the final follow-up evaluation. The difference was statistically significant (P < 0.05). The mean Constant score was 45.5 ± 2.0 preoperatively, compared to 94.0 ± 0.73 at the final follow-up evaluation. The difference was statistically significant (P < 0.05). Patients had statistically significant preoperative and postoperative AC (acromioclavicular distance) and CC (coracoclavicular distance) distances (P < 0.05); 6 months postoperatively the AC(P = 0.412) and CC(P = 0.324) distances were not statistically significant compared to the healthy side. Conclusion Nice knot provides a reliable fixation for the single-endobutton technique in the treatment of acromioclavicular dislocations. The modified single-endobutton technique combined with the nice knot can achieve good clinical outcomes in the treatment of Rockwood type III or V acromioclavicular joint dislocation.

A Modified Single-Endobutton Technique Combined with Nice Knot for Treatment of Rockwood Type III Acromioclavicular Joint Dislocation

Purpose: Double-endobutton technique, as a widely accepted strategy for the treatment of acromioclavicular joint dislocation , is undergoing constant improvement. This study was to assess the clinical effect of a modified single-endobutton combined with nice knot in the fixation of Rockwood type III acromioclavicular joint dislocation.Methods: From January 2016 to January 2018, 16 adult patients (13 males and 3 females) with Rockwood type III acromioclavicular joint dislocation were treated with a modified single-endobutton technique combined with nice knot in our department. The age ranged from 18 to 64 years old with an average of 32.8 years old. Operative time and intraoperative blood loss were recorded, post-operative clinical outcomes and radiographic results were recorded and analyzed. Preoperative and last follow up scores in the Constant-Murley Scale, Neer score, Rating Scale of the American Shoulder and Elbow Surgeons and VAS scale and complications such as infection, re-dislocation, implant loosening, medical origin fracture and hardware pain were recorded and evaluated. Results: 16 patients were followed up for 6 to 18 months with an average of 10.3 months. The operative time was 50-90 minutes with an average of (62.5±3.10) min. The intraoperative blood loss was 30-100 ml, with an average of (55.0±4.28) ml. The complications, such as wound infection, internal fixation failure and fractures, were not found in these cases. According to Karlsson criteria, there were excellent in 14 cases, good in 2 cases at the final follow up. The mean VAS score of the patients was 5.88±0.26 preoperatively, compared with 0.19±0.14 at the final follow-up evaluation. The difference was statistically significant (P<0.01). The mean Constant score was 45.5±2.0 preoperatively, compared to 94.0±0.73 at the final follow-up evaluation. The difference was statistically significant (P<0.01). Conclusion: Nice knot provides a reliable fixation for the single-Endobutton technique in the treatment of acromioclavicular dislocations. The modified single-Endobutton technique combined with nice knot can achieve good clinical outcomes in treatment of Rockwood type III acromioclavicular joint dislocation.

Is coracoclavicular reconstruction necessary in hook plate fixation for acute unstable acromioclavicular dislocation?

Background Acromioclavicular joint (ACJ) dislocation is a relatively common shoulder injury. For the treatment of cases of severe ACJ dislocation (Rockwood type III–V), hook plate fixation is an easy-to-master and minimally-invasive approach to surgical intervention. Over stress on the acromion following hook plate fixation often leads to acromial complications such as osteolysis and loss of reduction. We hypothesized that suspensory reconstruction alongside hook plate fixation might provide a superior stability and reduce complications as compared with hook plate fixation alone. The purpose of the study was to assess the clinical and radiographic outcomes of these two surgical modalities. Methods We retrospectively enrolled 49 patients with acute ACJ dislocation from May 2010 to December 2018. Among them, 19 patients received hook plate fixation only (HP group), and 19 underwent concomitant hook plate fixation and loop suspension fixation with two mersilene sutures (HM group). The demographic data of the patients were recorded and analyzed. All patients underwent a shoulder X-ray initially, immediately postoperatively, and at 1, 3, 6 and 12 months to measure the relative coracoclavicular distance (rCCD). Clinical assessment of shoulder function outcome was conducted using the Constant Murley Score (CMS); the University of California at Los Angeles (UCLA) Shoulder Score was also measured at the latest follow-up. Results There were no significant differences in the demographic data between the two groups. With regards to the CMS and the UCLA score, the HM group and HP group both had excellent outcomes, and no significant differences in scores were observed between groups (CMS: 93.90 ± 6.16 versus 94.47 ± 7.26, p = 0.47; UCLA score: 32.84 ± 2.91 versus 34.32 ± 1.16, p = 0.07). However, the HM group demonstrated substantial superiority in terms of maintenance of the rCCD over the HP group (91.47 ± 27.47 versus 100.75 ± 48.70, p = 0.015). In addition, there was less subacromial osteolysis in the HM group than the HP group (52.6% versus 15.8%, p = 0.038). Conclusion Both fixations yielded excellent functional outcomes. However, concomitant hook plate fixation with loop suspensory reconstruction demonstrated the fewer acromion complications and statistical differences in reduction maintenance with less clinical significance.

Is coracoclavicular reconstruction necessary in hook plate fixation for acute unstable acromioclavicular dislocation?

