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MUSCULOSKELETAL SURGERY

, Volume 102, Issue 1, pp 73–79 | Cite as

A comparison between two double-button endoscopically assisted surgical techniques for the treatment acute acromioclavicular dislocations

  • P. Vulliet
  • M. Le Hanneur
  • V. Cladiere
  • P. Loriaut
  • P. Boyer
Original Article
  • 188 Downloads

Abstract

Purpose

To compare clinical and radiological outcomes between two endoscopically assisted double-button techniques in high-grade acute acromioclavicular separations.

Methods

A retrospective single-center study was conducted in patients with acute acromioclavicular joint dislocation Rockwood types III and V, from 2009 to 2014. All were treated endoscopically, with a 1-year minimum follow-up. Two consecutive series were conducted; the first (TR group) received the TightRope® system, whereas last series (DB group) was treated with the Dog Bone® button technology (Arthrex, Naples, FL, USA). Primary endpoints were last follow-up values of Constant score (CS) and Quick-DASH (QD) score. Moreover, the posttraumatic displacement and its evolution were assessed on bilateral Zanca radiographs. A displacement of 5 mm or greater the day after surgery was considered as a lack of reduction; the same difference on last follow-up X-rays was considered as a loss of reduction.

Results

Forty patients were reviewed: 22 in the TR group and 18 in the DB group. After a mean follow-up of 27.7 ± 8.3 months, CS and QD averaged, respectively, 94.3 ± 4.4 and 2.0 ± 2.6 in the TR series, whereas they averaged, respectively, 95 ± 6.1 and 3.4 ± 3.3 in the DB series after a mean follow-up of 24.1 ± 5 months (PCS = 0.16, PQDS = 0.08). Lack of reduction and loss of reduction rates were significantly higher in the DB group, with P = 0.0005 and P < 0.0001, respectively.

Conclusions

Both techniques provided good to excellent functional outcomes. However, considering inferior radiological results using the Dog Bone® device, we would prefer the TightRope® device in acute acromioclavicular dislocations.

Level of evidence

IV: Therapeutic study—cases series.

Keywords

Acromioclavicular instability Arthroscopic stabilization Button TightRope Dog Bone 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interests. None of them has a financial interest in any of the products, devices or drugs mentioned in this manuscript. They have not received or will receive any financial aid, in any form, for this study, from any of the following organizations: National Institutes of Health (NIH); Wellcome Trust; Howard Hughes Medical Institute (HHMI); or other(s).

