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Functional reconstruction of chronic acromioclavicular joint separation using a double suture technique combined with semitendinosus autograft

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A Correction to this article was published on 18 March 2024

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Abstract

Purpose

We present the functional and clinical results of a combined surgical technique that functionally restores chronic Acromioclavicular Joint Instability (AJI). The method combines a double-looped suture fixation augmented with a semitendinosus autograft.

Methods

Between 2017 and 2021, 15 patients were treated using the surgical technique. All patients suffered an Acromioclavicular Joint Separation that remained untreated for at least 6 (6–16) weeks after the initial injury. Four Ethibond sutures were passed below the coracoid process and through a 4.5 drill hole in the clavicle. The sutures provided adequate horizontal and vertical reduction and stabilization of the clavicle. A semitendinosus autograft was passed below the coracoid process and looped around the clavicle. The remaining graft limbs were used to reconstruct the acromioclavicular capsule. Patients were radiologically evaluated with bilateral anteroposterior (AP), Zanca, and Alexander views. The clinical evaluation was based on the Acromioclavicular Joint Instability Score and the Constant-Murley Score.

Results

The mean follow-up period was 31.2 months (17–61). The mean last ACJIS and CMS scores were 96 (90–100) and 97.67 (87–100), respectively. Reduction of the clavicle was radiologically confirmed in all cases throughout the follow-up period. AC arthritis was reported in 1 case without associated clinical symptoms. No significant complications were reported, and all patients returned to the pre-injury activity level.

Conclusion

The presented functional reconstruction of the AC joint disruption in chronic cases is an effective and secure method with low complication rates and good clinical results.

Level of Evidence III

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References

  1. Kiel J, Taqi M, Kaiser K (2022) Acromioclavicular Joint Injury. In: StatPearls. StatPearls Publishing. Retrieved from 14 Jan 2023 from https://www.ncbi.nlm.nih.gov/books/NBK493188/

  2. Rockwood CA Jr (1984) Fractures and dislocations of the shoulder. In: Rockwood CA Jr, Green DP (eds) Fractures in adults. PA: Lippincott, Philadelphia, pp 860–910

  3. Gorbaty JD, Hsu JE, Gee AO (2016) Classifications in brief: rockwood classification of acromioclavicular joint separations. Clin. Orthop. Relat. Res. 475(1):283–287. https://doi.org/10.1007/s11999-016-5079-6

    Article  PubMed  PubMed Central  Google Scholar 

  4. Dyrna F, Imhoff FB, Haller B, Braun S, Obopilwe E, Apostolakos JM, Morikawa D, Imhoff AB, Mazzocca AD, Beitzel K (2018) Primary stability of an acromioclavicular joint repair is affected by the type of additional reconstruction of the acromioclavicular capsule. Am J Sports Med 46(14):3471–3479. https://doi.org/10.1177/0363546518807908

    Article  PubMed  Google Scholar 

  5. Hislop P, Sakata K, Ackland DC, Gotmaker R, Evans MC (2019) Acromioclavicular joint stabilization: a biomechanical study of bidirectional stability and strength. Orthop J Sports Med 7(4):232596711983675. https://doi.org/10.1177/2325967119836751

    Article  Google Scholar 

  6. Dyrna FGE, Imhoff FB, Voss A, Braun S, Obopilwe E, Apostolakos JM, Morikawa D, Comer B, Imhoff AB, Mazzocca AD, Beitzel K (2018) The integrity of the acromioclavicular capsule ensures physiological centering of the acromioclavicular joint under rotational loading. Am J Sports Med 46(6):1432–1440. https://doi.org/10.1177/0363546518758287

    Article  PubMed  Google Scholar 

  7. Morikawa D, Dyrna F, Cote MP, Johnson JD, Obopilwe E, Imhoff FB, Beitzel K, Mazzocca AD, Scheiderer B (2018) Repair of the entire superior acromioclavicular ligament complex best restores posterior translation and rotational stability. Knee Surg Sports Traumatol Arthrosc 27(12):3764–3770. https://doi.org/10.1007/s00167-018-5205-y

    Article  PubMed  Google Scholar 

  8. Gumina S, Carbone S, Postacchini F (2009) Scapular dyskinesis and SICK scapula syndrome in patients with chronic type III acromioclavicular dislocation. Arthroscopy 25(1):40–45. https://doi.org/10.1016/j.arthro.2008.08.019

