Arthroscopic Twin Tail TightRope combined with distal joint capsule repair technique for acute acromioclavicular dislocation_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Chaoran ¹ ,  ZHANG Jun ¹ , CHEN Hong ² , ZHAO Daohong ¹ , ZHANG Yuhao ¹ , WU Zhidan ¹

1. Department of Orthopedics, the Second Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650101, P.R.China;
2. Department of Sports Medicine, Calmette International Hospital of Kunming First People’s Hospital, Kunming Yunnan, 650051, P.R.China;

Corresponding?author：

ZHANG Jun, Email: Hxzhangjun08@163.com

Keywords：

Acromioclavicular dislocation; arthroscopy; minimal invasive surgery

DOI：

10.7507/1002-1892.201903019

Video：

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Objective To investigate arthroscopic treatment for acute acromioclavicular dislocation by using Twin Tail TightRope combined with distal joint capsular repair. Methods The clinical data of 40 patients with acromioclavicular dislocation treated between February 2016 and December 2017 were retrospectively analyzed. The patients were divided into arthroscopic group (20 cases, using arthroscopic Twin Tail TightRope combined with distal joint capsular repair for anatomical repair of stable structure of acromioclavicular joint) and control group (20 cases, treated with clavicular hook plate internal fixation) according to different surgical methods. There was no significant difference in gender, age, cause of injury, Rockwood classification, time from injury to operation, preoperative visual analogue scale (VAS) score and Constant score between the two groups (P>0.05), which were comparable. Postoperative VAS score and Constant score were used to assess shoulder function and re-dislocation was also observed. Results The incisions of the two groups healed by first intention, and no early postoperative complications occurred. All patients were followed up 12-18 months (mean, 13.5 months). Postoperative X-ray films showed good anatomical reduction in both groups, but the clavicular hook had a presense in the subacromial space in control group. All patients in arthroscopic group achieved satisfactory shoulder function and returned to work after operation; there was no obvious pain, no complications such as exposure of implant after operation, and no need to remove the implant. In the control group, 4 patients had obvious subacromial impingement pain after operation, and 1 patient had re-dislocation after removal of internal fixator at 1 year after operation; the rest had no complications related to internal fixation, and the internal fixators were removed at 1.0-1.5 years after operation, without re-dislocation. The VAS score and Constant score at 3 months and 1 year after operation in both groups significantly improved when compared with those before operation, and further improved at 1 year after operation (P<0.05). The VAS score and Constant score at 3 months and 1 year after operation in arthroscopic group were significantly better than those in control group (P<0.05). Conclusion Arthroscopic treatment for acute acromioclavicular joint dislocation by using Twin Tail TightRope combined with distal capsular repair is more effective than traditional incision surgery and can obtain more satisfactory results in patient compliance and function recovery because of minimally invasive surgery.

Citation： WANG Chaoran, ZHANG Jun, CHEN Hong, ZHAO Daohong, ZHANG Yuhao, WU Zhidan. Arthroscopic Twin Tail TightRope combined with distal joint capsule repair technique for acute acromioclavicular dislocation. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(8): 970-975. doi: 10.7507/1002-1892.201903019 Copy

