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Published in: Knee Surgery, Sports Traumatology, Arthroscopy 12/2009

01-12-2009 | Shoulder

Arthroscopic treatment of acute acromioclavicular joint dislocation with double flip button

Authors: L. Murena, Ettore Vulcano, C. Ratti, L. Cecconello, P. R. Rolla, M. F. Surace

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 12/2009

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Abstract

The ideal treatment for acute acromioclavicular joint dislocation is still controversial, both in terms of indications and surgical technique. The clinical and radiographic outcomes of 16 patients affected by acute AC joint dislocation (type III–V) and arthroscopically treated with a coracoclavicular double flip button are presented. Despite the excellent clinical results both in terms of Constant score (mean 97 points) and patient satisfaction, at a mean follow-up of 31 months the radiographs showed partial loss of reduction due to distal migration of the flip button within the upper third of the clavicle in one-fourth of the cases. The technique presented here proved to be safe and minimally invasive while delivering good aesthetic results and allowing for the treatment of associated lesions. Furthermore, the technique could benefit from more advanced retention devices, which ought to reduce or avoid migration of the flip buttons.
Literature
1.
go back to reference Bakalim G, Wilppula E (1975) Surgical or conservative treatment of total dislocation of the acromioclavicular joint. Acta Chir Scand 141:43–47PubMed Bakalim G, Wilppula E (1975) Surgical or conservative treatment of total dislocation of the acromioclavicular joint. Acta Chir Scand 141:43–47PubMed
2.
go back to reference Baker JE, Nicandri GT, Young DC et al (2003) A cadaveric study examining acromioclavicular joint congruity after different methods of coracoclavicular loop repair. J Shoulder Elbow Surg 12:595–598CrossRefPubMed Baker JE, Nicandri GT, Young DC et al (2003) A cadaveric study examining acromioclavicular joint congruity after different methods of coracoclavicular loop repair. J Shoulder Elbow Surg 12:595–598CrossRefPubMed
3.
go back to reference Bjerneld H, Hovelius L, Thorling J (1983) Acromioclavicular separations treated conservatively. A 5-year follow-up study. Acta Orthop Scand 54:743–745PubMed Bjerneld H, Hovelius L, Thorling J (1983) Acromioclavicular separations treated conservatively. A 5-year follow-up study. Acta Orthop Scand 54:743–745PubMed
4.
go back to reference Bosworth BM (1941) Acromioclavicular separation: a new method of repair. Surg Gynecol Obstet 73:866–871 Bosworth BM (1941) Acromioclavicular separation: a new method of repair. Surg Gynecol Obstet 73:866–871
5.
go back to reference Bosworth BM (1948) Acromioclavicular dislocation: end result of screw suspension treatment. Ann Surg Gynecol Obstet 127:98–111 Bosworth BM (1948) Acromioclavicular dislocation: end result of screw suspension treatment. Ann Surg Gynecol Obstet 127:98–111
6.
go back to reference Broos P, Stoffelen D, Van de Sijpe K et al (1997) Operative Versorgung der vollstandingen AC-Luxation TossY III mit der Bosworth-Schraube oder der Wolter-Platte. Eine Kritische Bethachtung. Unfallchirurgie 23:153–160CrossRefPubMed Broos P, Stoffelen D, Van de Sijpe K et al (1997) Operative Versorgung der vollstandingen AC-Luxation TossY III mit der Bosworth-Schraube oder der Wolter-Platte. Eine Kritische Bethachtung. Unfallchirurgie 23:153–160CrossRefPubMed
7.
go back to reference Brunelli G, Brunelli F (1988) The treatment of acromioclavicular dislocation by transfer of the short head of the biceps. Int Orthop 12:105–108CrossRefPubMed Brunelli G, Brunelli F (1988) The treatment of acromioclavicular dislocation by transfer of the short head of the biceps. Int Orthop 12:105–108CrossRefPubMed
8.
go back to reference Constant CR, Murly AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164PubMed Constant CR, Murly AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164PubMed
9.
