Operative treatment of acute acromioclavicular joint dislocations graded Rockwood III-V: a retrospective and comparative study between three different surgical techniques
Keywords:
acromioclavicular dislocation, acromioclavicular surgical treatment, acromioclavicular joint, coracoclavicular ligaments, shoulder surgery, dislocation, tightrope, hookplateAbstract
Background: the optimal treatment of acute type III-V acromioclavicular (A-C) Rockwood dislocations is still a matter of discussion in orthopaedic surgery.
Aim of the work: retrospective and comparative evaluation of the clinical and radiographic results of three different surgical techniques for stabilization of A-C joint using tension band wiring, hook plate and TightRope.
Methods: a consecutive series of patients, treated from January 2014 and November 2019, were divided into three groups according to the surgical method used. They were clinically and radiographically assessed and the results were compared with those present in the literature.
Results:66 patients, with a mean age of 44.7 years, were enrolled with a mean follow-up of 37.7 months (range 6-58 months). All patients, regardless of the group, had satisfactory outcome. According to the DASH score, statistically significant difference favours the TightRope Group (TRG) fixation (p<0.005). The TRG showed the highest mean Constant score (96,1); there are no significative differences between the clinical scores of Hook Plate Group (HPG) and Tension Band Wiring Group (TBWG). However, these two methods showed numerous complications, especially metal-work mobilization and stiffness respectively.
Conclusions: good results can be overall achieved with primary fixation by the three different surgical methods under investigation. The TightRope system exhibited some advantages such as higher clinical scores, early recovery of range of movements, longitudinal surgical incision with non-keloid scar, no need for a second surgery and lower rate of complications.
References
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11. Larsen E, Bjerg-Nielsen A, Christensen P. Conservative or surgical treatment of acromioclavicular dislocation: a prospective, controlled, randomized study. J Bone Joint Surg [Am] 1986; 68-A: 552–555.
12. Tamaoki MJ, Belloti JC, Lenza M, et al. Surgical versus conservative interventions for treating acromioclavicular dislocation of the shoulder in adults. Cochrane Database Syst Rev 2010; 8: CD007429.
13. Epstein D, Day M, Rokito A. Current concepts in the surgical management of acromioclavicular joint injuries. Bull NYU Hosp Jt Dis 2012; 70: 11–24.
14. Costic RS, Labriola JE, Rodosky MW, Debski RE. Biomechanical rationale for development of anatomical reconstructions of coracoclavicular ligaments after complete acromioclavicular joint dislocations. Am J Sports Med 2004; 32: 1929-36.
15. Smith TO, Chester R, Pearse EO, Hing CB. Operative versus non-operative management following Rockwood grade III acromioclavicular separation: a meta-analysis of the current evidence base. J Orthop Traumatol 2011; 12: 19–27.
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17. Tang G, Zhang Y, Liu Y, Qin X, Hu J, Li X. Comparison of surgical and conservative treatment of Rockwood type-III acromioclavicular dislocation: A meta-analysis. Medicine (Baltimore) 2018; 97(4): e9690.
18. Gstettner C, Tauber M, Hitzl W, Resch H. Rockwood type III acromioclavicular dislocation: surgical versus conservative treatment. J Shoulder Elbow Surg 2008; 17: 220–225.
19. Ryhänen J, Niemelä E, Kaarela O, Raatikainen T. Stabilization of acute, complete acromioclavicular joint dislocations with a new C hook implant. J Shoulder Elbow Surg 2003; 12(5): 442–5.
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21.Lizaur A, Sanz-Reig J, Gonzalez-Parreño S. Long-term results of the surgical treatment of type III acromioclavicular dislocations: an update of a previous report. J Bone Joint Surg (Br) 2011; 93(8): 1088–92.
22. Johansen JA, Grutter PW, McFarland EG, Petersen SA. Acromioclavicular joint injuries: indications for treatment and treatment options. J Shoulder Elbow Surg 2011; 20(2 Suppl): 70-82.
