Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 12/2018

01-12-2018 | Shoulder

Return to sport after acute acromioclavicular stabilization: a randomized control of double-suture-button system versus clavicular hook plate compared to uninjured shoulder sport athletes

Authors: D. Müller, Y. Reinig, R. Hoffmann, M. Blank, F. Welsch, U. Schweigkofler, T. Stein

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 12/2018

Login to get access

Abstract

Purpose

Traumatic high-grade acromioclavicular joint (ACJ) separations can be surgically stabilized by numerous anatomic and non-anatomic procedures. The return to sport (Maffe et al. in Am J Sports Med 23:93–98, 1995] and remaining sport-associated impairments after acute ACJ stabilization has not yet been investigated.

Methods

73 consecutive athletes with acute high-grade ACJ separation were prospectively assigned into two groups (64.4% randomized, 35.6% intention-to-treat): open clavicular hook plate (cHP) implantation (GI) or arthroscopically assisted double double-suture-button (dDSB) implantation (GII). Patients were analyzed using shoulder sport-specific measurement tools for sport ability (ASOSS), sport activity (SSAS), and numerical analog scales: NASpain during sport, NASshoulder function in sport, and NASre-achievement of sport level. Four points of examination were established: preoperative evaluation (FU0) and first postoperative follow-up (FU1) at 6 months; FU2 at 12 months; and FU3 at 24 months after surgery. The control group (GIII) consisted of 140 healthy athletes without anamnesis of prior macro-injury or surgery.

Results

After surgical stabilization, 29 of 35 athletes in GI (82.9%; 38.6 ± 9.9 years) and 32 of 38 in GII (82.9%; 38.6 ± 9.9 years) were followed up for 24 months (FU3) (loss 17.8%). All operated athletes showed significantly increased scores compared to FU0 (p < 0.05). Compared to GI, GII showed significantly superior outcome data for sporting ability as well as for NASre-achievement of sport level (p < 0.05). While GII re-achieved GIII-comparable SSAS and ASOSS levels, GI remained at a significantly inferior level. Athletes after ACJ injury of Rockwood grade IV/V and overhead athletes benefited significantly from the dDSB procedure.

Conclusion

The dDSB procedure enabled significantly superior sport-specific outcomes compared to the cHP procedure. Athletes after dDSB surgeries re-achieved the sporting ability and the sport activity levels of healthy athletes, whereas athletes after cHP implantation remained at significantly inferior levels. The more extensive dDSB procedure and the more restrictive rehabilitation are recommended for treatment of acute high-grade ACJ separations of functionally high-demanding athletes.

