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Arthroscopic-Assisted Double-Bundle Coracoclavicular Ligament Reconstruction Using Cortical Fixation Buttons With Suture Tape Provides Superior Vertical Stability Than the Single-Bundle Reconstruction for Acute Acromioclavicular Joint Dislocation

Published:October 06, 2022DOI:https://doi.org/10.1016/j.arthro.2022.09.018

      Purpose

      This study aimed to compare clinical and radiologic outcomes between single- and double-bundle arthroscopic-assisted coracoclavicular (CC) ligament reconstruction using cortical fixation buttons with suture tapes for acute acromioclavicular (AC) joint dislocation.

      Methods

      Patients who underwent arthroscopic-assisted CC ligament reconstruction using cortical fixation buttons with suture tapes for acute AC joint dislocation from July 2014 to March 2019 were identified. This study included patients treated for acute AC joint dislocation within 2 weeks after an injury, with a Rockwood classification of III or V and at least 2 years of follow-up. Patients were divided into 2 groups based on the reconstruction technique: group I (single-bundle technique) and group II (double-bundle technique). The clinical outcomes were compared using the American Shoulder Elbow Surgeons (ASES) score, Constant score, and visual analog scale for pain score between the 2 groups. On the plain radiograph, the CC interval ratio (CCIR) was measured to evaluate maintenance of CC interval fixation. Postoperative complications, including reduction failure, were also documented.

      Results

      Fifty-eight patients (26 in group I, 32 in group II) were enrolled. There were no significant differences in CCIR between the 2 groups preoperatively and 3 months postoperatively. However, the CCIR of group I was significantly greater than that of group II 6 months postoperatively (group I: 160.5% ± 48.5%, group II: 125.4% ± 38.9% at 6 months postoperatively, P = .01; group I: 164.0% ± 57.3%, group II: 123.2% ± 35.9% at the last visit, P = .01). Despite radiologic differences, the clinical outcomes demonstrated no significant differences between 2 the groups (ASES score: 93.5 ± 5.2 in group I, 94.4 ± 4.5 in group II, P = .54; Constant score: 92.9 ± 5.3 in group I, 94.8 ± 4.3 in group II, P = .16). Reduction failure occurred in 4 patients (15.3%) in group I and in 1 patient (3.2%) in group II (P = .16).

      Conclusions

      Arthroscopic-assisted double-bundle CC ligament reconstruction using cortical fixation buttons with suture tapes provided superior vertical stability than the single-bundle technique.

      Level of Evidence

      Level III, retrospective comparative study.
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      References

