Application of TightRope system combined with Locking-Loop biplane anatomical reconstruction technique for acute acromioclavicular joint dislocation_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

XU Jian ¹ , KANG Yunkang ¹ ^# , BI Wenzhi ² , JI Yuncong ² , MA Wei ¹ , YANG Dongqiang ¹ , CUI Honglin ¹ , FU Pengfei ¹ , WANG Jialiang ³ , JIANG Jishi ² , YU Haiyang ¹ ,  GUO Biao ¹

1. Department of Orthopedic Sports Medicine and Arthroscopic Surgery, Fuyang People’s Hospital of Anhui Medical University (Fuyang People’s Hospital), Fuyang Anhui, 236000, P. R. China;
2. Department of Orthopedics, Fuyang People’s Hospital of Bengbu Medical College (Fuyang People’s Hospital), Fuyang Anhui, 236000, P. R. China;
3. Hospital Infection Management Section, Fuyang People’s Hospital of Anhui Medical University (Fuyang People’s Hospital), Fuyang Anhui, 236000, P. R. China;

Corresponding?author：

GUO Biao, Email: happygb@126.com

Keywords：

Acromioclavicular joint dislocation; biplane; anatomical reconstruction

DOI：

10.7507/1002-1892.202212069

Video：

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Objective To investigate the effectiveness of TightRope system combined with Locking-Loop biplane anatomical reconstruction technique in the treatment of acute acromioclavicular joint dislocation. Methods A clinical data of 28 patients with acute acromioclavicular joint dislocation who met the selection criteria and admitted between June 2018 and December 2021 was retrospectively analyzed. There were 18 males and 10 females, with an average age of 47.7 years (range, 22-72 years). The causes of injury included falling (13 cases) and traffic accidents (15 cases). The acromioclavicular joint dislocation was rated as Rockwood type Ⅲ in 7 cases, type Ⅳ in 16 cases, and type Ⅴ in 5 cases. The time from injury to operation was 4-13 days, with an average of 9.5 days. The acromioclavicular joint dislocation was reconstructed with TightRope system and high-strength wire by Locking-Loop methods during operation. The operation time and complications were recorded. Visual analogue scale (VAS) score, Constant-Murley score, and active range of motion of shoulder (forward flexion and upward lift, abduction and upward lift, and external rotation) were recorded before operation and at 12 months after operation to evaluate the functional recovery of shoulder. The loss of acromioclavicular joint reduction was assessed by comparing the coracoclavicular distance (CCD) based on the anteroposterior X-ray films at 3 days and 12 months after operation. Results The operation time was 58-100 minutes (median, 85 minutes). All incisions healed by first intention. All patients were followed up 12 months. During follow-up, 2 patients developed shoulder adhesion, which recovered after rehabilitation exercise. At 12 months after operation, the VAS score was significantly lower, the Constant-Murley score was significantly higher, and the range of motion of the shoulder joint (forward flexion and upward lift, abduction and upward lift, and external rotation) significantly increased when compared with preoperative ones (P<0.05). X-ray films showed that the CCD was 8.4 (7.3, 9.4) and 9.2 (8.1, 10.1) mm at 3 days and 12 months after operation, respectively, with a significant difference (Z=?4.665, P<0.001). During follow-up, there was no complication such as infection, titanium plate entrapment, fracture, internal fixation failure, or redislocation. Conclusion The treatment of acute acromioclavicular joint dislocation with TightRope system combined with Locking-Loop biplane anatomical reconstruction has the advantages of small incision, joint reduction under direct vision, high fixation strength, and low incidence of postoperative complications, which can effectively relieve the pain of patients’ shoulder joint and facilitate the recovery of shoulder joint function.

Citation： XU Jian, KANG Yunkang, BI Wenzhi, JI Yuncong, MA Wei, YANG Dongqiang, CUI Honglin, FU Pengfei, WANG Jialiang, JIANG Jishi, YU Haiyang, GUO Biao. Application of TightRope system combined with Locking-Loop biplane anatomical reconstruction technique for acute acromioclavicular joint dislocation. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(3): 257-263. doi: 10.7507/1002-1892.202212069 Copy

