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Arthroscopic-Assisted AC Joint Reconstruction

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Minimally Invasive Surgery in Orthopedics

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Abstract

Acromioclavicular (AC) joint injuries are common place; however, their optimal treatment is still a source of debate. Classification of this injury is well established and is the platform on which successful treatment is based. The degree of injury to the surrounding ligamentous and capsular structures must be evaluated thoroughly. The surgeon must use the patient’s history and physical examination and corroborate their findings with appropriate imaging. Once an accurate diagnosis has been made, the surgeon can incorporate the patient’s preferences and demands to tailor a suitable treatment program. More minor injuries to the AC and CC ligaments can be treated nonoperatively with physical therapy and strengthening, while more severe injuries require surgical stabilization. This chapter highlights the relevant anatomy, biomechanics, classification scheme, imaging, and both nonoperative and operative treatment modalities, and the authors preferred treatment method for displaced AC separations. Finally, a brief review of rehabilitation and return to play will be discussed.

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References

  1. Williams GR, Nguyen VD, Rockwood CA. Classification and radiographic analysis of acromioclavicular dislocations. Appl Radiol. 1989;18:29–34.

    Google Scholar 

  2. Dawson PA, Adamson GJ, Pink MM, Kornswietd M, Lin S, Shankwiler JA. Relative contribution of acromioclavicular joint capsule and coracoclavicular ligaments to acromioclavicular stability. J Shoulder Elbow Surg. 2009;18(2):237–44.

    Article  PubMed  Google Scholar 

  3. Fukuda K, Craig EV, An KN, Cofield RH, Chao EY. Biomechanical study of the ligamentous system of the acromioclavicular joint. J Bone Joint Surg Am. 1986;68(3):434–40.

    CAS  PubMed  Google Scholar 

  4. Bearden JM, Hughston JC, Whatley GS. Acromioclavicular dislocation: method of treatment. J Sports Med. 1973;1(4):5–17.

    Article  CAS  PubMed  Google Scholar 

  5. Rios CG, Arciero RA, Mazzocca AD. Anatomy of the clavicle and coracoid process for reconstruction of the coracoclavicular ligaments. Am J Sports Med. 2007;35:811–7.

    Article  PubMed  Google Scholar 

  6. Stine IA, Vangsness Jr CT. Analysis of the capsule and ligament insertions about the acromioclavicular joint: a cadaveric study. Arthroscopy. 2009;25(9):968–74.

    Article  PubMed  Google Scholar 

  7. Motamedi AR, Blevins FT, Willis MC, McNally TP, Shahinpoor M. Biomechanics of the coracoclavicular ligament complex and augmentations used in its repair and reconstruction. Am J Sports Med. 2000;28(3):380–4.

    CAS  PubMed  Google Scholar 

  8. Woo SL, Hollis JM, Adams DJ, Lyon RM, Takai S. Tensile properties of the human femur-anterior cruciate ligament-tibia complex. The effects of specimen age and orientation. Am J Sports Med. 1991;19(3):217–25.

    Article  CAS  PubMed  Google Scholar 

  9. Tossy JD, Mead NC, Sigmond HM. Acromioclavicular separations: useful and practical classification for treatment. Clin Orthop Relat Res. 1963;28:111–9.

    CAS  PubMed  Google Scholar 

  10. Trainer G, Arciero RA, Mazzocca AD. Practical management of grade III acromioclavicular separations. Clin J Sport Med. 2008;18(2):162–6.

    Article  PubMed  Google Scholar 

  11. Smith TO, Chester R, Pearse EO, Hing CB. Operative versus non-operative management following Rockwood grade III acromioclavicular separation: a meta-analysis of the current evidence base. J Orthop Traumatol. 2011;12:19–27.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Weaver JK, Dunn HK. Treatment of acromioclavicular injuries, especially complete acromioclavicular separations. J Bone Joint Surg Am. 1972;54(6):1187–94 (reprint).

    CAS  PubMed  Google Scholar 

  13. Lee SJ, Nicholas SJ, Akizuki KH, McHugh MP, Kremenic IJ, Ben-Avi S. Reconstruction of the coracoclavicular ligaments with tendon grafts: a comparative biomechanical study. Am J Sports Med. 2003;31:648–55.

    PubMed  Google Scholar 

  14. Mazzocca AD, Santangelo SA, Johnson ST, Rios CG, Dumonski ML, Arciero RA. A biomechanical evaluation of an anatomical coracoclavicular ligament reconstruction. Am J Sports Med. 2006;34(2):236–46. Epub 2005 Nov 10.

    Article  PubMed  Google Scholar 

  15. Lemos M, Tolo E. Complications of the treatment of the acromioclavicular and sternoclavicular joint injuries, including instability. Clin Sports Med. 2003;22(2):371–85.

    Article  PubMed  Google Scholar 

  16. Eaton R, Serletti J. Computerized axial tomography – a method of localizing Steinmann pin migration. Orthopedics. 1981;4:1357–60.