Background:Acromioclavicular joint (ACJ) dislocation is a relatively common shoulder injury. For the treatment of cases of severe ACJ dislocation (Rockwood type III–V), hook plate fixation is a neasy-to-master and minimally-invasive approach to surgical intervention. Over stress on the acromion following hook plate fixation often leads to acromial complications such as osteolysis and loss of reduction. We hypothesized that suspensory reconstruction a longside hook plate fixation might provide a superior stability and reduce complications as compared with hook plate fixation alone. The purpose of the study was to assess the clinical and radiographic outcomes of these two surgical modalities.Methods: We retrospectively enrolled 49 patients with acute ACJ dislocation from May 2010 to December 2018. Among them, nineteen patients received hook plate fixation only (HP group), and 19 underwent concomitant hook plate fixation and loop suspension fixation with two mersilene sutures (HM group). The demographic data of the patients were recorded and analyzed. All patients underwent a shoulder x-ray initially, immediately postoperatively, and at 1, 3, 6 and12 months to measure the relative coracoclavicular distance (rCCD). Clinical assessment of shoulder function outcome was conducted using the Constant Murley Score (CMS); the University of California at Los Angeles (UCLA) Shoulder Score was also measured at the latest follow-up.Results: There were no significant differences in the demographic data between the two groups. With regards to the CMS and the UCLA score, the HM group and HP group both had excellent outcomes, and no significant differences in scores were observed between groups (CMS: 93.90±6.16 versus 94.47±7.26, p=0.47; UCLA score: 32.84±2.91 versus 34.32±1.16, p=0.07). However, the HM group demonstrated substantial superiority in terms of maintenance of the rCCD over the HP group (91.47±27.47 versus 100.75±48.70, p=0.015). In addition, there was less subacromial osteolysis in the HM group than the HP group (52.6% versus 15.8%, p=0.038).Conclusion: Both fixations yielded excellent functional outcomes. However, concomitant hook plate fixation with loop suspensory reconstruction demonstrated the fewer acromion complications and statistical differences in reduction maintenance with less clinical significance.

Effectiveness of Surgical Treatment of Rockwood Type III Acromioclavicular Joint Dislocation Using Clavicle Hook Plate and Tension Band Wiring: A Comparative Study to Evaluate the Functional and Surgical Outcome

Introduction: Acromioclavicular joint dislocation Type III is still controversial for its management, despite of numerous trials and reviews. Aims: To compare and evaluate the functional and surgical outcome of Rockwood Type III acromioclavicular joint dislocation treated surgically with clavicular Hook plate and Tension Band wiring with K-wires. Methods: In a prospective hospital based interventional study comprising of total 22 patients with a mean age of 31.36 ± 7.53 years who presented with Rockwood Type III acromioclavicular joint dislocation were carried between January 2018 to December 2019. They were graded according to Rockwood et al. classification. All 22 patients underwent open reduction and internal fixation. These patients were divided into two groups according to operative procedure; of which 11 patients were treated with clavicular hook plate (CHP) and rest 11 were treated with tension band wiring with K-wires (TBW). Descriptive comparison was tabulated during pre-operative, intra-operative and post-operative periods. The Constant-Murley Shoulder scoring system was applied for evaluating the results. Results: The mean follow up period was 7.6 months. The clavicular hook plate was removed at 10 months in one patient due to severe pain and limited range of motion , and removal of Tension Band wiring with K-wires were done in two patients due to wound dehiscence and Kirschner wire back out at 5 and 6 months. The mean Constant- Murley shoulder score was 82.6 (min. 70 & max. 93) in clavicular hook plate and 74.72 (min 68 & max. 84) in Tension band wiring with K-wires which found to be significantly difference in mean scoring between two groups. Conclusion: Patients treated with Clavicular Hook Plate for Rockwood Type III acromioclavicular joint dislocation had a very good functional and surgical outcome over Tension Band wiring with K-wires.

Is coracoclavicular reconstruction necessary in hook plate fixation for acute unstable acromioclavicular dislocation?

Background: Acromioclavicular joint (ACJ) dislocation is a relatively common shoulder injury. For the treatment of cases of severe ACJ dislocation (Rockwood type III–V), hook plate fixation is a neasy-to-master and minimally-invasive approach to surgical intervention. Over stress on the acromion following hook plate fixation often leads to acromial complications such as osteolysis and loss of reduction. We hypothesized that suspensory reconstruction a longside hook plate fixation might provide a superior stability and reduce complications as compared with hook plate fixation alone. The purpose of the study was to assess the clinical and radiographic outcomes of these two surgical modalities.Methods: We retrospectively enrolled 49 patients with acute ACJ dislocation from May 2010 to December 2018. Among them, nineteen patients received hook plate fixation only (HP group), and 19 underwent concomitant hook plate fixation and loop suspension fixation with two mersilene sutures (HM group). The demographic data of the patients were recorded and analyzed. All patients underwent a shoulder x-ray initially, immediately postoperatively, and at 1, 3, 6 and12 months to measure the relative coracoclavicular distance (rCCD). Clinical assessment of shoulder function outcome was conducted using the Constant Murley Score (CMS); the University of California at Los Angeles (UCLA) Shoulder Score was also measured at the latest follow-up.Results: There were no significant differences in the demographic data between the two groups. With regards to the CMS and the UCLA score, the HM group and HP group both had excellent outcomes, and no significant differences in scores were observed between groups (CMS: 93.90±6.16 versus 94.47±7.26, p=0.47; UCLA score: 32.84±2.91 versus 34.32±1.16, p=0.07). However, the HM group demonstrated substantial superiority in terms of maintenance of the rCCD over the HP group (91.47±27.47 versus 100.75±48.70, p=0.015). In addition, there was less subacromial osteolysis in the HM group than the HP group (52.6% versus 15.8%, p=0.038).Conclusion: Both fixations yielded excellent functional outcomes. However, concomitant hook plate fixation with loop suspensory reconstruction demonstrated the fewer acromion complications and statistical differences in reduction maintenance with less clinical significance.

Can an acute high-grade acromioclavicular joint separation be reduced and stabilized without surgery? A surgeon’s experience

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.