Strategies in Trauma and Limb Reconstruction

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VOLUME 13 , ISSUE 2 ( August, 2018 ) > List of Articles

Review

Surgical reconstruction of the acromioclavicular joint: Can we identify the optimal approach?

Alexander S. North, Tracey Wilkinson

Keywords : Acromioclavicular, Rockwood, Reconstruction, Anatomical, Hook plate, Biomechanics

Citation Information : North AS, Wilkinson T. Surgical reconstruction of the acromioclavicular joint: Can we identify the optimal approach?. 2018; 13 (2):69-74.

DOI: 10.1007/s11751-018-0314-1

License: CC BY-NC-SA 4.0

Published Online: 01-06-2016

Copyright Statement:  Copyright © 2018; The Author(s).


Abstract

Injuries to the acromioclavicular (AC) joint are common, tending to occur secondary to traumatic injuries. Rockwood grade IV, V and VI injuries involve complete dislocation of the joint and require surgical reconstruction, with inconclusive literature on whether grade III injuries should be surgically or conservatively managed. There are over one hundred reported surgical techniques which reconstruct the AC joint, with little indication of which methods achieve the best results. Techniques can generally be considered as: anatomical reduction; CC ligament reconstruction; and anatomical reconstruction. Techniques which implant hardware to reduce the AC joint, such as the hook plate, are commonly implemented, but have been shown to alter the mechanics of the joint significantly, resulting in poor short-term and long-term outcomes. Methods which reconstruct both the acromioclavicular and coracoclavicular ligaments are comparatively new, and early reports suggest that they achieve biomechanical properties similar to the native joint. More focus should be placed on such techniques in the future to determine whether they offer a more suitable approach to improve patient outcomes following AC joint reconstruction.