    Article  PubMed  Google Scholar 

  9. Tauber M, Valler D, Lichtenberg S, Magosch P, Moroder P, Habermeyer P (2015) Arthroscopic stabilization of chronic acromioclavicular joint dislocations. Am J Sports Med 44(2):482–489. https://doi.org/10.1177/0363546515615583

    Article  PubMed  Google Scholar 

  10. Garofalo R, Ceccarelli E, Castagna A, Calvisi V, Flanagin B, Conti M, Krishnan SG (2017) Open capsular and ligament reconstruction with semitendinosus hamstring autograft successfully controls superior and posterior translation for type V acromioclavicular joint dislocation. Knee Surg Sports Traumatol Arthrosc 25(7):1989–1994. https://doi.org/10.1007/s00167-017-4509-7

    Article  PubMed  Google Scholar 

  11. Beitzel K, Cote MP, Apostolakos J, Solovyova O, Judson CH, Ziegler CG, Edgar CM, Imhoff AB, Arciero RA, Mazzocca AD (2013) Current concepts in the treatment of acromioclavicular joint dislocations. Arthroscopy 29(2):387–97. https://doi.org/10.1016/j.arthro.2012.11.023

    Article  PubMed  Google Scholar 

  12. Nolte PC, Lacheta L, Dekker TJ, Elrick BP, Millett PJ (2020) Optimal management of acromioclavicular dislocation: current perspectives. Orthop Res Rev 12:27–44. https://doi.org/10.2147/orr.s218991

    Article  PubMed  PubMed Central  Google Scholar 

  13. Grutter PW, Petersen SA (2005) Anatomical acromioclavicular ligament reconstruction. Am J Sports Med 33(11):1723–1728. https://doi.org/10.1177/0363546505275646

    Article  PubMed  Google Scholar 

  14. Mazzocca AD, Conway JE, Johnson S, Rios CG, Dumonski ML, Santangelo SA, Arciero RA (2004) The anatomic coracoclavicular ligament reconstruction. Oper Tech Sports Med 12(1):56–61. https://doi.org/10.1053/j.otsm.2004.04.001

    Article  Google Scholar 

  15. 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(5):648–654. https://doi.org/10.1177/03635465030310050301

    Article  PubMed  Google Scholar 

  16. Saccomanno MF, Fodale M, Capasso L, Cazzato G, Milano G (2014) Reconstruction of the coracoclavicular and acromioclavicular ligaments with semitendinosus tendon graft: a pilot study. Joints 2(1):6–14

    PubMed  PubMed Central  Google Scholar 

  17. 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(2):236–246. https://doi.org/10.1177/0363546505281795

    Article  PubMed  Google Scholar 

  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(8):1929–1936. https://doi.org/10.1177/0363546504264637

    Article  PubMed  Google Scholar 

  19. Hohmann E, Tetsworth K (2023) Clinical outcomes for grades III-V acromioclavicular dislocations favor double-button fixation compared to clavicle hook plate fixation: a systematic review and meta-analysis. Eur J Orthop Surg Traumatol 33(7):2831–2846. https://doi.org/10.1007/s00590-023-03492-3

    Article  PubMed  PubMed Central  Google Scholar 

  20. Spiegl UJ, Smith SD, Euler SA, Dornan GJ, Millett PJ, Wijdicks CA (2014) Biomechanical consequences of coracoclavicular reconstruction techniques on clavicle strength. Am J Sports Med 42(7):1724–1730. https://doi.org/10.1177/0363546514524159

    Article  PubMed  Google Scholar 

  21. Rylander LS, Baldini T, Mitchell JJ, Messina M, Justl Ellis IA, McCarty EC (2014) Coracoclavicular ligament reconstruction: coracoid tunnel diameter correlates with failure risk. Orthopedics 37(6):e531-535. https://doi.org/10.3928/01477447-20140528-52

    Article  PubMed  Google Scholar 

  22. Dimakopoulos P, Panagopoulos A, Syggelos SA, Panagiotopoulos E, Lambiris E (2006) Double-loop suture repair for acute acromioclavicular joint disruption. Am J Sports Med 34(7):1112–1119. https://doi.org/10.1177/0363546505284187

    Article  PubMed  Google Scholar 

  23. Scheibel M, Dröschel S, Gerhardt C, Kraus N (2011) Arthroscopically assisted stabilization of acute high-grade acromioclavicular joint separations. Am J Sports Med 39(7):1507–1516. https://doi.org/10.1177/0363546511399379

