Raşit ÖZCAFER, Kutalmış ALBAYRAK, Osman LAPÇİN, Engin ÇETİNKAYA, Yavuz ARIKAN, Murat GÜL

Early clinical and radiographic results of fixation with the TightRope device for Rockwood type Vacromioclavicular joint dislocation: A retrospective review of 15 patients

Objective: The aims of this study were, first, to assess the loss of reduction after fixation of Rockwood type V acromioclavicular joint dislocation (ACJD) with the TightRope device (Arthrex, Naples, FL, USA) and, second, to present the functional and radiological outcomes of this treatment.Methods: We retrospectively reviewed the medical records of 15 patients (12 males; mean age=39.2 years; age range=23-61) with Rockwood type V ACJD who were treated by the TightRope fixation device. The mean follow-up period was 19.3 (range=12-30) months. Functional status was assessed using the Constant-Murley score (CMS) at the final follow-up examination. To determine the reduction loss of ACJ, we measured and compared the coracoclavicular (CC) distance using radiographs with Zanca view in the early postoperative period and at the final follow-up examination. The fixation procedures were performed with an open technique using the TightRope fixation device.Results: The mean CMS at the final follow-up was 93.2 (range=82-100) points. All the patients experienced full recovery of the shoulder’s range of motion, were able to return to the activities of daily living, and were satisfied with the treatment. ACJ reduction was successfully achieved in all the patients using the TightRope technique. Postoperative radiographs revealed no reduction loss in the ACJ, and the CC distance was well maintained. The mean CC distance was 19.95 (range=13.1-28.3) mm before surgery. The mean CC distance was 7.47 (range=4.2-11.5) mm in the early postoperative radiographic measurements. This difference was statistically significant (p=0.001). The mean CC distance at the final follow-up examination was 7.70 (range=4.5-11.7) mm. At the final follow-up visit, the shoulders of all the patients were still completely reduced, with a mean difference in the CC of 0.23 (range=0-1.3) mm compared with that in the early postoperative period. The difference in the CC between the early postoperative and final follow-up intervals was not statistically significant (p=0.055). No patient experienced recurrence or required an operation for hardware removal.Conclusion: It seems that the TightRope device can provide anatomical restoration in patients with acute type V ACJD without subluxation at the final follow-up examination.Level of Evidence: Level IV, Therapeutic study

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1. Tischer T, Salzmann GM, El-Azab H, Vogt S, Imhoff AB. Incidence of associated injuries with acute acromioclavicular joint dislocations types III through V. Am J Sports Med 2009; 37: 136-9. [Crossref]

2. Coale RM, Hollister SJ, Dines JS, Allen AA, Bedi A. Anatomic considerations of transclavicular-transcoracoid drilling for coracoclavicular ligament reconstruction. J Shoulder Elbow Surg 2013; 22: 137-44. [Crossref]

3. Rockwood CA, Williams GR, Young DC. Acromioclavicular injuries. In: Rockwood CA, Green DP, Bucholz RW, Heckman JD, editors. Fractures in Adults. 4th ed. Vol I. Philadelphia.

4. Horst K, Dienstknecht T, Pishnamaz M, Sellei RM, Kobbe P, Pape HC. 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 Surg 2013; 7: 18. doi: 10.1186/1754-9493-7-18. eCollection 2013. [Crossref]

5. Faraj AA, Ketzer B. The use of a hookplate in the management of acromioclavicular injuries. Report of ten cases. Acta Orthop Belg 2001; 67: 448-51.

6. Weaver JK, Dunn HK. Treatment of acromioclavicular injuries, especially complete acromioclavicular separation. JBJS 1972; 54: 1187-94. [Crossref]

7. Bhattacharya R, Goodchild L, Rangan A. Acromioclavicular joint reconstruction using the Nottingham Surgilig: A preliminary report. Acta Orthop Belg 2008; 74: 167-72.

