Arthroscopic treatment of acute acromioclavicular joint dislocation with double flip button

Abstract

The ideal treatment for acute acromioclavicular joint dislocation is still controversial, both in terms of indications and surgical technique. The clinical and radiographic outcomes of 16 patients affected by acute AC joint dislocation (type III–V) and arthroscopically treated with a coracoclavicular double flip button are presented. Despite the excellent clinical results both in terms of Constant score (mean 97 points) and patient satisfaction, at a mean follow-up of 31 months the radiographs showed partial loss of reduction due to distal migration of the flip button within the upper third of the clavicle in one-fourth of the cases. The technique presented here proved to be safe and minimally invasive while delivering good aesthetic results and allowing for the treatment of associated lesions. Furthermore, the technique could benefit from more advanced retention devices, which ought to reduce or avoid migration of the flip buttons.

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References

  1. 1.

    Bakalim G, Wilppula E (1975) Surgical or conservative treatment of total dislocation of the acromioclavicular joint. Acta Chir Scand 141:43–47

    CAS  PubMed  Google Scholar 

  2. 2.

    Baker JE, Nicandri GT, Young DC et al (2003) A cadaveric study examining acromioclavicular joint congruity after different methods of coracoclavicular loop repair. J Shoulder Elbow Surg 12:595–598

    Article  PubMed  Google Scholar 

  3. 3.

    Bjerneld H, Hovelius L, Thorling J (1983) Acromioclavicular separations treated conservatively. A 5-year follow-up study. Acta Orthop Scand 54:743–745

    CAS  PubMed  Google Scholar 

  4. 4.

    Bosworth BM (1941) Acromioclavicular separation: a new method of repair. Surg Gynecol Obstet 73:866–871

    Google Scholar 

  5. 5.

    Bosworth BM (1948) Acromioclavicular dislocation: end result of screw suspension treatment. Ann Surg Gynecol Obstet 127:98–111

    Google Scholar 

  6. 6.

    Broos P, Stoffelen D, Van de Sijpe K et al (1997) Operative Versorgung der vollstandingen AC-Luxation TossY III mit der Bosworth-Schraube oder der Wolter-Platte. Eine Kritische Bethachtung. Unfallchirurgie 23:153–160

    Article  CAS  PubMed  Google Scholar 

  7. 7.

    Brunelli G, Brunelli F (1988) The treatment of acromioclavicular dislocation by transfer of the short head of the biceps. Int Orthop 12:105–108

    Article  CAS  PubMed  Google Scholar 

  8. 8.

    Constant CR, Murly AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164

    PubMed  Google Scholar 

  9. 9.

    Deshmukh AV, Wilson DR, Zilberfarb JL et al (2004) Stability of acromioclavicular joint reconstruction: biomechanical testing of various surgical techniques in a cadaveric model. Am J Sports Med 32:1492–1498

    Article  PubMed  Google Scholar 

  10. 10.

    Dias JJ, Steingold RF, Richardson RA et al (1987) The conservative treatment of acromioclavicular dislocation. Review after five years. J Bone Joint Surg Br 69:719–722

    CAS  PubMed  Google Scholar 

  11. 11.

    Diederichsen LP, Norregaard J, Krogsgaard M et al (2004) Reflexes in the shoulder muscles elicited from the human coracoacromial ligament. J Orthop Res 22:976–983

    Article  PubMed  Google Scholar 

  12. 12.

    Field LD, Dines DM, Zabinski SJ (1997) Hemiarthroplasty of the shoulder for rotator cuff arthropathy. J Shoulder Elbow Surg 6:18–23

    Article  CAS  PubMed  Google Scholar 

  13. 13.

    Fredenschuss B, Boszotta H, Helperstorfer W (1991) Ergebnisse nach operativer Stabilisierung des zerrissenen Schultergelenkes. Kombinationsverfahren versus Bosworth-Schraube. Unfallchirurg 94:95–98

    Google Scholar 

  14. 14.

    Harris RI, Wallace AL, Harper GD et al (2000) Structural properties of the intact end the reconstructed coracoclavicular ligament complex. Am J Sports Med 28:103–108

    CAS  PubMed  Google Scholar 

  15. 15.

    Hellmich A, Sievers U (1988) Operative repair of acromioclavicular separation via transcutaneous Kirschner wire fixation: results of follow-up examinations in 45 patients. Aktuelle Traumatol 18:9–13

    CAS  PubMed  Google Scholar 

  16. 16.

    Jerosch J, Filler T, Peuker E, Greig M et al (1999) Which stabilization technique corrects anatomy best in patients with AC-separation? An experimental study. Knee Surg Sports Traumatol Arthrosc 7:365–372

    Article  CAS  PubMed  Google Scholar 

  17. 17.

    Kippe MA, Demetropoulos CK, Jurist KA et al (2006) Modes of failure in acromioclavicular joint reconstruction: a biomechanical analysis of clavicular motion and its role in construct failure. Presented at the 52nd annual meeting of the Orthopaedic Research Society, Chicago, IL, 19–22 March 2006

  18. 18.

    Lafosse L, Bayer GP, Leuzzinger J (2005) Arthroscopic treatment of acute and chronic acromioclavicular joint dislocation. Arthroscopy 21:1117e1–1117e8

    Article  Google Scholar 

  19. 19.

