The long-term efficacy of the GraftRope technique.

BACKGROUND: Acromioclavicular joint separations continue to be a challenge for surgeons, and modern arthroscopically assisted techniques are becoming increasingly widespread. The aim of this study is to evaluate if the use of a biological support in association with a nonresorbable subcoracoid fixation can improve long-term stability in acromioclavicular joint dislocation surgically treated. We assessed clinical and radiographic results, patients' return to daily activities and the risk of complications. MATERIALS AND METHODS: Fourteen patients underwent subcoracoid fixation with the GraftRope system for chronic Rockwood type IV acromioclavicular joint dislocation. A total of 12 patients were evaluated clinically and radiologically with a minimum of 7 years of follow-up. RESULTS: Good reduction was obtained in all patients. All patients returned to work and sports at the pretrauma level with high mean scores on clinical evaluation. Regarding complications, 3 patients developed acromioclavicular arthritis. Ossifications were a common finding on x-rays, but they did not worsen the clinical outcome. CONCLUSIONS: The GraftRope surgical technique allows us to obtain an anatomical reduction of the acromio-clavicular joint, along with the restoration of the mechanical properties of the joint, owing to the use of a biological material with rigidity and load resistance features. Clinical results over the long term are encouraging. However, a 6-mm bone tunnel is too large since the average thickness of the coracoid process is only approximately 12 mm. This technique has some advantages over others: it avoids detachment of the deltoid, avoids the use of bulky metal implants with an important dissection of soft tissue, while it has all the advantages of an arthroscopic procedure.

Acute lateral dislocated clavicular fractures: arthroscopic stabilization with TightRope.

HYPOTHESIS: Type IIA, IIB, and V lateral clavicular fractures (Craig modification of the Neer classification) are characterized by a constant displacement and are associated with a high rate of nonunion. The aim of this study is to verify whether the reduction and arthroscopic stabilization of these clavicular fractures with coracoclavicular cerclage provide stable fixation to allow for bone healing. To date, the treatment of these fractures is still controversial in young active patients in whom functional requirements are to be met. METHODS: Fourteen male patients, with type IIA, IIB, and V lateral clavicular fractures (2 type IIA, 10 type IIB, and 2 type V) had been treated arthroscopically with a TightRope (Arthrex, Naples, FL, USA) and had a radiologic/clinical follow-up of at least 2 years. RESULTS: All fractures were confirmed to have healed without limitations in range of motion or loss of reduction. The acromioclavicular joint and the coracoclavicular interspace were restored to the level of the healthy site in all but 1 patient, in whom a reduction was observed because of hypercorrection of the fracture. The mean Constant score was 95, and all patients had a Simple Shoulder Test score of 12 points. Healing was delayed up to 20 days in 1 patient because of a skin infection, and the coracoid bone tunnel was too marginal in another patient, in whom the coracoid button broke the lateral side of the tunnel during fixation. CONCLUSIONS: The arthroscopic procedure with the TightRope allows for fracture healing with no loss of reduction in the acromioclavicular joint and full return to everyday activities.

Acromioclavicular motion after surgical reconstruction.

PURPOSE: A retrospective long-term study was carried out to determine whether there was any correlation between the clinical motion of the acromioclavicular joint evaluated by a test we set up using 90° of abduction and 0° of external rotation against resistance [90°/0°RTest] and the cross arm test (compared to the healthy side) and full return to everyday activities after surgical repair. METHODS: A clinical and radiographic evaluation was carried out on 51/80 subjects at a 5.4-year mean follow-up, treated for acromioclavicular joint dislocation with an extra-articular artificial loop, between 2000 and 2006. RESULTS: The 25 subjects with ossifications obtained a normal acromioclavicular joint motion, on both the horizontal and vertical planes. There was a correlation between the normal motion of the reconstructed acromioclavicular joint (compared to the healthy side) in these 25 patients and full clinical recovery, whilst there was no correlation between the Constant score, the simple shoulder test, the radiographic evaluation on one hand and the clinical motion of the joint on the other. Two patients had recurrent dislocation. Three had mobilization of the screws without reduction loss, or negative clinical outcome. CONCLUSIONS: A postoperative radiographic evaluation should be correlated with a clinical evaluation of the acromioclavicular joint motion (normal, hypermobile, unstable). Normal acromioclavicular joint motion was observed in subjects who developed significant ossifications. The study shows that the clinical evaluation of acromioclavicular joint motion is a simple and trustworthy method to assess the clinical result of a surgical repair. LEVEL OF EVIDENCE: Diagnostic study investigating a diagnostic test, Level III.

Suture rupture in acromioclavicular joint dislocations treated with flip buttons.

Acute acromioclavicular joint dislocations (ACDs) may be treated arthroscopically with flip buttons. This extra-articular fixation is easy to implant and is well tolerated. Between 2007 and 2009, 20 ACD patients (2 women and 18 men; mean age, 32 years) had surgery by the arthroscopic TightRope technique (Arthrex, Naples, FL). The main complication of this technique that has been reported is the partial loss of reduction at follow-up due to clavicular osteolysis under the superior flip button. We describe 4 cases with loss of reduction due to rupture of the sutures running across the buttons: 2 women with joint hyperlaxity and acute Rockwood grade IV ACD and 2 men, heavy manual workers, with joint hyperlaxity and acute Rockwood grade IV ACD. The use of flip buttons might not be indicated in patients with joint hyperlaxity because they are able to obtain immediate stability only on the vertical plane and not on the horizontal plane. Anteroposterior movements of the acromioclavicular joint might rub the suture against the bone tunnels leading to wear and cutting.