Abstract
Purpose
The most appropriate procedure for surgical treatment of severe acromioclavicular (AC) joint dislocation was still not clear. The purpose of this study is to evaluate the outcomes of coracoclavicular (CC) reconstruction with ligament augmentation and reconstruction system (LARS) artificial ligaments for the treatment of acute complete AC joint dislocation.
Methods
Twenty-four patients (16 male and 8 female, ages ranged from 21 to 45) with acute complete AC joint dislocations were treated with CC reconstruction using LARS artificial ligaments. All these dislocations were unstable injuries. Clinical evaluation was used by the Constant scores and VAS. The radiographic evaluation consisted of Zanca radiographs for bilateral AC joint and axillary radiographs for the injured shoulder.
Results
All patients had follow-up times of 36 months (range 6–60). The Constant scores rose from 62.3 ± 6.9 preoperatively to 94.5 ± 9.3 at final evaluation (P < 0.05). Preoperative VAS scores were 5.1 ± 1.7, and the VAS scores at the last review were 0.7 ± 1.4 (P < 0.05). Follow-up radiographs showed anatomical reduction in 20 patients and slight loss of reduction in 4 patients. Calcification of CC ligament in 4 patients, degenerative change around the AC joint in 2 patient and clavicular osteolysis around screws in one patient were found.
Conclusions
LARS artificial ligament for reconstruction of CC can provide immediate stability and allow early shoulder mobilization with good functional results and few complications. This procedure was an effective and safe method to treat grade III and more AC joint dislocations.
Level of evidence
IV.
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References
Ball SV, Sankey A, Cobiella C (2007) Clavicle fracture following tight rope fixation of acromioclavicular joint dislocation. Injury Extra 38:430–432
Clavenger T, Vance RE, Bachus KN, Burks RT, Tashjian RZ (2011) Biomechanical comparison of acromioclavicular joint reconstructions using coracoclavicular tendon grafts with and without coracoacromial ligament transfer. Arthroscopy 27:24–30
Cohen G, Boyer P, Pujol N, Hamida Ferjani B, Massin P, Hardy P (2011) Endoscopically assisted reconstruction of acute acromioclavicular joint dislocation using a synthetic ligament. Outcomes at 12 months. Orthop Traumatol Surg Res. 97:145–151
Colosimo AJ, Hummer CD 3rd, Heidt RS Jr (1996) Aseptic foreign body reaction to Dacron graft material used for coracoclavicular ligament reconstruction after type III acromioclavicular dislocation. Am J Sports Med 24:561–563
Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164
El Shewy MT, El Azizi H (2011) Suture repair using loop technique in cases of acute complete acromioclavicular joint dislocation. J Orthop Traumatol 12:29–35
Eskola A, Vainionpää S, Korkala O (1987) Acute complete acromioclavicular dislocation: a prospective randomized trial of fixation with smooth or threaded Kirschner wire or cortical screw. J Ann Chir Gynaecol 76:323–326
Fialka C, Michlits W, Stampfl P, Oberleitner G, Funovic P, Schmidt W, Aharinejad A (2005) Biomechanical analysis of different operative techniques for complete acromioclavicular joint. Osteo Trauma Care 13:154–159
Fraschini G, Ciampi P, Scotti C, Ballis R, Peretti GM (2010) Surgical treatment of chronic acromioclavicular dislocation: comparison between two surgical procedures for anatomic reconstruction. Injury 41:1103–1106
Liu ZT, Zhang XL, Jiang Y, Zeng BF (2010) Four-strand hamstring tendon autograft versus LARS artificial ligament for anterior cruciate ligament reconstruction. Int Orthop 34:45–49
Martell JR (1992) Clavicular nonunion: complication with the use of mersilene tape. Am J Sports Med 20:360–361
Martetschläger F, Buchholz A, Sandmann G, Siebenlist S, Döbele S, Hapfelmeier A, Stöckle U, Millett PJ, Elser F, Lenich A (2012) Acromioclavicular and coracoclavicular PDS augmentation for complete AC joint dislocation showed insufficient properties in a cadaver model. Knee Surg Sports Traumatol Arthrosc 21:438–444
Mazzocca AD, Santangelo SA, Johnson ST, Rios CG, Dumonski ML, Arciero RA (2006) A biomechanical evaluation of an anatomical coracoclavicular ligament reconstruction. Am J Sports Med 34:236–246
Milewski MD, Tompkins M, Giugale JM, Carson EW, Miller MD, Diduch DR (2012) Complications related to anatomic reconstruction of the coracoclavicular ligaments. Am J Sports Med 40:1628–1634
Motta P, Bruno L, Maderni A, Tosco P, Mariotti U (2012) Acromioclavicular motion after surgical reconstruction. Knee Surg Sports Traumatol Arthrosc 20:1012–1018
Rolf O, Weyhern A, Ewers A, Boehm TD, Gohlke F (2008) Acromioclavicular dislocation Rockwood III–V: results of early versus delayed surgical treatment. Arch Orthop Trauma Surg 128:1153–1157
Scheibel M, Dröschel S, Gerhardt C, Kraus N (2011) Arthroscopically assisted stabilization of acute high-grade acromioclavicular joint separations. Am J Sports Med 39:1507–1516
Stewart AM, Ahmad CS (2004) Failure of acromioclavicular reconstruction using Gore-Tex graft due to aseptic foreign-body reaction and clavicle osteolysis: a case report. J Shoulder Elbow Surg 13:558–561
Taft TN, Wilson FC, Oglesby JW (1987) Dislocation of the acromioclavicular joint. An end-result study. J Bone Joint Surg Am 69:1045–1051
Thiel E, Mutnal A, Gilot GJ (2011) Surgical outcome following arthroscopic fixation of acromioclavicular joint disruption with the tightrope device. Orthopedics 34:e267–e274
Tiren D, van Bemmel AJ, Swank DJ, van der Linden FM (2012) Hook plate fixation of acute displaced lateral clavicle fractures: mid-term results and a brief literature overview. J Orthop Surg Res 7:2–9
Trieb K, Blahovec H, Brand G, Sabeti M, Dominkus M, Kotz R (2004) In vivo and in vitro cellular ingrowth into a new generation of artificial ligaments. Eur Surg Res 36:148–151
Ye T, Chen A (2010) Stress fracture of the clavicle secondary to coracoclavicular fixation using a multistrand titanium cable: a case report. Chin Med J 123:3157–3159
Acknowledgments
We would like to thank Xianren Wu, MD, Geisinger Medical Center, Danville, PA 17822, USA, for his extensive editing. We also thank Amruta Ashtekar, BS, Laboratory for Regenerative Technologies in Orthopedic Surgery, Northwestern University, Chicago, IL 60611, USA, for her English language editing.
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No potential conflict of interest declared.
Ethical standard
All patients gave informed consent, and the Ethical Committee of the Second Military Medical University approved this study.
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N. Lu, L. Zhu and T. Ye have contributed equally to this work.
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Lu, N., Zhu, L., Ye, T. et al. Evaluation of the coracoclavicular reconstruction using LARS artificial ligament in acute acromioclavicular joint dislocation. Knee Surg Sports Traumatol Arthrosc 22, 2223–2227 (2014). https://doi.org/10.1007/s00167-013-2582-0
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DOI: https://doi.org/10.1007/s00167-013-2582-0