    Lee SJ, Nikolas SJ, Akizuki KH et al (2003) Reconstruction of the coracoclavicular ligaments with tendon grafts. A comparative biomechanical study. Am J Sports Med 31:648–654

    PubMed  Google Scholar 

  20. 20.

    Lee TQ, Black AD, Tibone JE et al (2001) Release of the coracoacromial ligament can lead to glenohumeral laxity: a biomechanical study. J Shoulder Elbow Surg 10:68–72

    Article  CAS  PubMed  Google Scholar 

  21. 21.

    Lim YW, Sood A, Van Riet RP (2007) Acromioclavicular joint reduction, repair and reconstruction using metallic buttons-early results and complications. Tech Shoulder Elbow Surg 8:213–221

    Article  Google Scholar 

  22. 22.

    Lim YW (2008) Triple endobutton technique in acromioclavicular joint reduction and reconstruction. Ann Acad Med Singap 37:294–299

    PubMed  Google Scholar 

  23. 23.

    Lindsey RW, Gutowski WT (1986) The migration of a broken pin following fixation of the acromioclavicular joint: a case report and review of the literature. Orthopedics 9:413–416

    CAS  PubMed  Google Scholar 

  24. 24.

    Lo IK, Burkhart SS, Parten PM (2004) Surgery about the coracoid: neurovascular structures at risk. Arthroscopy 20:591–595

    PubMed  Google Scholar 

  25. 25.

    Lowe GP, Fogarty MJ (1977) Acute acromioclavicular joint dislocation: result of operative treatment with the Bosworth screw. Aust NZ J Surg 47:664–667

    Article  CAS  Google Scholar 

  26. 26.

    Mayr E, Braun W, Eber W et al (1999) Treatment of acromioclavicular joint separations: central Kirschner-wire and PDS-augmentation. Unfallchirurg 102:278–286

    Article  CAS  PubMed  Google Scholar 

  27. 27.

    Mlasowsky B, Brenner P, Duben W et al (1988) Repair of complete acromioclavicular dislocation (Tossy stage III) using Balser’s hook plate combined with ligament sutures. Injury 19:227–232

    Article  CAS  PubMed  Google Scholar 

  28. 28.

    Motamedi AR, Blevins FT, Willis MC et al (2000) Biomechanics of the coracoclavicular ligament complex and augmentations used in its repair and reconstruction. Am J Sports Med 28:380–384

    CAS  PubMed  Google Scholar 

  29. 29.

    Norrell H Jr, Llewellyn RC (1965) Migration of a threaded Steinmann pin from an acromioclavicular joint into the spinal canal: a case report. J Bone Joint Surg Am 47:1024–1026

    PubMed  Google Scholar 

  30. 30.

    Paavolainen P, Bjorkenheim JM, Paukku P et al (1983) Surgical treatment of acromioclavicular dislocation: a review of 39 patients. Injury 14:415–420

    Article  CAS  PubMed  Google Scholar 

  31. 31.

    Rockwood CA Jr, Williams GR Jr, Young DC (1988) Disorder of the acromioclavicular joint. In: Rockwood CA Jr, Matsen FAIII (eds) The shoulder, 2nd edn. WB Saunders, Philadelphia, pp 483–553

    Google Scholar 

  32. 32.

    Rockwood CA Jr (1984) Injuries to the acromioclavicular joint. In: Rockwood CA Jr, Green DP (eds) Fractures in adults, 2nd edn. JB Lippincott, Philadelphia, pp 860–910

    Google Scholar 

  33. 33.

    Shin SJ, Yun YH, Yoo JD (2008) Coracoclavicular ligament reconstruction for acromioclavicular dislocation using 2 suture anchors and coracoacromial ligament transfer. Am J Sports Med 37:346–351

    Article  PubMed  Google Scholar 

  34. 34.

    Sim E, Schwarz N, Hocker K et al (1995) Repair of complete acromioclavicular separations using the acromioclavicular-hook plate. Clin Orthop Relat Res 314:134–142

    PubMed  Google Scholar 

  35. 35.

    Tischer T, Salzmann GM, El-Azab H et al (2009) Incidence of associated injuries with acute acromioclavicular joint dislocations types III through V. Am J Sports Med 37:136–139

    Article  PubMed  Google Scholar 

  36. 36.

    Walz L, Salzmann GM, Fabbro T et al (2008) The anatomic reconstruction of acromioclavicular joint dislocations using 2 TightRope devices. Am J Sports Med 36:2398–2406

    Article  PubMed  Google Scholar 

  37. 37.

    Wellmann M, Zantop T, Petersen W (2007) Minimally invasive coracoclavicular ligament augmentation with a flip button/polydioxanone repair for treatment of total acromioclavicular joint dislocation. Arthroscopy 23:1132.e1–1132.e5

    Google Scholar 

  38. 38.

    Wellmann M, Zantop T, Weimann A et al (2007) Biomechanical evaluation of minimally invasive repairs for complete AC joint dislocation. Am J Sports Med 35:955–961

    Article  PubMed  Google Scholar 

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Correspondence to Ettore Vulcano.

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Murena, L., Vulcano, E., Ratti, C. et al. Arthroscopic treatment of acute acromioclavicular joint dislocation with double flip button. Knee Surg Sports Traumatol Arthrosc 17, 1511–1515 (2009). https://doi.org/10.1007/s00167-009-0838-5

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Keywords

  • Arthroscopy
  • Acromioclavicular joint
  • Coracoclavicular
  • Dislocation
  • Endobutton