go back to reference Deshmukh AV, Wilson DR, Zilberfarb JL et al (2004) Stability of acromioclavicular joint reconstruction: biomechanical testing of various surgical techniques in a cadaveric model. Am J Sports Med 32:1492–1498CrossRefPubMed Deshmukh AV, Wilson DR, Zilberfarb JL et al (2004) Stability of acromioclavicular joint reconstruction: biomechanical testing of various surgical techniques in a cadaveric model. Am J Sports Med 32:1492–1498CrossRefPubMed
10.
go back to reference Dias JJ, Steingold RF, Richardson RA et al (1987) The conservative treatment of acromioclavicular dislocation. Review after five years. J Bone Joint Surg Br 69:719–722PubMed Dias JJ, Steingold RF, Richardson RA et al (1987) The conservative treatment of acromioclavicular dislocation. Review after five years. J Bone Joint Surg Br 69:719–722PubMed
11.
go back to reference Diederichsen LP, Norregaard J, Krogsgaard M et al (2004) Reflexes in the shoulder muscles elicited from the human coracoacromial ligament. J Orthop Res 22:976–983CrossRefPubMed Diederichsen LP, Norregaard J, Krogsgaard M et al (2004) Reflexes in the shoulder muscles elicited from the human coracoacromial ligament. J Orthop Res 22:976–983CrossRefPubMed
12.
go back to reference Field LD, Dines DM, Zabinski SJ (1997) Hemiarthroplasty of the shoulder for rotator cuff arthropathy. J Shoulder Elbow Surg 6:18–23CrossRefPubMed Field LD, Dines DM, Zabinski SJ (1997) Hemiarthroplasty of the shoulder for rotator cuff arthropathy. J Shoulder Elbow Surg 6:18–23CrossRefPubMed
13.
go back to reference Fredenschuss B, Boszotta H, Helperstorfer W (1991) Ergebnisse nach operativer Stabilisierung des zerrissenen Schultergelenkes. Kombinationsverfahren versus Bosworth-Schraube. Unfallchirurg 94:95–98 Fredenschuss B, Boszotta H, Helperstorfer W (1991) Ergebnisse nach operativer Stabilisierung des zerrissenen Schultergelenkes. Kombinationsverfahren versus Bosworth-Schraube. Unfallchirurg 94:95–98
14.
go back to reference Harris RI, Wallace AL, Harper GD et al (2000) Structural properties of the intact end the reconstructed coracoclavicular ligament complex. Am J Sports Med 28:103–108PubMed Harris RI, Wallace AL, Harper GD et al (2000) Structural properties of the intact end the reconstructed coracoclavicular ligament complex. Am J Sports Med 28:103–108PubMed
15.
go back to reference Hellmich A, Sievers U (1988) Operative repair of acromioclavicular separation via transcutaneous Kirschner wire fixation: results of follow-up examinations in 45 patients. Aktuelle Traumatol 18:9–13PubMed Hellmich A, Sievers U (1988) Operative repair of acromioclavicular separation via transcutaneous Kirschner wire fixation: results of follow-up examinations in 45 patients. Aktuelle Traumatol 18:9–13PubMed
16.
go back to reference Jerosch J, Filler T, Peuker E, Greig M et al (1999) Which stabilization technique corrects anatomy best in patients with AC-separation? An experimental study. Knee Surg Sports Traumatol Arthrosc 7:365–372CrossRefPubMed Jerosch J, Filler T, Peuker E, Greig M et al (1999) Which stabilization technique corrects anatomy best in patients with AC-separation? An experimental study. Knee Surg Sports Traumatol Arthrosc 7:365–372CrossRefPubMed
17.
go back to reference Kippe MA, Demetropoulos CK, Jurist KA et al (2006) Modes of failure in acromioclavicular joint reconstruction: a biomechanical analysis of clavicular motion and its role in construct failure. Presented at the 52nd annual meeting of the Orthopaedic Research Society, Chicago, IL, 19–22 March 2006 Kippe MA, Demetropoulos CK, Jurist KA et al (2006) Modes of failure in acromioclavicular joint reconstruction: a biomechanical analysis of clavicular motion and its role in construct failure. Presented at the 52nd annual meeting of the Orthopaedic Research Society, Chicago, IL, 19–22 March 2006
18.
go back to reference Lafosse L, Bayer GP, Leuzzinger J (2005) Arthroscopic treatment of acute and chronic acromioclavicular joint dislocation. Arthroscopy 21:1117e1–1117e8CrossRef Lafosse L, Bayer GP, Leuzzinger J (2005) Arthroscopic treatment of acute and chronic acromioclavicular joint dislocation. Arthroscopy 21:1117e1–1117e8CrossRef
