Monoplanar horizontal instability of the acromioclavicular joint: case report and stabilization surgical technique.
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ABSTRACT:
SUBMITTER: Afonso J
PROVIDER: S-EPMC7910732 | biostudies-literature | 2021 Mar
REPOSITORIES: biostudies-literature
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Monoplanar horizontal instability of the acromioclavicular joint: case report and stabilization surgical technique.
Afonso João J Agneskirchner Jens J
JSES international 20201125 2
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Project description:The biomechanical and anatomical complexity of the acromioclavicular joint makes its repair techniques particularly challenging. High rates of reduction subsidence and construction failures transversally affect both anatomic and nonanatomic repair techniques. The importance of addressing both vertical and horizontal instability has been highlighted in recent years. The authors aim to describe a surgical technique that combines vertical, horizontal, and rotational stabilization, in an attempt to restore the coracoacromioclavicular circle of stability.
| S-EPMC9437616 | biostudies-literature
Project description:Acromioclavicular (AC) dislocation is a common lesion often resulting from a sports injury. Nowadays, treatment is still controversial mainly in grade III lesions according to the Rockwood classification. For most surgically treated AC acute dislocations, treatment is performed with an arthroscopic procedure that anatomically reconstructs the coracoclavicular ligaments. Increasing knowledge about AC joint biomechanics has underlined the importance of its horizontal stability through the superior and inferior AC ligaments. Moreover, the pattern of lesion tends to repeat itself, with the superior AC ligament being torn most frequently from the clavicular side in a peeling fashion. Therefore, the purpose of this note is to describe the technical aspects of additional horizontal stability through superior AC ligament repair using suture anchors.
| S-EPMC7917010 | biostudies-literature
Project description:We present an arthroscopic technique for stabilization of chronic acromioclavicular (AC) joint instability using a transclavicular-transcoracoidal button technique, combined with a coracoclavicular and AC ligament reconstruction using the gracilis tendon. This arthroscopic technique achieves an anatomic reduction of the clavicle without further implant removal. It ensures vertical and horizontal stabilization of the AC joint. Using a horizontal drill hole through the clavicle and looping the gracilis tendon graft around the coracoid avoids weakening of the coracoid with the risk of fracture.
| S-EPMC5382553 | biostudies-literature
Project description:BackgroundAcromioclavicular (AC) horizontal instability is a problem affecting not only young athletic patients after a trauma to the AC joint but also older patients who have undergone distal clavicle resection. It may cause pain and poor functional outcomes unless the reconstruction technique specifically addresses the horizontal instability of the clavicle, in addition to the well-known superior instability.MethodsThree cadaveric specimens underwent dissection of the AC joint capsule to determine the superior attachments of the AC joint capsule. These shoulders subsequently underwent distal clavicle resection and were loaded to a 7-kg weight in the horizontal plane. The horizontal displacement of the clavicle was measured and resection continued to the point of horizontal instability of the clavicle. Thereafter, the reverse coracoacromial ligament reconstruction technique was performed and recreation of horizontal stability assessed. Utilization of the reverse coracoacromial ligament transfer in two clinical cases will also be presented.ResultsThe AC joint capsule is continuous with trapezius and deltoid insertions. The average distance between the articular surface and insertion of the capsule on the clavicle is 10 mm and on the acromion is 14.8 mm. Horizontal clavicular translation increased from 2.3 mm when intact to 3.3 mm with capsular transection, 8.7 mm with 5 mm clavicle resection, and finally 15 mm with a 10-mm clavicle resection. Horizontal instability of the clavicle was demonstrated with a 10-mm clavicle resection.ConclusionHorizontal instability of the clavicle is evident with distal clavicle resection of greater than 10 mm. A reverse coracoacromial ligament transfer may be a reasonable technique to address horizontal stability of the clavicle during AC joint reconstruction in the context of painful instability.
