Advertisement

Vascular graft employment in the surgical treatment of acute and chronic acromio-clavicular dislocation

  • Matteo Vitali
  • Alberto Pedretti
  • Nadim Naim RodriguezEmail author
  • Alessandro Franceschi
  • Gianfranco Fraschini
Technical Note • SHOULDER - TRAUMA

Abstract

Objectives

To show the efficiency and safety of a surgical treatment in both acute and chronic acromio-clavicular junction (ACJ) dislocations.

Design

Retrospective.

Setting

Department of Orthopedics and Traumatology at IRCCS San Raffaele Hospital.

Patients/participants

This study was performed on 37 subjects classified as Rockwood grade III–V or Tossy III ACJ dislocation.

Procedure

The surgical treatment was carried out by placing a vascular graft (GorePropaten®) between the tip of the coracoid process and the mid-lateral side of the clavicle with two temporary percutaneous K-wires positioned in a parallel manner in the AC ligament through the acromion and clavicle for 30 days to improve stability.

Main outcome measurements

Outcomes were assessed using the Constant Shoulder (CS) score, DASH score, subjective satisfaction, and stability of AC joint at 24 months. UCLA scores taken preoperatively and at 15-month follow-up were used to perform statistical analysis significance using a control group treated conservatively. Postoperative X-rays were examined to assess joint stability after 24 months.

Results

Preoperative CS score was 51 ± 12 in the acute group and 55 ± 15 in the chronic group. Follow-up mean CS score was 88 ± 11 in the acute group and 82 ± 20 in the chronic group at 24 months. Preoperative DASH score was 19 ± 3 in the acute group and 14 ± 5 in the chronic group. Mean DASH score was 3.60 ± 7 in the acute group and 6.42 ± 6 in the chronic group. Preoperative UCLA scores were 14.6 ± 2 and 15 ± 7 in the acute group and chronic group, respectively. At 15-month follow-up, UCLA scores of 28.1 ± 1.9 and 27.7 ± 1 in the acute and chronic group, respectively, showed a significant improvement (p < 0.05) compared with UCLA scores taken preoperatively and at 15 months in the control group treated conservatively of 15.8 ± 0.9 and 16.2 ± 0.9, respectively. Results were good to excellent in 10 patients from the acute group and 23 patients from the chronic group who presented clinical stability of the AC joint without pain. Postoperative radiography showed anatomical repositioning of the ACJ and joint stability in 35 cases, but only two patients showed a partial re-dislocation at the 24-month X-ray follow-up. No infections, either deep or superficial, or nerve palsies were reported.

Conclusions

Given the results obtained during the study and the response of the patients in both acute and chronic groups, the authors found that the employment of a vascular graft combined with temporary percutaneous K-wires is able to improve the patient’s clinical outcome following an acromio-clavicular joint dislocation.

Keywords

Acromioclavicular joint Disclocation Acute Chronic Vascular graft Acromioclavicular disclocation 

Notes

Compliance with ethical standards

Conflict of interest

The authors hereby state that they have no conflict of interest in regards to this paper.

