Functional Reconstruction of Chronic Acromioclavicular Joint Separation Using a Double Suture Technique Combined with Semitendinosus Autograft

Overview

Journal Eur J Orthop Surg Traumatol

Specialty Orthopedics

Date 2024 Feb 18

PMID 38368580

Authors

Giannis Kotsalis

Kostantinos Giatroudakis

Maria Ladogianni

Emmanouil Fandridis

Affiliations

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Abstract

Purpose: We present the functional and clinical results of a combined surgical technique that functionally restores chronic Acromioclavicular Joint Instability (AJI). The method combines a double-looped suture fixation augmented with a semitendinosus autograft.

Methods: Between 2017 and 2021, 15 patients were treated using the surgical technique. All patients suffered an Acromioclavicular Joint Separation that remained untreated for at least 6 (6-16) weeks after the initial injury. Four Ethibond sutures were passed below the coracoid process and through a 4.5 drill hole in the clavicle. The sutures provided adequate horizontal and vertical reduction and stabilization of the clavicle. A semitendinosus autograft was passed below the coracoid process and looped around the clavicle. The remaining graft limbs were used to reconstruct the acromioclavicular capsule. Patients were radiologically evaluated with bilateral anteroposterior (AP), Zanca, and Alexander views. The clinical evaluation was based on the Acromioclavicular Joint Instability Score and the Constant-Murley Score.

Results: The mean follow-up period was 31.2 months (17-61). The mean last ACJIS and CMS scores were 96 (90-100) and 97.67 (87-100), respectively. Reduction of the clavicle was radiologically confirmed in all cases throughout the follow-up period. AC arthritis was reported in 1 case without associated clinical symptoms. No significant complications were reported, and all patients returned to the pre-injury activity level.

Conclusion: The presented functional reconstruction of the AC joint disruption in chronic cases is an effective and secure method with low complication rates and good clinical results.

Level Of Evidence Iii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

References

Gorbaty J, Hsu J, Gee A . Classifications in Brief: Rockwood Classification of Acromioclavicular Joint Separations. Clin Orthop Relat Res. 2016; 475(1):283-287. PMC: 5174051. DOI: 10.1007/s11999-016-5079-6. View

Dyrna F, Imhoff F, Haller B, Braun S, Obopilwe E, Apostolakos J . Primary Stability of an Acromioclavicular Joint Repair Is Affected by the Type of Additional Reconstruction of the Acromioclavicular Capsule. Am J Sports Med. 2018; 46(14):3471-3479. DOI: 10.1177/0363546518807908. View

Dyrna F, Imhoff F, Voss A, Braun S, Obopilwe E, Apostolakos J . The Integrity of the Acromioclavicular Capsule Ensures Physiological Centering of the Acromioclavicular Joint Under Rotational Loading. Am J Sports Med. 2018; 46(6):1432-1440. DOI: 10.1177/0363546518758287. View

Morikawa D, Dyrna F, Cote M, Johnson J, Obopilwe E, Imhoff F . Repair of the entire superior acromioclavicular ligament complex best restores posterior translation and rotational stability. Knee Surg Sports Traumatol Arthrosc. 2018; 27(12):3764-3770. DOI: 10.1007/s00167-018-5205-y. View

Gumina S, Carbone S, Postacchini F . Scapular dyskinesis and SICK scapula syndrome in patients with chronic type III acromioclavicular dislocation. Arthroscopy. 2008; 25(1):40-5. DOI: 10.1016/j.arthro.2008.08.019. View

Tauber M, Valler D, Lichtenberg S, Magosch P, Moroder P, Habermeyer P . Arthroscopic Stabilization of Chronic Acromioclavicular Joint Dislocations: Triple- Versus Single-Bundle Reconstruction. Am J Sports Med. 2015; 44(2):482-9. DOI: 10.1177/0363546515615583. View

Garofalo R, Ceccarelli E, Castagna A, Calvisi V, Flanagin B, Conti M . Open capsular and ligament reconstruction with semitendinosus hamstring autograft successfully controls superior and posterior translation for type V acromioclavicular joint dislocation. Knee Surg Sports Traumatol Arthrosc. 2017; 25(7):1989-1994. DOI: 10.1007/s00167-017-4509-7. View

