Zekeriya Okan Karaduman, Zafer Orhan, Yalçın Turhan, Mehmet Arıcan, Erdem Değirmenci, Ozan Turhal

Rockwood Tip III Akromiyoklaviküler Eklem Çıkıklarının Cerrahi Tedavisinde Modifiye Bosworth ve Endobutton Tekniklerinin Karşılaştırılması

Amaç: Bu çalışmada tip III akromiyoklaviküler çıkıkların cerrahi tedavisinde modifiye Bosworth tekniğinin ve Endobutton tekniğinin uzun dönem klinik ve radyolojik sonuçlarını retrospektif olarak karşılaştırmak amaçlanmıştır. Gereç ve Yöntemler: Otuz iki hasta (26 erkek, 6 kadın) (ortalama yaş 37, dağılım 15–78 yıl) akromiyoklaviküler eklem (AKE) çıkığı nedeniyle cerrahi yolla tedavi edildi. Tüm hastalarda tip III çıkık vardı. Yirmi iki hastada sağ AKE çıkığı, 10 hastada sol AKE çıkığı mevcuttu. Çıkıkların 18’i düşme, 9’u spor yaralanması, 5’i trafik kazası sonucunda meydana gelmişti. Hastaların 18’i Endobutton tekniği, 14’ü ise modifiye Bosworth tekniği ile opere edildi. Hastalar ameliyat sonrası fonksiyonel Constant, DASH ve VAS skorları üzerinden ve radyolojik olarak da KKM (korakoklaviküler mesafe) ölçümü ile değerlendirildi. Ortalama takip süresi 52 (37–66) ay idi. Bulgular: Tüm hastalarda akromiyoklaviküler eklem dizilimi normaldi. Hiçbir hastada eklem dejenerasyonu görülmedi. Tüm hastalarda omuz hareketleri ağrısız ve tamdı. Endobutton grubunun ortalama postoperatif 3., 12. ve 24. ay Constant skorları modifiye Bosworth grubununkilerden istatistiksel olarak anlamlı şekilde yüksek bulundu (p=0,001). Endobutton grubunun ortalama postoperatif 3., 12. ve 24. ay DASH skorları modifiye Bosworth grubununkilerden istatistiksel olarak anlamlı şekilde düşüktü (p=0,003). Endobutton grubunun ortalama postoperatif 3. 12. ve 24. ay VAS skorları modifiye Bosworth grubununkilerden istatistiksel olarak anlamlı şekilde düşüktü (p=0,001). İki grubun preoperatif ve postoperatif KKM ortalamaları arasında ise istatistiksel olarak anlamlı fark gözlenmedi (p=0,104). Tartışma ve Sonuç: Endobutton tekniği akromiyoklaviküler çıkıkların cerrahi tedavisinde modifiye Bosworth tekniğine karşı iyi bir alternatiftir.

A Comparison of the Modified Bosworth and Endobutton Techniques in the Surgical Treatment of Rockwood Type III Acromioclavicular Joint Dislocations

Aim: In this study, we aimed to retrospectively compare the long-term clinical and radiological outcomesobtained with the modified Bosworth technique and Endobutton technique in surgical treatment of type IIIacromioclavicular dislocations.Materials and Methods: Thirty-two patients (26 males, 6 females) (mean age 37, range 15–78 years) weretreated surgically for acromioclavicular joint (ACJ) dislocation. All patients had type III dislocation. Twentytwo patients had right ACJ dislocation and 10 patients had left ACJ dislocation. Of the dislocations, 18 occurred due to falls; 9, sports injuries; and 5, traffic accidents. Of the patients, 18 were operated on with theEndobutton technique and 14 with the modified Endobutton technique. Patients were evaluated postoperatively in terms of functional Constant, DASH, and VAS scores and radiologically with coracoclavicular distance(CCD) assessment. The mean follow-up was 52 (37–66) months.Results: The alignment of the acromioclavicular joint was normal in all patients. No joint degeneration wasobserved in any patient. Shoulder movements were painless and complete in all patients. The mean postoperative 3rd, 12th, and 24th month Constant scores were found significantly higher for the Endobutton group thanfor the modified Bosworth group (p=0.001). The mean postoperative 3rd, 12th, and 24th month DASH scoreswere significantly lower for the Endobutton Group than for the modified Bosworth group (p=0.003). Themean postoperative 3rd, 12th, and 24th month VAS scores were significantly lower for the Endobutton groupthan for the modified Bosworth group (p=0.001). However, no statistically significant difference was foundbetween the mean preoperative and postoperative CCD values of the two groups (p=0.104).Discussion and Conclusion: The Endobutton technique is a good alternative to the modified Bosworthtechnique in the surgical treatment of acromioclavicular dislocations.