1.	金翔赟, 張增, 李廣翼, 等. 肩鎖關節脫位的治療進展. 國際骨科學雜志, 2018, 39(2): 76-80.
2.	田旭, 郭強, 東靖明. 肩鎖關節脫位的治療進展. 中國矯形外科雜志, 2015, 23(24): 2252-2254.
3.	Keener JD. Acromioclavicular joint anatomy and biomechanics. Oper Tech Sports Med, 2014, 22(3): 210-213.
4.	印飛, 孫振中, 韋旭明, 等. 自體及同種異體肌腱重建喙鎖韌帶結合鉤鋼板固定治療肩鎖關節脫位的療效比較. 中國修復重建外科雜志, 2016, 30(5): 532-536.
5.	Kienast B, Thietje R, Queitsch C, et al. Mid-term results after operative treatment of rockwood grade Ⅲ-Ⅴ acromioclavicular joint dislocations with an AC-hook-plate. Eur J Med Res, 2011, 16(2): 52-56.
6.	Lee CH, Shih CM, Huang KC, et al. Biomechanical analysis of implanted clavicle hook plates with different implant depths and materials in the acromioclavicular joint: a finite element analysis study. Artif Organs, 2016, 40(11): 1062-1070.
7.	宋鑫, 買買提沙吾提阿吉·買買提, 伊力哈木·托合提, 等. Endobutton 鋼板與鎖骨鉤鋼板治療肩鎖關節脫位優良率及并發癥的 Meta 分析. 中國組織工程研究, 2018, 22(3): 478-485.
8.	湯紅偉, 高生, 殷勇, 等. 兩種喙鎖韌帶重建技術治療 Tossy Ⅲ型肩鎖關節脫位的臨床療效研究. 中國修復重建外科雜志, 2015, 29(11): 1321-1326.
9.	Bin Abd Razak HR, Yeo EN, Yeo W, et al. Short-term outcomes of arthroscopic TightRope^? fixation are better than hook plate fixation in acute unstable acromioclavicular joint dislocations. Eur J Orthop Surg Traumatol, 2018, 28(5): 869-875.
10.	Wolf EM, Pennington WT. Arthroscopic reconstruction for acromioclavicular joint dislocation. Arthroscopy, 2001, 17(5): 558-563.
11.	Rolla PR, Surace MF, Murena L. Arthroscopic treatment of acute acromioclavicular joint dislocation. Arthroscopy, 2004, 20(6): 662-668.
12.	Cai L, Wang T, Lu D, et al. Comparison of the tight rope technique and clavicular hook plate for the treatment of rockwood type Ⅲ acromioclavicular joint dislocation. J Invest Surg, 2018, 31(3): 226-233.
13.	Shin SJ, Jeon YS, Kim RG. Arthroscopic-assisted coracoclavicular ligament reconstruction for acute acromioclavicular dislocation using 2 clavicular and 1 coracoid cortical fixation buttons with suture tapes. Arthroscopy, 2017, 33(8): 1458-1466.
14.	Hann C, Kraus N, Minkus M, et al. Combined arthroscopically assisted coraco- and acromioclavicular stabilization of acute high-grade acromioclavicular joint separations. Knee Surg Sports Traumatol Arthrosc, 2018, 26(1): 212-220.
15.	Zhang LF, Yin B, Hou S, et al. Arthroscopic fixation of acute acromioclavicular joint disruption with TightRope^TM: Outcome and complications after minimum 2(2-5) years follow-up. J Orthop Surg (Hong Kong), 2017, 25(2): 2309499016684493.
16.	Richards A, Tennent TD. Arthroscopic stabilization of acute acromioclavicular joint dislocation using the Tightrope system. Tech Shoulder Elbow Surg, 2008, 9(2): 51-54.
17.	Gowd AK, Liu JN, Cabarcas BC, et al. Current concepts in the operative management of acromioclavicular dislocations: a systematic review and meta-analysis of operative techniques. Am J Sports Med, 2018.DOI: 10.1177/0363546518795147.
18.	Cook JB, Shaha JS, Rowles DJ, et al. Clavicular bone tunnel malposition leads to early failures in coracoclavicular ligament reconstructions. Am J Sports Med, 2013, 41(1): 142-148.
19.	Rios CG, Arciero RA, Mazzocca AD. Anatomy of the clavicle and coracoid process for reconstruction of the coracoclavicular ligaments. Am J Sports Med, 2007, 35(5): 811-817.