1.	Mazzocca AD, Arciero RA, Bicos J. Evaluation and treatment of acromioclavicular joint injuries. Am J Sports Med, 2007, 35(2): 316-329.
2.	Yu P, Zhang Y, Ye T, et al. Clinical and radiological outcomes of acute Rookwood type ⅢB acromioclavicular joint dislocation: Mini-open tightrope technique versus hook plate. Injury, 2022, S0020-1383(22)00119-X. doi: 10.1016/j.injury.2022.02.019.
3.	Kocadal O, Yüksel K, Güven M. Evaluation of the clavicular tunnel placement on coracoclavicular ligament reconstruction for acromioclavicular dislocations: a finite element analysis. Int Orthop, 2018, 42(8): 1891-1896.
4.	馬滾韶, 羅裕強, 徐勤. 穿梭導線小隧道Endobutton技術治療Rockwood Ⅲ型急性肩鎖關節脫位的療效分析. 中華創傷骨科雜志, 2021, 23(6): 535-538.
5.	Martetschl?ger F, Saier T, Weigert A, et al. Effect of coracoid drilling for acromioclavicular joint reconstruction techniques on coracoid fracture risk: A biomechanical study. Arthroscopy, 2016, 32(6): 982-987.
6.	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(3): 615-621.
7.	鄧富元, 李忠, 劉俊才. 關節鏡輔助雙Endobutton “8” 字扣鎖固定治療Rockwood Ⅲ型急性肩鎖關節脫位. 中國修復重建外科雜志, 2020, 34(9): 1125-1129.
8.	Pattu R, Chellamuthu G, Sellappan K, et al. Anatomic reconstruction for acromioclavicular joint injuries: a pilot study of a cost-effective new technique. Clin Shoulder Elb, 2021, 24(4): 209-214.
9.	Marsalli M, Bistolfi G, Morán N, et al. High early-onset acromioclavicular secondary pathologies after acute arthroscopic joint reduction: a cohort study. Arch Orthop Trauma Surg, 2022, 142(7): 1623-1631.
10.	Jeon N, Choi NH, Ha JH, et al. Clavicular tunnel complications after coracoclavicular reconstruction in acute acromioclavicular dislocation: Coracoid loop versus coracoid tunnel fixation. Clin Orthop Surg, 2022, 14(1): 128-135.
11.	Jordan RW, Malik S, Bentick K, et al. Acromioclavicular joint augmentation at the time of coracoclavicular ligament reconstruction fails to improve functional outcomes despite significantly improved horizontal stability. Knee Surg Sports Traumatol Arthrosc, 2019, 27(12): 3747-3763.
12.	Thangaraju S, Tauber M, Habermeyer P, et al. Clavicle and coracoid process periprosthetic fractures as late post-operative complications in arthroscopically assisted acromioclavicular joint stabilization. Knee Surg Sports Traumatol Arthrosc, 2019, 27(12): 3797-3802.
13.	Park I, Lee S, Shin SJ. Arthroscopic-assisted double-bundle coracoclavicular ligament reconstruction using cortical fixation buttons with suture tape provides superior vertical stability than the single-bundle reconstruction for acute acromioclavicular joint dislocation. Arthroscopy, 2023, 39(2): 213-221.
14.	Civan O, Atmaca H, U?ur L. Biomechanical comparison of double versus triple button reconstruction techniques in patients with acromioclavicular joint dislocation. Int J Med Robot, 2020, 16(1): e2057. doi: 10.1002/rcs.2057.
15.	?zcafer R, Albayrak K, Lap?in O, et al. Early clinical and radiographic results of fixation with the TightRope device for Rockwood type Ⅴ acromioclavicular joint dislocation: A retrospective review of 15 patients. Acta Orthop Traumatol Turc, 2020, 54(5): 473-477.
16.	Campagna V, Piccinni V, Rotundo G, et al. The Kite technique: a new all-arthroscopic technique for the treatment of acute acromioclavicular joint dislocation. Knee Surg Sports Traumatol Arthrosc, 2021, 29(7): 2055-2063.
17.	Motta P, Maderni A, Bruno L, et al. Suture rupture in acromioclavicular joint dislocations treated with flip buttons. Arthroscopy, 2011, 27(2): 294-298.
18.	Theopold J, Sch?bel T, Fischer JP, et al. Acromioclavicular joint reconstruction: an additional acromioclavicular cerclage does not improve horizontal stability in double coraco-clavicular tunnel technique. Knee Surg Sports Traumatol Arthrosc, 2019, 27(12): 3827-3834.
19.	Kurata S, Inoue K, Hasegawa H, et al. The role of the acromioclavicular ligament in acromioclavicular joint stability: A cadaveric biomechanical study. Orthop J Sports Med, 2021, 9(2): 2325967120982947. doi: 10.1177/2325967120982947.
20.	Cho CH, Kim BS, Kwon DH. Importance of additional temporary pin fixation combined coracoclavicular augmentation using a suture button device for acute acromioclavicular joint dislocation. Arch Orthop Trauma Surg, 2016, 136(6): 763-770.
21.	LeVasseur MR, Mancini MR, Kakazu R, et al. Three-dimensional footprint mapping of the deltoid and trapezius: Anatomic pearls for acromioclavicular joint reconstruction. Arthroscopy, 2022, 38(3): 701-708.
22.	Pastor MF, Averbeck AK, Welke B, et al. The biomechanical influence of the deltotrapezoid fascia on horizontal and vertical acromioclavicular joint stability. Arch Orthop Trauma Surg, 2016, 136(4): 513-519.