Level of evidence

I.
Literature
1.
Abrams JS (2007) Role of arthroscopy in treating anterior instability of the athlete’s shoulder. Sports Med Arthrosc 15:230–238CrossRef
2.
Baskurt Z, Baskurt F, Gelecek N, Ozkan MH (2011) The effectiveness of scapular stabilization exercise in the patients with subacromial impingement syndrome. J Back Musculoskelet Rehabil 24:173–179CrossRef
3.
Bath SS, Bath SS, Tehranzadeh J (2012) Anterosuperior glenoid impingement syndrome. Clin Med Insights Arthritis Musculoskelet Disord 5:15–18CrossRef
4.
Beitzel K, Cote MP, Apostolakos J, Solovyova O, Judson CH, Ziegler CG et al (2013) Current concepts in the treatment of acromioclavicular joint dislocations. Arthroscopy 29:387–397CrossRef
5.
Brophy RH, Gill CS, Lyman S, Barnes RP, Rodeo SA, Warren RF (2011) Effect of shoulder stabilization on career length in national football league athletes. Am J Sports Med 39:704–709CrossRef
6.
Buteau JL, Eriksrud O, Hasson SM (2007) Rehabilitation of a glenohumeral instability utilizing the body blade. Physiother Theory Pract 23:333–349CrossRef
7.
Darabos N, Vlahovic I, Gusic N, Darabos A, Bakota B, Miklic D (2015) Is AC TightRope fixation better than Bosworth screw fixation for minimally invasive operative treatment of Rockwood III AC joint injury? Injury 46(Suppl 6):S113–S118CrossRef
8.
Fessa CK, Peduto A, Linklater J, Tirman P (2015) Posterosuperior glenoid internal impingement of the shoulder in the overhead athlete: pathogenesis, clinical features and MR imaging findings. J Med Imaging Radiat Oncol 59:182–187CrossRef
9.
Horst K, Dienstknecht T, Andruszkow H, Gradl G, Kobbe P, Pape HC (2013) Radiographic changes in the operative treatment of acute acromioclavicular joint dislocation—tight rope technique vs. K-wire fixation. Pol J Radiol 78:15–20PubMedPubMedCentral
10.
Jobe FW, Kvitne RS, Giangarra CE (1989) Shoulder pain in the overhand or throwing athlete. The relationship of anterior instability and rotator cuff impingement. Orthop Rev 18:963–975PubMed
11.
12.
Kibler WB (1998) The role of the scapula in athletic shoulder function. Am J Sports Med 26:325–337CrossRef
13.
Kibler WB, Sciascia A (2010) Current concepts: scapular dyskinesis. Br J Sports Med 44:300–305CrossRef
14.
Korsten K, Gunning AC, Leenen LP (2014) Operative or conservative treatment in patients with Rockwood type III acromioclavicular dislocation: a systematic review and update of current literature. Int Orthop 38:831–838CrossRef
15.
Kraus N, Haas NP, Scheibel M, Gerhardt C (2013) Arthroscopically assisted stabilization of acute high-grade acromioclavicular joint separations in a coracoclavicular Double-TightRope technique: V-shaped versus parallel drill hole orientation. Arch Orthop Trauma Surg 133:1431–1440CrossRef
16.
Lajtai G, Pfirrmann CW, Aitzetmuller G, Pirkl C, Gerber C, Jost B (2009) The shoulders of professional beach volleyball players: high prevalence of infraspinatus muscle atrophy. Am J Sports Med 37:1375–1383CrossRef
17.
Longo UG, Ciuffreda M, Rizzello G, Mannering N, Maffulli N, Denaro V (2017) Surgical versus conservative management of Type III acromioclavicular dislocation: a systematic review. Br Med Bull 122:31–49CrossRef
18.
Maffet MW, Gartsman GM, Moseley B (1995) Superior labrum-biceps tendon complex lesions of the shoulder. Am J Sports Med 23:93–98CrossRef
19.
Natera-Cisneros L, Sarasquete-Reiriz J, Escola-Benet A, Rodriguez-Miralles J (2016) Acute high-grade acromioclavicular joint injuries treatment: arthroscopic non-rigid coracoclavicular fixation provides better quality of life outcomes than hook plate ORIF. Orthop Traumatol Surg Res 102:31–39CrossRef
20.
Nuchtern JV, Sellenschloh K, Bishop N, Jauch S, Briem D, Hoffmann M et al (2013) Biomechanical evaluation of 3 stabilization methods on acromioclavicular joint dislocations. Am J Sports Med 41:1387–1394CrossRef
21.
Pallis M, Cameron KL, Svoboda SJ, Owens BD (2012) Epidemiology of acromioclavicular joint injury in young athletes. Am J Sports Med 40:2072–2077CrossRef
22.
Rios CG, Arciero RA, Mazzocca AD (2007) Anatomy of the clavicle and coracoid process for reconstruction of the coracoclavicular ligaments. Am J Sports Med 35:811–817CrossRef
23.
Saier T, Plath JE, Beitzel K, Minzlaff P, Feucht JM, Reuter S et al (2016) Return-to-activity after anatomical reconstruction of acute high-grade acromioclavicular separation. BMC Musculoskelet Disord 17:145CrossRef
24.