19.
go back to reference Lee SJ, Nikolas SJ, Akizuki KH et al (2003) Reconstruction of the coracoclavicular ligaments with tendon grafts. A comparative biomechanical study. Am J Sports Med 31:648–654PubMed Lee SJ, Nikolas SJ, Akizuki KH et al (2003) Reconstruction of the coracoclavicular ligaments with tendon grafts. A comparative biomechanical study. Am J Sports Med 31:648–654PubMed
20.
go back to reference Lee TQ, Black AD, Tibone JE et al (2001) Release of the coracoacromial ligament can lead to glenohumeral laxity: a biomechanical study. J Shoulder Elbow Surg 10:68–72CrossRefPubMed Lee TQ, Black AD, Tibone JE et al (2001) Release of the coracoacromial ligament can lead to glenohumeral laxity: a biomechanical study. J Shoulder Elbow Surg 10:68–72CrossRefPubMed
21.
go back to reference Lim YW, Sood A, Van Riet RP (2007) Acromioclavicular joint reduction, repair and reconstruction using metallic buttons-early results and complications. Tech Shoulder Elbow Surg 8:213–221CrossRef Lim YW, Sood A, Van Riet RP (2007) Acromioclavicular joint reduction, repair and reconstruction using metallic buttons-early results and complications. Tech Shoulder Elbow Surg 8:213–221CrossRef
22.
go back to reference Lim YW (2008) Triple endobutton technique in acromioclavicular joint reduction and reconstruction. Ann Acad Med Singap 37:294–299PubMed Lim YW (2008) Triple endobutton technique in acromioclavicular joint reduction and reconstruction. Ann Acad Med Singap 37:294–299PubMed
23.
go back to reference Lindsey RW, Gutowski WT (1986) The migration of a broken pin following fixation of the acromioclavicular joint: a case report and review of the literature. Orthopedics 9:413–416PubMed Lindsey RW, Gutowski WT (1986) The migration of a broken pin following fixation of the acromioclavicular joint: a case report and review of the literature. Orthopedics 9:413–416PubMed
24.
go back to reference Lo IK, Burkhart SS, Parten PM (2004) Surgery about the coracoid: neurovascular structures at risk. Arthroscopy 20:591–595PubMed Lo IK, Burkhart SS, Parten PM (2004) Surgery about the coracoid: neurovascular structures at risk. Arthroscopy 20:591–595PubMed
25.
go back to reference Lowe GP, Fogarty MJ (1977) Acute acromioclavicular joint dislocation: result of operative treatment with the Bosworth screw. Aust NZ J Surg 47:664–667CrossRef Lowe GP, Fogarty MJ (1977) Acute acromioclavicular joint dislocation: result of operative treatment with the Bosworth screw. Aust NZ J Surg 47:664–667CrossRef
26.
go back to reference Mayr E, Braun W, Eber W et al (1999) Treatment of acromioclavicular joint separations: central Kirschner-wire and PDS-augmentation. Unfallchirurg 102:278–286CrossRefPubMed Mayr E, Braun W, Eber W et al (1999) Treatment of acromioclavicular joint separations: central Kirschner-wire and PDS-augmentation. Unfallchirurg 102:278–286CrossRefPubMed
27.
go back to reference Mlasowsky B, Brenner P, Duben W et al (1988) Repair of complete acromioclavicular dislocation (Tossy stage III) using Balser’s hook plate combined with ligament sutures. Injury 19:227–232CrossRefPubMed Mlasowsky B, Brenner P, Duben W et al (1988) Repair of complete acromioclavicular dislocation (Tossy stage III) using Balser’s hook plate combined with ligament sutures. Injury 19:227–232CrossRefPubMed
28.
go back to reference Motamedi AR, Blevins FT, Willis MC et al (2000) Biomechanics of the coracoclavicular ligament complex and augmentations used in its repair and reconstruction. Am J Sports Med 28:380–384PubMed Motamedi AR, Blevins FT, Willis MC et al (2000) Biomechanics of the coracoclavicular ligament complex and augmentations used in its repair and reconstruction. Am J Sports Med 28:380–384PubMed
29.
go back to reference Norrell H Jr, Llewellyn RC (1965) Migration of a threaded Steinmann pin from an acromioclavicular joint into the spinal canal: a case report. J Bone Joint Surg Am 47:1024–1026PubMed Norrell H Jr, Llewellyn RC (1965) Migration of a threaded Steinmann pin from an acromioclavicular joint into the spinal canal: a case report. J Bone Joint Surg Am 47:1024–1026PubMed
