nach oben

Knee Surgery, Sports Traumatology, Arthroscopy

Erschienen in:

16.08.2019 | SHOULDER

Acromioclavicular joint reconstruction: an additional acromioclavicular cerclage does not improve horizontal stability in double coraco-clavicular tunnel technique

verfasst von: Jan Theopold, Tobias Schöbel, Jean-Pierre Fischer, Sabine Löffler, Georg Osterhoff, Stefan Schleifenbaum, Pierre Hepp

Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy | Ausgabe 12/2019

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Horizontal instability—especially in the posterior plane—is a common problem after acromioclavicular joint injuries. The purpose was to compare the stability of a single coraco-clavicular tunnel technique and a double coraco-clavicular tunnel technique for coraco-clavicular ligament reconstruction and to examine the influence of an additional acromioclavicular cerclage on the horizontal stability in the acromioclavicular joint.

Methods

21 acromioclavicular joints of human cadaveric shoulders were randomly assigned to the following groups: single coraco-clavicular tunnel technique with horizontal augmented acromioclavicular cerclage (SCT + AC); double coraco-clavicular tunnel technique (DCT); double coraco-clavicular tunnel technique and acromioclavicular cerclage (DCT + AC). The specimens underwent cyclic horizontal testing and were recorded using a 3D optical measuring system.

Results

The displacement and the increase in displacement in relation to the displacement after precondition for SCT + AC were significantly higher after every measured amount of cycles than for DCT (p₁₀ = 0.0023; p₅₀₀₀ = 0.0012) and DCT + AC (p₁₀ = 0.0006; p₅₀₀₀ = 0.0012). There was no significant difference in the total displacement, or in the increase in total displacement between double coraco-clavicular tunnel reconstructed groups with and without additional acromioclavicular cerclage.

Conclusion

Double coraco-clavicular tunnel technique with and without additional acromioclavicular cerclage results in a significant higher stability regarding the horizontal plane in comparison to single coraco-clavicular tunnel technique with acromioclavicular cerclage. Based on the results of this biomechanical in vitro study, the use of an additional acromioclavicular cerclage with single coraco-clavicular tunnel technique may not be indicated in most cases. The effect of an additional acromioclavicular cerclage seems to be negligible, at least in presence of a double-coraco-clavicular tunnel technique reconstruction. Techniques of AC joint reconstruction should focus on the use of double coraco-clavicular tunnel devices.

Abat F, Sarasquete J, Natera LG et al (2015) Biomechanical analysis of acromioclavicular joint dislocation repair using coracoclavicular suspension devices in two different configurations. J Orthop Traumatol 16(3):215–219CrossRef

Banffy MB, Uquillas C, Neumann JA et al (2018) Biomechanical evaluation of a single- versus double-tunnel coracoclavicular ligament reconstruction with acromioclavicular stabilization for acromioclavicular joint injuries. Am J Sports Med 46(5):1070–1076CrossRef

Baumgarten KM, Altchek DW, Cordasco FA (2006) Arthroscopically assisted acromioclavicular joint reconstruction. Arthroscopy 22(2):228.e1–228.e6CrossRef

Beitzel K, Mazzocca AD, Bak K et al (2014) ISAKOS upper extremity committee consensus statement on the need for diversification of the Rockwood classification for acromioclavicular joint injuries. Arthroscopy 30(2):271–278CrossRef

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(9):2141–2148CrossRef

Beitzel K, Obopilwe E, Chowaniec DM et al (2011) Biomechanical comparison of arthroscopic repairs for acromioclavicular joint instability: suture button systems without biological augmentation. Am J Sports Med 39(10):2218–2225CrossRef

Braun S, Beitzel K, Buchmann S et al (2015) Arthroscopically assisted treatment of acute dislocations of the acromioclavicular joint. Arthrosc Tech 4(6):e681–e685CrossRef

Chernchujit B, Tischer T, Imhoff AB (2006) Arthroscopic reconstruction of the acromioclavicular joint disruption: surgical technique and preliminary results. Arch Orthop Trauma Surg 126(9):575–581CrossRef

Dyrna F, Imhoff FB, Haller B et al (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):3471–3479CrossRef

10.

Dyrna FGE, Imhoff FB, Voss A et al (2018) The integrity of the acromioclavicular capsule ensures physiological centering of the acromioclavicular joint under rotational loading. Am J Sports Med 46(6):1432–1440CrossRef

11.

Gerhardt C, Kraus N, Pauly S et al (2013) Arthroskopisch assistierte stabilisierung akuter schultereckgelenkverletzungen in Doppel-TightRope-Technik: einjahresergebnisse (Arthroscopically assisted stabilization of acute injury to the acromioclavicular joint with the double TightRope technique: one-year results). Unfallchirurg 116(2):125–130CrossRef

12.

Grutter PW, Petersen SA (2005) Anatomical acromioclavicular ligament reconstruction: a biomechanical comparison of reconstructive techniques of the acromioclavicular joint. Am J Sports Med 33(11):1723–1728CrossRef

13.

Hammer N, Löffler S, Feja C et al (2012) Ethanol-glycerin fixation with thymol conservation: a potential alternative to formaldehyde and phenol embalming. Anat Sci Educ 5(4):225–233CrossRef

14.

Hann C, Kraus N, Minkus M et al (2018) Combined arthroscopically assisted coraco- and acromioclavicular stabilization of acute high-grade acromioclavicular joint separations. Knee Surg Sports Traumatol Arthrosc 26(1):212–220CrossRef

15.