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24. Ladermann A, Grosclaude M, Lubbeke A, Christofilopoulos P, Stern R, Rod T, et al. Acromioclavicular and coracoclavicular cerclage reconstruction for acute acromioclavicular joint dislocations. J Shoulder Elbow Surg 2011; 20: 401-8.
25. Ejam S, Lind T, Falkenberg B. Surgical treatment of acute and chronic acromioclavicular dislocation Tossy type III and V using the Hook plate. Acta Orthop Belg 2008, 74(4): 441-445.
26. Horst K, Dienstknecht T, Pishnamaz M, Sellei RM, Kobbe P, Pape HC. Operative treatment of acute acromioclavicular joint injuries graded Rockwood III and IV: risks and benefits in tight rope technique vs. k-wire fixation. Patient Saf Surg 2013; 7: 18.
27 Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 1987 Jan; 214: 160-4.
28. Germann G, Wind G, Harth A. The DASH (Disability of Arm-Shoulder-Hand) Questionnaire--a new instrument for evaluating upper extremity treatment outcome. Handchir Mikrochir Plast Chir 1999 May; 31(3): 149-52.
29. Zanca P. Shoulder pain: involvement of AC joint (analysis of 1000 cases). Am J Roentgenol Radium Ther Nucl Med 1971; 112(3): 493-506.
30.Cooper ES. New method of treating long standing dislocations of the scapula-clavicular articulation. Am J Med Sci 1861; 1: 389-392.
31. Helfen T, Siebenbürger G, Ockert B, Haasters F. Therapy of acute acromioclavicular joint instability. Meta-analysis of arthroscopic/minimally invasive versus open procedures. Unfallchirurg 2015; 118: 415–426.
32. Horst K, Garving C, Thometzki T, et al. Comparative study on the treatment of Rockwood type III acute acromioclavicular dislocation: Clinical results from the TightRope((R)) technique vs. K-wire fixation. Orthop Traumatol Surg Res 2017; 103(2): 171-6.
33. Andreani L, Bonicoli E, Parchi P, Piolanti N, Michele L. Acromioclavicular repair using two different techniques. Eur J Orthop Surg Traumatol 2012; DOI 10.1007/s00590-013-1186-1
34. von Heideken J, Bostrom Windhamre H, Une-Larsson V, et al. Acute surgical treatment of acromioclavicular dislocation type V with a hook plate: superiority to late reconstruction. J Shoulder Elbow Surg 2013; 22: 9–17.
35. Kumar N, Sharma V. Hook-plate fixation for acute acromioclavicular dislocations without coracoclavicular ligament reconstruction: a functional outcome study in military personnel. Strategies Trauma Limb Reconstr 2015; 10: 79–85.
36. Leidel BA, Braunstein V, Kirchhoff C, et al. Consistency of long-term outcome of acute Rockwood grade III acromioclavicular joint separations after K-wire transfixation. J Trauma 2009; 66: 1666–1671.
37. Ejeskar A. Coracoclavicular wiring for acromioclavicular joint dislocation. A ten year follow-up study. Acta Orthop Scand 1974; 45: 652-61.
38. Franssen BB, Schuurman AH, Van der Molen AM, Kon M One century of Kirschner wires and Kirschner wire insertion techniques: a historical review. Acta Orthop Belg 2010; 76(1): 1-6.
39. Ladermann A, Gueorguiev B, Stimec B, Fasel J, Rothstock S, Hoffmeyer P. Acromioclavicular joint reconstruction: a comparative biomechanical study of three techniques. J Shoulder Elbow Surg 2013; 22: 171-178.
40. Chen CH, Dong QR, Zhou RK, Zhen HQ, Jiao YJ. Effects of hook plate on shoulder function after treatment of acromioclavicular joint dislocation. Int J Clin Exp Med 2014; 7(9): 2564-70.
