Arthroscopic Coracoclavicular Reconstruction Combined with Open Acromioclavicular Reconstruction Using Knot Hiding Clavicular Implants Is a Stable Solution

Publisher Copyright: © 2021 Arthroscopy Association of North AmericaPurpose: The purpose of this noninterventional, register-based study was to report the outcomes and wound healing of surgically treated chronic acromioclavicular (AC) dislocations using a tendon graft and knot-hiding titanium implants. Methods: Thirty-two cases with chronic AC separation underwent an arthroscopic coracoclavicular (CC) ligament reconstruction and an open AC ligament reconstruction using knot-hiding titanium implants. The wound healing was assessed 2 months after the operation. The Nottingham Clavicle score, Constant score, and Simple Shoulder Test were obtained postoperatively and at a minimum of one-year postsurgery. The radiographic change in distance between the clavicular and coracoid cortices and clavicular tunnel diameter was measured. General patient satisfaction with the outcome (poor, fair, good, or excellent) was also assessed 1 year postoperatively. Results: The mean Nottingham Clavicle score increased from a preoperative mean of 41.66 ± 9.86 to 96.831 ± 5.86 (P ≤.05). The Constant score increased from a preoperative mean of 44.66 ± 12.54 to 93.59 ± 7.01 (P ≤.05). The Simple Shoulder Test score increased from a preoperative mean of 7.00 ± 2.14 to 11.84 ±.63 (P ≤.05). The coracoclavicular distance increased from 11.32 ± 3.71 to 13.48 ± 3.79 mm (P ≤.05). The clavicular drill hole diameter increased from 6 mm to a mean of 6 to a mean of 8.13 ± 1.12 mm. Twenty-three (71.9%) patients reported an excellent outcome, and nine (28.1%) reported a good outcome. One clavicular fracture occurred but no coracoid fractures. There was one reconstruction failure leading to a reoperation. Conclusions: In this series, combining the arthroscopic CC ligament reconstruction to an open reconstruction of the AC joint with a tendon graft proved to be a stable solution. The knot-hiding titanium implant effectively eliminated the problems related to the clavicular wound healing. Level of Evidence: Level IV, therapeutic case series.Peer reviewe

Arthroscopic Coracoclavicular Ligament Reconstruction Using Graft Augmentation and Titanium Implants

Several techniques have been introduced to treat acromioclavicular separation with coracoclavicular ligament reconstruction using graft augmentation. A modified arthroscopic technique for coracoclavicular ligament reconstruction was used based on a previous technique where the supportive device and tendon graft share the clavicular and coracoid drill holes. A notable problem with the previous technique was large protruding suture knots on the washer and clavicle, which could predispose to wound infection. In this modified technique, titanium implants were introduced. The implants hid the suture knot on the clavicle, and less foreign material was needed between the clavicular and coracoid implants.</p

Arthroscopic Coracoclavicular Reconstruction Combined with Open Acromioclavicular Reconstruction Using Knot Hiding Clavicular Implants Is a Stable Solution

PurposeThe purpose of this noninterventional, register-based study was to report the outcomes and wound healing of surgically treated chronic acromioclavicular (AC) dislocations using a tendon graft and knot-hiding titanium implants.MethodsThirty-two cases with chronic AC separation underwent an arthroscopic coracoclavicular (CC) ligament reconstruction and an open AC ligament reconstruction using knot-hiding titanium implants. The wound healing was assessed 2 months after the operation. The Nottingham Clavicle score, Constant score, and Simple Shoulder Test were obtained postoperatively and at a minimum of one-year postsurgery. The radiographic change in distance between the clavicular and coracoid cortices and clavicular tunnel diameter was measured. General patient satisfaction with the outcome (poor, fair, good, or excellent) was also assessed 1 year postoperatively.ResultsThe mean Nottingham Clavicle score increased from a preoperative mean of 41.66 ± 9.86 to 96.831 ± 5.86 (P ≤ .05). The Constant score increased from a preoperative mean of 44.66 ± 12.54 to 93.59 ± 7.01 (P ≤ .05). The Simple Shoulder Test score increased from a preoperative mean of 7.00 ± 2.14 to 11.84 ± .63 (P ≤ .05). The coracoclavicular distance increased from 11.32 ± 3.71 to 13.48 ± 3.79 mm (P ≤ .05). The clavicular drill hole diameter increased from 6 mm to a mean of 6 to a mean of 8.13 ± 1.12 mm. Twenty-three (71.9%) patients reported an excellent outcome, and nine (28.1%) reported a good outcome. One clavicular fracture occurred but no coracoid fractures. There was one reconstruction failure leading to a reoperation.ConclusionsIn this series, combining the arthroscopic CC ligament reconstruction to an open reconstruction of the AC joint with a tendon graft proved to be a stable solution. The knot-hiding titanium implant effectively eliminated the problems related to the clavicular wound healing.Level of EvidenceLevel IV, therapeutic case series.</p

