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Combined Coracoclavicular and Acromioclavicular Joint Reconstruction with Allograft Using a Cerclage Tensioning System.

ABSTRACT: Acromioclavicular joint separations are common shoulder injuries, yet standard treatment practices vary. Popular surgical techniques include reconstruction using allografts or neighboring ligaments as well as repair using screws and sutures. This Technical Note and accompanying video describe both an acromioclavicular and coracoclavicular joint reconstruction using an allograft to replace native acromioclavicular ligament along with an AC joint reduction using a Suture Cerclage System to precisely control reduction and restore anatomic alignment.

SUBMITTER: Kim JY

PROVIDER: S-EPMC7917031 | biostudies-literature | 2021 Feb

REPOSITORIES: biostudies-literature

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Combined Coracoclavicular and Acromioclavicular Joint Reconstruction with Allograft Using a Cerclage Tensioning System.

Kim Joo Yeon JY Park Hee-Yon HY Bryant Stewart S Gardner Brandon B Chakrabarti Moyukh M McGahan Patrick P Chen James L JL

Arthroscopy techniques 20210116 2

Acromioclavicular joint separations are common shoulder injuries, yet standard treatment practices vary. Popular surgical techniques include reconstruction using allografts or neighboring ligaments as well as repair using screws and sutures. This Technical Note and accompanying video describe both an acromioclavicular and coracoclavicular joint reconstruction using an allograft to replace native acromioclavicular ligament along with an AC joint reduction using a Suture Cerclage System to precise ...[more]

PMID: 33680762

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Acromioclavicular Joint Repair Using a Suture Cerclage Tensioning System.

Project description:Injuries to the acromioclavicular (AC) joint are common among adults in their twenties and account for 8% of all joint dislocations. Although there are numerous operative approaches to treating AC joint separations, a gold standard does not exist because of lack of conclusive evidence supporting the use of 1 standard technique. In this Technical Note and accompanying video, we describe an anatomic AC joint repair using a suture cerclage tensioning system to accurately control the reduction and improve the precision and outcomes of the repair.

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Arthroscopic Acromioclavicular Joint Treatment With Coracoclavicular Fixation and Allograft Coracoclavicular Ligament Reconstruction for Acute Acromioclavicular Dislocations.

Project description:Treatment of severe acromioclavicular joint injuries remains controversial and has evolved over the past 4-plus decades. Although several variations on reconstruction exist, an ideal technique will likely use a combination of coracoclavicular ligament reconstruction with suture backup stabilization, minimal drill holes to reduce the risk of fracture, arthroscopic-assisted guidance for anatomic graft and suture placement in and around the coracoid, and fluoroscopic-aided reduction to ensure an anatomic acromioclavicular joint. The objective of this Technical Note is to describe an arthroscopic-assisted coracoclavicular ligament reconstruction with allograft using fluoroscopically guided and cerclage-controlled anatomic reduction of the acromioclavicular joint.

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Open Acromioclavicular Joint Reconstruction With Semitendinosus Allograft Utilizing the Cerclage Technique.

Project description:Acromioclavicular (AC) joint injuries most commonly occur in young males after a direct injury at the acromion. General consensus stresses nonoperative treatment for type I and II injuries and surgical treatment for types IV through VI, whereas management of type III injuries is more controversial. If surgery is indicated, there are multiple techniques including hook plate, screw fixation, coracoclavicular fixation, and anatomic and nonanatomic reconstruction. The overall complication rate is high (14%), regardless of technique. In this Technical Note, we outline a technique for open repair of a chronic AC joint separation using a semitendinosus allograft using the cerclage for enhanced fixation.

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Arthroscopically Assisted Tensionable Cerclage Reconstruction of an Acromioclavicular Separation With Combined Fixation of the Coracoclavicular and Acromioclavicular Ligaments

Project description:A variety of surgical techniques are currently available to manage high-grade acromioclavicular (AC) separations, including hook plates/wires, nonanatomic ligament reconstruction, and anatomic cerclage with or without biological augmentation. Traditional reconstructions focused on the coracoclavicular ligaments alone and often were associated with high rates of recurrent deformity. Biomechanical and clinical data have suggested that additional fixation of the AC ligaments is beneficial. This Technical Note describes an arthroscopically assisted approach for combined reconstruction of the coracoclavicular and AC ligaments with a tensionable cerclage. Technique Video Video 1 The video for an arthroscopically assisted cerclage fixation and biologic reconstruction of the coracoclavicular and acromioclavicular ligaments for acromioclavicular joint separation on a right shoulder in a patient in lateral decubitus position.

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Arthroscopic Acromioclavicular Joint Reconstruction Using Knotless Coracoclavicular Fixation and Soft-Tissue Anatomic Coracoclavicular Ligament Reconstruction.

Project description:Acromioclavicular joint injuries are one of the most common shoulder injuries, and there are a variety of treatment options. Recently, there have been newer arthroscopic techniques that have addressed coracoid and clavicle fracture risk by using a knotted suture-button fixation through a single, small bone tunnel with additional looped soft-tissue graft stabilization. Although clinical outcomes have been good to excellent, there have still been instances of knot and hardware irritation. The described technique builds on the latest advances and achieves an anatomic coracoclavicular (CC) reconstruction through a single knotless CC fixation device with additional soft-tissue allograft reconstruction of the CC ligaments. This technique minimizes the risks of coracoid and clavicle fractures and knot and hardware irritation while maintaining excellent stability.