Jensen G, Ellwein A, Voigt C et al (2015) Doppel-button-fixierung mit minimalinvasiver akromioklavikularer cerclage: arthroskopisch-assistierte Versorgung der akuten Schultereckgelenkinstabilitat (Double button Fixation with minimally invasive acromioclavicular cerclage: arthroscopically-assisted treatment of acute acromioclavicular joint instability). Unfallchirurg 118(12):1056–1061CrossRef

16.

Kowalsky MS, Kremenic IJ, Orishimo KF et al (2010) The effect of distal clavicle excision on in situ graft forces in coracoclavicular ligament reconstruction. Am J Sports Med 38(11):2313–2319CrossRef

17.

Kraus N, Haas NP, Scheibel M et al (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(10):1431–1440CrossRef

18.

Kraus N, Hann C, Gerhardt C et al (2018) Dynamic instability of the acromioclavicular joint. Obere Extremität 13(4):279–285CrossRef

19.

Mazzocca AD, Arciero RA, Bicos J (2007) Evaluation and treatment of acromioclavicular joint injuries. Am J Sports Med 35(2):316–329CrossRef

20.

Mazzocca AD, Santangelo SA, Johnson ST et al (2006) A biomechanical evaluation of an anatomical coracoclavicular ligament reconstruction. Am J Sports Med 34(2):236–246CrossRef

21.

Nuchtern JV, Sellenschloh K, Bishop N et al (2013) Biomechanical evaluation of 3 stabilization methods on acromioclavicular joint dislocations. Am J Sports Med 41(6):1387–1394CrossRef

22.

Pastor MF, Averbeck AK, Welke B et al (2016) The biomechanical influence of the deltotrapezoid fascia on horizontal and vertical acromioclavicular joint stability. Arch Orthop Trauma Surg 136(4):513–519CrossRef

23.

Saier T, Venjakob AJ, Minzlaff P et al (2015) Value of additional acromioclavicular cerclage for horizontal stability in complete acromioclavicular separation: a biomechanical study. Knee Surg Sports Traumatol Arthrosc 23(5):1498–1505CrossRef

24.

Schär MO, Jenni S, Fessel G et al (2019) Biomechanical comparison of two biplanar and one monoplanar reconstruction techniques of the acromioclavicular joint. Arch Orthop Trauma Surg 139(6):779–786CrossRef

25.

Scheibel M, Droschel S, Gerhardt C et al (2011) Arthroscopically assisted stabilization of acute high-grade acromioclavicular joint separations. Am J Sports Med 39(7):1507–1516CrossRef

26.

Walz L, Salzmann GM, Fabbro T et al (2008) The anatomic reconstruction of acromioclavicular joint dislocations using 2 TightRope devices: a biomechanical study. Am J Sports Med 36(12):2398–2406CrossRef

27.

Weiser L, Nüchtern JV, Sellenschloh K et al (2017) Acromioclavicular joint dislocations: Coracoclavicular reconstruction with and without additional direct acromioclavicular repair. Knee Surg Sports Traumatol Arthrosc 25(7):2025–2031CrossRef

28.

Wellmann M, Zantop T, Petersen W (2007) Minimally invasive coracoclavicular ligament augmentation with a flip button/polydioxanone repair for treatment of total acromioclavicular joint dislocation. Arthroscopy 23(10):1132.e1–e5CrossRef

Titel: Acromioclavicular joint reconstruction: an additional acromioclavicular cerclage does not improve horizontal stability in double coraco-clavicular tunnel technique
verfasst von: Jan Theopold
Tobias Schöbel
Jean-Pierre Fischer
Sabine Löffler
Georg Osterhoff
Stefan Schleifenbaum
Pierre Hepp
Publikationsdatum: 16.08.2019
Verlag: Springer Berlin Heidelberg
Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy / Ausgabe 12/2019
Print ISSN: 0942-2056
Elektronische ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-019-05674-1

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen.
» Jetzt entdecken

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Proximale Humerusfraktur: Auch 100-Jährige operieren?

01.05.2024 DCK 2024 Kongressbericht

Mit dem demographischen Wandel versorgt auch die Chirurgie immer mehr betagte Menschen. Von Entwicklungen wie Fast-Track können auch ältere Menschen profitieren und bei proximaler Humerusfraktur können selbst manche 100-Jährige noch sicher operiert werden.

Sind Frauen die fähigeren Ärzte?

30.04.2024 Gendermedizin Nachrichten

Patienten, die von Ärztinnen behandelt werden, dürfen offenbar auf bessere Therapieergebnisse hoffen als Patienten von Ärzten. Besonders scheint das auf weibliche Kranke zuzutreffen, wie eine Studie zeigt.

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Arthroskopie kann Knieprothese nicht hinauszögern

25.04.2024 Gonarthrose Nachrichten

Ein arthroskopischer Eingriff bei Kniearthrose macht im Hinblick darauf, ob und wann ein Gelenkersatz fällig wird, offenbar keinen Unterschied.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusion

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 12/2019

Low prevalence of relevant associated articular lesions in patients with acute III–VI acromioclavicular joint injuries

The importance of biomechanical properties in revision acromioclavicular joint stabilization: a scoping review

Double on-lay fixation using all suture-type anchor for subpectoral biceps tenodesis has favorable functional outcomes and leads to less cosmetic deformities than single on-lay fixation

Arthroscopic subscapularis augmentation combined with capsulolabral reconstruction is safe and reliable

Anatomic and non-anatomic reconstruction improves post-operative outcomes in chronic acromio-clavicular instability: a systematic review

Immediate self-rehabilitation after open Latarjet procedures enables recovery of preoperative shoulder mobility at 3 months