Beitzel K, Cote M, Apostolakos J, Solovyova O, Judson C, Ziegler C . Current concepts in the treatment of acromioclavicular joint dislocations. Arthroscopy. 2013; 29(2):387-97. DOI: 10.1016/j.arthro.2012.11.023. View

Nolte P, Lacheta L, Dekker T, Elrick B, Millett P . Optimal Management of Acromioclavicular Dislocation: Current Perspectives. Orthop Res Rev. 2020; 12:27-44. PMC: 7062404. DOI: 10.2147/ORR.S218991. View

10.

Grutter P, Petersen S . Anatomical acromioclavicular ligament reconstruction: a biomechanical comparison of reconstructive techniques of the acromioclavicular joint. Am J Sports Med. 2005; 33(11):1723-8. DOI: 10.1177/0363546505275646. View

11.

Lee S, Nicholas S, Akizuki K, McHugh M, Kremenic I, Ben-Avi S . Reconstruction of the coracoclavicular ligaments with tendon grafts: a comparative biomechanical study. Am J Sports Med. 2003; 31(5):648-55. DOI: 10.1177/03635465030310050301. View

12.

Saccomanno M, Fodale M, Capasso L, Cazzato G, Milano G . Reconstruction of the coracoclavicular and acromioclavicular ligaments with semitendinosus tendon graft: a pilot study. Joints. 2015; 2(1):6-14. PMC: 4295659. View

13.

Mazzocca A, Santangelo S, Johnson S, Rios C, Dumonski M, Arciero R . A biomechanical evaluation of an anatomical coracoclavicular ligament reconstruction. Am J Sports Med. 2005; 34(2):236-46. DOI: 10.1177/0363546505281795. View

14.

Costic R, Labriola J, Rodosky M, Debski R . Biomechanical rationale for development of anatomical reconstructions of coracoclavicular ligaments after complete acromioclavicular joint dislocations. Am J Sports Med. 2004; 32(8):1929-36. DOI: 10.1177/0363546504264637. View

15.

Hohmann E, Tetsworth K . Clinical outcomes for grades III-V acromioclavicular dislocations favor double-button fixation compared to clavicle hook plate fixation: a systematic review and meta-analysis. Eur J Orthop Surg Traumatol. 2023; 33(7):2831-2846. PMC: 10504211. DOI: 10.1007/s00590-023-03492-3. View

16.

Spiegl U, Smith S, Euler S, Dornan G, Millett P, Wijdicks C . Biomechanical Consequences of Coracoclavicular Reconstruction Techniques on Clavicle Strength. Am J Sports Med. 2014; 42(7):1724-30. DOI: 10.1177/0363546514524159. View

17.

Rylander L, Baldini T, Mitchell J, Messina M, Justl Ellis I, McCarty E . Coracoclavicular ligament reconstruction: coracoid tunnel diameter correlates with failure risk. Orthopedics. 2014; 37(6):e531-5. DOI: 10.3928/01477447-20140528-52. View

18.

Dimakopoulos P, Panagopoulos A, Syggelos S, Panagiotopoulos E, Lambiris E . Double-loop suture repair for acute acromioclavicular joint disruption. Am J Sports Med. 2006; 34(7):1112-9. DOI: 10.1177/0363546505284187. View

19.

Scheibel M, Droschel S, Gerhardt C, Kraus N . Arthroscopically assisted stabilization of acute high-grade acromioclavicular joint separations. Am J Sports Med. 2011; 39(7):1507-16. DOI: 10.1177/0363546511399379. View

20.

Reintgen C, Gerlach E, Schoch B, Mamelson K, Wright T, Farmer K . What Outcome Measures Are Reported in the Management of Acromioclavicular Joint Injuries?. Orthop J Sports Med. 2020; 8(1):2325967119892322. PMC: 6950540. DOI: 10.1177/2325967119892322. View