| S-EPMC10426700 | biostudies-literature
Project description:BackgroundAcromioclavicular joint (AC joint) disruption is a common injury with considerable variation with regards to surgical management. The Lockdown™ procedure (previously known as Surgilig™), Modified Weaver-Dunn procedure, Arthroscopic AC joint stabilization and Ligament Augmentation and Reconstruction system (LARS) procedure have all been described for treatment of this injury with varying outcomes.PurposeTo measure the functional and radiological outcomes following all cases of AC joint reconstruction using the Lockdown™ technique over the last 10 years at Medway Maritime Hospital.MethodsData on a total of 53 patients who underwent AC joint reconstruction between 2012 and 2021 were collected. Electronic records were used to extract data regarding patient characteristics, surgery details, and duration of follow-up. Telephonic interviews of patients were conducted to collect data on hand dominance, surgical complications, and responses to Oxford shoulder score (OSS) and QuickDASH score questionnaires. Hospital PACS data were reviewed to record preoperative injury severity and postoperative acromioclavicular joint reduction.ResultsResults for 42 patients were available and analysed as 10 could not be contacted and 1 patient sadly passed away. Of the patients reviewed, 92.9% were males with a mean age of 42.2 years (Range 16-67 years) and mean follow up of 68 months (12-119.1 months). The injury involved the dominant arm in 59.5%cases. Majority of the cases were Rockwood type V injuries (71.43%) while the rest were either type III(19.05%) or type IV(9.52%).The mean preoperative OSS was 21.3/48 which improved to 44.3/48 in the postoperative period. Similarly, the mean QuickDASH score was 50.6 preoperatively, that improved to 9.1 postoperatively.The most common patient reported complication was prominent metalwork seen in 5 cases (11.6%) followed by stiffness seen in 3 cases (7%) and superficial infection seen in 1 case (2.3%). The AC joint remained reduced radiologically in 81% of cases, while a resubluxation between 50 and 100% was seen in the rest of the cases. Patients with radiological resubluxation did not report this as a complication in 87.5% of the cases. Overall, 38 patients reported their outcome as excellent, 2 patients rated it good while 1 patient reported it as fair and 1 as poor.ConclusionThe Lockdown™ technique for stabilization of AC joint has excellent or good patient satisfaction in 95.2% of cases in long term follow up of more than 5.7 years. Prominent metalwork and stiffness are the commonest clinical complications. Radiological resubluxation can be seen in a fifth of the cases but does not directly lead to patient dissatisfaction.Level of evidenceLevel IV Retrospective case series.
| S-EPMC10480073 | biostudies-literature
Project description:Loss of reduction is the most common complication following acromioclavicular dislocations treatment, with literature showing greater postoperative coracoclavicular distances associated with worse clinical results. We present a surgical gesture that aims to help surgeons achieve and secure an anatomic acromioclavicular reduction during coracoclavicular fixation. This technique has the possibility to improve radiological and functional results of acromioclavicular dislocation treatment.
| S-EPMC8417394 | biostudies-literature
Project description:We describe the technical aspects of an arthroscopy-assisted procedure indicated for the management of acute unstable acromioclavicular joint injuries, consisting of a synthetic augmentation of both the coracoclavicular and acromioclavicular ligaments, that anatomically reproduces the coracoclavicular biomechanics and offers fixation that keeps the torn ends of the ligaments facing one another, thus allowing healing of the native structures without the need for a second surgical procedure for metal hardware removal.
| S-EPMC4738758 | biostudies-literature
Project description:Acromioclavicular joint separations are common shoulder injuries in the active patient population. Nonoperative management is recommended for Rockwood type I and II injuries, whereas surgical reconstruction is recommended for type IV and VI separations. The management for type III and V injuries is more controversial and is determined on a case-by-case basis. A multitude of surgical reconstruction techniques exist, and there is little evidence to support one technique over another. The anatomic technique aims at reconstructing the coracoclavicular ligaments and bringing the clavicle back into its anatomic position. When the anatomic technique is augmented with a graft, biomechanical studies have shown superior reconstruction strength and stability compared with standard nonanatomic techniques. Additionally, anatomic reconstruction allows for better cosmesis and functional outcome measures at midterm follow-up compared with nonanatomic techniques. In this Technical Note, we describe our preferred technique for anatomic repair of acromioclavicular joint separation using a semitendinosus allograft.
| S-EPMC5793897 | biostudies-literature
Project description: Not available
| S-EPMC11843450 | biostudies-literature
Project description:Acromioclavicular joint injuries are a common shoulder injury encountered by orthopaedic surgeons. Many different surgical techniques have been described for the operative treatment of these injuries with no single, clear gold standard technique on which surgeons agree. Among the most common complications after surgical management of acromioclavicular injuries are loss of reduction, infection, fracture of clavicle or coracoid, and need for reoperation. We propose an arthroscopic-assisted, tunnel-free surgical technique using a tibialis anterior allograft combined with a FiberTape Cerclage (Arthrex, Naples, FL) to manage both acute and chronic acromioclavicular joint injuries. No bony tunnels are drilled and no hardware is implanted, which should obviate the risk for subsequent bony failure through a fracture, nor require subsequent hardware removal. In addition, the combination of suspensory and allograft fixation should impart sufficient stability to maintain an adequate reduction even in the face of failure of one of the fixation methods. Technique Video Video 1 This video demonstrates the surgical technique for arthroscopically-assisted treatment of acromioclavicular (AC) joint instability in a way that avoids creation of bony tunnels through the clavicle or coracoid. In this case, a patient with a symptomatic complete high-grade AC separation undergoes surgical reconstruction.
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