8. Jeon IH, Dewnany G, Hartley R, Neumann L, Wallace WA. Chronic acromioclavicular separation: the medium term results of coracoclavicular ligament reconstruction using braided polyester prosthetic ligament. Injury 2007; 38: 1247-53. [Crossref]

9. Gurd FB. The treatment of complete dislocation of the outer end of the clavicle: an hitherto undescribed operation. Ann Surg 1941; 113: 1094-8. [Crossref]

10. DeBerardino TM, Pensak MJ, Ferreira J, Mazzocca AD. Arthroscopic stabilization of acromioclavicular joint dislocation using the AC graftrope system. J Shoulder Elbow Surg 2010; 19: 47-52. [Crossref]

11. Tsou PM. Percutaneous cannulated screw coracoclavicular fixation for acute acromioclavicular dislocations. Clin Orthop Relat Res 1989; 243: 112- 21. [Crossref]

12. Li X, Ma R, Bedi A, Dines DM, Altchek DW, Dines JS. Management of acromioclavicular joint injuries. J Bone Joint Surg Am 2014; 96: 73-84. [Crossref]

13. Beitzel K, Cote MP, Apostolakos J, et al. Current concepts in the treatment of acromioclavicular joint dislocations. Arthroscopy 2013; 29: 387-97. [Crossref]

14. Olivos-Meza A, Almazán-Diaz A, Calvo JA, et al. Radiographic displacement of acute acromioclavicular joint dislocations fixed with AC TightRope. JSES Int 2020; 4: 49-54. [Crossref]

15. Lim YW, Sood A, van Riet R, Bain GI. Acromioclavicular joint reduction, repair and reconstruction using metallic buttons: Early results and complications. Tech Shoulder Elbow Surg. 2007; 8: 213-21. [Crossref]

16. Lu D, Wang T, Hong JJ, Chen H, Sun LJ. Acute acromioclavicular joint dislocation treated with tightrope: Mini-open versus percutaneous stabilization. Acta Orthop Belg 2019; 85: 406-11.

17. Constant CR, Murley AG. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 1987; 214: 160-4. [Crossref]

18. Zanca P. Shoulder pain: involvement of the acromioclavicular joint (analysis of 1,000 cases). Am J Roentgenol Radium Ther Nucl Med 1971; 112: 493-506. [Crossref]

19. Pfahler M, Krödel A, Refior HJ. Surgical treatment of acromioclavicular dislocation. Arch Orthop Trauma Surg 1994; 113: 308-11. [Crossref]

20. Martetschläger F, Horan MP, Warth RJ, Millet PJ. Complications after anatomic fixation and reconstruction of the coracoclavicular ligaments. Am J Sports Med 2013; 41: 2896-903. [Crossref]

21. Fukuda K, Craig EV, An KN, Cofield RH, Chao EY. Biomechanical study of the ligamentous system of the acromioclavicular joint. J Bone Joint Surg Am 1986; 68: 434-40. [Crossref]

22. Cano-Martínez JA, Nicolas Serrano G, Bento-Gerard J, Picazo-Marin F, Andres-Grau J. Acute high-grade acromioclavicular dislocations treated with triple button device (MINAR): Preliminary results. Injury 2016; 47: 2512-9. [Crossref]

23. Faria RS, Ribeiro FR, Amin Bde O, et al. Acromioclavicular dislocation: postoperative evaluation of the coracoclavicular ligaments using magnetic resonance. Rev Bras Ortop 2015; 50: 195-9. [Crossref]

24. Weiser L, Nüchtern JV, Sellenschloh K, et al. Acromioclavicular joint dislocations: coracoclavicular reconstruction with and without additional direct acromioclavicular repair. Knee Surg Sports Traumatol Arthrosc 2017; 25: 2025-31. [Crossref]

25. Vulliet P, Le Hanneur M, Cladiere V, Loriaut P, Boyer P. A comparison between two double-button endoscopically assisted surgical techniques for the treatment acute acromioclavicular dislocations. Musculoskelet Surg 2018; 102: 73-9. [Crossref]

