Authors

1 Assistant Professor of Orthopedics, Physiology Research Center & Afzalipour School of Medicine, Kerman University of Medical Sciences, Kerman, Iran

2 Resident of orthopedics, Afzalipour School of Medicine, Kerman University of Medical Sciences, Kerman, Iran

Abstract

Background & Aims: Acute acromioclavicular (AC) joint dislocation is common in shoulder injuries. Considering the biomechanics of this joint, the use of a treatment method, which can restore joint physiology and biomechanics to the extent possible, is important. This study aimed to compare the treatment of acute AC joint dislocation by screw fixation with and without ligament reconstruction. Methods: In the present study, 28 patients with AC joint dislocation type 4, 5, and 6, were randomly treated with either coracoclavicular screw fixation with ligamentous reconstruction or screw fixation without ligament reconstruction. Screws were removed after 8 weeks. The follow-up period lasted for 2 months. The simple shoulder test (SST), disabilities of the arm, shoulder, and hand (DASH) score, and the University of California-Los Angeles (UCLA) shoulder scale were conducted using specific questionnaires. Results: Based on the SST, mean shoulder function was better in the ligament reconstruction group compared to the group without ligament reconstruction (P = 0.028). The result of the UCLA shoulder scale indicate a significantly better returning to original and natural function of the AC joint in the ligament reconstruction group than the other group (P = 0.012). DASH score indicated a significantly lower disability rate in the group that underwent ligament reconstruction than the other group (P = 0.001). Conclusion: The results suggest that ligament reconstruction in the Ac joint significantly increases the rate of returning to normal function, joint stability, and normal joint physiology.

Keywords

  1. Rockwood CA, Bucholz R, Court-Brown CM, Heckman JD, Tornetta P. Rockwood and Green's Fractures in adults. Philadelphia, PA: Lippincott Williams & Wilkins; 2010. p. 1243-79.
  2. Wei H, Chen YF, Zeng B, Zhang CQ, Chai Y, Wang H, et al. Triple endobuttton technique for the treatment of acute complete acromioclavicular joint dislocations: preliminary results. Int Orthop 2011; 35(4): 555-9.
  3. Cave E. Fractures & other injuries. Chicago, Il: Year Book Publishers; 2008.
  4. Riand N, Sadowski C, Hoffmeyer P. [Acute acromioclavicular dislocations]. Acta Orthop Belg 1999; 65(4): 393-403.
  5. Bannister GC, Wallace WA, Stableforth PG, Hutson MA. The management of acute acromioclavicular dislocation. A randomised prospective controlled trial. J Bone Joint Surg Br 1989; 71(5): 848-50.
  6. Hosseini H, Friedmann S, Troger M, Lobenhoffer P, Agneskirchner JD. Arthroscopic reconstruction of chronic AC joint dislocations by transposition of the coracoacromial ligament augmented by the Tight Rope device: a technical note. Knee Surg Sports Traumatol Arthrosc 2009; 17(1): 92-7.
  7. Costic RS, Labriola JE, Rodosky MW, Debski RE. Biomechanical rationale for development of anatomical reconstructions of coracoclavicular ligaments after complete acromioclavicular joint dislocations. Am J Sports Med 2004; 32(8): 1929-36.
  8. Lemos MJ. The evaluation and treatment of the injured acromioclavicular joint in athletes. Am J Sports Med 1998; 26(1): 137-44.
  9. Dumontier C, Sautet A, Man M, Apoil A. Acromioclavicular dislocations: treatment by coracoacromial ligamentoplasty. J Shoulder Elbow Surg 1995; 4(2): 130-4.
  10. Weinstein DM, McCann PD, Mcllveen S, Flatow F, Bigliani L. Surgical treatment of complete acromioclavicular dislocations. Am J Sports Med 1995; 23(3): 324-31.
  11. Weaver JK, Dunn HK. Treatment of acromioclavicular injuries, especially complete acromioclavicular separation. J Bone Joint Surg Am 1972; 54(6): 1187-94.
  12. Bishap JY, Kaeding C. Treatment of the acute traumatic acromioclavicular separation. Sports Med Arthrosc 2006; 14(4): 237-45.
  13. Motamedi AR, Blevins FT, Willis MC, McNally TP, Shahinpoor M. Biomechanics of the coracoclavicular ligament complex and augmentations used in its repair and reconstruction. Am J Sports Med 2000; 28(3): 380-4.
  14. Morrison DS, Lemos MJ. Acromioclavicular separation. Reconstruction using synthetic loop augmentation. Am J Sports Med 1995; 23(1): 105-10.
  15. Jones HP, Lemos MJ, Schepsis AA. Salvage of failed acromioclavicular joint reconstruction using autogenous semitendinosus tendon from the knee. Surgical technique and case report. Am J Sports Med 2001; 29(2): 234-7.
  16. Lee SJ, Nicholas SJ, Akizuki KH, McHugh MP, Kremenic IJ, Ben-Avi S. Reconstruction of the coracoclavicular ligaments with tendon grafts: a comparative biomechanical study. Am J Sports Med 2003; 31(5): 648-55.
  17. Amstutz HC, Sew Hoy Al, Clark IC. UCLA anatomic total shoulder arthroplasty: Clin Orthop Relat Res 1981; 155: 7-20.
  18. Richards RR, An KN, Bigliani LU, Friedman RJ,Gartsman GM, Gristina AG, et al. A standardized method for the assessment of shoulder function. J Shoulder Elbow Surg 1994; 3(6):347-52
  19. Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand). The Upper Extremity Collaborative Group (UECG). Am J Ind Med 1996; 29(6):602-8.
  20. Collins DN. Disorders of the acromioclavicular joint. In: Rockwood CA, Matsen FA, Wirth MA, Lippitt SB, Editors. The shoulder. Philadelphia, PA: Elsevier Health Sciences, 2004. p. 521-95.
  21. Grutter PW, Petersen SA. Anatomical acromioclavicular ligament reconstruction: a biomechanical comparison of reconstructive techniques of the acromioclavicular joint. Am J Sports Med 2005; 33(11): 1723-8.
  22. LaPrade RF, Hilger B. Coracoclavicular ligament reconstruction using a semitendinosus graft for failed acromioclavicular separation surgery. Arthroscopy 2005; 21(10): 1277.