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Short-term outcomes of arthroscopic tightrope® fixation are better than hook plate fixation in acute unstable acromioclavicular joint dislocations
Abstracts / Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology 9 (2017) 12e58
Keywords: posterior shoulder tightness, shear wave elastography, Infraspinatus, lower trapezius
Shoulder - Miscellaneous disorder OP-047 A FEW CASES OF ARTHROSCOPIC RECONSTRUCTION WITH USING THE FIBRE TAPE AND THE DOG BONE BUTTON FOR DISTAL CLAVICLE FRACTURE Kei Fujiwara, Kenichi Matsumura. Department of Orthopaedics, Tane General Hospital, Japan Distal clavicle fracture is not uncommon condition and this is counted up to about 15% of all types of the clavicle fracture. This fracture is considered with the damage of the coracoclavicular ligament and Craig classification is often used. We experienced a few cases of Craig classification Type 2b distal clavicle fracture which the trapezoid ligament is intact but the conoid ligament is torn. Although there are some surgical procedures such as the use of hook plate or tension band wiring etc, we performed the procedure of arthroscopic reconstruction of coracoclavicular ligament with using the fibre tape and the dog bone button for those Craig Type 2b fractures. This procedure is often performed for the acromioclavicular joint dislocation these days. The purposes of this study are to evaluate the shoulder function and the heeling position of the clavicle post operatively, and to evaluate and to discuss the position and the size changes of the bone tunnel in the clavicle and the coracoid process. All patients were injured by falling and complained the shoulder pain and the difficulty of the upper limb elevation. We performed this arthroscopic reconstruction procedure for nine clavicles of nine patients consisting of 2 females and 7 males from February 2015 to August 2016 in our hospital. We followed up about an average of 5 months post operatively. The results in the time of final follow-up are satisfaction and great in shoulder functional score such as JOA score. The position of the distal clavicle fraction site is less than 50% of dislocated position from the intact one. The distance of the bone tunnel from the distal edge of the clavicle is approximately 30mm and the size change of the bone hole in 5 months post operatively is about 1mm wider in diameter from the size of drilling in the operation. We discussed and considered about these results with referring a few literatures and essays. We need to experience more number of cases and we also need to know the physiologically accurate position of bone tunnel for the reconstruction and we concluded that the proficiency level of the procedure is required. Keywords: distal clavicle fracture, arthroscopic reconstruction, dog bone button, Craig type 2b
Shoulder - Miscellaneous disorder OP-048 SHORT-TERM OUTCOMES OF ARTHROSCOPIC TIGHTROPE® FIXATION ARE BETTER THAN HOOK PLATE FIXATION IN ACUTE UNSTABLE ACROMIOCLAVICULAR JOINT DISLOCATIONS Hamid Rahmatullah Bin Abd Razak 1, Eng-Meng Nicholas Yeo 1, William Yeo 2, Tijauw-Tjoen Denny Lie 1. 1 Department of Orthopaedic Surgery, Singapore General Hospital, Singapore; 2 Department of Orthopaedic Diagnostic Centre, Singapore General Hospital, Singapore Background: Treatment of acute high-grade acromioclavicular joint (ACJ) separation (types IIIeVI) is still controversial. Currently, the two modern techniques that are widely used include hook plate fixation and coracoclavicular (CC) ligament fixation using a suspensory loop device (tightrope®, synthetic ligament or absorbable polydioxansulfate sling). We aimed to compare the short term outcomes of arthroscopic tightrope® fixation with that of hook plate fixation in patients with acute unstable ACJ
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dislocations. Materials and Method: Twenty-six patients with an acute (within 3 weeks of trauma) complete ACJ dislocation underwent surgical repair with either an arthroscopic tightrope® fixation or a conventional hook plate in an Asian tertiary teaching hospital. Demographic information such as age, gender, body mass index as well as injury-related variables and health services utilization information were collected for all patients. All clinical and functional outcomes were collected prospectively as part of registry data. Functional outcomes were evaluated using the Constant Score, The University of California at Los Angeles (UCLA) Shoulder Score, Oxford Shoulder Score as well as the Visual Analogue Scale (VAS) for pain. Clinical outcomes were assessed with the degree of forward flexion, abduction as well as the maximum isometric strength of the operated shoulder. Radiological outcomes were assessed with the coracoclavicular distance (CCD). All hardcopy and electronic medical records were reviewed and postoperative complications noted. We conducted a retrospective review of all data preoperatively and at 6-months and 1-year postoperatively. IBM SPSS Statistics, version 19 (SPSS, Chicago, IL) was used for statistical analysis. Results: 16 patients (15 male, 1 female; mean age: 41.4 ± 12.3) underwent arthroscopic tightrope® fixation. 