Skip to main content
Erschienen in:

20.07.2020 | SHOULDER

Long-term stability of coracoclavicular suture fixation for acute acromioclavicular joint separation

verfasst von: A. Panagopoulos, E. Fandridis, G. Delle Rose, R. Ranieri, A. Castagna, Z. T. Kokkalis, P. Dimakopoulos

Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy | Ausgabe 7/2021

Einloggen, um Zugang zu erhalten

Abstract

Purpose

The optimal (SBJI) surgical treatment for acute acromioclavicular (AC) joint disruption remains controversial. What is being presented is the long-term functional outcomes of a double cross-looped coracoclavicular (CC) suture technique with the intention of restoring both anteroposterior and superior displacement of the clavicle.

Methods

Between 2007 and 2016, 81 patients underwent surgical reconstruction for acute acromioclavicular joint (AC) disruption in two orthopaedic centers. Two patients died for reasons unrelated to the treatment, and seven missed the final follow-up appointment, leaving 72 patients (67 males; 5 females; age 37 ± 12.4; range 15–64 years) for clinical and radiological assessments. All cases were classified according to the Rockwood classification as type III (n = 34), IV (n = 14) or V (n = 24). The dislocation was repaired with double cross-looped CC fixation using four Ethibond sutures passing underneath the coracoid and through a 4.5 mm drill hole in the clavicle in opposing directions to control both anteroposterior and vertical displacement. Radiological investigation preoperatively and at the last follow-up included anteroposterior and/or Zanca views, axillary or Alexander views, and comparative stress radiography of both AC joints. Patients were evaluated clinically with the Constant-Murley score (CMS) and Acromio Clavicular Joint Instability Score (ACJIS). Loss of reduction, subluxation, CC ligament ossification, post-traumatic arthritis, and peri-implant fractures were also recorded.

Results

Seventy-two patients were available for the last clinical and radiological evaluations. At a median follow-up period of 6.3 ± 2.1 years (range 3–12 years), the CMS and ACJIS were 92.1 ± 7.2 (range 60–100 points) and 90.4 ± 8.6 (range 45–100 points), respectively. Complications included 9 (12.5%) patients with slight loss of reduction, 2 (1.7%) with dislocation recurrence, 1 (1.3%) with superficial infection, 1 (1.3%) with a fracture of the lateral end of the clavicle, and 2 (1.7%) with persistent tenderness in the AC joint. The incidence of periarticular ossification was 22.4% and did not affect the final outcome.

Conclusions

This technique represents an effective and low-cost treatment for acute AC joint separations.