    Article  PubMed  Google Scholar 

  24. Reintgen C, Gerlach EB, Schoch BS, Mamelson K, Wright TW, Farmer KW, King JJ (2020) What outcome measures are reported in the management of acromioclavicular joint injuries? Orthop J Sports Med 8(1):2325967119892322. https://doi.org/10.1177/2325967119892322

    Article  PubMed  PubMed Central  Google Scholar 

  25. Dimakopoulos P, Panagopoulos A (2007) Functional coracoclavicular stabilization for acute acromioclavicular joint disruption. Orthopedics 30(2):103–108. https://doi.org/10.3928/01477447-20070201-08

    Article  PubMed  Google Scholar 

  26. Panagopoulos A, Fandridis E, Rose GD, Ranieri R, Castagna A, Kokkalis ZT (2020) Long-term stability of coracoclavicular suture fixation for acute acromioclavicular joint separation. Knee Surg Sports Traumatol Arthrosc 29(7):2103–2109. https://doi.org/10.1007/s00167-020-06158-3

    Article  PubMed  Google Scholar 

  27. Thomas K, Litsky A, Jones G, Bishop JY (2011) Biomechanical comparison of Coracoclavicular reconstructive techniques. Am J Sports Med 39(4):804–810. https://doi.org/10.1177/0363546510390482

    Article  PubMed  Google Scholar 

  28. Beitzel K, Mazzocca AD (2014) Offen anatomische Rekonstruktion der chronischen Akromioklavikularinstabilität. Oper Orthop Traumatol 26(3):237–244. https://doi.org/10.1007/s00064-013-0277-9

    Article  CAS  PubMed  Google Scholar 

  29. Wellmann M, Kempka JP, Schanz S, Zantop T, Waizy H, Rashke MJ, Petersen W (2009) Coracoclavicular ligament reconstruction: biomechanical comparison of tendon graft repairs to a synthetic double bundle augmentation. Knee Surg Sports Traumatol Arthrosc 17(5):521–528. https://doi.org/10.1007/s00167-009-0737-9

    Article  PubMed  Google Scholar 

  30. Kibler WB, Sciascia AD, Morris BJ, Dome DC (2017) Treatment of Symptomatic Acromioclavicular Joint Instability by a Docking Technique: Clinical Indications, Surgical Technique, and Outcomes. Arthroscopy 33(4):696-708e2. https://doi.org/10.1016/j.arthro.2016.08.023

    Article  PubMed  Google Scholar 

  31. Coale RM, Hollister SJ, Dines JS, Allen AA, Bedi A (2013) Anatomic considerations of transclavicular-transcoracoid drilling for coracoclavicular ligament reconstruction. J Shoulder Elbow Surg 22(1):137–144. https://doi.org/10.1016/j.jse.2011.12.008

    Article  PubMed  Google Scholar 

  32. Xue C, Zhang M, Zheng TS, Zhang GY, Fu P, Fang JH, Li X (2013) Clavicle and coracoid process drilling technique for truly anatomic coracoclavicular ligament reconstruction. Injury 44(10):1314–1320. https://doi.org/10.1016/j.injury.2013.06.022

    Article  PubMed  Google Scholar 

  33. Balke M, Wafaisade A, Hoeher J, Greshake O (2023) Minimally invasive reconstruction of acute acromioclavicular joint injuries using the Twin Bridge button system. Eur J Orthop Surg Traumatol 33(4):1349–1355. https://doi.org/10.1007/s00590-022-03293-0

    Article  PubMed  Google Scholar 

  34. Flint JH, Wade AM, Giuliani J, Rue JP (2013) Defining the terms acute and chronic in orthopaedic sports injuries: a systematic review. Am J Sports Med 42(1):235–241. https://doi.org/10.1177/0363546513490656

    Article  PubMed  Google Scholar 

  35. Muench LN, Kia C, Jerliu A, Murphy M, Berthold DP, Cote MP, Arciero RA, Mazzocca AD (2019) Functional and radiographic outcomes after anatomic coracoclavicular ligament reconstruction for type III/V acromioclavicular joint injuries. Orthop J Sports Med 7(11):232596711988453. https://doi.org/10.1177/2325967119884539

