Arthroscopic stabilization of acromioclavicular joint dislocation using the AC graftrope system

https://doi.org/10.1016/j.jse.2009.12.014Get rights and content

Background

Separation of the acromioclavicular joint (ACJ) is a common orthopaedic injury among athletes involved in contact sports and victims of motor vehicle accidents, particularly motorcycle crashes. High-grade ACJ disruptions (type IV-VI) are managed surgically through a variety of procedures. These range from simple plate and screw fixation to more complex procedures involving ligament repair, transfer, and reconstruction.

Methods

This paper describes a new technique utilizing a direct subacromial arthroscopic approach to performing a reconstruction of the ruptured coracoclavicular ligaments. The appropriately over-engineered fixation device is made up of a subcoracoid button secured via nonabsorbable sutures to a special clavicular washer and augmented by a centrally placed soft tissue graft.

Results

To date, the senior author has performed 10 cases on both acute and chronic high-grade ACJ separations. All patients greater than 6 months out from surgery have returned to their normal pre-injury level of activity. No complications (infection, hardware, or graft failure) have been documented, and all have maintained the interoperative reduction of the acromioclavicular joint and coracoclavicular space.

Conclusion

The arthroscopic reconstruction of the AC separation is a low-morbidity, safe, and reproducible operation that provides adequate fixation and stability combined with the use of a soft tissue graft to promote sound biologic healing.

Section snippets

Treatment

Nonoperative management is the accepted method of treatment for low-grade injuries (types I and II). There is still significant controversy regarding the proper management of type III injuries, as they do not significantly disrupt the dynamic stabilizers of the AC joint. Literature has shown no significant difference between operative and nonoperative treatment, with 1 specific study showing no strength difference at 2-year follow-up.12 One review of 2000 patients with type III AC joint

New surgical technique

We describe a technique utilizing a direct subacromial approach developed by the senior author (T.M.D.). The patient is placed in the beach chair position using a Spider Limb Positioner (Tenet Medical, Calgary, Alberta, Canada) to hold the arm in the desired position, especially during the crucial reduction and fixation phase of the operation (Figure 1). In isolated ACJ reconstructive cases, the 30° arthroscope is placed in the subacromial space via a straight lateral portal. An accessory

Early clinical results

To date, the senior author has performed 10 cases on both acute and chronic high-grade ACJ separations. All patients greater than 6 months out from surgery have returned to their normal pre-injury level of activity. No complications (infection, hardware, or graft failure) have been documented and all have maintained the interoperative reduction of the acromioclavicular joint and coracoclavicular space.

Discussion

The goals of surgical treatment of ACJ injuries adhere to the same management principles for dealing with articular injuries elsewhere in the body; that is, anatomic reduction and restoration of normal arthrokinematics. This is the best way to minimize complications including pain, loss of reduction, arthrosis and decreased extremity function. Currently, there are 4 main surgical options for ACJ disruptions: (1) primary ACJ fixation (using pins, screws, suture wires, plates, and hook plates)

Disclaimer

T.M.D. and A.D.M. are clinical consultants for Arthrex, Inc., which is related to the subject of this work. Both A.D.M. and T.M.D. receive research support in the form of supplies and financial support to conduct ongoing research. No funding was received for this study.

References (15)

  • B.M. Bosworth

    Acromioclavicular separation: new method for repair

    Surg Gynecol Obstet

    (1941)
  • S.J. Lee et al.

    Reconstruction of the coracoclavicular ligament with tendon grafts: a comparative biomechanical study

    Am J Sports Med

    (2003)
  • Y.W. Lim et al.

    Acromioclavicular joint reduction, repair and reconstruction using metallic buttons–Early results and complications

    Tech Shoulder Elbow Surg

    (2007)
  • R.W. Lindsey et al.

    The migration of a broken pin following fixation of the acromioclavicular joint: a case report and review of literature

    Orthopaedics

    (1986)
  • F.A. Lyons et al.

    Migration of pins used in operations on the shoulder

    J Bone Joint Surg Am

    (1990)
  • A.D. Mazzocca et al.

    Evaluation and treatment of acromioclavicular injuries

    Am J Sports Med

    (2007)
  • Mazzocca AD, Guerra J. Biomechanical Testing of AC Graft Repairs, University of Connecticut Health...
There are more references available in the full text version of this article.

Cited by (0)

View full text
Copyright © 2010 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.