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Comparing mini-open and arthroscopic acromioclavicular joint repair: functional results and return to sport

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Abstract

Introduction

Acromioclavicular joint (ACJ) dislocation is a common injury that can result from sports activities. The surgical technique for the treatment of Type III and Type IV injuries, according to the Rockwood classification, remains controversial. The purpose of the study was to determine the functional outcome after minimally invasive and arthroscopic surgery. The mini-open surgery was done with MINAR® system, whereas the arthroscopic technique was done with Dog BoneTM Button.

Study design

Retrospective Cohort study.

Methods

We reviewed 31 who were surgically treated for acute acromioclavicular dislocation Type III and Type IV (2012-2015). We excluded subjects with chronic dislocation or other injury. We selected 16 patients (average age 37).  Half of the sample patients were treated with mini-open surgery with the MINAR® system, and the other half of the patients were treated with the Dog Bone arthroscopic technique. The Constant Shoulder Score, the Oxford Shoulder Score, the Simple Shoulder Test and the Subjective Patient Outcome for Return to Sports (SPORTS) score were used to assess functional outcome of the treated shoulder.

Results

Mean follow-up was 13 months (range 6–27 months). The mean Constant Shoulder Score was 91.10 (range 82.76–96.66), Oxford Shoulder Score was 46.19 (range 42.00–48.00), the Simple Shoulder Test was 10.50 (range 9.00–12.00), and the SPORTS score was 7.88 (range 3–10). There is a statistically significant difference between the sample operated with the mini-open surgery and the group operated with arthroscopic technique. The probability of return to their sport, according to the results of the SPORTS score, was significantly higher for patients treated with the MINAR® system (p < 0.001). However, the objective parameter of Constant scale is statistically better in patients operated by arthroscopic technique (p < 0.05; p < 0.001).

Conclusion

Restoration of ACJ anatomy is the key to a successful therapy. The surgical technique should be personalized. The miny-open surgery and also the arthroscopic surgery are adequate with good clinical results. However, according to the SPORTS score, the patients treated with mini-open surgery returned to their sport with less pain and better performance than those belonging to the other group.

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References

  1. Clarke MG, Dewing CB, Schroder DT, Solomon DJ, Provencher MT (2009) Normal shoulder outcome score values in the young, active adult. J Shoulder Elb Surg 18:424–428

    Article  Google Scholar 

  2. Spencer EE (2007) Treatment of grade III acromioclavicular joint injuries: a systematic review. Clin Orthop Relat Res 455:38–44

    Article  PubMed  Google Scholar 

  3. Exhibit E. Acromioclavicular OBJECTIVES. Radiographics. 2008:463–480

  4. Modi CS, Beazley J, Zywiel MG, Lawrence TM, Veillette CJH (2013) Controversies relating to the management of acromioclavicular joint dislocations. Bone Joint J 95 B(12):1595–1602

    Article  PubMed  Google Scholar 

  5. Saccomanno MF, Ieso CDE, Milano G (2014) Acromioclavicular joint instability: anatomy, biomechanics and evaluation. Joints 2(Cc):87–92

    PubMed  PubMed Central  Google Scholar 

  6. Fraser-Moodie JA, Shortt NL, Robinson CM (2008) Injuries to the acromioclavicular joint. J Bone Joint Surg Br 90(6):697–707

    Article  CAS  PubMed  Google Scholar 

  7. Kocher MS, Feagin JA (1996) Shoulder injuries during alpine skiing. Am J Sports Med 24:665–669

    Article  CAS  PubMed  Google Scholar 

  8. Wellmann M, Lodde I, Schanz S, Zantop T, Raschke MJ, Petersen W (2008) Biomechanical evaluation of an augmented coracoacromial ligament transfer for acromioclavicular joint instability. Arthrosc J Arthrosc Relat Surg 24(12):1395–1401

    Article  Google Scholar 

  9. Hootman JM (2004) Acromioclavicular dislocation: conservative or surgical therapy. J Athl Train 39(1):10–11

    PubMed  PubMed Central  Google Scholar 

  10. Tamaoki MJ, Belloti JC, Lenza M, Matsumoto MH, Gomes Dos Santos JB, Faloppa F (2010) Surgical versus conservative interventions for treating acromioclavicular dislocation of the shoulder in adults [review] [37 refs]. Cochrane Database Syst Rev 8:CD007429

    Google Scholar 

  11. Ceccarelli E, Bondí R, Alviti F, Garofalo R, Miulli F, Padua R (2008) Treatment of acute grade III acromioclavicular dislocation: a lack of evidence. J Orthop Traumatol 9:105–108

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Cho C, Hwang I, Seo J (2014) Reliability of the classification and treatment of dislocations of the acromioclavicular joint. J Shoulder Elb Surg 23(5):665–670

    Article  Google Scholar 

  13. Metzlaff S, Rosslenbroich S, Forkel PH, Schliemann B, Arshad H, Raschke M, Petersen W (2014) Surgical treatment of acute acromioclavicular joint dislocations: hook plate versus minimally invasive reconstruction. Knee Surg Sport Traumatol Arthrosc 11(2):29

