Asian Journal of Orthopaedic Research

Acromioclavicular Joint Dislocation Repair Using Double Endobutton Technique: Analysis of Functional Outcome

Sujay Gupta *

Department of Orthopaedics, Government Medical College, Kota, Rajasthan, India.

Lokesh Jangir

Department of Orthopaedics, Government Medical College, Kota, Rajasthan, India.

Ram Prasad Meena

Department of Orthopaedics, Government Medical College, Kota, Rajasthan, India.

Dinesh Kumar Bairwa

Department of Orthopaedics, RVRS Medical College, Bhilwara, Rajasthan, India.

*Author to whom correspondence should be addressed.

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Abstract

Introduction: Many procedures have been described for the operative management of acromioclavicular (AC) joint injuries. Some of these techniques, including hardware fixation and non-anatomical reconstructions, are associated with some serious complications and high failure rates. Recently, AC joint reconstruction techniques have focused more on anatomical restoration of the coracoclavicular ligaments to achieve optimal clinical outcomes. In our study, we have used a Double Endobutton technique to separately reconstruct the trapezoid and the coronoid portions of the coracoclavicular ligament. The purpose of this study was to evaluate the preliminary clinical and radiological results of this technique in patients with acute complete dislocation of the AC joint.

Methods: This was a prospective study conducted in Government Medical College, Kota during the period between December 2020 to December 2022, a total of 20 cases of complete Acromioclavicular Joint injuries(Rockwood type III-V) treated by reconstruction of coracoclavicular ligaments using Double Endobutton , Mersilene tape and # 5 Ethibond. We had 9 cases of Rockwood type 5, 6 cases of type 4, 5 cases of type 3. We had 6 right sided cases and 14 left sided cases. All injuries opened with vertical strap incision followed by reduction of AC joint and reconstruction done with this double endobutton technique.

Results: Outcome was measured based on DASH questionnaire and Constant score at intervals of 6 weeks, 12 weeks and 24 weeks . Radiological assessment was done at intervals of 6weeks , 12 weeks and 24 weeks with x-ray shoulder Zanca view and x-ray both shoulder AP stress view. Post operative complications were noted .At the last follow-up, 18 patients had an excellent outcome as assessed by Constant score, DASH and Quick DASH scores. One patient had good outcome while one patient had fair outcome. The mean scores at the last follow-up were: Constant score was 96 (range 80 -100), DASH score was 5.3 (range 1-11).

Conclusion: In our series double Endobutton technique has good results of functional outcome and pain free shoulder movements at a mean follow-up interval of 12 months (range, 8–14 months). Excellent reduction of the AC joint was maintained. The Double Endobutton technique is a safe and effective for the treatment of complete AC joint dislocations.

Keywords: Acromioclavicular, endobutton, mersilene, dislocation, repair

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References

Renger RJ, Roukema GR, Reurings JC, Raams PM, Font J, Verleisdonk EJMM. The Clavicle Hook Plate for Neer Type II Lateral Clavicle Fractures. Journal of Orthopaedic Trauma [Internet]. 2009;23(8). Available:http://journals.lww.com/jorthotrauma/Fulltext/2009/09000/The_Clavicle_Hook_Plate_for _Neer_Type_II_Lateral.5.aspx

MacDonald PB, Lapointe P. Acromioclavicular and sternoclavicular joint injuries. Orthopedic Clinics of North America. 2008;39(4):535–545.

Meda PVK, Machani B, Sinopidis C, Braithwaite I, Brownson P, Frostick SP. Clavicular hook plate for lateral end fractures:- A prospective study. Injury. 2006;37(3):277-283.

Rockwood and Green's Fractures in Adults, 7th edition - home [Internet]. [Cited 2010 Nov 27];

Available:http://www.rockwoodadultsfractures.com/pt/re/bucholz7e/home.htm;jsessionid=MwDFC DcKBQNp21m3pZ1135htv8JbTXTV2xh9JlyhLK27vTzQN8Jf!628309595!181195628!8 091!-1

Henry J. Repair of complete acromioclavicular separations using the acromioclavicular-Hook Plate. Internet

Sage Fp, Salvatore Je. Injuries of the acromioclavicular joint: A study of results in 96 patients. Southern Medical Journal [Internet]. 1963;56(5).

Available:http://journals.lww.com/smajournalonline/Fulltext/1963/05000/Injuries_of_the_Acromioc lavicular_Joint__A_Study.9.aspx

Dias J, Steingold R, Richardson R, Tesfayo hannes B, Gregg P. The conservative treatment of acromioclavicular dislocation. Review after five years. J Bone Joint Surg Br. 1987;69-B(5):719 722.

Weaver Jk, Dunn Hk. Treatment of Acromioclavicular Injuries, Especially Complete Acromioclavicular Separation. J Bone Joint Surg Am. 1972;54(6): 1187-1194.

Rockwood CA. The Shoulder. Elsevier Health Sciences; 2009.

Bannister G, Wallace W, Stableforth P, Hutson M. The management of acute acromioclavicular dislocation. A randomised prospective controlled trial. J Bone Joint Surg Br. 1989 Nov 1;71-B(5):848-850.90.

Urist Mr. The nature of the traumatic lesion and effective methods of treatment with an analysis of forty-one cases. J Bone Joint Surg Am. 1946;28(4):813-837.

Post M. Current concepts in the diagnosis and management of acromio-clavicular dislocations. Clin. Orthop. Relat. Res. 1985 Nov;200:234-247.

Dewar FP, Barrington TW. The treatment of chronic acromioclavicular dislocation. J Bone Joint Surg Br. 1965;47-B(1): 32-35.

Kashii M, Inui H, Yamamoto K. Surgical Treatment of Distal Clavicle Fractures Using the Clavicular Hook Plate. Clinical Orthopaedics and Related Research [Internet]. 2006;447.

Available:http://journals.lww.com/corr/Fulltext/2006/06000/Surgical_Treatment_of_Distal_Clavicle _Fractures.28.aspx

Lizaur A, Marco L, Cebrian R. Acute dislocation of the acromioclavicular joint. Traumatic anatomy and the importance of deltoid and trapezius. J Bone Joint Surg Br. 1994;76-B(4):602-606.