30.
go back to reference Paavolainen P, Bjorkenheim JM, Paukku P et al (1983) Surgical treatment of acromioclavicular dislocation: a review of 39 patients. Injury 14:415–420CrossRefPubMed Paavolainen P, Bjorkenheim JM, Paukku P et al (1983) Surgical treatment of acromioclavicular dislocation: a review of 39 patients. Injury 14:415–420CrossRefPubMed
31.
go back to reference Rockwood CA Jr, Williams GR Jr, Young DC (1988) Disorder of the acromioclavicular joint. In: Rockwood CA Jr, Matsen FAIII (eds) The shoulder, 2nd edn. WB Saunders, Philadelphia, pp 483–553 Rockwood CA Jr, Williams GR Jr, Young DC (1988) Disorder of the acromioclavicular joint. In: Rockwood CA Jr, Matsen FAIII (eds) The shoulder, 2nd edn. WB Saunders, Philadelphia, pp 483–553
32.
go back to reference Rockwood CA Jr (1984) Injuries to the acromioclavicular joint. In: Rockwood CA Jr, Green DP (eds) Fractures in adults, 2nd edn. JB Lippincott, Philadelphia, pp 860–910 Rockwood CA Jr (1984) Injuries to the acromioclavicular joint. In: Rockwood CA Jr, Green DP (eds) Fractures in adults, 2nd edn. JB Lippincott, Philadelphia, pp 860–910
33.
go back to reference Shin SJ, Yun YH, Yoo JD (2008) Coracoclavicular ligament reconstruction for acromioclavicular dislocation using 2 suture anchors and coracoacromial ligament transfer. Am J Sports Med 37:346–351CrossRefPubMed Shin SJ, Yun YH, Yoo JD (2008) Coracoclavicular ligament reconstruction for acromioclavicular dislocation using 2 suture anchors and coracoacromial ligament transfer. Am J Sports Med 37:346–351CrossRefPubMed
34.
go back to reference Sim E, Schwarz N, Hocker K et al (1995) Repair of complete acromioclavicular separations using the acromioclavicular-hook plate. Clin Orthop Relat Res 314:134–142PubMed Sim E, Schwarz N, Hocker K et al (1995) Repair of complete acromioclavicular separations using the acromioclavicular-hook plate. Clin Orthop Relat Res 314:134–142PubMed
35.
go back to reference Tischer T, Salzmann GM, El-Azab H et al (2009) Incidence of associated injuries with acute acromioclavicular joint dislocations types III through V. Am J Sports Med 37:136–139CrossRefPubMed Tischer T, Salzmann GM, El-Azab H et al (2009) Incidence of associated injuries with acute acromioclavicular joint dislocations types III through V. Am J Sports Med 37:136–139CrossRefPubMed
36.
go back to reference Walz L, Salzmann GM, Fabbro T et al (2008) The anatomic reconstruction of acromioclavicular joint dislocations using 2 TightRope devices. Am J Sports Med 36:2398–2406CrossRefPubMed Walz L, Salzmann GM, Fabbro T et al (2008) The anatomic reconstruction of acromioclavicular joint dislocations using 2 TightRope devices. Am J Sports Med 36:2398–2406CrossRefPubMed
37.
go back to reference Wellmann M, Zantop T, Petersen W (2007) Minimally invasive coracoclavicular ligament augmentation with a flip button/polydioxanone repair for treatment of total acromioclavicular joint dislocation. Arthroscopy 23:1132.e1–1132.e5 Wellmann M, Zantop T, Petersen W (2007) Minimally invasive coracoclavicular ligament augmentation with a flip button/polydioxanone repair for treatment of total acromioclavicular joint dislocation. Arthroscopy 23:1132.e1–1132.e5
38.
go back to reference Wellmann M, Zantop T, Weimann A et al (2007) Biomechanical evaluation of minimally invasive repairs for complete AC joint dislocation. Am J Sports Med 35:955–961CrossRefPubMed Wellmann M, Zantop T, Weimann A et al (2007) Biomechanical evaluation of minimally invasive repairs for complete AC joint dislocation. Am J Sports Med 35:955–961CrossRefPubMed
Metadata
Title
Arthroscopic treatment of acute acromioclavicular joint dislocation with double flip button
Authors
L. Murena
Ettore Vulcano
C. Ratti
L. Cecconello
P. R. Rolla
M. F. Surace
Publication date
01-12-2009
Publisher
Springer-Verlag
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 12/2009
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-009-0838-5

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