    Google Scholar 

  14. Petersen W, Wellmann M, Rosslenbroich SZT (2010) Minimally invasive acromioclavicular joint reconstruction (MINAR). Oper Orthop Traumatol 22(1):52–61

    Article  PubMed  Google Scholar 

  15. Tauber M (2013) Management of acute acromioclavicular joint dislocations: current concepts. Arch Orthop Trauma Surg 133:985–995

    Article  PubMed  Google Scholar 

  16. Trikha SP, Acton D, Wilson AJ, Curtis MJ (2004) A new method of arthroscopic reconstruction of the dislocated acromio-clavicular joint. Ann R Coll Surg Engl 86:161–164

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Murena L, Vulcano E, Ratti C, Cecconello L, Rolla PR, Surace MF (2009) Arthroscopic treatment of acute acromioclavicular joint dislocation with double flip button. Knee Surg Sport Traumatol Arthrosc 17:1511–1515

    Article  CAS  Google Scholar 

  18. Baumgarten KM, Altchek DW, Cordasco FA (2006) Arthroscopically assisted acromioclavicular joint reconstruction. Arthrosc J Arthrosc Relat Surg 22(2):228-e1

    Article  Google Scholar 

  19. Motta P, Maderni A, Bruno L, Mariotti U (2011) Suture rupture in acromioclavicular joint dislocations treated with flip buttons. Arthrosc J Arthrosc Relat Surg 27(2):294–298

    Article  Google Scholar 

  20. Defoort S, Verborgt O (2010) Functional and radiological outcome after arthroscopic and open acromioclavicular stabilization using a double-button fixation system. Acta Orthop Belg 76:585–591

    PubMed  Google Scholar 

  21. Saccomanno MF, Fodale M, Cazzato G (2014) Joints Reconstruction of the coracoclavicular and acromioclavicular ligaments with semitendinosus tendon graft: a pilot study. Joints 2(Cc):6–14

    PubMed  PubMed Central  Google Scholar 

  22. Mara G (2011) Surgical treatment of acromioclavicular dislocation with minimally invasive surgery. Acta Ortop Mex 25(6):359–365

    Google Scholar 

  23. Glanzmann MC, Buchmann S, Audigé L, Kolling C, Flury M (2013) Clinical and radiographical results after double flip button stabilization of acute grade III and IV acromioclavicular joint separations. Arch Orthop Trauma Surg 133:1699–1707

    Article  PubMed  Google Scholar 

  24. Blonna D, Scelsi M, Marini E et al (2012) Can we improve the reliability of the Constant-Murley Score? J Shoulder Elb Surg 21(1):4–12

    Article  Google Scholar 

  25. Katolik LI, Romeo AA, Cole BJ, Verma NN, Hayden JK, Bach BR (2005) Normalization of the Constant score. J Shoulder Elb Surg 14(3):279–285

    Article  Google Scholar 

  26. Constant CR, Gerber C, Emery RJH, Søjbjerg JO, Gohlke F, Boileau P (2008) A review of the Constant score: modifications and guidelines for its use. J Shoulder Elb Surg 17:355–361

    Article  Google Scholar 

  27. Tavakkolizadeh A, Ghassemi A, Colegate-Stone T, Latif A, Sinha J (2009) Gender-specific Constant score correction for age. Knee Surg Sport Traumatol Arthrosc 17:529–533

    Article  CAS  Google Scholar 

  28. Dawson J, Rogers K, Fitzpatrick R, Carr A (2009) The Oxford shoulder score revisited. Arch Orthop Trauma Surg 129:119–123

    Article  PubMed  Google Scholar 

  29. Skare Ø, Schrøder CP, Mowinckel P, Reikerås O, Brox JI (2011) Reliability, agreement and validity of the 1988 version of the Rowe Score. J Shoulder Elb Surg 20:1041–1049

    Article  Google Scholar 

  30. Marchese C, Cristalli G, Pichi B et al (2012) Italian cross-cultural adaptation and validation of three different scales for the evaluation of shoulder pain and dysfunction after neck dissection: university of California—Los Angeles (UCLA) Shoulder Scale, Shoulder Pain and Disability Index (SPADI). Acta Otorhinolaryngol Ital 32:12–17

    CAS  PubMed  PubMed Central  Google Scholar 

  31. Blonna D, Castoldi F, Delicio D et al (2012) Validity and reliability of the SPORTS score. Knee Surg Sport Traumatol Arthrosc 20:356–360

    Article  Google Scholar 

  32. Rosslenbroich SB, Schliemann B, Schneider KN et al (2015) Minimally invasive coracoclavicular ligament reconstruction with a flip-button technique (MINAR). Clin Radiol Midterm Results XX(X):1–7

    Google Scholar 

  33. Esposito JG, Ono Y, Boorman RS, Thornton GM, Lo IKY (2015) Complications following arthroscopic fixation of acromioclavicular separations: a systematic review of the literature. Open Access J Sports Med 6:97–107

