Functional and Radiologic Results of Tight Rope Technique in Acute Rockwood Type 5 Acromioclavicular Separations

Yıl 2023, Cilt: 20 Sayı: 3, 533 - 538, 31.12.2023

Ozan Altun , Yılmaz Ergişi , Mehmet Baran Uslu , Erdi Özdemir , Uygar Daşar

https://doi.org/10.35440/hutfd.1339247

Öz

Background
We aimed to reveal clinical, functional and radiological mid-term results of double button implant technique in acute type 5 acromioclavicular joint separations.
Materials and Methods
Patients who were surgically treated in our clinic for acromioclavicular joint separation by using the double-button implant technique between January 2019 and June 2021 were retrospectively analyzed. Patients, with acute traumatic type 5 dislocations, over the age of 18, with at least 12 months follow-up period and patients without history of an injury in the affected upper extremity were included in the study. Patients with open injuries, accompanying acromion fractures, clavicle fractures or glenoid fractures, patients with a history of previous shoulder surgery, and chronic cases were excluded from the study. At the final outpatient follow-up, coracoclavicular distances of both the operated shoulder double button implant technique and the unaffected shoulder were measured from shoulder radiographs. Radiographs were simultaneously examined for the reduction quality and acromioclavicular joint osteoarthritis status. Also in the final follow-up, pain status, as well as functional status were evaluated by Visual Analog Score and Constant-Murley shoulder scoring system, respectively.
Results
A total of 16 patients, 15 male and 1 female, were included in the study. The mean age of the included patients was 42.1 (19-66). The mean follow-up period was 28.0 (15-44) months. Mean coracoclavicular distance of the unaffected and operated shoulders were 7.8 mm (5.7-9.8) and 8.4 mm (5.8-13.9), respectively. Reduction quality distribution was seen as type 4 in 1 patient, type 2 in 2 patients, type 3 in 1 patient, and type 1 in 12 patients. While acromioclavicular joint osteoarthritis developed in 3 patients, 1 of which was stage 2 and 2 of which was stage 3, rest of the patients had no osteoarthritis. The mean Visual analog pain score was 1.3 (0-4) and the mean modified Constant score was 86.1 (73-93) in the final follow-up.
Conclusions
Results of this study suggests that the double button implant technique can be considered in acute type 5 acromioclavicular joint separations as a reliable and a successful surgical procedure.

Anahtar Kelimeler

Acromioclavicular joint dislocation, Rockwood, surgical treatment, tightrope, coracoclavicular distance

Akut Rockwood Tip 5 Akromioklaviküler Eklem Çıkıklarında Uygulanan Çift Düğme İmplantı Tekniğinin Fonksiyonel ve Radyolojik Sonuçları

Öz

Amaç: Akut tip 5 akromioklavikular eklem çıkıklarında çift düğme implantı tekniğinin orta dönemde klinik, fonksi-yonel ve radyolojik sonuçlarını ortaya koymayı hedefledik.
Materyal ve metod: Kliniğimizde Ocak 2019- Haziran 2021 tarihleri arasında akromiyoklaviküler eklem çıkığı nedeniyle çift düğme implantı tekniği kullanılarak cerrahi tedavi edilmiş hastalar geriye dönük olarak tarandı. Son poliklinik kontrollerinde hastaların omuz radyografilerinden etkilenmemiş omuzda korakoklaviküler mesafeleri ile çift düğme implantı tekniği uygulanan omuzdaki korakoklaviküler mesafeleri ölçüldü. Aynı zamanda hastaların omuz radyografileri incelenerek redüksiyon kaliteleri ve akromioklaviküler eklemin Kellgren-Lawrence sınıflama-sına göre osteoartrit durumu not edildi. Hastaların son poliklinik kontrollerinde; ağrı durumları Visual Analog Score, fonksiyonel durumları Constant-Murley omuz skorlama sistemi kullanılarak değerlendirildi.
Bulgular: Çalışmaya 15’i erkek, 1’i kadın olmak üzere toplam 16 hasta dâhil edildi. Dâhil edilen hastaların yaş orta-laması 42,1 (19-66) idi. Ortalama takip süresi 28.0 (15-44) ay idi. Son poliklinik kontrolünde, etkilenmemiş omuzda ölçülen korakoklaviküler mesafe ortalama 7,7±1.0 mm , düğme implantı tekniği uygulanan omuzda ortalama kora-koklaviküler mesafe 8,4± 2.0 mm olarak ölçüldü. Redüksiyon kalitesi dağılımı; 1 hastada tip 4, 2 hastada tip 2, 1 hastada tip 3, 12 hastada ise tip 1 olarak görüldü. Hastalardan 1’inde evre 2 ve 2’sinde ise evre 3 olmak üzere toplam 3 hastada akromioklaviküler eklem osteoartriti gelişimi gözlenirken 13 hastada osteoartrit gelişimi gözlen-medi. Ameliyat sonrası son poliklinik kontrollerinde ortalama Visual analog ağrı skoru 1,3 (0-4), ortalama modifiye Constant skoru ise 86,1 (73-93) olarak ölçüldü.
Sonuç: Akut tip 5 akromioklaviküler eklem çıkıklarında uygulanan çift düğme implantı tekniğinin başarılı ve güvenli bir cerrahi prosedürdür.