41. Lin HY, Wong PK, Ho WP, et al. Clavicular hook plate may induce subacromial shoulder impingement and rotator cuff lesion – dynamic sonographic evaluation. J Orthop Surg Res 2014; 9: 6.
42. Sim E, Schwarz N, Hocker K, Berzlanovich A. Repair of complete acromioclavicular separations using the acromioclavicular-hook plate. Clin Orthop Relat Res 1995; 314: 134-42.
43. Kienast B, Thietje R, Queitsch C, et al. 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: 52–56.
44 Nadarajah R, Mahaluxmivala J, Amin A, Goodier DW. Clavicular hook-plate: complications of retaining the implant. Injury 2005; 36: 681-3.
45. Arirachakaran A, Boonard M, Piyapittayanun P, Kanchanatawan W, Chaijenkij K, Prommahachai A, et al. Post-operative outcomes and complications of suspensory loop fixation device versus hook plate in acute unstable acromioclavicular joint dislocation: a systematic review and meta-analysis. J Orthop Traumatol 2017; 18(4): 293-304.
46. Qi W, Xu Y, Yan Z, Zhan J et al.. The Tight-Rope Technique versus Clavicular Hook Plate for Treatment of Acute Acromioclavicular Joint Dislocation: A Systematic Review and Meta-Analysis. J Invest Surg 2019 May; 14: 1-10.
47.Cai L, Wang T, Lu D, Hu W, Hong J, Chen H. Comparison of the tight rope technique and clavicular hook plate for the treatment of Rockwood type III acromioclavicular Joint Dislocation. J Invest Surg 2017; 31(3): 226-33.
48. Motta P, Maderni A, Bruno L, et al. Suture rupture in acromioclavicular joint dislocations treated with flip buttons. Arthroscopy 2011; 27: 294–298.
49. Woodmass JM, Esposito JG, Ono Y, et al. Complications following arthroscopic fixation of acromioclavicular separations: a systematic review of the literature. Open Access JSports Med 2015; 6: 97–107.
50. Gerhardt DC, VanDerWerf JD, Rylander LS, McCarty EC. Postoperative coracoid fracture after transcoracoid acromioclavicular joint reconstruction. J Shoulder Elbow Surg 2011; 20(5): e6–10.
51.Walz L, Salzmann GM, Fabbro T, et al. The anatomic reconstruction of acromioclavicular joint dislocations using 2 TightRope devices: a biomechanical study.AmJ SportsMed 2008; 36: 2398–2406.
52 Natera-Cisneros L, Sarasquete-Reiriz J, Escolà-Benet A, Rodriguez-Miralles J. Acute high-grade acromioclavicular joint injuries treatment: arthroscopic non- rigid coracoclavicular fixation provides better quality of life outcomes than hook plate ORIF. Orthop Traumatol Surg Res 2016; 102: 31-39.
53. Scheibel M, Dröschel S, Gerhardt C, Kraus N. Arthroscopically assisted stabilization of acute high-grade acromioclavicular joint separations. Am J Sports Med 2011; 39: 1507-1516.
54. El Sallakh SA. Evaluation of arthroscopic stabilization of acute acromioclavicular joint dislocation using the TightRope system. Orthopedics 2012; 16: 18-22.
2. Teodoro RL, Nishimi AY, Pascarelli L, Bongiovanni RR, Velasco MA, Dobashi ET. Surgical treatment of acromioclavicular dislocation using the endobutton. Acta Ortop Bras 2017; 25(3): 81-4.
3. Webb J, Bannister G. Acromioclavicular disruption in first class rugby players. Br JSports Med 1992; 26: 247–248.
4. Rockwood CA Jr. Injuries to the acromioclavicular joint. In: Rockwood CA Jr, Williams GR, Young DC, editors. Rockwood & Green’s fractures in adults. 4th ed. Philadelphia: Lippincott-Raven Publishers; 1996.
