A second 2-cm incision was created over the coracoid process, followed by meticulous dissection down to the base of the coracoid process (Fig. A vertical 1- cm skin incision was created at the top of the clavicle, 2.5 cm medial to the AC joint. A mini-open technique was used for all cases. The upper extremity was prepared and draped in the usual sterile manner, and appropriate antibiotic prophylaxis was administered before the incision. The patient was placed in the beach chair position and examined under anesthesia to assess shoulder stability and reducibility of the AC joint. Surgical technique and rehabilitationĪll patients underwent surgery by the same surgeon within the first 2 weeks after trauma. Radiological failure was defined as greater than 50% increase in CC distance in 1 of both measurements. Second comparison of CC distances measured on the operative side and unaffected side at the final follow-up. First comparison of CC distance of the patients measured immediately after the surgery and at the last follow-up. In our study, we identified 2 criterias for radiological failure. The affected AC joint was also evaluated for any signs of postoperative degenerative arthritis, loss of reduction, and osteolysis. The CC distance was defined as the vertical distance between the anterior–inferior border of the clavicle and the superior border of the coracoid process.Īll measurements were performed and analyzed preoperatively, in the early postoperative period, and at the time of the last follow-up by 2 blinded investigators. The AC distance was defined as the middle of the clavicle and the middle of the acromion. The radiologic assessment included standard anterior-posterior (AP) views of the AC and CC distances. A functional assessment was performed by 2 independent reviewers using the Constant score and University of California Los Angeles (UCLA) score. Clinical and radiological assessmentsĬlinical data regarding age, sex, hand dominance, mechanism of injury, range of motion of the affected shoulder, time from surgery to the return to daily activities, and length of follow-up were collected. The present study evaluated the functional and radiographic outcomes of acute AC joint reconstruction using the mini-open technique and knotless SLD system.Ģ.1. The ZipTight (Zimmer Biomet, Parsippany, NJ) endobutton system is an SLD that eliminates the knot profile on top of the clavicle due to its knotless feature. Reconstruction of the CC ligament using the SLD system has been proven to be an effective technique for the management of acute AC joint dislocations in biomechanical and clinical studies. The suspensory loop device (SLD), which is used to treat CC ligament disruption, provides stability to the AC joint by suspensory fixation between the clavicle and the coracoid process. Furthermore, some movement of the AC joint must be allowed during the rehabilitation period. Sufficient strength to maintain the CC interval should be provided until biological healing of the soft tissue around the CC ligaments occurs. However, previous fixation methods have caused some complications, including implant breakage or migration, bony erosion of the clavicle, and recurrent dislocation therefore, serious concerns still exist. Surgical methods used for the fixation of the CC interval include AC joint pinning, CC loop cerclage, hook plates, CC screws, CC ligament repair, and ligament or muscle transfer. Therefore, recently proposed surgical techniques for the treatment of AC joint dislocation have focused on CC interval fixation. Ĭoracoclavicular (CC) ligaments anatomically contribute to the stability of the AC joint. In a recent study involving a nationwide survey, 73% of the responding surgeons preferred performing surgical procedures to treat Rockwood type III injuries. Although conservative treatment is recommended by some studies, good clinical results after operative procedures have been reported. Treatment of type III injuries should be personalized based on the patient's request, activity level, and response to conservative treatment. According to this classification, there is a consensus that minor dislocations, such as type I and type II, are best treated nonoperatively however, type IV through type VI should be managed with surgical reconstruction. Treatment is commonly guided by Rockwood's classification. Acromioclavicular (AC) joint dislocation is 1 of the most common injuries of the shoulder girdle in young adults.
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