To review outcome after arthroscopic fixation for acute acromioclavicular (AC) joint dislocation using the TightRope device.
Methods.
Records of 15 men and 2 women aged 19 to 52 (mean, 35) years who underwent arthroscopic fixation using the TightRope device for acute (<3 weeks) AC joint dislocation of Rockwood type III (n=6), type IV (n=1), and type V (n=10) were reviewed. Outcome was evaluated using the Constant score. The coracoclavicular (CC) distance before and after surgery was compared.
Results.
The mean follow-up period was 22.1 (range, 12–37) months. The mean time to return to work was 4 (range, 1.5–12) months, excluding one failure. The mean postoperative Constant score was 86.4 (range, 63–96). The CC distance decreased from 21.5±5.2 mm preoperatively to 9.8±3.5 mm at 6 months and to 10±3.2 mm at one year. There was no over-correction. All patients had satisfactory outcome except for one who had rupture of the TightRope suture at 6 months. Two patients had partial loss of reduction (≥2 mm) after 3 to 6 months secondary to osteolysis at the clavicular button site.
Conclusion.
Arthroscopic fixation using the TightRope device for acute AC joint dislocation achieves satisfactory outcome.
RockwoodCAJrYoungDC. Disorders of the acromioclavicular joint. In: RockwoodCAJrMatsenFAIII, editors. The shoulder. Philadelphia: WB Saunders; 1990:413–68.
2.
NguyenVWilliamsGRockwoodC. Radiography of acromioclavicular dislocation and associated injuries. Crit Rev Diagn Imaging1991;32:191–228.
3.
BradleyJPElkousyH. Decision making: Operative versus nonoperative treatment of acromioclavicular joint injuries. Clin Sports Med2003;22:277–90.
4.
BannisterGCWallaceWAStableforthPGHutsonMA. The management of acute acromioclavicular dislocation. A randomised prospective controlled trial. J Bone Joint Surg Br1989;71:848–50.
5.
LiXMaRBediADinesDMAltchekDWDinesJS. Management of acromioclavicular joint injuries. J Bone Joint Surg Am2014;96:73–84.
6.
KorstenKGunningACLeenenLP. Operative or conservative treatment in patients with Rockwood type III acromioclavicular dislocation: A systematic review and update of current literature. Int Orthop2014;38:831–8.
7.
HorstKDienstknechtTPishnamazMSelleiRMKobbePPapeHC. Operative treatment of acute acromioclavicular joint injuries graded Rockwood III and IV: Risks and benefits in tight rope technique vs. k-wire fixation. Patient Saf Surg2013;7:18.
8.
FarajAAKetzerB. The use of a hook-plate in the management of acromioclavicular injuries. Report of ten cases. Acta Orthop Belg2001;67:448–51.
9.
SimESchwarzNHöckerKBerzlanovichA. Repair of complete acromioclavicular separations using the acromioclavicular-hook plate. Clin Orthop Relat Res1995;314:134–42.
10.
BallmerFTGerberC. Coracoclavicular screw fixation for unstable fractures of the distal clavicle: A report of five cases. J Bone Joint Surg Br1991;73:291–4.
WeaverJKDunnHK. Treatment of acromioclavicular injuries, especially complete acromioclavicular separation. J Bone Joint Surg Am1972;54:1187–94.
13.
WoodTARosellPAClasperJC. Preliminary results of the ‘Surgilig’ synthetic ligament in the management of chronic acromioclavicular joint disruption. J R Army Med Corps2009;155:191–3.
14.
BhattacharyaRGoodchildLRanganA. Acromioclavicular joint reconstruction using the Nottingham Surgilig: A preliminary report. Acta Orthop Belg2008;74:167–72.
15.
JeonIHDewnanyGHartleyRNeumannLWallaceWA. Chronic acromioclavicular separation: The medium term results of coracoclavicular ligament reconstruction using braided polyester prosthetic ligament. Injury2007;38:1247–53.
16.
StamLDawsonI. Complete acromioclavicular dislocations: Treatment with a Dacron ligament. Injury1991;22:173–6.
17.
MumfordEB. Acromioclavicular dislocation: A new operative treatment. J Bone Joint Surg Am1941;23:799–802.
18.
GurdFB. The treatment of complete dislocation of the outer end of the clavicle: An hitherto undescribed operation. Ann Surg1941;113:1094–8.
19.
DeBerardinoTMPensakMJFerreiraJMazzoccaAD. Arthroscopic stabilization of acromioclavicular joint dislocation using the AC graftrope system. J Shoulder Elbow Surg2010;19(2 Suppl):47–52.
20.
TrikhaSPActonDWilsonAJCurtisMJ. A new method of arthroscopic reconstruction of the dislocated acromio-clavicular joint. Ann R Coll Surg Engl2004;86:161–4.
21.
LimYWSoodAvan RietRBainGI. Acromioclavicular joint reduction, repair and reconstruction using metallic buttons: Early results and complications. Tech Shoulder Elbow Surg2007;8:213–21.
22.
RichardsATennentTD. Arthroscopic stabilization of acute acromioclavicular joint dislocation using the tightrope system. Tech Shoulder Elbow Surg2008;9:51–4.
23.