    PubMed  PubMed Central  Google Scholar 

  34. Luis GE, Yong CK, Singh DA, Sengupta S, Choon DS (2007) Acromioclavicular joint dislocation: a comparative biomechanical study of the palmaris-longus tendon graft reconstruction with other augmentative methods in cadaveric models. J Orthop Surg Res 2:22

    Article  PubMed  PubMed Central  Google Scholar 

  35. Hosseini H, Friedmann S, Tröger M, Lobenhoffer P, Agneskirchner JD (2009) Arthroscopic reconstruction of chronic AC joint dislocations by transposition of the coracoacromial ligament augmented by the tight rope device: a technical note. Knee Surg Sport Traumatol Arthrosc 17:92–97

    Article  Google Scholar 

  36. Walz L, Salzmann GM, Fabbro T, Eichhorn S, Imhoff AB (2008) The anatomic reconstruction of acromioclavicular joint dislocations using 2 TightRope devices: a biomechanical study. Am J Sports Med 36:2398–2406

    Article  PubMed  Google Scholar 

  37. Motta P, Bruno L, Maderni A, Tosco P, Mariotti U (2014) Acute lateral dislocated clavicular fractures: arthroscopic stabilization with TightRope. J Shoulder Elb Surg 23(3):e47–e52

    Article  Google Scholar 

  38. Jiang C, Wang M, Rong G (2008) Proximally based conjoined tendon transfer for coracoclavicular reconstruction in the treatment of acromioclavicular dislocation. Surgical technique. J Bone Joint Surg Am 90(Suppl 2):299–308

    Article  PubMed  Google Scholar 

  39. Jari R, Costic RS, Rodosky MW, Debski RE (2004) Biomechanical function of surgical procedures for acromioclavicular joint dislocations. Arthrosc J Arthrosc Relat Surg 20(3):237–245

    Article  Google Scholar 

  40. Baker JE, Nicandri GT, Young DC, Owen JR, Wayne JS (2003) A cadaveric study examining acromioclavicular joint congruity after different methods of coracoclavicular loop repair. J Shoulder Elb Surg 12:595–598

    Article  Google Scholar 

  41. Yoon JP, Lee B, Nam SJ, Chung SW (2015) Comparison of results between hook plate fixation and ligament reconstruction for acute unstable acromioclavicular joint dislocation. Clin Orthop Surg 7:97–103

    Article  PubMed  PubMed Central  Google Scholar 

  42. Lädermann A, Gueorguiev B, Stimec B, Fasel J, Rothstock S, Hoffmeyer P (2012) Acromioclavicular joint reconstruction: a comparative biomechanical study of three techniques. J Shoulder Elb Surg 22:171–178

    Article  Google Scholar 

  43. Esenyel CZ, Öztürk K, Bülbül M, Ayanoǧlu S, Ceylan HH (2010) Coracoclavicular ligament repair and screw fixation in acromioclavicular dislocations. Acta Orthop Traumatol Turc. 44:194–198

    Article  PubMed  Google Scholar 

  44. Dumrongwanich PPP (2009) Outcomes of percutaneous K-wire fixation for AC joint separation type III. Med Assoc Thail 92:S211–S216

    Google Scholar 

  45. Defoort SVO (2010) Functional and radiological outcome after arthroscopic and open acromioclavicular stabilization using a double-button fixation system. Acta Orthop Belg 76(5):585

    PubMed  Google Scholar 

  46. Taft TN, Wilson FCOJ, Oglesby JW (1987) Dislocation of the acromioclavicular joint An end-result study. J Bone Joint Surg Am 69(7):1045

    Article  CAS  PubMed  Google Scholar 

  47. Jensen G, Katthagen JC, Alvarado LE, Lill H, Voigt C (2014) Has the arthroscopically assisted reduction of acute AC joint separations with the double tight-rope technique advantages over the clavicular hook plate fixation? Knee Surg Sport Traumatol Arthrosc 22:422–430

    Article  Google Scholar 

  48. Rotini R, Cavaciocchi M, Fabbri D, Bettelli G (2015) Proximal humeral fracture fixation: multicenter study with carbon fiber peek plate. Musculoskelet Surg 99(Supplement 1):1–8

    Article  Google Scholar 

  49. Krishnan SG, Garofalo R, Flanagin B, Castagna A (2015) Intramedullary clavicle fixation with single large fragmentary screw. Musculoskelet Surg 99(Supplement 1):25–30

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, CTO and Maria Adelaide Hospital, University of Turin Medical School, 29, Via Zuretti, 10126, Turin, TO, Italy

    M. Faggiani, G. P. Vasario, L. Mattei, M. J. Calò & F. Castoldi

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  1. M. Faggiani
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  2. G. P. Vasario
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  3. L. Mattei
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  4. M. J. Calò
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Faggiani, M., Vasario, G.P., Mattei, L. et al. Comparing mini-open and arthroscopic acromioclavicular joint repair: functional results and return to sport. Musculoskelet Surg 100, 187–191 (2016). https://doi.org/10.1007/s12306-016-0411-6

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