    Article  Google Scholar 

  36. Rolf O, Hann von Weyhern A, Ewers A, Boehm TD, Gohlke F (2007) Acromioclavicular dislocation Rockwood III–V: results of early versus delayed surgical treatment. Arch Orthop Trauma Surg 128(10):1153–1157. https://doi.org/10.1007/s00402-007-0524-3

    Article  PubMed  Google Scholar 

  37. Song T, Yan X, Ye T (2014) Comparison of the outcome of early and delayed surgical treatment of complete acromioclavicular joint dislocation. Knee Surg Sports Traumatol Arthrosc 24(6):1943–1950. https://doi.org/10.1007/s00167-014-3225-9

    Article  PubMed  Google Scholar 

  38. Borbas P, Churchill J, Ek ET (2019) Surgical management of chronic high-grade acromioclavicular joint dislocations: a systematic review. J Shoulder Elbow Surg 28(10):2031–2038. https://doi.org/10.1016/j.jse.2019.03.005

    Article  PubMed  Google Scholar 

  39. Cisneros LN, Reiriz JS (2017) Management of chronic unstable acromioclavicular joint injuries. J Orthop Traumatol 18(4):305–318. https://doi.org/10.1007/s10195-017-0452-0

    Article  PubMed  PubMed Central  Google Scholar 

  40. Weaver JK, Dunn HK (1972) Treatment of acromioclavicular injuries, especially complete acromioclavicular separation. J Bone Joint Surg Am 54(6):1187–1194

    Article  CAS  PubMed  Google Scholar 

  41. Rauschning W, Nordesjö LO, Nordgren B, Sahlstedt B, Wigren A (1980) Resection arthroplasty for repair of complete acromioclavicular separations. Arch Orthop Trauma Surg 97(3):161–164. https://doi.org/10.1007/BF00389721

    Article  CAS  PubMed  Google Scholar 

  42. Kawabe N, Watanabe R, Sato M (1984) Treatment of complete acromioclavicular separation by coracoacromial ligament transfer. Clin Orthop Relat Res 185:222–227

    Article  Google Scholar 

  43. Harris RI, Wallace AL, Harper GD, Goldberg JA, Sonnabend DH, Walsh WR (2000) Structural properties of the intact and the reconstructed coracoclavicular ligament complex. Am J Sports Med 28(1):103–108. https://doi.org/10.1177/03635465000280010201

    Article  CAS  PubMed  Google Scholar 

  44. Weinstein DM, McCann PD, McIlveen SJ, Flatow EL, Bigliani LU (1995) Surgical treatment of complete acromioclavicular dislocations. Am J Sports Med 23(3):324–331. https://doi.org/10.1177/036354659502300313

    Article  CAS  PubMed  Google Scholar 

  45. Giannotti S, Dell’osso G, Bugelli G, Cazzella N, Guido G (2013) Surgical treatment of acromioclavicular dislocation with LARS artificial ligament. Eur J Orthop Surg Traumatol 23(8):873–876. https://doi.org/10.1007/s00590-012-1113-x

    Article  CAS  PubMed  Google Scholar 

  46. Carofino BC, Mazzocca AD (2010) The anatomic coracoclavicular ligament reconstruction: surgical technique and indications. J Shoulder Elbow Surg 19(2 Suppl):37–46. https://doi.org/10.1016/j.jse.2010.01.004

    Article  PubMed  Google Scholar 

  47. Fauci F, Merolla G, Paladini P, Campi F, Porcellini G (2013) Surgical treatment of chronic acromioclavicular dislocation with biologic graft vs synthetic ligament: a prospective randomized comparative study. J Clin Orthop Trauma 14(4):283–290. https://doi.org/10.1007/s10195-013-0242-2

    Article  Google Scholar 

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Authors and Affiliations

  1. A Orthopedic Department, General Hospital of Athens G. Gennimatas, Athens, Greece

    Giannis Kotsalis & Kostantinos Giatroudakis

  2. Upper Limb & Microsurgery Department, KAT General Hospital, Athens, Greece

    Maria Ladogianni & Emmanouil Fandridis

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  1. Giannis Kotsalis
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Correspondence to Giannis Kotsalis.

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Kotsalis, G., Giatroudakis, K., Ladogianni, M. et al. Functional reconstruction of chronic acromioclavicular joint separation using a double suture technique combined with semitendinosus autograft. Eur J Orthop Surg Traumatol 34, 1635–1645 (2024). https://doi.org/10.1007/s00590-024-03850-9

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