References

  1. 1.
    Beitzel K, Cote MP, Apostolakos J et al (2013) Current concepts in the treatment of acromioclavicular joint dislocations. Arthroscopy 29:387–397CrossRefPubMedGoogle Scholar
  2. 2.
    Rockwood CA (1984) Injuries to the acromioclavicular joint. In: Rockwood CA, Green DP (eds) Fractures in adults, vol 1, 2nd edn. JB Lippincott, Philadelphia, pp 860–910Google Scholar
  3. 3.
    Tauber M (2013) Management of acute acromioclavicular joint dislocations: current concepts. Arch Orthop Trauma Surg 133:985–995CrossRefPubMedGoogle Scholar
  4. 4.
    Korsten K, Gunning AC, Leenen LP (2014) Operative or conservative treatment in patients with Rockwood type III acromioclavicular dislocation: a systematic review and update of current literature. Int Orthop 38:831–838CrossRefPubMedGoogle Scholar
  5. 5.
    Epstein D, Day M, Rokito A (2012) Current concepts in the surgical management of acromioclavicular joint injuries. Bull NYU Hosp Jt Dis 70:11–24PubMedGoogle Scholar
  6. 6.
    Jari R, Costic RS, Rodosky MW, Debski RE (2004) Biomechanical function of surgical procedures for acromioclavicular joint dislocations. Arthroscopy 20:237–245CrossRefPubMedGoogle Scholar
  7. 7.
    Wellmann M, Zantop T, Weimenn A, Raschke MJ, Petersen W (2007) Biomechanical evaluation of minimally invasive repairs for complete acromioclavicular joint dislocation. Am J Sports Med 35:955–961CrossRefPubMedGoogle Scholar
  8. 8.
    Walz L, Salzmann GM, Fabbro T, Eichhorn S, Imhoff AB (2008) The anatomic reconstruction of acromioclavicular joint dislocations using 2 TightRope devices: a biomechanical study. Am J Sports Med 36:2398–2406CrossRefPubMedGoogle Scholar
  9. 9.
    Beitzel K, Obopilwe E, Apostolakos J et al (2014) Rotational and translational stability of different methods for direct acromioclavicular ligament repair in anatomic acromioclavicular joint reconstruction. Am J Sports Med 42:2141–2148CrossRefPubMedGoogle Scholar
  10. 10.
    Barth J, Duparc F, Andrieu K et al (2015) French Society of Arthroscopy. Is coracoclavicular stabilisation alone sufficient for the endoscopic treatment of severe acromioclavicular joint dislocation (Rockwood types III, IV, and V)? Orthop Traumatol Surg Res 101:S297–S303CrossRefPubMedGoogle Scholar
  11. 11.
    Gstettner C, Tauber M, Hitzl W, Resch H (2008) Rockwood type III acromioclavicular dislocation: surgical versus conservative treatment. J Shoulder Elbow Surg 17:220–225CrossRefPubMedGoogle Scholar
  12. 12.
    Horst K, Garving C, Thometzki T et al (2016) Comparative study on the treatment of Rockwood type III acute acromioclavicular dislocation: clinical results from the TightRope® technique vs. K-wire fixation. Orthop Traumatol Surg Res pii:S1877-0568(16)30229-8Google Scholar
  13. 13.
    Darabos N, Gusic N, Darabos A, Bakota B, Miklic D (2015) Is AC TightRope fixation better than Bosworth screw fixation for minimally invasive operative treatment of Rockwood III AC joint injury? Injury 46:S113–S118CrossRefPubMedGoogle Scholar
  14. 14.
    Salzmann GM, Walz L, Buchmann S, Glabgly P, Venjakob A, Imhoff AB (2010) Arthroscopically assisted 2-bundle anatomical reduction of acute acromioclavicular joint separations. Am J Sports Med 38:1179–1187CrossRefPubMedGoogle Scholar
  15. 15.
    Rosslenbroich SB, Schliemann B, Schneider KN et al (2015) Minimally invasive coracoclavicular ligament reconstruction with a flip-button technique (MINAR): clinical and radiological midterm results. Am J Sports Med 43:1751–1757CrossRefPubMedGoogle Scholar
  16. 16.
    Nascimento AT, Claudio GK (2016) Functional and radiological evaluation of acute acromioclavicular dislocation treated with anchors without eyelet: comparison with other techniques. Rev Bras Orthop 51:561–568CrossRefGoogle Scholar
  17. 17.
    Lu D, Wang T, Chen H, Sun LJ (2016) A comparison of double Endobutton and triple Endobutton techniques for acute acromioclavicular joint dislocation. Orthop Traumatol Surg Res 102:891–895CrossRefPubMedGoogle Scholar
  18. 18.
    Faggiani M, Vasario GP, Mattei L, Calò MJ, Castoldi F (2016) Comparing mini-open and arthroscopic acromioclavicular joint repair: functional results and return to sport. Musculoskelet Surg 100:187–191CrossRefPubMedGoogle Scholar
  19. 19.
    Cano-Martinez JA, Nicolas-Serrano G, Bento-Gerard J, Picazo-Marin F, Andrés-Grau J (2016) Acute high-grade acromioclavicular dislocations treated with triple button device (MINAR): preliminary results. Injury 47:2512–2519CrossRefPubMedGoogle Scholar
  20. 20.
    Arthrex Incorporation. TightRope® technique [Arthrex Inc. web site]. https://www.arthrex.com/shoulder/ac-tightrope-technique. Accessed 1 Jan 2017
  21. 21.
    Arthrex Incorporation. Dog Bone® Button [Arthrex Inc. web site]. https://www.arthrex.com/shoulder/dog-bone-button. Accessed 1 Jan 2017
  22. 22.
    Beris A, Lykissas M, Kostas-Agnantis I, Vekris M, Mitsionis G, Korompilias A (2013) Management of acute acromioclavicular joint dislocation with a double-button fixation system. Injury 44:288–292CrossRefPubMedGoogle Scholar
  23. 23.
    Kraus N, Haas NP, Scheibel M, Gerhardt C (2013) Arthroscopically assisted stabilization of acute high-grade acromioclavicular joint separations in a coracoclavicular Double-TightRope technique: V-shaped versus parallel drill hole orientation. Arch Orthop Trauma Surg 133:1431–1440CrossRefPubMedGoogle Scholar
  24. 24.
    Venjakob AJ, Salzmann GM, Gabel F et al (2013) Arthroscopically assisted 2-bundle anatomic reduction of acute acromioclavicular joint separations: 58-month findings. Am J Sports Med 41:615–621CrossRefPubMedGoogle Scholar
  25. 25.
    Jensen G, Katthagen JC, Alvarado LE, Lill H, Voigt C (2014) Has the arthroscopically assisted reduction of acute AC joint separations with the double tight-rope technique advantages over the clavicular hook plate fixation? Knee Surg Sports Traumatol Arthrosc 22:422–430CrossRefPubMedGoogle Scholar
  26. 26.
    Glanzmann MC, Buchmann S, Audigé L, Kolling C, Flury M (2013) Clinical and radiographical results after double flip button stabilization of acute grade III and IV acromioclavicular joint separations. Arch Orthop Trauma Surg 133:1699–1707CrossRefPubMedGoogle Scholar
  27. 27.
    Scheibel M, Dröschel S, Gerhardt C, Kraus N (2011) Arthroscopically assisted stabilization of acute high-grade acromioclavicular joint separations. Am J Sports Med 39:1507–1516CrossRefPubMedGoogle Scholar
  28. 28.
    Brady P. The Dog Bone Technique for AC joint reconstruction. [Arthrex Inc. web site]. https://www.arthrex.com/resources/presentation/30it8OU_y0WLIgFXviksA/the-dog-bone-technique-for-ac-joint-reconstruction. Accessed 1 Jan 2017
  29. 29.
    Türker M, Kiliçoglu O, Salduz A, Bozdag E, Sünbüloglu E (2011) Loop security and tensile properties of polyblend and traditional suture materials. Knee Surg Sports Traumatol Arthrosc 19:296–302CrossRefPubMedGoogle Scholar
  30. 30.
    Motta P, Maderni A, Bruno L, Mariotti U (2011) Suture rupture in acromioclavicular joint dislocations treated with flip buttons. Arthroscopy 27:294–298CrossRefPubMedGoogle Scholar
  31. 31.
    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 34:236–246CrossRefPubMedGoogle Scholar

Copyright information

© Istituto Ortopedico Rizzoli 2017

Authors and Affiliations

  1. 1.Department of Orthopedics and Traumatology – Service of Hand, Upper Limb and Peripheral Nerve Surgery - Assistance Publique – Hôpitaux de Paris, Georges Pompidou European Hospital (HEGP)Paris Descartes UniversityParisFrance
  2. 2.Department of Orthopedic Surgery, Assistance Publique – Hôpitaux de Paris, Bichat – Claude Bernard HospitalParis Diderot UniversityParisFrance
  3. 3.Clinique des LilasLes LilasFrance

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