    CAS  PubMed  Google Scholar 

  17. Mazet R. Migration of a Kirschner wire from the shoulder region into the lung: report of two cases. J Bone Joint Surg. 1943;25A(2):477–83.

    Google Scholar 

  18. Norrell H, Llewellyn R. Migration of a threaded Steinmann pin from an acromioclavicular joint into the spinal canal: a case report. J Bone Joint Surg. 1965;47A:1024–6.

    Google Scholar 

  19. Yoon JP, Lee BJ, Nam SJ, Chung SW, Jeong WJ, Min WK, Oh JH. Comparison of results between hook plate fixation and ligament reconstruction for acute unstable acromioclavicular joint dislocation. Clin Orthop Surg. 2015;7(1):97–103.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Modi CS, Beazley J, Zywiel MG, Lawrence TM, Veillette CJ. Controversies relating to the management of acromioclavicular joint dislocations. Bone Joint J. 2013;95-B(12):1595–602.

    Article  CAS  PubMed  Google Scholar 

  21. Bosworth BM. Acromioclavicular separation. New method of repair. Surg Gynecol Obstet. 1941;73:866–71.

    Google Scholar 

  22. Lindsey R, Gutowski W. The migration of a broken pin following fixation of the acromioclavicular joint: a case report and review of the literature. Orthopedics. 1986;9:413–6.

    CAS  PubMed  Google Scholar 

  23. Grauthoff V, Kalmmer H. Complications due to migration of a Kirschner wire from the clavicle. Fortschr Rontgenstr. 1978;128:591–4.

    Article  CAS  Google Scholar 

  24. Sethi GK, Scott SM. Subclavian artery laceration due to migration of a Hagie pin. Surgery. 1976;80(5):644–6.

    CAS  PubMed  Google Scholar 

  25. Li X, Ma R, Bedi A, Dines DM, Altchek DW, Dines JS. Management of acromioclavicular joint injuries. J Bone Joint Surg Am. 2014;96(1):73-84.

    Google Scholar 

  26. Reish TG. The failure of a series of acromioclavicular dislocations treated with an arthroscopic flip button device. Poster #345 AAOS, San Francisco; 2012.

    Google Scholar 

  27. Spencer HT, Hsu L, Sodl J, Arianjam A, Yian EH. Radiographic failure and rates of re-operation after acromioclavicular joint reconstruction: a comparison of surgical techniques. Bone Joint J. 2016;98-B(4):512–8.

    Google Scholar 

  28. Deshmukh AV, Wilson DR, Zilberfarb JL, Perlmutter GS. Stability of acromioclavicular joint reconstruction: biomechanical testing of various surgical techniques in a cadaveric model. Am J Sports Med. 2004;32(6):1492–8.

    Google Scholar 

  29. Freedman JA, Adamson GJ, Bui C, Lee TQ. Biomechanical evaluation of the acromioclavicular capsular ligaments and reconstruction with an intramedullary free tissue graft. Am J Sports Med. 2010;38(5):958–64.

    Google Scholar 

  30. Beitzel K, Obopilwe E, Chowaniec DM, Niver GE, Nowak MD, Hanypsiak BT, Guerra JJ, Arciero RA, Mazzocca AD. Biomechanical comparison of arthroscopic repairs for acromioclavicular joint instability: suture button systems without biological augmentation. Am J Sports Med. 2011;39(10):2218–25.

    Google Scholar 

  31. Morrison DS, Lemos MJ: Acromioclavicular separation: reconstruction using synthetic loop augmentation. Am J Sports Med. 1995;23:105–10.

    Google Scholar 

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Author information

Authors and Affiliations

  1. Insall Scott Kelly Institute, New York, NY, USA

    Timothy G. Reish

  2. Hospital for Joint Diseases, NYU Langone, New York, NY, USA

    Andrew B. Old

Authors
  1. Timothy G. Reish
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  2. Andrew B. Old
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Corresponding author

Correspondence to Timothy G. Reish .

Editor information

Editors and Affiliations

  1. Orthopedic Service Line, Northwell Health , New York, New York, USA

    Giles R. Scuderi

  2. Department of Orthopedic Surgery, Rutgers-Robert Wood JohnsonMedicalSchool Department of Orthopedic Surgery, New Brunswick, New Jersey, USA

    Alfred J. Tria

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© 2016 Springer International Publishing Switzerland

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Reish, T.G., Old, A.B. (2016). Arthroscopic-Assisted AC Joint Reconstruction. In: Scuderi, G., Tria, A. (eds) Minimally Invasive Surgery in Orthopedics. Springer, Cham. https://doi.org/10.1007/978-3-319-34109-5_19

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  • DOI: https://doi.org/10.1007/978-3-319-34109-5_19

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-34107-1

  • Online ISBN: 978-3-319-34109-5

  • eBook Packages: MedicineReference Module Medicine

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