5. Luis GE, Yong CK, Singh DA, Sengupta S, Choon DS. Acromioclavicular joint dislocation: a comparative biomechanical study of the palmaris-longus tendon graft reconstruction with other augmentative methods in cadaveric models. J Orthop surg Res 2007; 2: 22.
6. Bannister GC, Wallace WA, Stableforth PG, et al. A classification of acute acromioclavicular dislocation: a clinical, radiological and anatomical study. Injury 1992; 23: 194–6.
7. Tossy JD, Mead NC, Sigmond HM. Acromioclavicular separations: useful andpractical classification for treatment. Clin Orthop Relat Res 1963; 28: 111–119.
8. Rockwood C. Injuries to the acromioclavicular joint. In: Ca R, Green D, editors. eds. Fractures in adults. 2nd ed. Philadelphia, PA: JB Lippincott, 1984: 860-910.
9. Rockwood CA, Williams G, Young D. Disorders of the acromioclavicular joint. In:Rockwood CA, Matsen FA, eds. The shoulder. Vol. 1. Fourth ed. Philadelphia: WBSaunders, 2009: 453–526.
10. C. S. Modi, J. Beazley, M. G. Zywiel, T. M. Lawrence, C. J. H. Veillette. Controversies relating to the management of acromioclavicular joint dislocations. Bone Joint J 2013; 95-B: 1595–1602.
11. Larsen E, Bjerg-Nielsen A, Christensen P. Conservative or surgical treatment of acromioclavicular dislocation: a prospective, controlled, randomized study. J Bone Joint Surg [Am] 1986; 68-A: 552–555.
12. Tamaoki MJ, Belloti JC, Lenza M, et al. Surgical versus conservative interventions for treating acromioclavicular dislocation of the shoulder in adults. Cochrane Database Syst Rev 2010; 8: CD007429.
13. Epstein D, Day M, Rokito A. Current concepts in the surgical management of acromioclavicular joint injuries. Bull NYU Hosp Jt Dis 2012; 70: 11–24.
14. Costic RS, Labriola JE, Rodosky MW, Debski RE. Biomechanical rationale for development of anatomical reconstructions of coracoclavicular ligaments after complete acromioclavicular joint dislocations. Am J Sports Med 2004; 32: 1929-36.
15. Smith TO, Chester R, Pearse EO, Hing CB. Operative versus non-operative management following Rockwood grade III acromioclavicular separation: a meta-analysis of the current evidence base. J Orthop Traumatol 2011; 12: 19–27.
16. Korsten K, Gunning AC, Leenen LPH. Operative or conservative treatment in patients with Rockwod type III acromionclavicular dislocation: a systematic review and update of current literature. Int Orthop 2014; 38: 831-38.
17. Tang G, Zhang Y, Liu Y, Qin X, Hu J, Li X. Comparison of surgical and conservative treatment of Rockwood type-III acromioclavicular dislocation: A meta-analysis. Medicine (Baltimore) 2018; 97(4): e9690.
18. Gstettner C, Tauber M, Hitzl W, Resch H. Rockwood type III acromioclavicular dislocation: surgical versus conservative treatment. J Shoulder Elbow Surg 2008; 17: 220–225.
19. Ryhänen J, Niemelä E, Kaarela O, Raatikainen T. Stabilization of acute, complete acromioclavicular joint dislocations with a new C hook implant. J Shoulder Elbow Surg 2003; 12(5): 442–5.
20. Jerosch J, Filler T, Peuker E, Greig M, Siewering U. Which stabilization technique corrects anatomy best in patients with AC separation? An experimental study. Knee Surg Sports Traumatol Arthrosc 1999; 7: 365-72.
21.Lizaur A, Sanz-Reig J, Gonzalez-Parreño S. Long-term results of the surgical treatment of type III acromioclavicular dislocations: an update of a previous report. J Bone Joint Surg (Br) 2011; 93(8): 1088–92.
