Advertisement

Acromioclavicular Joint Instability: When and How to Operate

  • Theresa Diermeier
  • Felix Dyrna
  • Andreas B. Imhoff
  • Knut Beitzel
Chapter

Abstract

In current literature, evidence for treatment of revision ACJ instability is still lacking, but surgical treatment continues to evolve. The importance of failure analysis and clinical relevant algorithms were highlighted in this chapter. It was also intended to point out technical errors and possible solution strategies in order to reduce failure rates and improve clinical outcomes. Precise attention on creating a biomechanically accurate repair is needed, to generate an optimal healing environment that will translate into patient satisfaction and long-term stability.

Keywords

Acromioclavicular Instability Failure Reconstruction Revision 

References

  1. 1.
    Williams G, Nguyen V, Rockwood C. Classification and radiographic analysis of acromioclavicular dislocations. Appl Radiol. 1989;18:29–34.Google Scholar
  2. 2.
    Dias JJ, et al. The conservative treatment of acromioclavicular dislocation. Review after five years. J Bone Joint Surg Br. 1987;69(5):719–22.CrossRefGoogle Scholar
  3. 3.
    Beitzel K, et al. Current concepts in the treatment of acromioclavicular joint dislocations. Arthroscopy. 2013;29(2):387–97.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Milewski MD, et al. Complications related to anatomic reconstruction of the coracoclavicular ligaments. Am J Sports Med. 2012;40(7):1628–34.CrossRefGoogle Scholar
  5. 5.
    Beitzel K, et al. ISAKOS upper extremity committee consensus statement on the need for diversification of the Rockwood classification for acromioclavicular joint injuries. Arthroscopy. 2014;30(2):271–8.CrossRefPubMedGoogle Scholar
  6. 6.
    Kibler WB, Sciascia A. Current concepts: scapular dyskinesis. Br J Sports Med. 2010;44(5):300–5.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Martetschlager F, et al. Complications after anatomic fixation and reconstruction of the coracoclavicular ligaments. Am J Sports Med. 2013;41(12):2896–903.CrossRefPubMedGoogle Scholar
  8. 8.
    Tauber M, et al. Arthroscopic stabilization of chronic acromioclavicular joint dislocations: triple-versus single-bundle reconstruction. Am J Sports Med. 2016;44(2):482–9.CrossRefPubMedGoogle Scholar
  9. 9.
    Mazzocca AD, et al. A biomechanical evaluation of an anatomical coracoclavicular ligament reconstruction. Am J Sports Med. 2006;34(2):236–46.CrossRefPubMedGoogle Scholar
  10. 10.
    Voss A, et al. A biomechanical analysis of different clavicular tunnel diameters in anatomic acromioclavicular ligament reconstruction. Arthroscopy. 2016;32(8):1551–7.CrossRefPubMedGoogle Scholar
  11. 11.
    Costic RS, et al. Biomechanical rationale for development of anatomical reconstructions of coracoclavicular ligaments after complete acromioclavicular joint dislocations. Am J Sports Med. 2004;32(8):1929–36.CrossRefPubMedGoogle Scholar
  12. 12.
    Erak S, et al. Acromioclavicular reconstructions with hamstring tendon grafts: a comparative biomechanical study. J Shoulder Elb Surg. 2008;17(5):772–8.CrossRefGoogle Scholar
  13. 13.
    Beitzel K, et al. Biomechanical comparison of arthroscopic repairs for acromioclavicular joint instability suture button systems without biological augmentation. Am J Sports Med. 2011;39(10):2218–25.CrossRefPubMedGoogle Scholar
  14. 14.
    Geaney LE, et al. Graft fixation is highest with anatomic tunnel positioning in acromioclavicular reconstruction. Arthroscopy. 2013;29(3):434–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Klimkiewicz JJ, et al. The acromioclavicular capsule as a restraint to posterior translation of the clavicle: a biomechanical analysis. J Shoulder Elb Surg. 1999;8(2):119–24.CrossRefGoogle Scholar
  16. 16.
    Beitzel K, et al. Rotational and translational stability of different methods for direct acromioclavicular ligament repair in anatomic acromioclavicular joint reconstruction. Am J Sports Med. 2014;42(9):2141–8.CrossRefPubMedGoogle Scholar
  17. 17.
    Grantham C, et al. A biomechanical assessment of a novel double endobutton technique versus a coracoid cerclage sling for acromioclavicular and coracoclavicular injuries. Knee Surg Sports Traumatol Arthrosc. 2016;24(6):1918–24.CrossRefPubMedGoogle Scholar
  18. 18.
    Saier T, et al. Value of additional acromioclavicular cerclage for horizontal stability in complete acromioclavicular separation: a biomechanical study. Knee Surg Sports Traumatol Arthrosc. 2015;23(5):1498–505.CrossRefPubMedGoogle Scholar
  19. 19.
    Scheibel M, et al. Arthroscopically assisted stabilization of acute high-grade acromioclavicular joint separations. Am J Sports Med. 2011;39(7):1507–16.CrossRefPubMedGoogle Scholar
  20. 20.
    Woodmass JM, et al. Complications following arthroscopic fixation of acromioclavicular separations: a systematic review of the literature. Open Access J Sports Med. 2015;6:97.PubMedPubMedCentralGoogle Scholar
  21. 21.
    Spiegl UJ, et al. Biomechanical consequences of coracoclavicular reconstruction techniques on clavicle strength. Am J Sports Med. 2014;42(7):1724–30.CrossRefPubMedGoogle Scholar
  22. 22.
    Martetschläger F, et al. Effect of coracoid drilling for acromioclavicular joint reconstruction techniques on coracoid fracture risk: a biomechanical study. Arthroscopy. 2016;32(6):982–7.CrossRefPubMedGoogle Scholar
  23. 23.
    Imhoff AB, Braun S, Beitzel K. Comments on complications after arthroscopic coracoclavicular reconstruction using a single adjustable loop length suspensory fixation device. Arthroscopy. 2015;31(6):1031–3.CrossRefPubMedGoogle Scholar

Copyright information

© ESSKA 2018

Authors and Affiliations

  • Theresa Diermeier
    • 1
  • Felix Dyrna
    • 1
  • Andreas B. Imhoff
    • 1
  • Knut Beitzel
    • 1
  1. 1.Department of Orthopaedic Sports MedicineTechnical UniversityMunichGermany

Personalised recommendations