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Arthroscopically Assisted Acromioclavicular and Coracoclavicular Ligament Reconstruction for Chronic Acromioclavicular Joint Instability.

Project description:Acromioclavicular (AC) joint injuries are common injuries, especially in the young and active, male population. AC joint injuries account for 12% of all injuries of the shoulder girdle in the overall population. Although conservative treatment is recommended for Rockwood type I and type II injuries, there is controversial debate about optimal treatment for type III injuries. High-grade injuries are typically treated operatively to avoid painful sequelae. A vast number of different surgical methods have been described over the past few decades. Recent advances in arthroscopic surgery have enabled the shoulder surgeon to treat acute and chronic AC lesions arthroscopically assisted. Clinical studies have already shown good and reliable results. Although surgeons agree that a biological augmentation is required to minimize the risk of recurrent instability in chronic cases, a gold standard still needs to be defined. We present an arthroscopically assisted biological augmentation technique to reconstruct the AC and coracoclavicular ligaments, protected by a button-suture tape construct for chronic AC joint instability. The presented arthroscopic biological augmentation technique uses less and/or smaller drill holes in the clavicle and coracoid than previously described, thus reducing weakening of the bony structures. At the same time it enhances both horizontal and vertical stability.

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Arthroscopically Assisted Acromioclavicular Joint Reconstruction Using the Infinity-Lock Button System With Allograft Augmentation.

Project description:Acromioclavicular (AC) joint injuries are extremely common in the athletic population. Although most low-grade injuries can be managed nonoperatively, high-grade injuries often require reconstruction of the AC joint. Various reconstructive options have been described with varying risks and benefits to each. Implant or graft failure with loss of reduction as well as clavicle and coracoid fracture are a few of the more common complications following AC joint reconstruction surgery. Currently, no gold standard exists. This technical paper describes an arthroscopically assisted AC joint reconstruction technique using the Infinity-Lock Button System with hamstring allograft augmentation. This technique provides an anatomic, minimally invasive, low-profile reconstruction that may minimize risk of clavicle and coracoid fracture. It also provides augmented stabilization across the AC joint, which may also help resist naturally occurring horizontal and rotational displacing forces.

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Arthroscopic Technique for Stabilization of Chronic Acromioclavicular Joint Instability With Coracoclavicular and Acromioclavicular Ligament Reconstruction Using a Gracilis Tendon Graft.

Project description:We present an arthroscopic technique for stabilization of chronic acromioclavicular (AC) joint instability using a transclavicular-transcoracoidal button technique, combined with a coracoclavicular and AC ligament reconstruction using the gracilis tendon. This arthroscopic technique achieves an anatomic reduction of the clavicle without further implant removal. It ensures vertical and horizontal stabilization of the AC joint. Using a horizontal drill hole through the clavicle and looping the gracilis tendon graft around the coracoid avoids weakening of the coracoid with the risk of fracture.

| S-EPMC5382553 | biostudies-literature

Arthroscopic Coracoclavicular Reconstruction Combined with Open Acromioclavicular Reconstruction Using Knot Hiding Clavicular Implants Is a Stable Solution.

Project description:PurposeThe purpose of this noninterventional, register-based study was to report the outcomes and wound healing of surgically treated chronic acromioclavicular (AC) dislocations using a tendon graft and knot-hiding titanium implants.MethodsThirty-two cases with chronic AC separation underwent an arthroscopic coracoclavicular (CC) ligament reconstruction and an open AC ligament reconstruction using knot-hiding titanium implants. The wound healing was assessed 2 months after the operation. The Nottingham Clavicle score, Constant score, and Simple Shoulder Test were obtained postoperatively and at a minimum of one-year postsurgery. The radiographic change in distance between the clavicular and coracoid cortices and clavicular tunnel diameter was measured. General patient satisfaction with the outcome (poor, fair, good, or excellent) was also assessed 1 year postoperatively.ResultsThe mean Nottingham Clavicle score increased from a preoperative mean of 41.66 ± 9.86 to 96.831 ± 5.86 (P ≤ .05). The Constant score increased from a preoperative mean of 44.66 ± 12.54 to 93.59 ± 7.01 (P ≤ .05). The Simple Shoulder Test score increased from a preoperative mean of 7.00 ± 2.14 to 11.84 ± .63 (P ≤ .05). The coracoclavicular distance increased from 11.32 ± 3.71 to 13.48 ± 3.79 mm (P ≤ .05). The clavicular drill hole diameter increased from 6 mm to a mean of 6 to a mean of 8.13 ± 1.12 mm. Twenty-three (71.9%) patients reported an excellent outcome, and nine (28.1%) reported a good outcome. One clavicular fracture occurred but no coracoid fractures. There was one reconstruction failure leading to a reoperation.ConclusionsIn this series, combining the arthroscopic CC ligament reconstruction to an open reconstruction of the AC joint with a tendon graft proved to be a stable solution. The knot-hiding titanium implant effectively eliminated the problems related to the clavicular wound healing.Level of evidenceLevel IV, therapeutic case series.

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Arthroscopic Coracoclavicular and Acromioclavicular Stabilization of Acute Acromioclavicular Joint Dislocation By Suspensory Fixation System.

Project description:Arthroscopic stabilization of acute acromioclavicular joint dislocations using coracoclavicular suspension techniques has become more popular, but lack of horizontal stability is a major concern that furthermore affects the final outcome. We present an arthroscopic technique to stabilize acute acromioclavicular joint dislocations in both the vertical and horizontal planes, with better results than conventional coracoclavicular suspension techniques.

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