22. Johansen JA, Grutter PW, McFarland EG, Petersen SA. Acromioclavicular joint injuries: indications for treatment and treatment options. J Shoulder Elbow Surg 2011; 20(2 Suppl): 70-82.
23. World Medical Association. (2001). World Medical Association Declaration of Helsinki. Ethical principles for medical research involving human subjects. Bulletin of the WorldHealthOrganization, 79(4), 373-374. WorldHealthOrganization.
24. Ladermann A, Grosclaude M, Lubbeke A, Christofilopoulos P, Stern R, Rod T, et al. Acromioclavicular and coracoclavicular cerclage reconstruction for acute acromioclavicular joint dislocations. J Shoulder Elbow Surg 2011; 20: 401-8.
25. Ejam S, Lind T, Falkenberg B. Surgical treatment of acute and chronic acromioclavicular dislocation Tossy type III and V using the Hook plate. Acta Orthop Belg 2008, 74(4): 441-445.
26. Horst K, Dienstknecht T, Pishnamaz M, Sellei RM, Kobbe P, Pape HC. Operative treatment of acute acromioclavicular joint injuries graded Rockwood III and IV: risks and benefits in tight rope technique vs. k-wire fixation. Patient Saf Surg 2013; 7: 18.
27 Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 1987 Jan; 214: 160-4.
28. Germann G, Wind G, Harth A. The DASH (Disability of Arm-Shoulder-Hand) Questionnaire--a new instrument for evaluating upper extremity treatment outcome. Handchir Mikrochir Plast Chir 1999 May; 31(3): 149-52.
29. Zanca P. Shoulder pain: involvement of AC joint (analysis of 1000 cases). Am J Roentgenol Radium Ther Nucl Med 1971; 112(3): 493-506.
30.Cooper ES. New method of treating long standing dislocations of the scapula-clavicular articulation. Am J Med Sci 1861; 1: 389-392.
31. Helfen T, Siebenbürger G, Ockert B, Haasters F. Therapy of acute acromioclavicular joint instability. Meta-analysis of arthroscopic/minimally invasive versus open procedures. Unfallchirurg 2015; 118: 415–426.
32. Horst K, Garving C, Thometzki T, et al. Comparative study on the treatment of Rockwood type III acute acromioclavicular dislocation: Clinical results from the TightRope((R)) technique vs. K-wire fixation. Orthop Traumatol Surg Res 2017; 103(2): 171-6.
33. Andreani L, Bonicoli E, Parchi P, Piolanti N, Michele L. Acromioclavicular repair using two different techniques. Eur J Orthop Surg Traumatol 2012; DOI 10.1007/s00590-013-1186-1
34. von Heideken J, Bostrom Windhamre H, Une-Larsson V, et al. Acute surgical treatment of acromioclavicular dislocation type V with a hook plate: superiority to late reconstruction. J Shoulder Elbow Surg 2013; 22: 9–17.
35. Kumar N, Sharma V. Hook-plate fixation for acute acromioclavicular dislocations without coracoclavicular ligament reconstruction: a functional outcome study in military personnel. Strategies Trauma Limb Reconstr 2015; 10: 79–85.
36. Leidel BA, Braunstein V, Kirchhoff C, et al. Consistency of long-term outcome of acute Rockwood grade III acromioclavicular joint separations after K-wire transfixation. J Trauma 2009; 66: 1666–1671.
37. Ejeskar A. Coracoclavicular wiring for acromioclavicular joint dislocation. A ten year follow-up study. Acta Orthop Scand 1974; 45: 652-61.
38. Franssen BB, Schuurman AH, Van der Molen AM, Kon M One century of Kirschner wires and Kirschner wire insertion techniques: a historical review. Acta Orthop Belg 2010; 76(1): 1-6.