References

  1. 1.
    Fukuda K, Craig EV, An KN et al (1986) Biomechanical study of the ligamentous system of the acromioclavicular joint. J Bone Joint Surg Am 68:434–440PubMedGoogle Scholar
  2. 2.
    Rockwood CA, Williams GR, Young DC (1996) Injuries to the acromioclavicular joint. In: Rockwood CA, Green DP, Bucholz RW (eds) Fractures in adults, vol 2, 4th edn. Lippincott-Raven Pub Publishers, Philadelphia, pp 1341–1413Google Scholar
  3. 3.
    Horn JS (1954) The traumatic anatomy and treatment of acute acromioclavicular dislocation. J Bone Joint Surg Br 36:194–1201PubMedGoogle Scholar
  4. 4.
    Lemos MJ (1998) The evaluation and treatment of the injured acromioclavicular joint in athletes. Am J Sports Med 26:137–144PubMedGoogle Scholar
  5. 5.
    Lizaur A, Marco L, Cebrian R (1994) Acute dislocation of the acromioclavicular joint. Traumatic anatomy and the importance of deltoid and trapezius. J Bone Joint Surg Br 76:602–606PubMedGoogle Scholar
  6. 6.
    Dias JJ, Gregg PJ (1991) Acromioclavicular joint injuries in sport. Recommendations for treatment. Sports Med 11(2):125–132CrossRefPubMedGoogle Scholar
  7. 7.
    Kim S, Blank A, Strauss E (2014) Management of type 3 acromioclavicular joint dislocations. Current controversies. Bull Hosp Jt Dis 72(1):53–60gGoogle Scholar
  8. 8.
    Epstein D, Day M, Rokito A (2012) Current concepts in the surgical management of acromioclavicular joint injuries. Bull NYU Hosp Jt Dis 70(1):11–24PubMedGoogle Scholar
  9. 9.
    Bannister GC, Wallace WA, Stableforth PG, Hutson MA (1989) The management of acute acromioclavicular dislocation. A randomized prospective controlled trial. J Bone Joint Surg Br 71(5):848–850PubMedGoogle Scholar
  10. 10.
    Phillips AM, Smart C, Groom AFG (1998) Acromioclavicular dislocation. Conservative or surgical therapy. Clin Orthop Relat Res 353:10–17CrossRefPubMedGoogle Scholar
  11. 11.
    Klepps SJ, Shenton DW (2007) Current treatment of acromioclavicular separations. Curr Opin Orthop 18:373–379CrossRefGoogle Scholar
  12. 12.
    Tossy JD, Mead NC, Sigmond HM (1963) Acromioclavicular separations: useful and practical classification for treatment. Clin Orthop Relat Res 28:111–119PubMedGoogle Scholar
  13. 13.
    Fremerey RW, Lobenhoffer P, Ramacker K, Gerich T, Skutek M, Bosch U (2001) Acute acromioclavicular joint dislocation: operative or conservative therapy? Unfallchirurg 104(4):294–299CrossRefPubMedGoogle Scholar
  14. 14.
    Glick JM, Milburn LJ, Haggerty JF, Nishimoto D (1977) Dislocated acromioclavicular joint: follow-up study of 35 unreduced acromioclavicular dislocations. Am J Sports Med 5(6):264–270CrossRefPubMedGoogle Scholar
  15. 15.
    Dias JJ, Steingold RF, Richardson RA, Tesfayohannes B, Gregg PJ (1987) The conservative treatment of acromioclavicular dislocation. Review after five years. J Bone Joint Surg Br 69(5):719–722PubMedGoogle Scholar
  16. 16.
    Rawes ML, Dias JJ (1996) Long term results of conservative treatment for acromioclavicular dislocations. J Bone Joint Surg Br 78:410–412PubMedGoogle Scholar
  17. 17.
    Erak S, Pelletier MH, Woods KR et al (2008) Acromioclavicular reconstructions with hamstring tendon grafts: a comparative biomechanical study. J Shoulder Elbow Surg 17(5):772–778CrossRefPubMedGoogle Scholar
  18. 18.
    Costic RS, Labriola JE, Rodosky MW, Debski RE (2004) Biomechanical rationale for development of anatomical reconstructions of coracoclavicular ligaments after complete acromioclavicular joint dislocations. Am J Sports Med 32:1929–1936CrossRefPubMedGoogle Scholar
  19. 19.
    Weaver J, Dunn H (1972) Treatment of acromioclavicular injuries, especially complete acromioclavicular separation. J Bone Joint Surg Am 54(6):1187–1194PubMedGoogle Scholar
  20. 20.