PDF

___

1. Collins DN. Disorders of the acromioclavicular joint. In: The Shoulder (vol. 4), 4. ed. Philadelphia: Saunders Elsevier; 2009.
2. Rockwood CA Jr.., Williams GR, Young DC. Injuries to the acromioclavicular joint. In: Rockwood CA Jr., Green DP, Bucholz RW, Heckmen JD (ed.), Rockwood and Green’s Fractures in Adults (vol. 2), 4. ed. Philadelphia: JB Lippincott-Raven; 1996:1341–413.
3. Lancaster S, Horowitz M, Alonso J. Complete acromioclavicular separations. A comparison of operative methods. Clin Orthop Relat Res. 1987;(216):80–8.
4. Salem KH, Schmelz A. Treatment of Tossy III acromioclavicular joint injuries using hook plates and ligament suture. J Orthop Trauma. 2009;23:565–9.
5. Bargren JH, Erlanger S, Dick HM. Biomechanics and comparison of two operative methods of treatment of complete acromioclavicular separation. Clin Orthop Relat Res. 1978;(130):267–72.
6. Fukuda K, Craig EV, An KN, Cofield RH, Chao EY. Biomechanical study of the ligamentous system of the acromioclavicular joint. J Bone Joint Surg. 1986;68:434–40.
7. Deshmukh AV, Wilson DR, Zilberfarb JL, Perlmutter GS. Stability of acromioclavicular joint reconstruction: biomechanical testing of various surgical techniques in a cadaveric model. Am J Sports Med. 2004;32:1492–8.
8. Grutter PW, Petersen SA. Anatomical acromioclavicular ligament reconstruction: a biomechanical comparison of reconstructive techniques of the acromioclavicular joint. Am J Sports Med. 2005;33:1723–8.
9. Wei HF, Chen YF, Zeng BF. Triple endobuttton technique for the treatment of acute complete acromioclavicular joint dislocations: preliminary results. Int Orthop. 2011;35(4):555–9.
10. Schlegel TF, Burks RT, Marcus RL, Dunn HK. A prospective evaluation of untreated acute grade III acromioclavicular separations. Am J Sports Med. 2001;29:699e703.
11. Smith TO, Chester R, Pearse EO, Hing CB. Operative versus non-operative management following Rockwood grade III acromioclavicular separation: a meta-analysis of the current evidence base. J Orthop Traumatol. 2011;12:19e27.
12. Press J, Zuckerman JD, Gallagher M, Cuomo F. Treatment of grade III acromioclavicular separations. Operative versus nonoperative management. Bull Hosp Jt Dis. 1997;56:77–83.
13. Tauber M. Management of acute acromioclavicular joint dislocations: current concepts. Arch Orthop Trauma Surg. 2013;133:985e995.
14. Takase K, Yamamoto K. Changes in surgical procedures for acromioclavicular joint dislocation over the past 30 years. Orthopedics. 2013;36:1277e1282.
15. Harris RI, Wallace AL, Harper GD, Goldberg JA, Sonnabend DH, Walsh WR. Structural properties of the intact and there constructed coracoclavicular ligament complex. Am J Sports Med. 2000;28:103–8.
16. Assaghir YM. Outcome of exact anatomic repair and coracoclavicular cortical lag screw in acute acromioclavicular dislocations. J Trauma Acute Care Surg. 2011;71:50e54.
17. Pavlik A, Csépai D, Hidas P. Surgical treatment of chronic acromioclavicular joint dislocation by modified Weaver–Dunn procedure. Knee Surg Sports Traumatol Arthrosc. 2001;9:307–12.
18. Bektaşer B, Bozkurt M, Öçgüder A, Solak Ş, Oğuz T. Tip III akromiyoklaviküler eklem çıkıklarının modifiye Bosworth tekniği ile cerrahi tedavisi. Ulus Travma Acil Cerrahi Derg. 2004;10:245–9.
19. Bhattacharya R, Goodchild L, Rangan A. Acromioclavicular joint reconstruction using the Nottingham Surgilig: a preliminary report. Acta Orthop Belg. 2008;74:167–72.
20. Bannister GC, Wallace WA, Stableforth PG, Hutson MA. The management of acute acromioclavicular dislocation. A randomized prospective controlled trial. J Bone Joint Surg. 1989;71:848–50.