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  1. Cooper ES (1861) New method of treating long-standing dislocations of the scapula-calvicular articulation. Am J Med Sci 41:389-392
  2. Sage FP, Salvatore JE (1963) Injuries of the acromioclavicular joint: a study of results in 96 patients. South Med J 56:486-495
  3. McKee M, Pelet S, McCormack RG, Harvey E, Papp S, Rouleau D, Furey A, Axelrod T, Buckley R, Guy P, Veillette C, Hall J, Wild L, Vicente M, Bedard L, Sinclair K, Reindl EHR, Berry G, Liew A, Gofton W, Kreder H, Hidy J, Cotu H, Stone T, Viskontas D, Boyer D, Moola F, Perey B, Lemke HM, Moon K, Zomar M, Reindl R, Houghton F, Foxall J, La Flamme Y, Beaumont P, Malo M, Parsons M, Kunz M, De Gorter R, Duffy P, Korley R, Puloski S, Carcary K, O'Brien PJ, Blachut PA, Broekhuyse HM, Lefaivre KA, Leung I, Azad T, Morison Z, Cote H, Blachut PA (2015) Multicentre randomized clinical trial of nonoperative versus operative treatment of acute acromioclavicular joint dislocation. J Orthop Trauma 29:479-487
  4. Weaver JK, Dunn HK (1972) Treatment of acromioclavicular injuries, especially complete acromioclavicular separations. J Bone Joint Surg 54:1187-1194
  5. Dimakopoulos P, Panagopoulos A, Syggelos SA, Panagiotopoulos E, Lambiris E (2006) Double-loop suture repair for acute acromioclavicular joint disruption. Am J Sports Med 34:1112-1119
  6. 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 38:1179-1187
  7. Grutter PW, Peterson SA (2005) Anatomical acromioclavicular ligament reconstruction a biomechanical comparison of reconstructive techniques of the acromioclavicular joint. Am J Sports Med 33:1723-1728
  8. 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 32:1929-1936
  9. Blazar PE, Iannotti JP, Williams GR (1998) Anteroposterior instability of the distal clavicle after distal clavicle resection. Clin Orthop Relat Res 348:114-120
  10. Scheibel M, Droschel S, Gerhardt C, Kraus N (2011) Arthroscopically assisted stabilization of acute high-grade acromioclavicular joint separation. Am J Sports Med 39:1507-1516
  11. McConnell AJ, Yoo DJ, Zdero R, Schemitsch EH, McKee MD (2007) Methods of operative fixation of the acromio-clavicular joint: a biomechanical comparison. J Orthop Trauma 21:248-253
  12. Nuchtern JV, Sellenschloh K, Bishop N, Jauch S, Briem D, Hoffmann M, Lehmann W, Pueschel K, Morlock MM, Rueger JM, GroƒÀterlinden LG (2013) Biomechanical evaluation of 3 stabilization methods of acromioclavicular joint dislocations. Am J Sports Med 41:1387-1394
  13. Di Francesco A, Zoccali C, Colafarina O, Pizzoferrato R, Flamini S (2012) The use of hook plate in type III and V acromioclavicular Rockwood dislocations: clinical and radiological midterm results and MRI evaluation in 42 patients. Injury 43:147-152
  14. Yoo YS, Seo YJ, Noh KC, Patro BP, Kim DY (2011) Arthroscopically assisted anatomical coracoclavicular ligament reconstruction using tendon graft. Int Orthop 35:1025-1030
  15. Sim E, Schwarz N, Hocker K, Berzlanovich A (1995) Repair of complete acromioclavicular separations using the acromioclavicular- hook plate. Clin Orthop Relat Res 314:134-142
  16. 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 28:103-108
  17. Costic RS, Jari R, Rodosky MW, Debski RE (2003) Joint compression alters the kinematics and loading patterns of the intact and capsule-transected AC joint. J Orthop Res 21:379-385
  18. 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 34:236-246
  19. Deshmukh AV, Wilson DR, Zilberfarb JL, Perlmutter GS (2004) Stability of acromioclavicular joint reconstruction: biomechanical testing of various surgical techniques in a cadaveric model. Am J Sports Med 32:1492-1498
  20. Walz L, Salzmann GM, Fabbro T, Eichhorn S, Imhoff AB (2008) The anatomic reconstruction of acromioclavicular joint dislocations using 2 tightrope devices. Am J Sports Med 36:2398-2406
  21. Thiel E, Mutnal A, Gilot GJ (2011) Surgical outcome following arthroscopic fixation of the acromioclavicular joint disruption with the tightrope device. Orthopedics 34:267-274
  22. Lim YW, Sood A, van Riet RP, Bain GI (2007) Acromioclavicular joint reduction, repair and reconstruction using metallic buttons-early results and complications. Tech Shoulder Elbow Surg 8:213-221
  23. Bindra J, van Den Bogaerde J, Hunter JC (2011) Coracoid fracture with recurrent AC joint separation after tightrope repair of AC joint dislocation. Radiol Case Rep 6:624
  24. Ladermann A, Grosclaude M, Lubbeke A, Christofilopoulos P, Stern R, Rod T, Hoffmeyer P (2011) Acromioclavicular and coracoclavicular cerclage reconstruction for acute acromioclavicular joint dislocations. J Shoulder Elbow Surg 20:401-408
  25. Mazzocca AD, Conway JE, Johnson S, Rios CG, Dumonski ML, Santangelo SA, Arciero RA (2004) The anatomic coracoclavicular ligament reconstruction. Oper Tech Sports Med 12:56-61
  26. Corteen DP, Teitge RA (2005) Stabilization of the clavicle after distal resection a biomechanical study. Am J Sports Med 33:61-67
  27. Klimkiewicz JJ, Williams GR, Sher JS, Karduna A, Des Jardins JD, Iannotti JP (1999) The acromioclavicular capsule as a restraint to posterior translation of the clavicle: a biomechanical analysis. J Shoulder Elbow Surg 8:119-124
  28. Saier T, Venjakob AJ, Minzlaft P, Fohr P, Lindell F, Imhoff AB, Vogt S, Braun A (2015) Value of additional acromioclavicular cerclage for horizontal stability in complete acromioclavicular separation: a biomechanical study. Knee Surg Sports Traumatol Arthrosc 23:1498-1505
  29. Beitzel K, Obopilwe E, Apostolakos J, Cote MP, Russell RP, Charette R, Singh H, Arciero RA, Imhoff AB, Mazzocca AD (2014) Rotational and translational stability of different methods for direct acromioclavicular ligament repair in anatomic acromioclavicular joint reconstructions. Am J Sports Med 42:2141-2148
  30. 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 2:6-14
  31. Tauber M, Valler D, Lichtenburg S, Magosch P, Moroder P, Habermeyer P (2016) Arthroscopic stabilization of chronic acromioclavicular joint dislocations triple-versus single-bundle reconstruction. Am J Sports Med 44:482-489
  32. Oki S, Matsumura N, Iwamoto W, Ikegami H, Kiriyama Y, Nakamura T, Toyama Y, Nagura T (2012) The function of the acromioclavicular and coracoclavicular ligaments in shoulder motion: a whole cadaver study. Am J Sports Med 40:2617-2626
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