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Combined arthroscopically assisted coraco- and acromioclavicular stabilization of acute high-grade acromioclavicular joint separations

Abstract

Purpose and hypothesis

Due to high rate of persisting dynamic posterior translation (DPT) following isolated coracoclavicular double-button technique for reconstruction of the acromioclavicular (AC) joint reported in the literature, an additional acromioclavicular cerclage was added to the procedure. The aim of this study was to evaluate the clinical and radiological results of patients with high-grade AC-joint instability treated with a double TightRope technique with an additional percutaneous acromioclavicular cerclage.

Methods

Fifty-nine patients (6 f/53 m; median age 38.3 (range 21.5–63.4 years) who sustained an acute high-grade AC-joint dislocation (Rockwood type V) were treated using the above-mentioned technique. At the final follow-up, the constant score (CS), the subjective shoulder value (SSV), the Taft score (TF) and the acromioclavicular joint instability score (ACJI) as well as bilateral anteroposterior stress views with 10 kg of axial load and bilateral modified Alexander views were obtained.

Results

At a median follow-up of 26.4 (range 20.3–61.0) months, 34 patients scored a median of 90 (33–100) points in the CS, 90 (25–100) % in the SSV, 11 (4–12) points in the TF and 87 (43–100) points in the ACJI. The coracoclavicular (CC) distance was 12.1 (6.5–19.8) mm and the CC difference 2.0 (0.0–11.0) mm. Two patients (5.8%) showed a complete DPT of the AC joint, and fourteen patients (41.1%) displayed a partial DPT. The overall revision rate was 11.7%. Two patients presented implant irritation, one patient a recurrent instability, and one patient suffered from a local infection.

Conclusion

The arthroscopically assisted and image-intensifier-controlled double TightRope technique with an additional percutaneous acromioclavicular cerclage leads to good and excellent clinical results after a follow-up of 2 years. The incidence of persisting dynamic horizontal translation is lower compared to isolated coracoclavicular stabilization. Thus, we recommend using the double TightRope implant with an additional acromioclavicular cerclage.

Level of evidence

IV.

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Acknowledgements

The authors would like to state that no outside funding or grants were received that assisted in the above-mentioned study. Carmen Hann, Natascha Kraus, Marvin Minkus and Nina Maziak, their immediate family, and any research foundation with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article. Markus Scheibel received consultant payments from Arthrex Company related to this work. This study was approved by the Local Ethical Committee (EA1/298/12).

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Correspondence to Markus Scheibel.

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Conflict of interest

Carmen Hann, Natascha Kraus, Marvin Minkus and Nina Maziak declare that they have no conflict of interest. Markus Scheibel is consultant for Arthrex.

Funding

No external source of funding was used.

Ethical approval

The local ethical committee of the Charité Universitaetsmedizin Berlin approved the study protocol (EA1/298/12).

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Patients gave written informed consent.

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Hann, C., Kraus, N., Minkus, M. et al. Combined arthroscopically assisted coraco- and acromioclavicular stabilization of acute high-grade acromioclavicular joint separations. Knee Surg Sports Traumatol Arthrosc 26, 212–220 (2018). https://doi.org/10.1007/s00167-017-4643-2

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Keywords

  • Acromioclavicular joint dislocation
  • Acromioclavicular joint instability
  • Arthroscopic coracoclavicular stabilization
  • TightRope