Functional and radiological evaluation of acute acromioclavicular dislocation treated with anchors without eyelet: comparison with other techniques

Nascimento, Alexandre Tadeu do; Claudio, Gustavo Kogake

doi:10.1016/j.rboe.2016.08.015

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ORIGINAL ARTICLES • Rev. bras. ortop. 51 (05) • Sep-Oct 2016 • https://doi.org/10.1016/j.rboe.2016.08.015 copy

Functional and radiological evaluation of acute acromioclavicular dislocation treated with anchors without eyelet: comparison with other techniques^☆ ☆ Study conducted at the Hospital Orthoservice, Grupo de Ombro e Cotovelo, São José dos Campos, SP, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE:

To assess the repair results of acromioclavicular dislocations (ACJD) grades III and V, with anchors without eyelet, when compared with other techniques, and to evaluate factors that can affect the final result.

METHODS:

A retrospective study of 36 patients with ACJD grades III and V in the Rockwood classification, 12 treated with anchors without eyelet, 11 with one tightrope, six with two tightropes, and six with subcoracoid cerclage, operated from September 2012 to February 2015. Patients were assessed radiographically and through DASH, UCLA, the visual analog scale of pain (VAS) and the Short-Form 36 (SF-36). Surgical time and the possible influence of some factors in the outcome were also assessed.

RESULTS:

The mean DASH score was 6.7; UCLA, 32.9; VAS, 1.2; and SF-36, 79.47. Radiographically, the final mean measurement was 9.93 mm, with no statistical difference between the groups. The mean surgical time for Group I was 31 min; Group II, 19 min; Group III, 29 min; and Group IV, 59 min. There was a significant difference between Groups II and IV when compared with the study group. The initial and immediate post-operative ACJD measurements ACJD were correlated with the final measure.

CONCLUSION:

The repair of acute ACJD with anchors without eyelet is as effective as the other methods, with significantly shorter operative time when compared with the subcoracoid cerclage technique. The final radiological result is influenced by the coracoclavicular initial distance and the immediate postoperative measurement.

Keywords:
Acromioclavicular joint; Suture anchors; Treatment outcome

Patient	Age	Sex	Side	ACJD Classification
Group I
1	40	Male	Left	5
2	42	Female	Left	5
3	43	Male	Left	3
4	48	Male	Left	3
5	19	Male	Left	3
6	24	Male	Left	5
7	21	Male	Right	5
8	58	Male	Left	5
9	65	Male	Left	5
10	20	Male	Right	5
11	23	Male	Left	5
12	22	Male	Right	5

Group II
1	34	Male	Left	5
2	60	Male	Left	5
3	22	Male	Left	5
4	32	Male	Left	3
5	19	Male	Right	3
6	36	Male	Left	5
7	28	Male	Left	3
8	32	Male	Right	5
9	28	Male	Left	5
10	22	Male	Right	5
11	43	Male	Right	3

Group III
1	50	Male	Left	5
2	29	Male	Left	5
3	37	Male	Right	3
4	23	Male	Right	5
5	35	Male	Right	3
6	29	Male	Right	3
7	27	Male	Right	5

Group IV
1	27	Male	Left	3
2	20	Male	Right	3
3	36	Male	Left	5
4	69	Male	Right	3
5	50	Male	Right	5
6	59	Female	Left	5

	Mean ACJD measurement, in mm	ACJD III	ACJD V
Group I	19.1	3	9
Group II	19.1	4	7
Group III	20.2	3	4
Group IV	17.9	3	3
p-Value between I and II	0.86	–a	–
p-Value between I and III	0.97	–	–
p-Value between I and IV	0.96	–	–

	Surgical time in minutes	Pre-op measurement (mm)	Immediate post-op measurement (mm)	Final measurement (mm)	Immediate post-op reduction percentage loss	Period in which the loss of reduction occurred, in weeks
Group I	31	19.1	4.89	8.23	68%	14.5
Group II	19	19.1	5.45	11.25	106%	12.7
Group III	29	20	4.96	8.17	65%	18.8
Group IV	59	18	4.27	8.86	107%	20.2
p-Value (between I and II)	<0.000000001	0.85	0.68	0.6	0.3	0.3
p-Value (between I and III)	0.12	0.97	0.95	0.47	0.4	0.42
p-Value (between I and IV)	0.000002	0.96	0.93	0.24	0.2	0.09

	UCLA	DASH	VAS
Group I	32.4±2.5 (26–35)	7.7±7.1 (0.83–25)	1.2±1.3 (0–4)
Group II	33.4±2.3 (27–35)	5.9±9.8 (0–34)	1.2±2.0 (0–7)
Group III	32.0±2.0 (29–35)	5.8±9.0 (0.83–25.83)	1.8±1.2 (0–4)
Group IV	29.4±1.9 (30–35)	6.5±19.1 (0–47.5)	0.9±1.2 (0–3)
Kruskal–Wallis test (p-value)	0.33	0.31	0.16

	Functional capacity	Limitation due to physical aspects	Pain	General health	Vitality	Social aspects	Limitations due to emotional aspects	Mental health
Group I	93±6.7 (84–100)	76±32.3 (25–100)	88±18.5 (62–100)	74±18.5 (55–100)	75±15.9 (40–90)	85±15.3 (45–100)	75±34.2 (0–100)	90±8.6 (80–100)
Group II	92±12.5 (60–100)	75±38.2 (0–100)	73±28.4 (0–100)	72±19 (45–100)	82±15 (50–100)	92±19 (37.5–100)	88±21.3 (33.3–100)	78±24 (33–100)
Group III	95±9 (75–100)	88±19 (50–100)	73±21 (41–95)	70±16 (55–100)	82±12 (80–100)	84±12 (75–100)	88±25 (33.3–100)	75±18 (52–100)
Group IV	87±24 (40–100)	75±38 (0–100)	81±100	75±25 (35–100)	92±8 (80–100)	90±17 (62.5–100)	74±39 (0–100)	89±15 (64–100)
Kruskal–Wallis test	0.9	0.91	0.23	0.78	0.13	0.33	0.8	0.23

	Final measurement	VAS	DASH	UCLA	SF36
Immediate post-op measurement	0.67	0.24	0.2	-0.1	-0.5
Initial measurement	0.37	0.14	0.5	-0.18	-0.12
Time to surgery	0.1	0.16	0.5	0.21	-0.8
Time to loss of reduction	-0.1	0.12	0.2	-0.7	-0.12
Age	0.8	0.6	0.2	0.3	0

Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
E-mail: rbo@sbot.org.br

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[1] * Corresponding author. E-mail: nascimento@icloud.com(A.T. do Nascimento).

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Functional and radiological evaluation of acute acromioclavicular dislocation treated with anchors without eyelet: comparison with other techniques☆ ☆ Study conducted at the Hospital Orthoservice, Grupo de Ombro e Cotovelo, São José dos Campos, SP, Brazil.

ABSTRACT

OBJECTIVE:

METHODS:

RESULTS:

CONCLUSION:

Functional and radiological evaluation of acute acromioclavicular dislocation treated with anchors without eyelet: comparison with other techniques^☆ ☆ Study conducted at the Hospital Orthoservice, Grupo de Ombro e Cotovelo, São José dos Campos, SP, Brazil.