1. Mazzocca AD, Arciero RA, Bicos J. Evaluation and treatment of acromioclavicular joint injuries. Am J Sports Med, 2007, 35(2): 316-329.
2. Yu P, Zhang Y, Ye T, et al. Clinical and radiological outcomes of acute Rookwood type ⅢB acromioclavicular joint dislocation: Mini-open tightrope technique versus hook plate. Injury, 2022, S0020-1383(22)00119-X. doi: 10.1016/j.injury.2022.02.019.
3. Kocadal O, Yüksel K, Güven M. Evaluation of the clavicular tunnel placement on coracoclavicular ligament reconstruction for acromioclavicular dislocations: a finite element analysis. Int Orthop, 2018, 42(8): 1891-1896.
4. 馬滾韶, 羅裕強, 徐勤. 穿梭導線小隧道Endobutton技術治療Rockwood Ⅲ型急性肩鎖關節脫位的療效分析. 中華創傷骨科雜志, 2021, 23(6): 535-538.
5. Martetschl?ger F, Saier T, Weigert A, et al. Effect of coracoid drilling for acromioclavicular joint reconstruction techniques on coracoid fracture risk: A biomechanical study. Arthroscopy, 2016, 32(6): 982-987.
6. 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(3): 615-621.
7. 鄧富元, 李忠, 劉俊才. 關節鏡輔助雙Endobutton “8” 字扣鎖固定治療Rockwood Ⅲ型急性肩鎖關節脫位. 中國修復重建外科雜志, 2020, 34(9): 1125-1129.
8. Pattu R, Chellamuthu G, Sellappan K, et al. Anatomic reconstruction for acromioclavicular joint injuries: a pilot study of a cost-effective new technique. Clin Shoulder Elb, 2021, 24(4): 209-214.
9. Marsalli M, Bistolfi G, Morán N, et al. High early-onset acromioclavicular secondary pathologies after acute arthroscopic joint reduction: a cohort study. Arch Orthop Trauma Surg, 2022, 142(7): 1623-1631.
10. Jeon N, Choi NH, Ha JH, et al. Clavicular tunnel complications after coracoclavicular reconstruction in acute acromioclavicular dislocation: Coracoid loop versus coracoid tunnel fixation. Clin Orthop Surg, 2022, 14(1): 128-135.
11. Jordan RW, Malik S, Bentick K, et al. Acromioclavicular joint augmentation at the time of coracoclavicular ligament reconstruction fails to improve functional outcomes despite significantly improved horizontal stability. Knee Surg Sports Traumatol Arthrosc, 2019, 27(12): 3747-3763.
12. Thangaraju S, Tauber M, Habermeyer P, et al. Clavicle and coracoid process periprosthetic fractures as late post-operative complications in arthroscopically assisted acromioclavicular joint stabilization. Knee Surg Sports Traumatol Arthrosc, 2019, 27(12): 3797-3802.
13. Park I, Lee S, Shin SJ. Arthroscopic-assisted double-bundle coracoclavicular ligament reconstruction using cortical fixation buttons with suture tape provides superior vertical stability than the single-bundle reconstruction for acute acromioclavicular joint dislocation. Arthroscopy, 2023, 39(2): 213-221.
14. Civan O, Atmaca H, U?ur L. Biomechanical comparison of double versus triple button reconstruction techniques in patients with acromioclavicular joint dislocation. Int J Med Robot, 2020, 16(1): e2057. doi: 10.1002/rcs.2057.
15. ?zcafer R, Albayrak K, Lap?in O, et al. Early clinical and radiographic results of fixation with the TightRope device for Rockwood type Ⅴ acromioclavicular joint dislocation: A retrospective review of 15 patients. Acta Orthop Traumatol Turc, 2020, 54(5): 473-477.
16. Campagna V, Piccinni V, Rotundo G, et al. The Kite technique: a new all-arthroscopic technique for the treatment of acute acromioclavicular joint dislocation. Knee Surg Sports Traumatol Arthrosc, 2021, 29(7): 2055-2063.
17. Motta P, Maderni A, Bruno L, et al. Suture rupture in acromioclavicular joint dislocations treated with flip buttons. Arthroscopy, 2011, 27(2): 294-298.
18. Theopold J, Sch?bel T, Fischer JP, et al. Acromioclavicular joint reconstruction: an additional acromioclavicular cerclage does not improve horizontal stability in double coraco-clavicular tunnel technique. Knee Surg Sports Traumatol Arthrosc, 2019, 27(12): 3827-3834.
19. Kurata S, Inoue K, Hasegawa H, et al. The role of the acromioclavicular ligament in acromioclavicular joint stability: A cadaveric biomechanical study. Orthop J Sports Med, 2021, 9(2): 2325967120982947. doi: 10.1177/2325967120982947.
20. Cho CH, Kim BS, Kwon DH. Importance of additional temporary pin fixation combined coracoclavicular augmentation using a suture button device for acute acromioclavicular joint dislocation. Arch Orthop Trauma Surg, 2016, 136(6): 763-770.
21. LeVasseur MR, Mancini MR, Kakazu R, et al. Three-dimensional footprint mapping of the deltoid and trapezius: Anatomic pearls for acromioclavicular joint reconstruction. Arthroscopy, 2022, 38(3): 701-708.
22. Pastor MF, Averbeck AK, Welke B, et al. The biomechanical influence of the deltotrapezoid fascia on horizontal and vertical acromioclavicular joint stability. Arch Orthop Trauma Surg, 2016, 136(4): 513-519.

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Application of TightRope system combined with Locking-Loop biplane anatomical reconstruction technique for acute acromioclavicular joint dislocation

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