Treatment of acute high-grade acromioclavicular joint dislocation

Jeung Yeol Jeong, Yong-Min Chun, Jeung Yeol Jeong, Yong-Min Chun

Abstract

Acromioclavicular (AC) joint dislocations account for about 9% of shoulder injuries. Among them, acute high-grade injury following high-energy trauma accounts for a large proportion of patients requiring surgical treatment. However, there is no gold standard procedure for operative treatment of acute high-grade AC joint injury, and several different procedures have been used for this purpose in clinical practice. This review article summarizes the most recent and relevant surgical options for acute high-grade AC joint dislocation patients and the outcomes of each treatment type.

Keywords: Acute high-grade acromioclavicular joint injuries; Shoulder; Treatments.

Conflict of interest statement

Conflict of interest None.

Copyright © 2020 Korean Shoulder and Elbow Society.

Figures

Fig. 1.
Fig. 1.
Serial radiographs from a 45-year-old man treated with reconstruction of an acute acromioclavicular joint separation of Rockwood type V using a hook plate showing good joint reduction and maintenance of joint reduction. (A) Preoperative. (B) Postoperative.
Fig. 2.
Fig. 2.
Arthroscopic-assisted procedures with a coracoclavicular (CC) suspension device. (A, B) TightRope device. (B) The subacromial space viewed through the anterolateral portal. Fixation findings of the TightRope anchored under the base of the coracoid process. (C) A postoperative anteroposterior radiograph revealing a slightly over-reduced CC interval and acromiohumeral joint.
Fig. 3.
Fig. 3.
A coracoclavicular suspension device: the EndoButton device.
Fig. 4.
Fig. 4.
A coracoclavicular (CC) suspension device: (A) the Dog-Bone device, (B) illustration of CC fixation using a Dog Bone device.
Fig. 5.
Fig. 5.
(A) A computed tomography image after three-dimensional reconstruction shows correction of horizontal instability of the left clavicle. The red lines show the horizontal stability of the acromioclavicular joint. (B) The arthroscopic finding of multiple knots anchoring under the base of the coracoid process. (C) The suspension bridge. (D) An illustration of coracoclavicular (CC) fixation using three vertical stabilizers. This method can restore horizontal stability and vertical stability, as in the suspension bridge principle. (E) Bilateral anteroposterior plain radiograph at final follow-up after surgery, showing maintenance of the CC distance. Asterisks indicate the clavicle tunnels. The red line shows the horizontal stability of the AC joint.

