Acta of Shoulder and Elbow Surgery | Volume 2 | Issue 2 | July-Dec 2017 | Page 27-29 | Ernesto Daniel Yedro, Claudia Alejandra Cáceres Saglio
Authors: Ernesto Daniel Yedro, Claudia Alejandra Cáceres Saglio.
 Ex fellow Servicio de Miembro superior Instituto Dupuytren (Cap. Federal.
BsAs). Ex Fellow de Artroscopia del CT8O San Isidro (BsAs) Argentina.
Traumatologo– Sanatorio Integral IOT. Ciudad de Posadas. Misiones. Argentina
 Servicio Miembro Superior Hospital Escuela de Agudos HEA. Traumatologa.
Sanatorio Integral IOT. Ciudad de Posadas. Misiones. Argentina
Address of Correspondence
Dr. Ernesto Daniel Yedro
Bolivar 2376 Posadas Misiones
Purpose: the purpose of this study is to report the clinical and radiological results of the reduction of acromioclavicular dislocation during the healing period without the anatomical reconstruction of the CC and AC ligaments.
Materials and Methods: twelve patients were treated between 2012 and 2015 with a mean follow-up of 1.5 years. Patients were included if they had Rockwood types III, IV and V acromioclavicular dislocation and were treated during the acute period (i.e. during the first three weeks of the injury). The technique employed was arthroscopic with mini-invasive. The reduction of ACD was achieved during the healing period by using two titanium buttons connected by four highly-resistant, non-reabsorbable suture cord: one button was placed in the clavicle and the other in the coracoid.
Results: results were reported after two years of post-surgical follow-up. The measurements included the static and dynamic evaluation and the DASH outcome scoring. Static radiographic measurements of the CC distance with mean discharge was 0.93 cm compared to 2.7 cm at the initial examination (p<0.0001); and DASH outcome measure of 14 compared to a pre-surgical scoring of 52 (p>0001). The patients were satisfied or very satisfied with the cosmesis and were able to return to their previous sorts and work routine normally.
Conclusion: this study confirms that he reduction of ACD by means of double button fixation during the acute healing period, and adequate immobilization helps to the biological repair without he need of anatomical reconstruction of AC and CC ligaments. In this way the patients could restore the function of the arm and achieve the static and dynamic stability. They were also able to reinstate their work and sport previous to the injury.
Keywords: acromioclavicular dislocation, button, arthroscopy, DASH score, coracoclavicular distance.
1. Collins DN. Disorders of the acromioclavicular joint. In: Rockwood CA Jr, editor. The shoulder. 4th ed. Philadelphia: Elsevier Health Sciences; 2009. pp. 453–526.
2. Mazzocca AD, Arciero RA, Bicos J. Evaluation and treatment of acromioclavicular joint injuries. Am J Sports Med. 2007;35(2):316–29.
3. Fukuda K, Craig EV, An KN, et al. Biomechanical Study of the ligametous systm of the acromioclavicular joint. J Bone Joint Surg Am. 1986; 68:434 – 440.
4. Verdano M, Pellegrini A, Zanelli M, Paterlini M, Ceccarelli F. Modified Phemister procedure for the surgical treatment of Rockwood types III, IV, V acute acromioclavicular joint dislocation. Musculoskeletal Surg. 2012;96(3):213–22
5. Bearden J, Hughson J, Whatley G. Acromioclavicular dislocation: method of treatment. Am J Sport Med. 1973; 1:5 – 17.
6. Jari R, Costic RS, Rodosky MW, Debski RE. Biomechanical function of surgical procedures for acromioclavicular joint dislocations Arthroscopy 2004; 20: 237 – 245.
7. Nissen CW, Chatterjee A. Type III acromioclavicular separation: Results of a recent survey on its management. Am JOrthop 2007;36:89-93.
8. Warren-Smith CD, Ward MW. Operation for acromioclavicular dislocation. A review of 29 cases treated by one method. J Bone Joint Surg Br 1987;69:715-718
9. Dimakopoulos P, Panagopoulos A, Syggelos SA, Panagiotopoulos E, Lambiris E. Double-loop suture repair for acute acromioclavicular joint disruption. Am J Sports Med. 2006; 34(7):1112-9.
