Paul Borbas1, James Churchill1, Eugene T Ek2. 1. Melbourne Orthopaedic Group, Melbourne, Victoria, Australia. 2. Melbourne Orthopaedic Group, Melbourne, Victoria, Australia; Department of Surgery, Monash Medical Centre, Monash University, Melbourne, Victoria, Australia. Electronic address: eugene_ek@me.com.
Abstract
BACKGROUND: To date, no gold-standard technique exists for the treatment of chronic acromioclavicular joint (ACJ) instability. We systematically reviewed the clinical results of 3 main categories of ACJ reconstruction for high-grade chronic instability. METHODS: A literature search was performed according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The inclusion criteria were clinical studies involving patients with ACJ instability (Rockwood grades III-VI) for at least 6 weeks, managed with ACJ stabilization, with a minimum 1-year follow-up. Depending on the surgical technique, patients were divided into 1 of 3 groups: nonbiological fixation between the coracoid and clavicle, for example, suture loops and synthetic ligaments (group 1); biological reconstruction of the coracoclavicular ligaments, for example, allograft or autograft ligament reconstruction (group 2); and ligament and/or tendon transfer, for example, the Weaver-Dunn procedure (group 3). Patient demographic characteristics, functional scores, radiographic outcomes, and complications were compared. RESULTS: Two independent investigators reviewed 960 articles. A total of 27 studies met the inclusion criteria, comprising 590 patients divided into 1 of 3 groups. The complication rates were similar among the 3 groups: 15% for nonbiological fixation, 15% for biological reconstruction, and 17% for ligament and/or tendon transfer, with failure rates of 8%, 7%, and 5%, respectively. In terms of functional results, the mean Constant score was 87.2 points for nonbiological fixation (n = 89), 92.4 points for biological reconstruction (n = 86), and 87.4 points for ligament and/or tendon transfer (n = 49). CONCLUSION: On comparison of the results of 3 different ACJ reconstruction methods, all techniques showed similar complication rates. Among the level II studies, ACJ reconstruction with a tendon graft showed superior results.
BACKGROUND: To date, no gold-standard technique exists for the treatment of chronic acromioclavicular joint (ACJ) instability. We systematically reviewed the clinical results of 3 main categories of ACJ reconstruction for high-grade chronic instability. METHODS: A literature search was performed according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The inclusion criteria were clinical studies involving patients with ACJ instability (Rockwood grades III-VI) for at least 6 weeks, managed with ACJ stabilization, with a minimum 1-year follow-up. Depending on the surgical technique, patients were divided into 1 of 3 groups: nonbiological fixation between the coracoid and clavicle, for example, suture loops and synthetic ligaments (group 1); biological reconstruction of the coracoclavicular ligaments, for example, allograft or autograft ligament reconstruction (group 2); and ligament and/or tendon transfer, for example, the Weaver-Dunn procedure (group 3). Patient demographic characteristics, functional scores, radiographic outcomes, and complications were compared. RESULTS: Two independent investigators reviewed 960 articles. A total of 27 studies met the inclusion criteria, comprising 590 patients divided into 1 of 3 groups. The complication rates were similar among the 3 groups: 15% for nonbiological fixation, 15% for biological reconstruction, and 17% for ligament and/or tendon transfer, with failure rates of 8%, 7%, and 5%, respectively. In terms of functional results, the mean Constant score was 87.2 points for nonbiological fixation (n = 89), 92.4 points for biological reconstruction (n = 86), and 87.4 points for ligament and/or tendon transfer (n = 49). CONCLUSION: On comparison of the results of 3 different ACJ reconstruction methods, all techniques showed similar complication rates. Among the level II studies, ACJ reconstruction with a tendon graft showed superior results.
Authors: Benjamin Bockmann; L Dankl; G Kucinskaite; A Kumar; J J Timothy; G Meschke; A J Venjakob; T L Schulte Journal: Arch Orthop Trauma Surg Date: 2022-03-28 Impact factor: 3.067
Authors: Daniel P Berthold; Lukas N Muench; Knut Beitzel; Simon Archambault; Aulon Jerliu; Mark P Cote; Bastian Scheiderer; Andreas B Imhoff; Robert A Arciero; Augustus D Mazzocca Journal: Orthop J Sports Med Date: 2020-09-16
Authors: Theodorakys Marín Fermín; Jean Michel Hovsepian; Víctor Miguel Rodrigues Fernandes; Ioannis Terzidis; Emmanouil Papakostas; Jason Koh Journal: Arthrosc Sports Med Rehabil Date: 2021-02-24
Authors: Juha O Ranne; Severi O Salonen; Terho U Kainonen; Jussi A Kosola; Lasse L Lempainen; Mika T Siitonen; Pekka T Niemi Journal: Arthrosc Sports Med Rehabil Date: 2021-08-27