10 patients (9 male, 1 female; mean age: 49.2 ± 16.9) underwent hook plate fixation. All patients were available after a mean follow-up of 23 months (range 14-35). There were no significant differences in the preoperative injury-related variables, body mass index or CCD between the two groups. There were no significant differences in the preoperative outcome variables except for the mean UCLA 4b infraspinatus score (tightrope®: 2.8 ± 1.3; hook plate: 3.8 ± 0.5; p ¼ 0.030). Duration of surgery was significantly longer in the tightrope® group (tightrope®: 75 ± 18 minutes; hook plate: 58 ± 15 minutes; p¼0.021). At 6months postoperatively, the tightrope® group had significantly better abduction (tightrope®: 140 ± 22 degrees; hook plate: 118 ± 8 degrees; p¼0.006). At 1-year postoperatively, the tightrope® group had better mean Constant Section 3 ER score (tightrope®: 10.0 ± 0; hook plate: 9.3 ± 1.0; p¼0.009), better mean Constant Section 3 IR score (tightrope®: 10.0 ± 0; hook plate: 7.0 ± 1.4; p<0.001) and better mean Constant score (tightrope®: 87.6 ± 11.7; hook plate: 77.5 ± 12.3; p¼0.046). The hook plate group had significantly better forward flexion at 1-year postoperatively (tightrope®: 135 ± 14 degrees; hook plate: 147 ± 5 degrees; p¼0.016) and better maximum isometric strength of the operated shoulder (tightrope®: 21.4 ± 6.5 lbs; hook plate: 26.0 ± 2.8; p¼0.046). At 1-year postoperatively, the tightrope® group had a significantly better CCD radiologically (tightrope®: 11.8 ± 1.7 mm; hook plate: 13.6 ± 4.8; p¼0.05). There were no complications reported in the tightrope® group. In the hook plate group, all 10 patients underwent removal of the hook plate within 6 months of the index surgery and there were 3 complications (1 hook plate cut out; 1 acromial erosion; 1 acromial erosion and tip fracture requiring tension band wiring). Discussion: Comparison of early functional and radiological outcomes following surgery for acute unstable ACJ dislocations tend to favour the tightrope® group. The results show that the tightrope® has better postoperative shoulder function but longer operative time when compared to hook plate fixation. Furthermore, there was a need for a second surgery to remove the hook plate in all patients. There were also more complications in the hook plate group. There are some limitations to this study. We have a relatively small sample size largely due to the rarity of such cases in our local population as well as the controversy of treatment for grade III injuries. Our study is also subjected to the biases of a retrospective study although we used prospectively collected registry data. However, we believe that our findings are still valuable as they pave the way for a more rigorous randomized controlled trial in comparing these two surgical procedures. Conclusion: Arthroscopic tightrope® fixation is a good option for the treatment of acute unstable ACJ dislocations. It has better short-term functional and radiological outcomes as well as lesser complications when compared to hook plate fixation. Keywords: tightrope, hook plate, acromioclavicular joint, ACJ
Keywords: posterior shoulder tightness, shear wave elastography, Infraspinatus, lower trapezius
Shoulder - Miscellaneous disorder OP-047 A FEW CASES OF ARTHROSCOPIC RECONSTRUCTION WITH USING THE FIBRE TAPE AND THE DOG BONE BUTTON FOR DISTAL CLAVICLE FRACTURE Kei Fujiwara, Kenichi Matsumura. Department of Orthopaedics, Tane General Hospital, Japan Distal clavicle fracture is not uncommon condition and this is counted up to about 15% of all types of the clavicle fracture. This fracture is considered with the damage of the coracoclavicular ligament and Craig classification is often used. We experienced a few cases of Craig classification Type 2b distal clavicle fracture which the trapezoid ligament is intact but the conoid ligament is torn. Although there are some surgical procedures such as the use of hook plate or tension band wiring etc, we performed the procedure of arthroscopic reconstruction of coracoclavicular ligament with using the fibre tape and the dog bone button for those Craig Type 2b fractures. This procedure is often performed for the acromioclavicular joint dislocation these days. The purposes of this study are to evaluate the shoulder function and the heeling position of the clavicle post operatively, and to evaluate and to discuss the position and the size changes of the bone tunnel in the clavicle and the coracoid process. All patients were injured by falling and complained the shoulder pain and the difficulty of the upper limb elevation. We performed this arthroscopic reconstruction procedure for nine clavicles of nine patients consisting of 2 females and 7 males from February 2015 to August 2016 in our hospital. We followed up about an average of 5 months post operatively. The results in the time of final follow-up are satisfaction and great in shoulder functional score such as JOA score. The position of the distal clavicle fraction site is less than 50% of dislocated position from the intact one. The distance of the bone tunnel from the distal edge of the clavicle is approximately 30mm and the size change of the bone hole in 5 months post operatively is about 1mm wider in diameter from the size of drilling in the operation. We discussed and considered about these results with referring a few literatures and essays. We need to experience more number of cases and we also need to know the physiologically accurate position of bone tunnel for the reconstruction and we concluded that the proficiency level of the procedure is required. Keywords: distal clavicle fracture, arthroscopic reconstruction, dog bone button, Craig type 2b