26. Fraser-Moodie JA, Shortt NL, Robinson CM. Injuries to the acromioclavicular joint. J Bone Joint Surg Br 2008; 90: 697-707. [Crossref]

27. Beitzel K, Cote MP, Apostolakos J, et al. Current concepts in the treatment of acromioclavicular joint dislocations. Arthroscopy 2013; 29: 387-97. [Crossref]

28. Walz L, Salzmann GM, Fabbro T, Eichhorn S, Imhoff AB. The anatomic reconstruction of acromioclavicular joint dislocations using 2 TightRope devices: A biomechanical study. Am J Sports Med 2008; 36: 2398-406. [Crossref]

29. Costic RS, Labriola JE, Rodosky MW, Debski RE. Biomechanical rationale for development of anatomical reconstructions of coracoclavicular ligaments after complete acromioclavicular joint dislocations. Am J Sports Med 2004; 32: 1929-36. [Crossref]

30. Costic RS, Vangura A Jr, Fenwick JA, Rodosky MW, Debski RE. Viscoelastic behavior and structural properties of the coracoclavicular ligaments. Scand J Med Sci Sports 2003; 13: 305-10. [Crossref]

31. Mazzocca AD, Santangelo SA, Johnson ST, Rios CG, Dumonski ML, Arciero RA. A biomechanical evaluation of an anatomical coracoclavicular ligament reconstruction. Am J Sports Med 2006; 34: 236-46. [Crossref]

32. Murena L, Vulcano E, Ratti C, Cecconello L, Rolla PR, Surace MF. Arthroscopic treatment of acute acromioclavicular joint dislocation with double flip button. Knee Surg Sports Traumatol Arthrosc 2009; 17: 1511-5. [Crossref]

33. Boileau P, Old J, Gastaud O, Brassart N, Roussanne Y. All-arthroscopic Weaver-Dunn-Chuinard procedure with double-button fixation for chronic acromioclavicular joint dislocation. Arthroscopy 2010; 26: 149-60. [Crossref]

34. Jensen G, Katthagen JC, Alvarado LE, Lill H, Voigt C. Has the arthroscopically assisted reduction of acute AC joint separations with the double tightrope technique advantages over the clavicular hook plate fixation? Knee Surg Sports Traumatol Arthrosc 2014; 22: 422-30. [Crossref]

35. Wellmann M, Zantop T, Weimann A, Raschke MJ, Petersen W. Biomechanical evaluation of minimally invasive repairs for complete acromioclavicular joint dislocation. Am J Sports Med 2007; 35: 955-61. [Crossref]

36. Lädermann A, Gueorguiev B, Stimec B, Fasel J, Rothstock S, Hoffmeyer P. Acromioclavicular joint reconstruction: a comparative biomechanical study of three techniques. J Shoulder Elbow Surg 2013; 22: 171-8. [Crossref]

37. Schliemann B, Roßlenbroich SB, Schneider KN, et al. Why does minimally invasive coracoclavicular ligament reconstruction using a flip button repair technique fail? An analysis of risk factors and complications. Knee Surg Sports Traumatol Arthrosc 2015; 23: 1419-25. [Crossref]

38. Venjakob AJ, Salzmann GM, Gabel F, et al. Arthroscopically assisted 2-bundle anatomic reduction of acute acromioclavicular joint separations: 58-month findings. Am J Sports Med 2013; 41: 615-21. [Crossref]

39. Calvo E, López-Franco M, Arribas IM. Clinical and radiologic outcomes of surgical and conservative treatment of type III acromioclavicular joint injury. J Shoulder Elbow Surg 2006; 15: 300-5. [Crossref]

40. Dimakopoulos P, Panagopoulos A, Syggelos SA, Panagiotopoulos E, Lambiris E. Double-loop suture repair for acute acromioclavicular joint disruption. Am J Sports Med 2006; 34: 1112-9. [Crossref]