10. Koukakis A, Manouras A, Apostolou CD, Lagoudianakis E, Papadima A, Triantafillou C, et al. Results using the AO hook plate for dislocations of the acromioclavicular joint. Expert Rev Med Devices. 2008; 5(5):567-72
11. Hellmich A, Sievers U. Operative repair ofacromioclavicular separation via transcutaneous Kirschner wire fixation: results of follow-up examinations in 45 patients. Aktuelle Traumatol.1988; 18(3):9-13.
12. Weaver JK, Dunn HK. Treatment of acromioclavicular injuries, speciallycomplete acromioclavicular separation. J Bone Joint Surg Am . 1972; 54:1187 – 1194.
13. Tossy J, Med N, Sigmond H. Acromioclavicular separations. Useful and practical classification for treatment. Clin Orthop Relat Res. 1963; 38: 111 – 119.
14. Rockwood CJ, William G, Young D. Disorders of the acromioclavicular joint. In: Rockwood CJ, Matsen FA III, eds. The Shoulder. Philadelphia: WB Saunders; 1998: 483 – 553.
15. Zanca P. Shouler pain: involvement of the acromioclavicular joint (analysis of 1000 cases) Am J Roentgenol Radium Ther Nucl Med; 1971; 112: 493 – 506.
16. Weinstein DM, McCann PD, Mcllveen SJ, et al. Surgical treatment of complete acromioclavicular dislocations. Am J Sport Med. 1995; 232: 324 – 331.
17. Nissen CW, Chatterjee A. Type III acromioclavicular separation: results of recen ton its management. Am J Orthop. 2007; 36: 89 – 93.
18. Spencer E. Treatment of grade III acromiocavicular joint injuries. Clin Orthop Realt Res. 2007; 455: 38 – 44.
19. Mc Farlan EG, Bilvin SJ, Doehring CB, et al. Treatment of grade III acromioclavicular separations in profesional throwing athletes: results of a survey. Am J Orthop. 1997; 16: 771 – 774.
20. Galpin RD; Hawkins RJ; Grainger RW. A comparative analysis of operative versus nonoperative treatment of grade III acromioclavicular separations. Clin J Sport –med. 2003; 18: 162 – 166.
21. MacDonald PB, Lapointe P. Acromioclavicular and sternoclavicular joint injuries. Orthop Clin North Am. 2008; 39(4):535-45.
22. Pan Z, Zhang H, Sun C, Qu L, Cui Y. Arthroscopyassisted reconstruction of coracoclavicular ligament by Endobutton fixation for treatment of acromioclavicular joint dislocation. Arch Orthop Trauma Surg. 2015; 135(1):9-16. 8. Iannotti JP, Williams GR. Disorders.
23. Habernek H, Weinstabl R, Schmid L, Fialka C. A crook plate for treatment of acromioclavicular joint separation: indication, technique, and results after one year. J Trauma. 1993; 35(6):893-901.
24. Phillips AM, Smart C, Groom AF. Acromioclavicular dislocation: Conservative or surgical therapy. Clin Orthop Relat Res. 1998; 353(2):10-7.
25. Gstettner C, Tauber M, Hitzl W, Resch H. Rockwood type III acromioclavicular dislocation: surgical versus conservative treatment. J Shoulder Elbow Surg. 2008; 17(2):220-5.
26. Dimakopoulos P, Panagopoulos A, Syggelos SA, Panagiotopoulos E, Lambiris E. Double-loop suture repair for acute acromioclavicular joint disruption. Am J Sports Med. 2006; 34(7):1112-9.
27. Paavolainen P, Björkenheim JM, Paukku P, Slätis P. Surgical treatment of acromioclavicular dislocation: a review of 39 patients. Injury. 1983; 14(5):415-20.
28. Hellmich A, Sievers U. Operative repair of acromioclavicular separation via transcutaneous Kirschner wire fixation: results of follow-up examinations in 45 patients. Aktuelle Traumatol. 1988; 18(3):9-13.
29. Bosworth BM. Acromioclavicular separation. New method of repair. Surg Gynecol Obstet. 1941; 73(1):866-71.
30. Wellmann M, Zantop T, Weimann A, Raschke MJ, Petersen W. Biomechanical evaluation of minimally invasive repairs for complete acromioclavicular joint dislocation. Am J Sports Med. 2007; 35(6):955-61.
|How to Cite this article: Yedro ED, Saglio CAC .Treatment of symptomatic acromioclavicular dislocation. Our experience. Acta of Shoulder and Elbow Surgery July – Dec 2017; 2(2): 27-29.|