The purpose of this study was to evaluate the results after arthroscopic treatment of traumatic AC joint dislocation using a Bosworth screw.
18 Patients with acute AC Joint dislocation type Rockwood 3 were arthroscopically treated with temporary transfixation using a 7.0mm cannulated titanium screw of the clavicle to the coracoid process. The coracoid process is arthroscopically visualized and a drill guide for tibial anterior cruciate ligament positioning is used to exactly place the screw into the coracoid process. The screws were removed after 8 weeks. Patients were followed using a prospective study using the Constant Score after 3, 6, 12 and 24 months.
17 Patients were completely evaluated. One screw slipped out of the coracoid process 3 days after surgery requiring revision surgery. No screw breakage was observed. There were no other operation conditioned complications. Constant score showed a mean of 94,7 at last follow up. At follow up, no patient hat a redislocation without weight bearing. With 10kg weight a mean clavicular elevation of 1,8mm was observed. All remaining patients were satisfied with the functional and cosmetic result.
There is some controversy about the surgical treatment of acute traumatic AC joint dislocation type Rockwood 3. Most open surgery techniques have the disadvantage of a poor cosmetic result or a difficult and dangerous hardware removal, because the scar of the AC joint capsule that is supposed to stabilize the clavicle has to be opened. The Bosworth screw technique does not touch the AC joint at all, but the open procedure has poor cosmetic outcome. It is also important to use a large screw to ensure proper hardware stability to avoid hardware failure. Our technique might be an alternative for the operative treatment of acute AC joint instability, because it is safe and all anatomical structures remain intact in case revision surgery with i.e. arthroscopic AC joint resection and ligamentoplasty is necessary.
© 2007 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.