Shoulder - Miscellaneous disorder OP-048 SHORT-TERM OUTCOMES OF ARTHROSCOPIC TIGHTROPE® FIXATION ARE BETTER THAN HOOK PLATE FIXATION IN ACUTE UNSTABLE ACROMIOCLAVICULAR JOINT DISLOCATIONS Hamid Rahmatullah Bin Abd Razak 1, Eng-Meng Nicholas Yeo 1, William Yeo 2, Tijauw-Tjoen Denny Lie 1. 1 Department of Orthopaedic Surgery, Singapore General Hospital, Singapore; 2 Department of Orthopaedic Diagnostic Centre, Singapore General Hospital, Singapore Background: Treatment of acute high-grade acromioclavicular joint (ACJ) separation (types IIIeVI) is still controversial. Currently, the two modern techniques that are widely used include hook plate fixation and coracoclavicular (CC) ligament fixation using a suspensory loop device (tightrope®, synthetic ligament or absorbable polydioxansulfate sling). We aimed to compare the short term outcomes of arthroscopic tightrope® fixation with that of hook plate fixation in patients with acute unstable ACJ
31
dislocations. Materials and Method: Twenty-six patients with an acute (within 3 weeks of trauma) complete ACJ dislocation underwent surgical repair with either an arthroscopic tightrope® fixation or a conventional hook plate in an Asian tertiary teaching hospital. Demographic information such as age, gender, body mass index as well as injury-related variables and health services utilization information were collected for all patients. All clinical and functional outcomes were collected prospectively as part of registry data. Functional outcomes were evaluated using the Constant Score, The University of California at Los Angeles (UCLA) Shoulder Score, Oxford Shoulder Score as well as the Visual Analogue Scale (VAS) for pain. Clinical outcomes were assessed with the degree of forward flexion, abduction as well as the maximum isometric strength of the operated shoulder. Radiological outcomes were assessed with the coracoclavicular distance (CCD). All hardcopy and electronic medical records were reviewed and postoperative complications noted. We conducted a retrospective review of all data preoperatively and at 6-months and 1-year postoperatively. IBM SPSS Statistics, version 19 (SPSS, Chicago, IL) was used for statistical analysis. Results: 16 patients (15 male, 1 female; mean age: 41.4 ± 12.3) underwent arthroscopic tightrope® fixation. 10 patients (9 male, 1 female; mean age: 49.2 ± 16.9) underwent hook plate fixation. All patients were available after a mean follow-up of 23 months (range 14-35). There were no significant differences in the preoperative injury-related variables, body mass index or CCD between the two groups. There were no significant differences in the preoperative outcome variables except for the mean UCLA 4b infraspinatus score (tightrope®: 2.8 ± 1.3; hook plate: 3.8 ± 0.5; p ¼ 0.030). Duration of surgery was significantly longer in the tightrope® group (tightrope®: 75 ± 18 minutes; hook plate: 58 ± 15 minutes; p¼0.021). At 6months postoperatively, the tightrope® group had significantly better abduction (tightrope®: 140 ± 22 degrees; hook plate: 118 ± 8 degrees; p¼0.006). At 1-year postoperatively, the tightrope® group had better mean Constant Section 3 ER score (tightrope®: 10.0 ± 0; hook plate: 9.3 ± 1.0; p¼0.009), better mean Constant Section 3 IR score (tightrope®: 10.0 ± 0; hook plate: 7.0 ± 1.4; p<0.001) and better mean Constant score (tightrope®: 87.6 ± 11.7; hook plate: 77.5 ± 12.3; p¼0.046). The hook plate group had significantly better forward flexion at 1-year postoperatively (tightrope®: 135 ± 14 degrees; hook plate: 147 ± 5 degrees; p¼0.016) and better maximum isometric strength of the operated shoulder (tightrope®: 21.4 ± 6.5 lbs; hook plate: 26.0 ± 2.8; p¼0.046). At 1-year postoperatively, the tightrope® group had a significantly better CCD radiologically (tightrope®: 11.8 ± 1.7 mm; hook plate: 13.6 ± 4.8; p¼0.05). There were no complications reported in the tightrope® group. In the hook plate group, all 10 patients underwent removal of the hook plate within 6 months of the index surgery and there were 3 complications (1 hook plate cut out; 1 acromial erosion; 1 acromial erosion and tip fracture requiring tension band wiring). Discussion: Comparison of early functional and radiological outcomes following surgery for acute unstable ACJ dislocations tend to favour the tightrope® group. The results show that the tightrope® has better postoperative shoulder function but longer operative time when compared to hook plate fixation. Furthermore, there was a need for a second surgery to remove the hook plate in all patients. There were also more complications in the hook plate group. There are some limitations to this study. We have a relatively small sample size largely due to the rarity of such cases in our local population as well as the controversy of treatment for grade III injuries. Our study is also subjected to the biases of a retrospective study although we used prospectively collected registry data. However, we believe that our findings are still valuable as they pave the way for a more rigorous randomized controlled trial in comparing these two surgical procedures. Conclusion: Arthroscopic tightrope® fixation is a good option for the treatment of acute unstable ACJ dislocations. It has better short-term functional and radiological outcomes as well as lesser complications when compared to hook plate fixation. Keywords: tightrope, hook plate, acromioclavicular joint, ACJ