Sacroiliac Separation that Can be Diagnosed After Pelvic Fixation During Surgery: A Case Report and Review of Literature

Introduction: Sacroiliac joint separation is a life-threatening serious condition in pelvic injuries. It should be diagnosed early and treated properly. Although these injuries can often be detected by imaging methods, in some cases, it is not diagnosed. Case presentation: We report a rare case of pelvic injury with sacroiliac separation during surgery, while the sacroiliac joint was completely normal on X-ray and CT and no pelvic binder was used in the patient. The sacroiliac separation noticed during the operation was fixed with a sacroiliac screw. Conclusion: Pelvic injuries, especially ligament injuries, may not be detected on both physical examination, direct radiography, and CT.

Acromioclavicular Joint Separation in UEFA Soccer Players: A Matched-Cohort Analysis of Return to Play and Player Performance From 1999 to 2018

Background: Acromioclavicular joint (ACJ) separation injuries are uncommon in professional soccer players, threatening future performance and team contributions. Data regarding return to play (RTP) in professional soccer players after ACJ separation are limited. Purpose: To determine the rate, time to RTP, and player performance after ACJ separation in soccer players from the top 5 professional European leagues when compared with a retrospective, matched cohort of uninjured players. Study Design: Cohort study; Level of evidence, 3. Methods: Professional soccer players suffering ACJ separation injuries between 1999 and 2018 were identified and were matched to uninjured players (2 controls to 1 injured player) by position, height, age, season year, and length of time played. Information on date of injury, timing to RTP, and player performance metrics (minutes played, games played, goals scored, assists made, and points per game) were collected from transfermarkt.co.uk, uefa.com , fifa.com , official team websites, public injury reports, and press releases. Change in performance metrics for the 4 seasons after the season of injury were based on metrics 1 season before injury. Univariate comparisons were performed using independent 2-group t tests and Wilcoxon rank-sum tests when normality of distributions was violated. Results: A total 59 soccer players with ACJ separation injuries were identified. Mean age at injury was 24.6 ± 5.3 years. Of these, 81% of the players returned to play, with 69% returning within postinjury season 1. Mean time to RTP was 49.8 ± 24.3 days (5.9 ± 4.1 games). Two players suffered recurrent ACJ separation injuries in their professional soccer careers. There were no significant differences between athletes who sustained ACJ injuries versus control athletes in the number of games played, minutes per game per season, goals scored, assists, or points in the 4 seasons after injury. Defenders played fewer minutes and recorded fewer assists during postinjury season 1 when compared with control athletes. Conclusion: Of the 59 elite soccer players who sustained ACJ separation injuries during the study period, 81% returned to elite competition. Performance metrics were similar to preinjury levels and matched, uninjured control players.

Clinical Outcome of a Modified Coracoid Tunnel-Free Coracoclavicular Sling Technique With Remnant Preservation for the Treatment of High-Grade Acromioclavicular Joint Separation: A Report of 48 Cases With 2 to 5 Years of Follow-up

Background: High-grade acromioclavicular (AC) joint separation injuries (Rockwood type IV or V) are surgically indicated because of complete disruption of the AC and coracoclavicular (CC) ligaments, leading to instability and pain. In surgical techniques that require a suspensory system, coracoid tunnel-related complications are not uncommon. Purpose: To report subjective and objective clinical outcomes and complication rates of a modified coracoid tunnel-free CC sling technique combined with CC ligament remnant preservation for a minimum 2-year follow-up. Study Design: Case series; Level of evidence, 4. Methods: Between January 2014 and January 2017, we prospectively enrolled patients who underwent a modified CC sling technique performed by 1 senior surgeon using the AC TightRope System in a coracoid tunnel-free fashion. The CC distance (CCD) and Rockwood AC joint classification were evaluated on radiographs preoperatively, immediately postoperatively, and at the final follow-up. The visual analog pain score, range of motion, American Shoulder and Elbow Surgeons score, Constant-Murley score, and University of California Los Angeles score were recorded preoperatively and at the final follow-up. Results: In total, 48 of 54 patients (88.9%) were included for the evaluation with a mean ± SD follow-up of 39.3 ± 8.9 months (range, 24.7-64.3 months). The CCD was significantly decreased from 22.7 ± 4.2 to 9.8 ± 2.3 mm ( P < .01) immediately after surgery and to 11.2 ± 1.8 mm ( P < .01) at final follow-up. At the final follow-up, the side-to-side difference of CCD was 3.5 ± 0.6 mm. Compared with the preoperative level, all subjective evaluations were significantly improved at the final follow-up. We observed that 4 of the 48 patients (8.3%) had a loss of reduction at the final follow-up, but no pain or instability was documented. Further, no coracoid-related complication or other complications were recorded. Conclusion: The coracoid tunnel-free CC sling technique using the AC TightRope System combined with CC ligament remnant preservation demonstrated significant improvement regarding both clinical and radiological outcomes, with a reduction loss rate of 8.3%. It is a safe method that could achieve satisfactory result without any coracoid drilling-related complications.

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.

Operative fixation of type IV-VI acromioclavicular joint separation: an internal splint technique

<p class="abstract">Treatment of acromioclavicular (AC) joint separation is controversial. Rockwood type I, II, III AC joint injuries generally treated conservatively. In the literature there is various treatment options described for treating type IV - VI injuries with good and poor outcome but no single gold standard method. Rockwood type IV - VI AC joint separation treated with internal splint technique by passing Merselene tape through drill hole at lateral end clavicle, passing it under coracoid process and tied it after reducing vertical displacement of AC joint. Simultaneously horizontal displacement corrected and Merselene tape passed through drill hole of acromian process and tied. Endobuttn supports Merselene tape at superior aspect of clavicle. This study was conducted between April 2015 to March 2019 in KPC Medical College and hospital, Kolkata after taking ethical committee permission. 20 patients undergo surgical fixation of type IV-VI AC joint separation within 3 weeks of injury. Outcome of clinical and radiological parameter assessment was at 6, 12, 24 weeks. Male female ratio was 7:3. Mean age 38.2 years, abduction was less than 100 degree in 2 patients at 6 months follow up due to inadequate compliance to physiotherapy. Other patients develop full Range of motion (ROM) and power of shoulder muscle 5/5. No cosmetic deformity except one painful scar. No postoperative displacement in alignment in Anteroposterior (AP) and axillary lateral view. This technique of interal spilint construct reduces need for rigid implant and biological procedure for acute AC joint dislocation though having excellent fixation strength, good reduction in both coronal and sagittal plane for proper healing of AC and Coracoclavicular (CC) ligaments.</p>