    Beitzel K, Mazzocca AD, Bak K, Itoi E, Kibler WB, Mirzayan R, Imhoff AB, Calvo E, Arce G, Shea K, and The upper extremity committee of ISAKOS: ISAKOS upper extremity committee consensus statement on the need for diversification of the Rockwood classification for acromioclavicular joint injuriesGoogle Scholar
  21. 21.
    Choi SW, Lee TJ, Moon KH et al (2008) Minimally invasive coracoclavicular stabilization with suture anchors for acute acromioclavicular dislocation. Am J Sports Med 36(5):961–965CrossRefPubMedGoogle Scholar
  22. 22.
    Salzmann GM, Walz L, Buchmann S et al (2010) Arthroscopically assisted 2-bundle anatomical reduction of acute acromioclavicular joint separations. Am J Sports Med 38(6):1179–1187CrossRefPubMedGoogle Scholar
  23. 23.
    Walz L, Salzmann GM, Fabbro T et al (2008) The anatomic reconstruction of acromioclavicular joint dislocations using 2 TightRope devices: a biomechanical study. Am J Sports Med 36(12):2398–2406CrossRefPubMedGoogle Scholar
  24. 24.
    Bosworth BM (1948) Acromioclavicular dislocation; end-results of screw suspension treatment. Ann Surg 127(1):98–111PubMedCentralCrossRefPubMedGoogle Scholar
  25. 25.
    Sim E, Schwarz N, Hocker K et al (1995) Repair of complete acromioclavicular separations using the acromioclavicular-hook plate. Clin Orthop Relat Res 314:134–142PubMedGoogle Scholar
  26. 26.
    Jones HP, Lemos MJ, Schepsis AA (2001) Salvage of failed acromioclavicular joint reconstruction using autogenous semitendinosus tendon from the knee. Surgical technique and case report. Am J Sports Med 29:234–237PubMedGoogle Scholar
  27. 27.
    Lee SJ, Nicholas SJ, Akizuki KH, McHugh MP, Kremenic IJ, Ben-Avi S (2003) Reconstruction of the coracoclavicular ligaments with tendon grafts: a comparative biomechanical study. Am J Sports Med 31:648–655PubMedGoogle Scholar
  28. 28.
    Gonzalez R, Damacen H, Nyland J et al (2007) Acromioclavicular joint reconstruction using peroneus brevis tendon allograft. Arthroscopy 23(7):788.e1–788.e4CrossRefGoogle Scholar
  29. 29.
    Goldberg JA, Viglione W, Cumming WJ et al (1987) Review of coracoclavicular ligament reconstruction using Dacron graft material. Aust N Z J Surg 57:441–445CrossRefPubMedGoogle Scholar
  30. 30.
    Milka S, Wojcik B, Nowak R (1994) Early results of coracoclavicular ligament reconstruction with carbon fiber prosthesis in patients with acromioclavicular dislocation. Chir Narzadow Ruchu Ortop Pol 59:491–496PubMedGoogle Scholar
  31. 31.
    Muller Mai CM, Gross UM (1991) Histological and ultrastructural observations at the interface of expanded polytetrafluorethylene anterior cruciate ligament implants. J Appl Biomater Spring 2(1):29–35CrossRefGoogle Scholar
  32. 32.
    Farber AJ, Cascio BM, Wilckens JH (2008) Type III acromioclavicular separation: rationale for anatomical reconstruction. Am J Orthop 37:349–355PubMedGoogle Scholar
  33. 33.
    Tauber M, Gordon K, Koller H et al (2009) Semitendinosus tendon graft versus a modified Weaver-Dunn procedure for acromioclavicular joint reconstruction in chronic cases: a prospective comparative study. Am J Sports Med 37:181–190CrossRefPubMedGoogle Scholar
  34. 34.
    Fraschini G, Ciampi P, Scotti C, Ballis R, Peretti GM (2010) Surgical treatment of chronic cromioclavicular dislocation: comparison between two surgical procedures for anatomic reconstruction. Injury Int J Care Injured 41:1103–1106CrossRefGoogle Scholar

Copyright information

© Springer-Verlag France 2015

Authors and Affiliations

  • Matteo Vitali
    • 1
  • Alberto Pedretti
    • 1
  • Nadim Naim Rodriguez
    • 1
    Email author
  • Alessandro Franceschi
    • 1
  • Gianfranco Fraschini
    • 1
  1. 1.Department of Orthopedics and Traumatology, San Raffaele HospitalVita-Salute San Raffaele UniversityMilanItaly

Personalised recommendations