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Arthroscopically assisted single tunnel reconstruction for acute high-grade acromioclavicular joint dislocation with an additional acromioclavicular joint cerclage

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Abstract

Purpose

Purpose of this study was to demonstrate that a single tunnel reconstruction of high-grade acromioclavicular (AC) joint instabilities with implants of the second generation is sufficient for stabilisation, especially in combination with an AC cerclage.

Methods

Patients with an acute AC-joint dislocation type Rockwood III-B and V were included. Besides clinical follow-up examination, radiographs were analysed. The functional outcome measures were Constant Score (CS), Taft score (TS), ACJI score and patient’s satisfaction. Horizontal instability was evaluated by clinical examination and radiological with an Alexander view.

Results

Thirty-five patients with a mean follow-up of 29 months were included. Ninety-seven per cent were satisfied with their result, with an average Subjective Shoulder Value of 90%. The CS averaged at 90 ± 10 points, TS at 11 ± 1 points and ACJI at 78 ± 18 points. Radiologically, 3 of 29 patients (10%) showed a persisting horizontal instability. The coracoclavicular (CC) distance improved from 22 preoperative to 10 mm postoperative, which was comparable to the contralateral side (10 mm, p = 0.103). At follow-up the CC distance increased to 13 mm (p = 0.0001).

Conclusion

AC-joint stabilisation with a single tunnel reconstruction using a second-generation implant results in good to excellent clinical results with high patient satisfaction. The additional AC augmentation improves stability in horizontal instable AC-joints and is recommended in all high-grade AC joint stabilisations. Nonetheless, reduction was slightly lost over time due to an elongation or suture failure of the coraco-clavicular fixation.

Level of evidence

IV.

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Data availability

The data that support the findings of this study are available from the corresponding author, [G.J.] upon reasonable request.

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Authors and Affiliations

  1. Department for Orthopaedic Surgery and Traumatology, DIAKOVERE Friederikenstift, Humboldtstraße 5, 30169, Hannover, Germany

    Gunnar Jensen, Rony-Orijit Dey Hazra, Mireille Al-Ibadi, Helmut Lill & Alexander Ellwein

  2. Unfallkrankenhaus Berlin, Warener Str. 7, 12683, Hannover, Lower Saxony, Germany

    Katharina Salmoukas

  3. Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus, building W1, 48149, Münster, Germany

    Jan Christoph Katthagen

  4. Department for Orthopaedic Surgery, Medical School Hannover, DIAKOVERE Annastift, Anna-von-Borries-Straße 1-7, 30625, Hannover, Germany

    Gunnar Jensen & Alexander Ellwein

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  1. Gunnar Jensen
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  2. Rony-Orijit Dey Hazra
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Contributions

AE, GJ, JCK and R-ODH were responsible for conception and design of the study. AE, GJ, R-ODH and JCK were responsible for analysis and interpretation of data. AE and GJ drafted the article. HL, MA, KS, AE, GJ, JCK and R-ODH were responsible for final approval of the version to be submitted. MA and KS were responsible for acquisition of data. JCK, R-ODH and HL were responsible for revising the article critically for important intellectual content.

Corresponding author

Correspondence to Gunnar Jensen.

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Conflict of interest

Helmut Lill is consultant for Arthrex. Jan Christoph Katthagen and Alexander Ellwein received speaker’s honorarium from Arthrex. All other authors declared that they have no conflict of interest.

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All patients signed informed consent regarding publishing their data.

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All patients approved the study with written informed consent.

Ethical approval

The study was performed in accordance with the ethical standards of the local ethics committee (Ethikkommission der MHH, No 1207–2011) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Jensen, G., Dey Hazra, RO., Al-Ibadi, M. et al. Arthroscopically assisted single tunnel reconstruction for acute high-grade acromioclavicular joint dislocation with an additional acromioclavicular joint cerclage. Eur J Orthop Surg Traumatol 33, 1185–1192 (2023). https://doi.org/10.1007/s00590-022-03271-6

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  • DOI: https://doi.org/10.1007/s00590-022-03271-6

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