El SallakhSA. Evaluation of arthroscopic stabilization of acute acromioclavicular joint dislocation using the TightRope system. Orthopedics2012;35:e18–22.
24.
ThielEMutnalAGilotGJ. Surgical outcome following arthroscopic fixation of acromioclavicular joint disruption with the tightrope device. Orthopedics2011;34:e267–74.
25.
FlinkkilaTEIhanainenE. Results of arthroscopy-assisted TightRope repair of acromioclavicular dislocations. Shoulder Elbow2014;6:18–22.
26.
WalzLSalzmannGMFabbroTEichhornSImhoffAB. The anatomic reconstruction of acromioclavicular joint dislocations using 2 TightRope devices: A biomechanical study. Am J Sports Med2008;36:2398–406.
27.
SalzmannGMWalzLBuchmannSGlabglyPVenjakobAImhoffAB. Arthroscopically assisted 2-bundle anatomical reduction of acute acromioclavicular joint separations. Am J Sports Med2010;38:1179–87.
28.
BeitzelKObopilweEChowaniecDMNiverGENowakMDHanypsiakBT. Biomechanical comparison of arthroscopic repairs for acromioclavicular joint instability: Suture button systems without biological augmentation. Am J Sports Med2011;39:2218–25.
29.
DefoortSVerborgtO. Functional and radiological outcome after arthroscopic and open acromioclavicular stabilization using a double-button fixation system. Acta Orthop Belg2010;76:585–91.
30.
LarsenEBjerg-NielsenAChristensenP. Conservative or surgical treatment of acromioclavicular dislocation. A prospective, controlled, randomized study. J Bone Joint Surg Am1986;68:552–5.
31.
FukudaKCraigEVAnKNCofieldRHChaoEY. Biomechanical study of the ligamentous system of the acromioclavicular joint. J Bone Joint Surg Am1986;68:434–40.
32.
NorrellHJrLlewellynRC. Migration of a threaded Steinmann pin from an acromioclavicular joint into the spinal canal: A case report. J Bone Joint Surg Am1965;47:1024–6.
33.
SethiGKScottSM. Subclavian artery laceration due to migration of a Hagie pin. Surgery1976;80:644–6.
34.
LiuHHChouYJChenCHChiaWTWongCY. Surgical treatment of acute acromioclavicular joint injuries using a modified Weaver-Dunn procedure and clavicular hook plate. Orthopedics2010;33.
35.
EsenyelCZOztürkKBülbülMAyanoluSCeylanHH. Coracoclavicular ligament repair and screw fixation in acromioclavicular dislocations. Acta Orthop Traumatol Turc2010;44:194–8.
36.
JensenGKatthagenJCAlvaradoLELillHVoigtC. 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 Sports Traumatol Arthrosc2014;22:422–30.
37.
TischerTSalzmannGMEl-AzabHVogtSImhoffAB. Incidence of associated injuries with acute acromioclavicular joint dislocations types III through V. Am J Sports Med2009;37:136–9.
38.
PaulySGerhardtCHaasNPScheibelM. Prevalence of concomitant intraarticular lesions in patients treated operatively for high-grade acromioclavicular joint separations. Knee Surg Sports Traumatol Arthrosc2009;17:513–7.
39.
BeardenJMHughstonJCWhatleyGS. Acromioclavicular dislocation: Method of treatment. J Sports Med1973;1:5–17.
40.
SpencerEEJr. Treatment of grade III acromioclavicular joint injuries: A systematic review. Clin Orthop Relat Res2007;455:38–44.
41.
HootmanJM. Acromioclavicular dislocation: Conservative or surgical therapy. J Athl Train2004;39:10–11.
42.
SchlegelTFBurksRTMarcusRLDunnHK. A prospective evaluation of untreated acute grade III acromioclavicular separations. Am J Sports Med2001;29:699–703.
43.
GstettnerCTauberMHitzlWReschH. Rockwood type III acromioclavicular dislocation: Surgical versus conservative treatment. J Shoulder Elbow Surg2008;17:220–5.
44.
LizaurASanz-ReigJGonzalez-ParreñoS. Long-term results of the surgical treatment of type III acromioclavicular dislocations: An update of a previous report. J Bone Joint Surg Br2011;93:1088–92.
45.
LuNZhuLYeTChenAJiangXZhangZ. Evaluation of the coracoclavicular reconstruction using LARS artificial ligament in acute acromioclavicular joint dislocation. Knee Surg Sports Traumatol Arthrosc2014;22:2223–7.
46.
MurenaLVulcanoERattiCCecconelloLRollaPRSuraceMF. Arthroscopic treatment of acute acromioclavicular joint dislocation with double flip button. Knee Surg Sports Traumatol Arthrosc2009;17:1511–5.
47.
ThorntonGMLeaskGPShriveNGFrankCB. Early medial collateral ligament scars have inferior creep behaviour. J Orthop Res2000;18:238–46.
48.
MazzoccaADSantangeloSAJohnsonSTRiosCGDumonskiMLArcieroRA. A biomechanical evaluation of an anatomical coracoclavicular ligament reconstruction. Am J Sports Med2006;34:236–46.
49.
LarsenEBjerg-NielsenChristensenP. Conservative or surgical treatment of acromioclavicular dislocation. A prospective, controlled, randomized study. J Bone Joint Surg Am1986;68:552–5.
