Scheibel, Am J Sports Med 2011 - Arthroscopically Assisted Stabilization of Acute High-Grade Acromioclavicular Joint Separations

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Arthroscopically Assisted Stabilization of Acute High-Grade Acromioclavicular Joint Separations

Scheibel, Kraus, et al.·Am J Sports Med·2011·416 citations·Case series

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Background

The purpose of this study was to evaluate the clinical and radiological results after arthroscopically assisted and image intensifier--controlled stabilization of high-grade acromioclavicular (AC) joint separations using the double TightRope technique with the first-generation implant.

Purpose

Hypothesis: The double TightRope technique using the first-generation implant leads to good clinical and radiological results by re-creating the anatomy of the AC joint.

Methods

Study Design: Case series; Level of evidence, 4.

37 consecutive patients (4 women and 33 men; mean age, 38.6 years) who sustained an acute AC joint dislocation grade V according to Rockwood were included in this prospective study.
The Subjective Shoulder Value (SSV), the Constant Score (CS), the Taft Score (TS), and a newly developed Acromioclavicular Joint Instability Score (ACJI) were used for final follow-up.
Bilateral stress views and bilateral Alexander views were taken to evaluate radiographic signs of recurrent vertical and horizontal AC joint instability.

Results

28 patients (2 women and 26 men; mean age, 38.8 years [range, 18-66 years]) could be evaluated after a mean follow-up of 26.5 months (range, 20.1-32.8 months).
The interval from trauma to surgery averaged 7.3 days (range, 0-18 days).
The mean SSV reached 95.1% (range, 85%-100%), the mean CS was 91.5 points (range, 84-100) (contralateral side: mean, 92.6 points), the mean TS was 10.5 points (range, 7-12), and the ACJI averaged 79.9 points (range, 45-100).
The final coracoclavicular distance was 13.6 mm (range, 5-27 mm) on the operated versus 9.4 mm (range, 4-15 mm) on the contralateral side (P < .05).
Radiographic signs of posterior instability were noted in 42.9% of cases.
Patients with evidence of posterior instability had significantly inferior results in the TS and the ACJI (P < .05).
Neither coracoid fractures nor early (within 6 weeks postoperatively) loss of reduction due to tunnel malpositioning or implant loosening was observed.

Conclusions

The combined arthroscopically assisted and image intensifier--controlled double TightRope technique using implants of the first-generation represents a safe technique and yields good to excellent early clinical results despite the presence of partial recurrent vertical and horizontal AC joint instability.

Copyright remains with the authors and publisher.

Arthroscopically Assisted Stabilization of Acute High-Grade Acromioclavicular Joint Separations.

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Arthroscopically Assisted Stabilization of Acute High-Grade Acromioclavicular Joint Separations

Scheibel, Kraus, et al.·Am J Sports Med·2011·416 citations·Case series

|

Background

The purpose of this study was to evaluate the clinical and radiological results after arthroscopically assisted and image intensifier--controlled stabilization of high-grade acromioclavicular (AC) joint separations using the double TightRope technique with the first-generation implant.

Purpose

Hypothesis: The double TightRope technique using the first-generation implant leads to good clinical and radiological results by re-creating the anatomy of the AC joint.

Methods

Study Design: Case series; Level of evidence, 4.

37 consecutive patients (4 women and 33 men; mean age, 38.6 years) who sustained an acute AC joint dislocation grade V according to Rockwood were included in this prospective study.
The Subjective Shoulder Value (SSV), the Constant Score (CS), the Taft Score (TS), and a newly developed Acromioclavicular Joint Instability Score (ACJI) were used for final follow-up.
Bilateral stress views and bilateral Alexander views were taken to evaluate radiographic signs of recurrent vertical and horizontal AC joint instability.

Results

28 patients (2 women and 26 men; mean age, 38.8 years [range, 18-66 years]) could be evaluated after a mean follow-up of 26.5 months (range, 20.1-32.8 months).
The interval from trauma to surgery averaged 7.3 days (range, 0-18 days).
The mean SSV reached 95.1% (range, 85%-100%), the mean CS was 91.5 points (range, 84-100) (contralateral side: mean, 92.6 points), the mean TS was 10.5 points (range, 7-12), and the ACJI averaged 79.9 points (range, 45-100).
The final coracoclavicular distance was 13.6 mm (range, 5-27 mm) on the operated versus 9.4 mm (range, 4-15 mm) on the contralateral side (P < .05).
Radiographic signs of posterior instability were noted in 42.9% of cases.
Patients with evidence of posterior instability had significantly inferior results in the TS and the ACJI (P < .05).
Neither coracoid fractures nor early (within 6 weeks postoperatively) loss of reduction due to tunnel malpositioning or implant loosening was observed.

Conclusions

The combined arthroscopically assisted and image intensifier--controlled double TightRope technique using implants of the first-generation represents a safe technique and yields good to excellent early clinical results despite the presence of partial recurrent vertical and horizontal AC joint instability.

Copyright remains with the authors and publisher.

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