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      • Record: found
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      Management of chronic unstable acromioclavicular joint injuries

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          Abstract

          Abstract

          The acromioclavicular joint represents the link between the clavicle and the scapula, which is responsible for the synchronized dynamic of the shoulder girdle. Chronic acromioclavicular joint instability involves changes in the orientation of the scapula, which provokes cinematic alterations that might result in chronic pain. Several surgical strategies for the management of patients with chronic and symptomatic acromioclavicular joint instability have been described. The range of possibilities includes anatomical and non-anatomical techniques, open and arthroscopy-assisted procedures, and biological and synthetic grafts. Surgical management of chronic acromioclavicular joint instability should involve the reconstruction of the torn ligaments because it is accepted that from three weeks after the injury, these structures may lack healing potential. Here, we provide a review of the literature regarding the management of chronic acromioclavicular joint instability.

          Level of evidence

          Expert opinion, Level V.

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          Most cited references48

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          Evaluation and treatment of acromioclavicular joint injuries.

          James Bicos, Augustus Mazzocca, R Arciero (2007)
          Acromioclavicular joint injuries and, more specifically, separations are commonplace both in general practice and during athletic participation. This article reviews the traditional classification as well as the clinical evaluation of patients with acute and chronic acromioclavicular joint separations. It also highlights many recent advances, principally in the anatomy and biomechanics of the acromioclavicular joint ligamentous complex. The concept of increases in superior translation as well as disturbances in horizontal translation with injuries to this joint and ligaments are discussed. This information, coupled with the unpredictable long-term results with the Weaver-Dunn procedure and its modifications, have prompted many recent biomechanical studies evaluating potential improvements in the surgical management of acute and chronic injuries. The authors present these recent works investigating cyclic loading and ultimate failure of traditional reconstructions, augmentations, use of free graft, and the more recent anatomic reconstruction of the conoid and trapezoid ligaments. The clinical results (largely retrospective), including acromioclavicular joint repair, reconstruction and augmentation with the coracoclavicular ligament, supplemental sutures, and the use of free autogenous grafts, are summarized. Finally, complications and the concept of the failed distal clavicle resection and reconstruction are addressed. The intent is to provide a current, in-depth treatise on all aspects of acromioclavicular joint complex injuries to include anatomy, biomechanics, benchmark studies on instability and reconstruction, clinical and radiographic evaluation, and to present the most recent clinical research on surgical outcomes.
          Article 0 comments Cited 116 times – based on 0 reviews     Review now
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            Current concepts in the treatment of acromioclavicular joint dislocations.

            Knut Beitzel, P Côté, Augustus Mazzocca … (2013)
            To conduct a systematic review of the literature in relation to 3 considerations in determining treatment options for patients with acromioclavicular (AC) joint dislocations: (1) operative versus nonoperative management, (2) early versus delayed surgical intervention, and (3) anatomic versus nonanatomic techniques. The PubMed database was searched in October 2011 using the single term acromioclavicular and the following search limits: any date, humans, English, and all adult (19+). Studies were included if they compared operative with nonoperative treatment, early with delayed surgical intervention, or anatomic with nonanatomic surgical techniques. Exclusion criteria consisted of the following: Level V evidence, laboratory studies, radiographic studies, biomechanical studies, fractures or revisions, meta-analyses, and studies reporting preliminary results. This query resulted in 821 citations. Of these, 617 were excluded based on the title of the study. The abstracts and articles were reviewed, which resulted in the final group of 20 studies that consisted of 14 comparing operative with nonoperative treatment, 4 comparing early with delayed surgical intervention, and 2 comparing anatomic with nonanatomic surgical techniques. The lack of higher level evidence prompted review of previously excluded studies in an effort to explore patterns of publication related to operative treatment of the AC joint. This review identified 120 studies describing 162 techniques for operative reconstruction of the AC joint. There is a lack of evidence to support treatment options for patients with AC joint dislocations. Although there is a general consensus for nonoperative treatment of Rockwood type I and II lesions, initial nonsurgical treatment of type III lesions, and operative intervention for Rockwood type IV to VI lesions, further research is needed to determine if differences exist regarding early versus delayed surgical intervention and anatomic versus nonanatomic surgical techniques in the treatment of patients with AC joint dislocations. Level III, systematic review of Level II and Level III studies and one case series. Copyright © 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
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              Treatment of acromioclavicular injuries, especially complete acromioclavicular separation.

              Donald Weaver, Malcolm H. Dunn (1972)
              Article 0 comments Cited 93 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Luis Natera Cisneros:
                ORCID: http://orcid.org/0000-0002-1403-192X
                +34-600393826 , luisgerardonaterac@gmail.com
                Journal
                Journal ID (nlm-ta): J Orthop Traumatol
                Journal ID (iso-abbrev): J Orthop Traumatol
                Title: Journal of Orthopaedics and Traumatology : Official Journal of the Italian Society of Orthopaedics and Traumatology
                Publisher: Springer International Publishing (Cham )
                ISSN (Print): 1590-9921
                ISSN (Electronic): 1590-9999
                Publication date (Electronic): 8 March 2017
                Publication date PMC-release: 8 March 2017
                Publication date (Print): December 2017
                Volume: 18
                Issue: 4
                Pages: 305-318
                Affiliations
                [1 ]GRID grid.7080.f, Hospital de la Santa Creu i Sant Pau, , Universitat Autònoma de Barcelona, ; Street Sant Quintí 89, 08026 Barcelona, Spain
                [2 ]GRID grid.440254.3, Hospital General de Catalunya, ; Street Pedro i Pons 1, 08190 Sant Cugat Del Vallés, Barcelona Spain
                [3 ]ISNI 0000 0004 1769 0319, GRID grid.416936.f, Hospital Quirón Teknon, ; Street Vilana 12, 08022 Barcelona, Spain
                Author information
                http://orcid.org/0000-0002-1403-192X
                Article
                Publisher ID: 452
                DOI: 10.1007/s10195-017-0452-0
                PMC ID: 5685976
                PubMed ID: 28275882
                SO-VID: 201c5947-3061-4137-9186-83f848d052d0
                Copyright © © The Author(s) 2017
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                Date received : 22 April 2016
                Date accepted : 13 February 2017
                Categories
                Subject: Review Article
                Custom metadata
                issue-copyright-statement © The Author(s) 2017

                ScienceOpen disciplines: Orthopedics
                Keywords: unstable acromioclavicular joint injuries,chronic setting,arthroscopically assisted management,anatomical ligament reconstruction,coracoclavicular ligaments,scapular dyskinesis
                Data availability:
                ScienceOpen disciplines: Orthopedics
                Keywords: unstable acromioclavicular joint injuries, chronic setting, arthroscopically assisted management, anatomical ligament reconstruction, coracoclavicular ligaments, scapular dyskinesis

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