Patient Safety in Surgery | |
Reconstruction of displaced acromio-clavicular joint dislocations using a triple suture-cerclage: description of a safe and efficient surgical technique | |
Sebastian Siebenlist2  Thomas Freude1  Ulrich Stöckle1  Philipp Ahrens2  Arne Buchholz2  Tobias M Kraus1  Lisa Mey2  Frank Martetschläger2  Gunther H Sandmann2  | |
[1] Berufsgenossenschaftliche Unfallklinik Tuebingen, Schnarrenbergstr. 9, Tuebingen D- 72076, Germany;Department of Traumatology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, Munich D- 81675, Germany | |
关键词: Cerclage; Rockwood; Dislocation; Acromioclavicular joint; | |
Others : 790332 DOI : 10.1186/1754-9493-6-25 |
|
received in 2012-08-02, accepted in 2012-10-19, 发布年份 2012 | |
【 摘 要 】
Purpose
In this retrospective study we investigated the clinical and radiological outcome after operative treatment of acute Rockwood III-V injuries of the AC-joint using two acromioclavicular (AC) cerclages and one coracoclavicular (CC) cerclage with resorbable sutures.
Methods
Between 2007 and 2009 a total of 39 patients fit the inclusion criteria after operative treatment of acute AC joint dislocation. All patients underwent open reduction and anatomic reconstruction of the AC and CC-ligaments using PDS® sutures (Polydioxane, Ethicon, Norderstedt, Germany). Thirty-three patients could be investigated at a mean follow up of 32±9 months (range 24–56 months).
Results
The mean Constant score was 94.3±7.1 (range 73–100) with an age and gender correlated score of 104.2%±6.9 (88-123%). The DASH score (mean 3.46±6.6 points), the ASES score (94.6±9.7points) and the Visual Analogue Scale (mean 0.5±0,6) revealed a good to excellent clinical outcome. The difference in the coracoclavicular distance compared to the contralateral side was <5 mm for 28 patients, between 5-10 mm for 4 patients, and more than 10 mm for another patient. In the axial view, the anterior border of the clavicle was within 1 cm (ventral-dorsal direction) of the anterior rim of the acromion in 28 patients (85%). Re-dislocations occured in three patients (9%).
Conclusion
Open AC joint reconstruction using AC and CC PDS cerclages provides good to excellent clinical results in the majority of cases. However, radiographically, the CC distance increased significantly at final follow up, but neither the amount of re-dislocation nor calcifications of the CC ligaments or osteoarthritis of the AC joint had significant influence on the outcome.
Level of evidence
Case series, Level IV
【 授权许可】
2012 Sandmann et al.; licensee BioMed Central Ltd.
【 预 览 】
Files | Size | Format | View |
---|---|---|---|
20140704234221773.pdf | 593KB | download | |
Figure 2. | 56KB | Image | download |
Figure 1. | 99KB | Image | download |
【 图 表 】
Figure 1.
Figure 2.
【 参考文献 】
- [1]Rockwood C, Williams G, Young D: Disorders of the acromioclavicular joint. In The Shoulder. 2nd edition. Edited by Rockwood CJ, Matsen FA. Philadelphia: WB Saunders; 1998:483-553.
- [2]Greiner S, Braunsdorf J, Perka C, Herrmann S, Scheffler S: Mid to long-term results of open acromioclavicular-joint reconstruction using polydioxansulfate cerclage augmentation. Arch Orthop Trauma Surg 2009, 129(6):735-740.
- [3]Ladermann A, Grosclaude M, Lubbeke A, Christofilopoulos P, Stern R, Rod T, Hoffmeyer P: Acromioclavicular and coracoclavicular cerclage reconstruction for acute acromioclavicular joint dislocations. J Shoulder Elbow Surg 2011, 20(3):401-408.
- [4]Salzmann GM, Walz L, Buchmann S, Glabgly P, Venjakob A, Imhoff AB: Arthroscopically assisted 2-bundle anatomical reduction of acute acromioclavicular joint separations. Am J Sports Med 2010, 38(6):1179-1187.
- [5]Fremerey R, Lobenhoffer P, Ramacker K, Gerich T, Skutek M: Acute acromioclavicular joint dislocation- operative or conservative therapy? Unfallchirurg 2001, 104(4):294-299.
- [6]Glick J, Milburn L, Haggerty J, Nishimoto D: Dislocated acromioclavicular joint: follow- up study of 35 unreduced acromioclavicular dislocations. Am J Sports Med 1977, 5(6):264-270.
- [7]Gstettner C, Tauber M, Hitzl W, Resch H: Rockwood type III AC dislocations: surgical versus conservative treatment. J Shoulder Elbow Surg 2008, 17(2):220-225.
- [8]Dias J, Steingold R, Richardson R, Tesfayohannes B, Gregg P: The conservative treatment of acromioclavicular dislocation. Review after five years. J Bone Joint Surg Br 1987, 69(5):719-722.
- [9]Rawes M, Dias J: Long term results of conservative treatment for acromioclavicular dislocations. J Bone Joint Surg Br 1996, 78:410-412.
- [10]Lizaur A, Marco L, Cebrian R: Acute dislocation of the acromioclavicular joint- traumatic anatomy and the importance of the deltoid and trapezius. J Bone Joint Surg Br 1994, 76:602-606.
- [11]Mlasowsky B, Brenner P, Duben W, Heymann H: Repair of complete acromioclavicular dislocation (Tossy stage III) using Balser′s hook plate combined with ligament sutures. Injury 1988, 19:227-232.