Anahtar Kelimeler

Akromioklaviküler eklem çıkığı, Rockwood, çift düğme implantı, cerrahi tedavi, korakoklaviküler mesafe

Kaynakça

• 1. Horst K, Dienstknecht T, Andruszkow H, Gradl G, Kobbe P, Pape HC. Radiographic changes in the operative treatment of acute acromioclavicular joint dislocation - tight rope technique vs. K-wire fixation. Pol J Radiol. 2013;78(4):15-20.
• 2. Weiser L, Nuchtern JV, Sellenschloh K, Puschel K, Morlock MM, Rueger JM, et al. Acromioclavicular joint dislocations: coracoclavicular reconstruction with and without additional direct acromioclavicular repair. Knee Surg Sports Traumatol Arthrosc. 2017;25(7):2025-31.
• 3. Horst K, Dienstknecht T, Pishnamaz M, Sellei RM, Kobbe P, Pape HC. Operative treatment of acute acromioclavicular joint injuries graded Rockwood III and IV: risks and benefits in tight rope technique vs. k-wire fixation. Patient Saf Surg. 2013;7:18.
• 4. LA GOV, Visco A, Daneu Fernandes LF, NG GOC. Arthro-scopic Treatment of Acromioclavicular Joint Dislocation by Tight Rope Technique (Arthrex((R))). Rev Bras Ortop. 2009;44(1):52-6.
• 5. Lemos MJ. The evaluation and treatment of the injured acromioclavicular joint in athletes. Am J Sports Med. 1998;26(1):137-44.
• 6. Dias JJ, Steingold RF, Richardson RA, Tesfayohannes B, Gregg PJ. The conservative treatment of acromioclavicular dislocation. Review after five years. J Bone Joint Surg Br. 1987;69(5):719-22.
• 7. Cox JS. The fate of the acromioclavicular joint in athletic injuries. Am J Sports Med. 1981;9(1):50-3.
• 8. Gultac E, Can FI, Kilinc CY, Aydogmus H, Topsakal FE, Acan AE, et al. Comparison of the Radiological and Functional Re-sults of Tight Rope and Clavicular Hook Plate Technique in the Treatment of Acute Acromioclavicular Joint Dislocation. J Invest Surg. 2022;35(3):693-6.
• 9. Sloan SM, Budoff JE, Hipp JA, Nguyen L. Coracoclavicular ligament reconstruction using the lateral half of the con-joined tendon. J Shoulder Elbow Surg. 2004;13(2):186-90.
• 10. Larsen E, Bjerg-Nielsen A, Christensen P. Conservative or surgical treatment of acromioclavicular dislocation. A pro-spective, controlled, randomized study. J Bone Joint Surg Am. 1986;68(4):552-5.
• 11. Bannister GC, Wallace WA, Stableforth PG, Hutson MA. The management of acute acromioclavicular dislocation. A ran-domised prospective controlled trial. J Bone Joint Surg Br. 1989;71(5):848-50.
• 12. Vrgoc G, Japjec M, Jurina P, Gulan G, Jankovic S, Sebecic B, et al. Operative treatment of acute acromioclavicular dislo-cations Rockwood III and V-Comparative study between K-wires combined with FiberTape((R)) vs. TightRope Sys-tem((R)). Injury. 2015;46 Suppl 6:S107-12.
• 13. Hann C, Kraus N, Minkus M, Maziak N, Scheibel M. Com-bined arthroscopically assisted coraco- and acromioclavicu-lar stabilization of acute high-grade acromioclavicular joint separations. Knee Surg Sports Traumatol Arthrosc. 2018;26(1):212-20.
• 14. Fraser-Moodie JA, Shortt NL, Robinson CM. Injuries to the acromioclavicular joint. J Bone Joint Surg Br. 2008;90(6):697-707.
• 15. Ejam S, Lind T, Falkenberg B. Surgical treatment of acute and chronic acromioclavicular dislocation Tossy type III and V using the Hook plate. Acta Orthop Belg. 2008;74(4):441-5.
• 16. Hackenberger J, Schmidt J, Altmann T. [The effects of hook plates on the subacromial space--a clinical and MRT study]. Z Orthop Ihre Grenzgeb. 2004;142(5):603-10.
• 17. Kienast B, Thietje R, Queitsch C, Gille J, Schulz AP, Meiners J. Mid-term results after operative treatment of rockwood grade III-V acromioclavicular joint dislocations with an AC-hook-plate. Eur J Med Res. 2011;16(2):52-6.
• 18. Choi NH, Lim SM, Lee SY, Lim TK. Loss of reduction and complications of coracoclavicular ligament reconstruction with autogenous tendon graft in acute acromioclavicular dislocations. J Shoulder Elbow Surg. 2017;26(4):692-8.
• 19. Hou Z, Graham J, Zhang Y, Strohecker K, Feldmann D, Bow-en TR, et al. Comparison of single and two-tunnel tech-niques during open treatment of acromioclavicular joint disruption. BMC Surg. 2014;14:53.