Saier T, Venjakob AJ, Minzlaff P, Fohr P, Lindell F, Imhoff AB et al (2015) Value of additional acromioclavicular cerclage for horizontal stability in complete acromioclavicular separation: a biomechanical study. Knee Surg Sports Traumatol Arthrosc 23:1498–1505CrossRef
25.
Salzmann GM, Paul J, Sandmann GH, Imhoff AB, Schottle PB (2008) The coracoidal insertion of the coracoclavicular ligaments: an anatomic study. Am J Sports Med 36:2392–2397CrossRef
26.
Salzmann GM, Walz L, Buchmann S, Glabgly P, Venjakob A, Imhoff AB (2010) Arthroscopically assisted 2-bundle anatomical reduction of acute acromioclavicular joint separations. Am J Sports Med 38:1179–1187CrossRef
27.
28.
Scheibel M, Ifesanya A, Pauly S, Haas NP (2008) Arthroscopically assisted coracoclavicular ligament reconstruction for chronic acromioclavicular joint instability. Arch Orthop Trauma Surg 128:1327–1333CrossRef
29.
Smith TO, Chester R, Pearse EO, Hing CB (2011) Operative versus non-operative management following Rockwood grade III acromioclavicular separation: a meta-analysis of the current evidence base. J Orthop Traumatol 12:19–27CrossRef
30.
Snyder SJ, Banas MP, Karzel RP (1995) An analysis of 140 injuries to the superior glenoid labrum. J Shoulder Elbow Surg 4:243–248CrossRef
31.
Soldatis JJ, Moseley JB, Etminan M (1997) Shoulder symptoms in healthy athletes: a comparison of outcome scoring systems. J Shoulder Elbow Surg 6:265–271CrossRef
32.
Stein T, Buckup J, Efe T, von Eisenhart-Rothe R, Hoffmann R, Zimmermann E et al (2015) Structural and clinical integrity of the rotator cuff in athletes after arthroscopic Bankart repair using the three-portal technique. Arch Orthop Trauma Surg 135:369–382CrossRef
33.
Stein T, Linke RD, Buckup J, Efe T, von Eisenhart-Rothe R, Hoffmann R et al (2011) Shoulder sport-specific impairments after arthroscopic Bankart repair: a prospective longitudinal assessment. Am J Sports Med 39:2404–2414CrossRef
34.
Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49
35.
Venjakob AJ, Salzmann GM, Gabel F, Buchmann S, Walz L, Spang JT et al (2013) Arthroscopically assisted 2-bundle anatomic reduction of acute acromioclavicular joint separations: 58-month findings. Am J Sports Med 41:615–621CrossRef
36.
Vrgoc G, Japjec M, Jurina P, Gulan G, Jankovic S, Sebecic B et al (2015) Operative treatment of acute acromioclavicular dislocations Rockwood III and V-comparative study between K-wires combined with FiberTape((R)) vs. TightRope System((R)). Injury 46(Suppl 6):S107–S112CrossRef
37.
Walz L, Salzmann GM, Fabbro T, Eichhorn S, Imhoff AB (2008) The anatomic reconstruction of acromioclavicular joint dislocations using 2 TightRope devices: a biomechanical study. Am J Sports Med 36:2398–2406CrossRef
38.
Weiser L, Nuchtern JV, Sellenschloh K, Puschel K, Morlock MM, Rueger JM et al (2017) Acromioclavicular joint dislocations: coracoclavicular reconstruction with and without additional direct acromioclavicular repair. Knee Surg Sports Traumatol Arthrosc 25:2025–2031CrossRef
39.
Zeichen J, Meller R, Siegel A, Gehrke A, Hecker H, Krettek C (2004) Is the shoulder sport activity after shoulder injuries quantifiable? Implementation of a new Shoulder Sport Activity Score. Paper presented at German congress for orthopedy and traumatology, 25 Oct 2004, Berlin
Metadata
Title
Return to sport after acute acromioclavicular stabilization: a randomized control of double-suture-button system versus clavicular hook plate compared to uninjured shoulder sport athletes
Authors
D. Müller
Y. Reinig
R. Hoffmann
M. Blank
F. Welsch
U. Schweigkofler
T. Stein
Publication date
01-12-2018
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 12/2018
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-018-5044-x

Other articles of this Issue 12/2018

Knee Surgery, Sports Traumatology, Arthroscopy 12/2018 Go to the issue

Knee

Risk factors for residual pivot shift after anterior cruciate ligament reconstruction: data from the MAKS group

Shoulder

The arthroscopic Bankart repair procedure enables complete quantitative labrum restoration in long-term assessments

Shoulder

An arthroscopic bone block procedure is effective in restoring stability, allowing return to sports in cases of glenohumeral instability with glenoid bone deficiency

Knee

Intraoperative fluoroscopy during MPFL reconstruction improves the accuracy of the femoral tunnel position

Knee

Greater fear of reinjury is related to stiffened jump-landing biomechanics and muscle activation in women after ACL reconstruction

Shoulder

Shoulder abduction diminishes self-reinforcement in transosseous-equivalent rotator cuff repair in both knotted and knotless techniques