1. 金翔赟, 張增, 李廣翼, 等. 肩鎖關節脫位的治療進展. 國際骨科學雜志, 2018, 39(2): 76-80.
2. 田旭, 郭強, 東靖明. 肩鎖關節脫位的治療進展. 中國矯形外科雜志, 2015, 23(24): 2252-2254.
3. Keener JD. Acromioclavicular joint anatomy and biomechanics. Oper Tech Sports Med, 2014, 22(3): 210-213.
4. 印飛, 孫振中, 韋旭明, 等. 自體及同種異體肌腱重建喙鎖韌帶結合鉤鋼板固定治療肩鎖關節脫位的療效比較. 中國修復重建外科雜志, 2016, 30(5): 532-536.
5. Kienast B, Thietje R, Queitsch C, et al. Mid-term results after operative treatment of rockwood grade Ⅲ-Ⅴ acromioclavicular joint dislocations with an AC-hook-plate. Eur J Med Res, 2011, 16(2): 52-56.
6. Lee CH, Shih CM, Huang KC, et al. Biomechanical analysis of implanted clavicle hook plates with different implant depths and materials in the acromioclavicular joint: a finite element analysis study. Artif Organs, 2016, 40(11): 1062-1070.
7. 宋鑫, 買買提沙吾提阿吉·買買提, 伊力哈木·托合提, 等. Endobutton 鋼板與鎖骨鉤鋼板治療肩鎖關節脫位優良率及并發癥的 Meta 分析. 中國組織工程研究, 2018, 22(3): 478-485.
8. 湯紅偉, 高生, 殷勇, 等. 兩種喙鎖韌帶重建技術治療 Tossy Ⅲ型肩鎖關節脫位的臨床療效研究. 中國修復重建外科雜志, 2015, 29(11): 1321-1326.
9. Bin Abd Razak HR, Yeo EN, Yeo W, et al. Short-term outcomes of arthroscopic TightRope^? fixation are better than hook plate fixation in acute unstable acromioclavicular joint dislocations. Eur J Orthop Surg Traumatol, 2018, 28(5): 869-875.
10. Wolf EM, Pennington WT. Arthroscopic reconstruction for acromioclavicular joint dislocation. Arthroscopy, 2001, 17(5): 558-563.
11. Rolla PR, Surace MF, Murena L. Arthroscopic treatment of acute acromioclavicular joint dislocation. Arthroscopy, 2004, 20(6): 662-668.
12. Cai L, Wang T, Lu D, et al. Comparison of the tight rope technique and clavicular hook plate for the treatment of rockwood type Ⅲ acromioclavicular joint dislocation. J Invest Surg, 2018, 31(3): 226-233.
13. Shin SJ, Jeon YS, Kim RG. Arthroscopic-assisted coracoclavicular ligament reconstruction for acute acromioclavicular dislocation using 2 clavicular and 1 coracoid cortical fixation buttons with suture tapes. Arthroscopy, 2017, 33(8): 1458-1466.
14. Hann C, Kraus N, Minkus M, et al. Combined arthroscopically assisted coraco- and acromioclavicular stabilization of acute high-grade acromioclavicular joint separations. Knee Surg Sports Traumatol Arthrosc, 2018, 26(1): 212-220.
15. Zhang LF, Yin B, Hou S, et al. Arthroscopic fixation of acute acromioclavicular joint disruption with TightRope^TM: Outcome and complications after minimum 2(2-5) years follow-up. J Orthop Surg (Hong Kong), 2017, 25(2): 2309499016684493.
16. Richards A, Tennent TD. Arthroscopic stabilization of acute acromioclavicular joint dislocation using the Tightrope system. Tech Shoulder Elbow Surg, 2008, 9(2): 51-54.
17. Gowd AK, Liu JN, Cabarcas BC, et al. Current concepts in the operative management of acromioclavicular dislocations: a systematic review and meta-analysis of operative techniques. Am J Sports Med, 2018.DOI: 10.1177/0363546518795147.
18. Cook JB, Shaha JS, Rowles DJ, et al. Clavicular bone tunnel malposition leads to early failures in coracoclavicular ligament reconstructions. Am J Sports Med, 2013, 41(1): 142-148.
19. Rios CG, Arciero RA, Mazzocca AD. Anatomy of the clavicle and coracoid process for reconstruction of the coracoclavicular ligaments. Am J Sports Med, 2007, 35(5): 811-817.

Chinese Journal of Reparative and Reconstructive Surgery

Arthroscopic Twin Tail TightRope combined with distal joint capsule repair technique for acute acromioclavicular dislocation

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