• 20. Saraglis G, Prinja A, To K, Khan W, Singh J. Surgical treat-ments for acute unstable acromioclavicular joint disloca-tions. SICOT J. 2022;8:38.
• 21. Bin Abd Razak HR, Yeo EN, Yeo W, Lie TD. Short-term out-comes of arthroscopic TightRope((R)) fixation are better than hook plate fixation in acute unstable acromioclavicular joint dislocations. Eur J Orthop Surg Traumatol. 2018;28(5):869-75.
• 22. Jensen G, Katthagen JC, Alvarado LE, Lill H, Voigt C. Has the arthroscopically assisted reduction of acute AC joint separa-tions with the double tight-rope technique advantages over the clavicular hook plate fixation? Knee Surg Sports Traumatol Arthrosc. 2014;22(2):422-30.
• 23. Mares O, Luneau S, Staquet V, Beltrand E, Bousquet PJ, Maynou C. Acute grade III and IV acromioclavicular disloca-tions: outcomes and pitfalls of reconstruction procedures using a synthetic ligament. Orthop Traumatol Surg Res. 2010;96(7):721-6.
• 24. Qi W, Xu Y, Yan Z, Zhan J, Lin J, Pan X, et al. The Tight-Rope Technique versus Clavicular Hook Plate for Treatment of Acute Acromioclavicular Joint Dislocation: A Systematic Re-view and Meta-Analysis. J Invest Surg. 2021;34(1):20-9.
• 25. Celik D. Turkish version of the modified Constant-Murley score and standardized test protocol: reliability and validity. Acta Orthop Traumatol Turc. 2016;50(1):69-75.
• 26. Conboy VB, Morris RW, Kiss J, Carr AJ. An evaluation of the Constant-Murley shoulder assessment. J Bone Joint Surg Br. 1996;78(2):229-32.
• 27. Lu D, Wang T, Chen H, Sun LJ. A comparison of double Endobutton and triple Endobutton techniques for acute acromioclavicular joint dislocation. Orthop Traumatol Surg Res. 2016;102(7):891-5.
• 28. Panagopoulos A, Fandridis E, Rose GD, Ranieri R, Castagna A, Kokkalis ZT, et al. Long-term stability of coracoclavicular suture fixation for acute acromioclavicular joint separation. Knee Surg Sports Traumatol Arthrosc. 2021;29(7):2103-9.
• 29. Hu JT, Lu JW, Fu LF. [Case control study on the treatment of acromioclavicular dislocation with Endobutton plates com-bined with an anchor]. Zhongguo Gu Shang. 2016;29(9):841-6.
• 30. Walz L, Salzmann GM, Fabbro T, Eichhorn S, Imhoff AB. The anatomic reconstruction of acromioclavicular joint disloca-tions using 2 TightRope devices: a biomechanical study. Am J Sports Med. 2008;36(12):2398-406.
• 31. Scheibel M, Droschel S, Gerhardt C, Kraus N. Arthroscopi-cally assisted stabilization of acute high-grade acromiocla-vicular joint separations. Am J Sports Med. 2011;39(7):1507-16.
• 32. Nie S, Lan M. Comparison of clinical efficacy between ar-throscopically assisted Tight-Rope technique and clavicular hook plate fixation in treating acute high-grade acromiocla-vicular joint separations. J Orthop Surg (Hong Kong). 2021;29(2):23094990211010562.
• 33. Shin SJ, Kim NK. Complications after arthroscopic coracocla-vicular reconstruction using a single adjustable-loop-length suspensory fixation device in acute acromioclavicular joint dislocation. Arthroscopy. 2015;31(5):816-24.
• 34. Milewski MD, Tompkins M, Giugale JM, Carson EW, Miller MD, Diduch DR. Complications related to anatomic recon-struction of the coracoclavicular ligaments. Am J Sports Med. 2012;40(7):1628-34.
• 35. Martetschlager F, Horan MP, Warth RJ, Millett PJ. Complica-tions after anatomic fixation and reconstruction of the coracoclavicular ligaments. Am J Sports Med. 2013;41(12):2896-903.
• 36. Cook JB, Shaha JS, Rowles DJ, Bottoni CR, Shaha SH, Tokish JM. Early failures with single clavicular transosseous coraco-clavicular ligament reconstruction. J Shoulder Elbow Surg. 2012;21(12):1746-52.
• 37. Gowd AK, Liu JN, Cabarcas BC, Cvetanovich GL, Garcia GH, Manderle BJ, et al. Current Concepts in the Operative Management of Acromioclavicular Dislocations: A System-atic Review and Meta-analysis of Operative Techniques. Am J Sports Med. 2019;47(11):2745-58.
• 38. Gu F, Tan L, Wang T, Wen Q, Su Z, Sui Z, et al. Comparison of single versus double TightRope system in the treatment of acute acromioclavicular joint dislocation. J Shoulder El-bow Surg. 2021;30(8):1915-23.