Level of evidence

IV.
Literatur
2.
Zurück zum Zitat Arirachakaran A, Boonard M, Piyapittayanun P, Phiphobmongkol V, Chaijenkij K, Kongtharvonskul J (2016) Comparison of surgical outcomes between fixation with hook plate and loop suspensory fixation for acute unstable acromioclavicular joint dislocation: a systematic review and meta-analysis. Eur J Orthop Surg Traumatol 26:565–574. https://doi.org/10.1007/s00590-016-1797-4CrossRefPubMed Arirachakaran A, Boonard M, Piyapittayanun P, Phiphobmongkol V, Chaijenkij K, Kongtharvonskul J (2016) Comparison of surgical outcomes between fixation with hook plate and loop suspensory fixation for acute unstable acromioclavicular joint dislocation: a systematic review and meta-analysis. Eur J Orthop Surg Traumatol 26:565–574. https://​doi.​org/​10.​1007/​s00590-016-1797-4CrossRefPubMed
11.
13.
Zurück zum Zitat Friedman DJ, Barron OA, Catalano L, Donahue JP, Zambetti G (2008) Coracoclavicular stabilization using a suture anchor technique. Am J Orthop (Belle Mead NJ) 37:294–300 (PMID: 18716693) Friedman DJ, Barron OA, Catalano L, Donahue JP, Zambetti G (2008) Coracoclavicular stabilization using a suture anchor technique. Am J Orthop (Belle Mead NJ) 37:294–300 (PMID: 18716693)
22.
23.
Zurück zum Zitat Kappakas GS, McMaster J (1978) Repair of acromioclavicular separation using dacron prosthesis graft. Clin Orthop Relat Res 131:247–251 Kappakas GS, McMaster J (1978) Repair of acromioclavicular separation using dacron prosthesis graft. Clin Orthop Relat Res 131:247–251
31.
Zurück zum Zitat Minkus M, Hann C, Scheibel M, Kraus N (2017) Quantification of dynamic posterior translation in modified bilateral Alexander views and correlation with clinical and radiological parameters in patients with acute acromioclavicular joint instability. Arch Orthop Trauma Surg 137:845–852. https://doi.org/10.1007/s00402-017-2691-1CrossRefPubMed Minkus M, Hann C, Scheibel M, Kraus N (2017) Quantification of dynamic posterior translation in modified bilateral Alexander views and correlation with clinical and radiological parameters in patients with acute acromioclavicular joint instability. Arch Orthop Trauma Surg 137:845–852. https://​doi.​org/​10.​1007/​s00402-017-2691-1CrossRefPubMed
37.
Zurück zum Zitat Panagopoulos A, Fandridis M, Delle Rose G, Tatani I, Castagna A, Dimakopoulos P (2018) Coracoclavicular cerclage with heavy sutures for acute (type III-V) AC joint separations long-term follow-up in 67 patients. Presented in ESA Closed Meeting, “Diagnosis and Treatment of Acromioclavicular Joint Disorders”, Athens Panagopoulos A, Fandridis M, Delle Rose G, Tatani I, Castagna A, Dimakopoulos P (2018) Coracoclavicular cerclage with heavy sutures for acute (type III-V) AC joint separations long-term follow-up in 67 patients. Presented in ESA Closed Meeting, “Diagnosis and Treatment of Acromioclavicular Joint Disorders”, Athens
38.
Zurück zum Zitat Rockwood CA Jr, Williams GR Jr, Young DC (1998) Disorders of the acromioclavicular joint. In: RockwoodMatsen CAFA (ed) The Shoulder, 2nd edn. Philadelphia, Pa, WB Saunders, pp 483–553 Rockwood CA Jr, Williams GR Jr, Young DC (1998) Disorders of the acromioclavicular joint. In: RockwoodMatsen CAFA (ed) The Shoulder, 2nd edn. Philadelphia, Pa, WB Saunders, pp 483–553
Metadaten
Titel
Long-term stability of coracoclavicular suture fixation for acute acromioclavicular joint separation
verfasst von
A. Panagopoulos
E. Fandridis
G. Delle Rose
R. Ranieri
A. Castagna
Z. T. Kokkalis
P. Dimakopoulos
Publikationsdatum
20.07.2020
Verlag
Springer Berlin Heidelberg
Erschienen in
Knee Surgery, Sports Traumatology, Arthroscopy / Ausgabe 7/2021
Print ISSN: 0942-2056
Elektronische ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-020-06158-3

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie erweitert durch Fallbeispiele, Videos und Abbildungen. Zur Fortbildung und Wissenserweiterung, verfasst und geprüft von Expertinnen und Experten der Gesellschaft für Arthroskopie und Gelenkchirurgie (AGA).


Jetzt entdecken!

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Ab sofort gelten die neuen Verordnungsausnahmen für Lipidsenker

Freie Fahrt für Lipidsenker? Das nicht, doch mit niedrigerem Schwellenwert fürs Infarktrisiko und neuen Indikationen hat der G-BA die Verordnungs-Handbremse ein gutes Stück weit gelockert.

Aerobes Training hilft bei Fibromyalgie

Sport im aeroben Bereich ist ein veritables Mittel, um die Schmerzen von Menschen mit Fibromyalgie zu reduzieren, wie eine Metaanalyse zeigt. Frequenz, Dauer und Intensität der Übungen geben den Ausschlag.

MedTalk Leitlinie KOMPAKT: S3-Leitline zu peripheren Nervenverletzungen

  • Webinar | 10.02.2025 | 13:00

Über den Weg zur finalen Fassung der S3-Leitlinie "Versorgung peripherer Nervenverletzungen" sprechen Prof. Dr. Leila Harhaus-Wähner und Ressortleiter Dr. Gunter Freese im WebTalk Leitlinie KOMPAKT, einer neuen Webcast-Serie von SpringerMedizin passend zu Ihrem Fachmagazin Orthopädie und Unfallchirurgie Mitteilungen und Nachrichten. In dem kurzen Video geht es darum, was sich im Vergleich zur vorigen Fassung der Leitlinie geändert hat, welche Aspekte für die tägliche Praxis besonders wichtig sind und was jeder gemäß Leitlinie nun anders oder besser machen sollte.

Zi veröffentlicht Ranking zur Fehleranfälligkeit gängiger Praxis-EDV

Welches Praxisverwaltungssystem macht am wenigsten Probleme? Das Zi dokumentiert jetzt detaillierte Produktbewertungen zu 17 konkreten Anwendungssituationen.

Update Orthopädie und Unfallchirurgie

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