39. Ladermann A, Gueorguiev B, Stimec B, Fasel J, Rothstock S, Hoffmeyer P. Acromioclavicular joint reconstruction: a comparative biomechanical study of three techniques. J Shoulder Elbow Surg 2013; 22: 171-178.
40. Chen CH, Dong QR, Zhou RK, Zhen HQ, Jiao YJ. Effects of hook plate on shoulder function after treatment of acromioclavicular joint dislocation. Int J Clin Exp Med 2014; 7(9): 2564-70.
41. Lin HY, Wong PK, Ho WP, et al. Clavicular hook plate may induce subacromial shoulder impingement and rotator cuff lesion – dynamic sonographic evaluation. J Orthop Surg Res 2014; 9: 6.
42. Sim E, Schwarz N, Hocker K, Berzlanovich A. Repair of complete acromioclavicular separations using the acromioclavicular-hook plate. Clin Orthop Relat Res 1995; 314: 134-42.
43. Kienast B, Thietje R, Queitsch C, et al. 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: 52–56.
44 Nadarajah R, Mahaluxmivala J, Amin A, Goodier DW. Clavicular hook-plate: complications of retaining the implant. Injury 2005; 36: 681-3.
45. Arirachakaran A, Boonard M, Piyapittayanun P, Kanchanatawan W, Chaijenkij K, Prommahachai A, et al. Post-operative outcomes and complications of suspensory loop fixation device versus hook plate in acute unstable acromioclavicular joint dislocation: a systematic review and meta-analysis. J Orthop Traumatol 2017; 18(4): 293-304.
46. Qi W, Xu Y, Yan Z, Zhan J et al.. The Tight-Rope Technique versus Clavicular Hook Plate for Treatment of Acute Acromioclavicular Joint Dislocation: A Systematic Review and Meta-Analysis. J Invest Surg 2019 May; 14: 1-10.
47.Cai L, Wang T, Lu D, Hu W, Hong J, Chen H. Comparison of the tight rope technique and clavicular hook plate for the treatment of Rockwood type III acromioclavicular Joint Dislocation. J Invest Surg 2017; 31(3): 226-33.
48. Motta P, Maderni A, Bruno L, et al. Suture rupture in acromioclavicular joint dislocations treated with flip buttons. Arthroscopy 2011; 27: 294–298.
49. Woodmass JM, Esposito JG, Ono Y, et al. Complications following arthroscopic fixation of acromioclavicular separations: a systematic review of the literature. Open Access JSports Med 2015; 6: 97–107.
50. Gerhardt DC, VanDerWerf JD, Rylander LS, McCarty EC. Postoperative coracoid fracture after transcoracoid acromioclavicular joint reconstruction. J Shoulder Elbow Surg 2011; 20(5): e6–10.
51.Walz L, Salzmann GM, Fabbro T, et al. The anatomic reconstruction of acromioclavicular joint dislocations using 2 TightRope devices: a biomechanical study.AmJ SportsMed 2008; 36: 2398–2406.
52 Natera-Cisneros L, Sarasquete-Reiriz J, Escolà-Benet A, Rodriguez-Miralles J. Acute high-grade acromioclavicular joint injuries treatment: arthroscopic non- rigid coracoclavicular fixation provides better quality of life outcomes than hook plate ORIF. Orthop Traumatol Surg Res 2016; 102: 31-39.
53. Scheibel M, Dröschel S, Gerhardt C, Kraus N. Arthroscopically assisted stabilization of acute high-grade acromioclavicular joint separations. Am J Sports Med 2011; 39: 1507-1516.
54. El Sallakh SA. Evaluation of arthroscopic stabilization of acute acromioclavicular joint dislocation using the TightRope system. Orthopedics 2012; 16: 18-22.
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Fosser M, Camporese A. Operative treatment of acute acromioclavicular joint dislocations graded Rockwood III-V: a retrospective and comparative study between three different surgical techniques. Acta Biomed. 2021;92(5):e2021325. doi:10.23750/abm.v92i5.10678