Arthroscopic Coracoclavicular Ligament Reconstruction Using Graft Augmentation and Titanium Implants

Several techniques have been introduced to treat acromioclavicular separation with coracoclavicular ligament reconstruction using graft augmentation. A modified arthroscopic technique for coracoclavicular ligament reconstruction was used based on a previous technique where the supportive device and tendon graft share the clavicular and coracoid drill holes. A notable problem with the previous technique was large protruding suture knots on the washer and clavicle, which could predispose to wound infection. In this modified technique, titanium implants were introduced. The implants hid the suture knot on the clavicle, and less foreign material was needed between the clavicular and coracoid implants.Peer reviewe

Proximal Adductor Longus Tendon Repair With a Concomitant Distal Fascial Release for Complete Hip Adductor Tendon Tears : Surgical Technique and Outcomes in 40 Male Athletes

Background: The optimal treatment for complete avulsions of the proximal adductor longus (AL) is still debatable, and different operative and nonoperative treatment options have been suggested. Purpose: To report surgical techniques and functional outcomes of a series of athletes who were treated operatively for proximal AL tears. Study Design: Case series; Level of evidence, 4. Methods: A retrospective evaluation of patients who underwent surgical repair of complete proximal AL tear with concomitant distal fascial release with or without lesions of the neighboring soft tissue structures was performed. This included preinjury Tegner score, age, number of tendons involved, time interval from injury to surgery, and postoperative complications. Self-reported outcomes were defined based on the ability to regain sports activities (excellent, good, moderate, fair, or poor). Between-group comparisons were performed to identify factors associated with improved outcomes. The Mann-Whitney nonparametric test was used for comparing continuous variables, and the Fisher exact test was used for comparing nominal variables. Results: A total of 40 male athletes were included in the evaluation, with an average follow-up of 11 months (range, 6 months-8 years). Self-reported outcome was excellent in 23 (57.5%), good in 13 (32.5%), and moderate in 4 (10%) patients. Comparisons between patients with excellent versus good/moderate outcomes revealed nonsignificant differences regarding age at injury and preinjury Tegner score. Athletes with excellent outcomes received surgery sooner after the injury compared with athletes with good/moderate outcomes (2.4 ± 1.8 vs 11.4 ± 11.0 weeks, respectively; P <.01). Conclusion: Surgical repair for complete proximal AL tears with a concomitant distal fascial release resulted in outcomes rated as good or excellent in 90% of the cases. This treatment should be considered particularly in high-level athletes with a clear tendon retraction and within the first month after the injury. Further research is nevertheless needed to compare these outcomes with other treatment alternatives to better define criteria advocating surgery.publishedVersionPeer reviewe

Proximal adductor longus tendon repair with a concomitant distal fascial release for complete hip adductor tendon tears:surgical technique and outcomes in 40 male athletes

Abstract Background: The optimal treatment for complete avulsions of the proximal adductor longus (AL) is still debatable, and different operative and nonoperative treatment options have been suggested. Purpose: To report surgical techniques and functional outcomes of a series of athletes who were treated operatively for proximal AL tears. Study Design: Case series; Level of evidence, 4. Methods: A retrospective evaluation of patients who underwent surgical repair of complete proximal AL tear with concomitant distal fascial release with or without lesions of the neighboring soft tissue structures was performed. This included preinjury Tegner score, age, number of tendons involved, time interval from injury to surgery, and postoperative complications. Self-reported outcomes were defined based on the ability to regain sports activities (excellent, good, moderate, fair, or poor). Between-group comparisons were performed to identify factors associated with improved outcomes. The Mann-Whitney nonparametric test was used for comparing continuous variables, and the Fisher exact test was used for comparing nominal variables. Results: A total of 40 male athletes were included in the evaluation, with an average follow-up of 11 months (range, 6 months-8 years). Self-reported outcome was excellent in 23 (57.5%), good in 13 (32.5%), and moderate in 4 (10%) patients. Comparisons between patients with excellent versus good/moderate outcomes revealed nonsignificant differences regarding age at injury and preinjury Tegner score. Athletes with excellent outcomes received surgery sooner after the injury compared with athletes with good/moderate outcomes (2.4 ± 1.8 vs 11.4 ± 11.0 weeks, respectively; P &lt; 0.01). Conclusion: Surgical repair for complete proximal AL tears with a concomitant distal fascial release resulted in outcomes rated as good or excellent in 90% of the cases. This treatment should be considered particularly in high-level athletes with a clear tendon retraction and within the first month after the injury. Further research is nevertheless needed to compare these outcomes with other treatment alternatives to better define criteria advocating surgery