References

    1. Pan Z, Zhang H, Sun C, Qu L, Cui Y. Arthroscopy-assisted reconstruction of coracoclavicular ligament by Endobutton fixation for treatment of acromioclavicular joint dislocation. Arch Orthop Trauma Surg. 2015;135:9–16.
    1. Cho CH, Kim BS, Kwon DH. Importance of additional temporary pin fixation combined coracoclavicular augmentation using a suture button device for acute acromioclavicular joint dislocation. Arch Orthop Trauma Surg. 2016;136:763–70.
    1. Millett PJ, Warth RJ, Greenspoon JA, Horan MP. Arthroscopically assisted anatomic coracoclavicular ligament reconstruction technique using coracoclavicular fixation and soft-tissue grafts. Arthrosc Tech. 2015;4:e583–7.
    1. Shetty NS, Yoo YS, Kim DY, Lee SS, Jeong US. Open anatomical coracoclavicular ligament reconstruction using a tendon graft with an Endobutton loop. Acta Orthop Belg. 2009;75:828–31.
    1. Lee SJ, Yoo YS, Kim YS, et al. Arthroscopic coracoclavicular fixation using multiple low-profile devices in acute acromioclavicular joint dislocation. Arthroscopy. 2019;35:14–21.
    1. Cetinkaya E, Arıkan Y, Beng K, Mutlu H, Yalçınkaya M, Üzümcügil O. Bosworth and modified Phemister techniques revisited: a comparison of intraarticular vs extraarticular fixation methods in the treatment of acute Rockwood type III acromioclavicular dislocations. Acta Orthop Traumatol Turc. 2017;51:455–8.
    1. Yin J, Yin Z, Gong G, Zhu C, Sun C, Liu X. Comparison of hook plate with versus without double-tunnel coracoclavicular ligament reconstruction for repair of acute acromioclavicular joint dislocations: a prospective randomized controlled clinical trial. Int J Surg. 2018;54(Pt A):18–23.
    1. Issa SP, Payan C, Le Hanneur M, Loriaut P, Boyer P. Arthroscopically assisted reduction of acute acromioclavicular joint dislocation using a single double-button device: medium-term clinical and radiological outcomes. Orthop Traumatol Surg Res. 2018;104:33–8.
    1. Woodmass JM, Esposito JG, Ono Y, et al. Complications following arthroscopic fixation of acromioclavicular separations: a systematic review of the literature. Open Access J Sports Med. 2015;6:97–107.
    1. Rockwood C, Williams G, Young D. Disorders of the acromioclavicular joint. In: Rockwood CA, editor. The shoulder. 3rd ed. Philadelphia, PA: WB Saunders; 2004. pp. 521–95.
    1. Tauber M. Management of acute acromioclavicular joint dislocations: current concepts. Arch Orthop Trauma Surg. 2013;133:985–95.
    1. Greiner S, Braunsdorf J, Perka C, Herrmann S, Scheffler S. Mid to long-term results of open acromioclavicular-joint reconstruction using polydioxansulfate cerclage augmentation. Arch Orthop Trauma Surg. 2009;129:735–40.
    1. Ceccarelli E, Bondì R, Alviti F, Garofalo R, Miulli F, Padua R. Treatment of acute grade III acromioclavicular dislocation: a lack of evidence. J Orthop Traumatol. 2008;9:105–8.
    1. Kienast B, Thietje R, Queitsch C, Gille J, Schulz AP, Meiners J. Mid-term results after operative treatment of rockwood grade III-V acromioclavicular joint dislocations with an AC-hook-plate. Eur J Med Res. 2011;16:52–6.
    1. Gstettner C, Tauber M, Hitzl W, Resch H. Rockwood type III acromioclavicular dislocation: surgical versus conservative treatment. J Shoulder Elbow Surg. 2008;17:220–5.
    1. Chiang CL, Yang SW, Tsai MY, Kuen-Huang Chen C. Acromion osteolysis and fracture after hook plate fixation for acromioclavicular joint dislocation: a case report. J Shoulder Elbow Surg. 2010;19:e13–5.
    1. Hoffler CE, Karas SG. Transacromial erosion of a locked subacromial hook plate: case report and review of literature. J Shoulder Elbow Surg. 2010;19:e12–5.
    1. Bahk MS, Kuhn JE, Galatz LM, Connor PM, Williams GR., Jr Acromioclavicular and sternoclavicular injuries and clavicular, glenoid, and scapular fractures. J Bone Joint Surg Am. 2009;91:2492–510.
    1. Kim YS, Yoo YS, Jang SW, Nair AV, Jin H, Song HS. In vivo analysis of acromioclavicular joint motion after hook plate fixation using three-dimensional computed tomography. J Shoulder Elbow Surg. 2015;24:1106–11.
    1. Bosworth BM. Acromioclavicular separation: new method of repair. Surg Gynecol Obstet. 1941;73:866–71.
    1. Tsou PM. Percutaneous cannulated screw coracoclavicular fixation for acute acromioclavicular dislocations. Clin Orthop Relat Res. 1989:112–71.
    1. Rockwood CA, Green DP, Bucholz RW. Rockwood and Green’s fractures in adults. 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2006. pp. 672–95.
    1. Kwon YW, Iannotti JP. Operative treatment of acromioclavicular joint injuries and results. Clin Sports Med. 2003;22:291–300.
    1. Tomlinson DP, Altchek DW, Davila J, Cordasco FA. A modified technique of arthroscopically assisted AC joint reconstruction and preliminary results. Clin Orthop Relat Res. 2008;466:639–45.
    1. Rolla PR, Surace MF, Murena L. Arthroscopic treatment of acute acromioclavicular joint dislocation. Arthroscopy. 2004;20:662–8.
    1. Lim YW, Sood A, van Riet RP, Bain GI. Acromioclavicular joint reduction, repair and reconstruction using metallic buttons: early results and complications. Tech Shoulder Elb Surg. 2007;8:213–21.
    1. Braun S, Imhoff AB, Martetschlaeger F. Primary fixation of acromioclavicular joint disruption. Oper Tech Sports Med. 2014;22:221–26.
    1. Shin SJ, Kim NK. Complications after arthroscopic coracoclavicular reconstruction using a single adjustable-loop-length suspensory fixation device in acute acromioclavicular joint dislocation. Arthroscopy. 2015;31:816–24.
    1. Scheibel M, Dröschel S, Gerhardt C, Kraus N. Arthroscopically assisted stabilization of acute high-grade acromioclavicular joint separations. Am J Sports Med. 2011;39:1507–16.
    1. Walz L, Salzmann GM, Fabbro T, Eichhorn S, Imhoff AB. The anatomic reconstruction of acromioclavicular joint dislocations using 2 TightRope devices: a biomechanical study. Am J Sports Med. 2008;36:2398–406.
    1. Mazzocca AD, Santangelo SA, Johnson ST, Rios CG, Dumonski ML, Arciero RA. A biomechanical evaluation of an anatomical coracoclavicular ligament reconstruction. Am J Sports Med. 2006;34:236–46.
    1. Venjakob AJ, Salzmann GM, Gabel F, et al. Arthroscopically assisted 2-bundle anatomic reduction of acute acromioclavicular joint separations: 58-month findings. Am J Sports Med. 2013;41:615–21.
    1. Fahmy FS, Fathi H, ElAttar M. Clinical outcomes of arthroscopic assisted fixation of acute high grade acromioclavicular joint disruption. J Orthop. 2019;16:133–6.
    1. Lu D, Wang T, Chen H, Sun LJ. A comparison of double Endobutton and triple Endobutton techniques for acute acromioclavicular joint dislocation. Orthop Traumatol Surg Res. 2016;102:891–5.
    1. Seo JB, Lee DH, Kim KB, Yoo JS. Coracoid clavicular tunnel angle is related with loss of reduction in a single-tunnel coracoclavicular fixation using a dog bone button in acute acromioclavicular joint dislocation. Knee Surg Sports Traumatol Arthrosc. 2019;27:3835–43.
    1. Martetschläger F, Horan MP, Warth RJ, Millett PJ. Complications after anatomic fixation and reconstruction of the coracoclavicular ligaments. Am J Sports Med. 2013;41:2896–903.
    1. Dyrna F, de Oliveira CC, Nowak M, et al. Risk of fracture of the acromion depends on size and orientation of acromial bone tunnels when performing acromioclavicular reconstruction. Knee Surg Sports Traumatol Arthrosc. 2018;26:275–84.

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