- [12]Leidel BA, Braunstein V, Pilotto S, Mutschler W, Kirchhoff C: Mid-term outcome comparing temporary K-wire fixation versus PDS augmentation of Rockwood grade III acromioclavicular joint separations. BMC Res Notes 2009, 2:84. BioMed Central Full Text
- [13]Bosworth BM: Acromioclavicular dislocation; end-results of screw suspension treatment. Ann Surg 1948, 127(1):98-111.
- [14]Weaver J, Dunn H: Treatment of acromioclavicular injuries, especially complete acromioclavicular separation. J Bone Joint Surg Am 1972, 54(6):1187-1194.
- [15]Salzmann GM, Walz L, Schoettle PB, Imhoff AB: Arthroscopic anatomical reconstruction of the acromioclavicular joint. Acta Orthop Belg 2008, 74(3):397-400.
- [16]Tischer T, Imhoff AB: Minimally invasive coracoclavicular stabilization with suture anchors for acute acromioclavicular dislocation. Am J Sports Med 2009, 37(3):e5.
- [17]Chernchujit B, Tischer T, Imhoff AB: Arthroscopic reconstruction of the acromioclavicular joint disruption: surgical technique and preliminary results. Arch Orthop Trauma Surg 2006, 126(9):575-581.
- [18]Dimakopoulos P, Panagopoulos A, Syggelos SA, Panagiotopoulos E, Lambiris E: Double-loop suture repair for acute acromioclavicular joint disruption. Am J Sports Med 2006, 34(7):1112-1119.
- [19]Rehbein K, Jung C, Becker U, Bauer G: Treatment of acute AC joint dislocationby transosseal acromioclavicular and coracoclavicular fiberwire cerclage. Z Orthop Unfall 2008, 146(3):339-343.
- [20]Rios C, Arciero R, Mazzocca A: Anatomy of the clavcile and the coracoid process for reconstruction of the coracoclavicular ligaments. Am J Sports Med 2007, 35(5):811-817.
- [21]Mäkelä P, Pohjonen T, Törmälä P, Waris T, Ashammakhi N: Strength retention properties of self-reinforced poly L-lactide (SR-PLLA) sutures compared with polyglyconate (Maxon) and polydioxane (PDS) sutures. An in vitro study. Biomaterials 2002, 23(12):2587-2592.
- [22]Persall A, Hollis J, Russell GJ, Strokes D: Biomechanical comparison of reconstruction techniques for disruption of the acromioclavicular and coracolavicular ligaments. J South Orthop Assoc 2002, 11(1):11-17.
- [23]Schulz- Gebhard B, Havemann D: Experimental in vivo studies of the stability of tendon sutures. Akt Traumatol 1991, 21(4):153-156.
- [24]Constant CR, Murley AH: A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 1987, 214:160-164.
- [25]Hessmann M, Gotzen L, Gehling H: Acromioclavicular reconstruction augmented with polydioxanonsulphate bands. Surgical technique and results. Am J Sports Med 1995, 23(5):552-556.
- [26]Boehm D, Wollmerstedt N, Doesch M, Handwerker M, Mehling E, Gohlke F: Development of a questionnaire based on the Constant-Murley-Score for self-evaluation of shoulder function by patients. Unfallchirurg 2004, 107(5):397-402.
- [27]Lim Y: Triple endobutton technique in acromioclavicular joint reduction and reconstruction. Ann Acad Med Singapore 2008, 37:294-299.
- [28]Pfahler M, Krodel A, Refior H: Surgical treatment of acromioclavicular dislocation. Arch Orthop Trauma Surg 1994, 113:308-311.
- [29]Gerhardt DC, Vanderwerf JD, Rylander LS, McCarty EC: Postoperative coracoid fracture after transcoracoid acromioclavicular joint reconstruction. J Shoulder Elbow Surg 2011, 20(5):e6-e10.
- [30]Jerosch J, Filler T, Peuker E, Greig M, Siewering U: Which stabilization technique corrects anatomy best in patients with AC-separation? An experimental study. Knee Surg Sports Traumatol Arthrosc 1999, 7:365-372.
- [31]Morrison D, Lemos M: Acromioclavicular separation. Reconstruction using synthetic loop augmentation. Am J Sports Med 1995, 23:105-110.
- [32]Beitzel K, Obopilwe E, Chowaniec DM, Niver GE, Nowak MD, Hanypsiak BT, Guerra JJ, Arciero RA, Mazzocca AD: Biomechanical comparison of arthroscopic repairs for acromioclavicular joint instability: suture button systems without biological augmentation. Am J Sports Med 2011, 39(10):2218-2225.
- [33]Larsen E, Bjerg- Nielsen A, Christensen P: Conservative or surgical treatment of acromioclavicular dislocation. A prospective, controlled, randomized study. J Bone Joint Surg Am 1986, 68:552-555.
- [34]Walz L, Salzmann GM, Fabbro T, Eichhorn S, Imhoff AB: The anatomic reconstruction of acromioclavicular joint dislocations using 2 TightRope devices: a biomechanical study. Am J Sports Med 2008, 36(12):2398-2406.
- [35]Tischer T, Salzmann GM, El-Azab H, Vogt S, Imhoff AB: Incidence of associated injuries with acute acromioclavicular joint dislocations types III through V. Am J Sports Med 2009, 37(1):136-139.