        • Balog T.P.
        • Min K.S.
        • Rumley J.C.
        • Wilson D.J.
        • Arrington E.D.
        Arthroscopic anatomic coracoclavicular ligament repair using a 6-strand polyester suture tape and cortical button construct.
        Arthrosc Tech. 2015; 4: e757-761
        • Cisneros L.N.
        • Reiriz J.S.
        Management of acute unstable acromioclavicular joint injuries.
        Eur J Orthop Surg Traumatol. 2016; 26: 817-830
        • El Sallakh S.A.
        Evaluation of arthroscopic stabilization of acute acromioclavicular joint dislocation using the TightRope system.
        Orthopedics. 2012; 35: e18-e22
        • Ladermann A.
        • Gueorguiev B.
        • Stimec B.
        • Fasel J.
        • Rothstock S.
        • Hoffmeyer P.
        Acromioclavicular joint reconstruction: a comparative biomechanical study of three techniques.
        J Shoulder Elbow Surg. 2013; 22: 171-178
        • Shin S.J.
        • Jeon Y.S.
        • Kim R.G.
        Arthroscopic-assisted coracoclavicular ligament reconstruction for acute acromioclavicular dislocation using 2 clavicular and 1 coracoid cortical fixation buttons with suture tapes.
        Arthroscopy. 2017; 33: 1458-1466
        • Topal M.
        • Kose A.
        Surgical management of Rockwood type 3 acromioclavicular joint injuries: a retrospective comparison of outcomes of suture anchor fixation and double-button fixation techniques.
        Medicine (Baltimore). 2020; 99e20312
        • Arirachakaran A.
        • Boonard M.
        • Piyapittayanun P.
        • et al.
        Post-operative outcomes and complications of suspensory loop fixation device versus hook plate in acute unstable acromioclavicular joint dislocation: A systematic review and meta-analysis.
        J Orthop Traumatol. 2017; 18: 293-304
        • Madi S.
        • Pandey V.
        • Murali S.
        • Acharya K.
        Clinical and radiological outcome of acute high-grade acromioclavicular joint dislocation: A retrospective cohort study on hook plate versus arthroscopic assisted single coracoclavicular tunnel with DogBone button dual FiberTape(R) construct.
        J Clin Orthop Trauma. 2022; 27101825
        • Shin S.J.
        • Kim N.K.
        Complications after arthroscopic coracoclavicular reconstruction using a single adjustable-loop-length suspensory fixation device in acute acromioclavicular joint dislocation.
        Arthroscopy. 2015; 31: 816-824
        • Park I.
        • Itami Y.
        • Hedayati B.
        • et al.
        Biomechanical analysis of single-, double-, and triple-bundle configurations for coracoclavicular ligament reconstruction using cortical fixation buttons with suture tapes: A cadaveric study.
        Arthroscopy. 2018; 34: 2983-2991
        • Struhl S.
        • Wolfson T.S.
        • Kummer F.
        Axial-plane biomechanical evaluation of 2 suspensory cortical button fixation constructs for acromioclavicular joint reconstruction.
        Orthop J Sports Med. 2016; 42325967116674668
        • Mazzocca A.D.
        • Santangelo S.A.
        • Johnson S.T.
        • Rios C.G.
        • Dumonski M.L.
        • Arciero R.A.
        A biomechanical evaluation of an anatomical coracoclavicular ligament reconstruction.
        Am J Sports Med. 2006; 34: 236-246
        • Walz L.
        • Salzmann G.M.
        • Fabbro T.
        • Eichhorn S.
        • Imhoff A.B.
        The anatomic reconstruction of acromioclavicular joint dislocations using 2 TightRope devices: A biomechanical study.
        Am J Sports Med. 2008; 36: 2398-2406
        • Yoo Y.S.
        • Tsai A.G.
        • Ranawat A.S.
        • et al.
        A biomechanical analysis of the native coracoclavicular ligaments and their influence on a new reconstruction using a coracoid tunnel and free tendon graft.
        Arthroscopy. 2010; 26: 1153-1161
        • Calvo E.
        • Lopez-Franco M.
        • Arribas I.M.
        Clinical and radiologic outcomes of surgical and conservative treatment of type III acromioclavicular joint injury.
        J Shoulder Elbow Surg. 2006; 15: 300-305
      1. Yu P, Zhang Y, Ye T, Liu J, Zhuang C, Wang L. Clinical and radiological outcomes of acute Rookwood type IIIB acromioclavicular joint dislocation: Mini-open tightrope technique versus hook plate [published online February 9, 2022]. Injury. doi:10.1016/j.injury.2022.02.019.

        • Tauber M.
        • Valler D.
        • Lichtenberg S.
        • Magosch P.
        • Moroder P.
        • Habermeyer P.
        Arthroscopic stabilization of chronic acromioclavicular joint dislocations: Triple- versus single-bundle reconstruction.
        Am J Sports Med. 2016; 44: 482-489
        • Xue C.
        • Song L.
        • Zheng X.
        • Li X.
        • Fang J.
        • Shen Y.
        Truly anatomic coracoclavicular ligament reconstruction with 2 EndoButton devices for acute Rockwood type V acromioclavicular joint dislocations: 5-year findings.
        J Shoulder Elbow Surg. 2022; 31: 855-859
        • Gu F.
        • Tan L.
        • Wang T.
        • et al.
        Comparison of single versus double TightRope system in the treatment of acute acromioclavicular joint dislocation.
        J Shoulder Elbow Surg. 2021; 30: 1915-1923
        • Beitzel K.
        • Obopilwe E.
        • Apostolakos J.
        • et al.
        Rotational and translational stability of different methods for direct acromioclavicular ligament repair in anatomic acromioclavicular joint reconstruction.
        Am J Sports Med. 2014; 42: 2141-2148
        • Salzmann G.M.
        • Walz L.
        • Buchmann S.
        • Glabgly P.
        • Venjakob A.
        • Imhoff A.B.
        Arthroscopically assisted 2-bundle anatomical reduction of acute acromioclavicular joint separations.
        Am J Sports Med. 2010; 38: 1179-1187
        • Grantham C.
        • Heckmann N.
        • Wang L.
        • Tibone J.E.
        • Struhl S.
        • Lee T.Q.
        A biomechanical assessment of a novel double endobutton technique versus a coracoid cerclage sling for acromioclavicular and coracoclavicular injuries.
        Knee Surg Sports Traumatol Arthrosc. 2016; 24: 1918-1924
        • Chahla J.
        • Marchetti D.C.
        • Moatshe G.
        • et al.
        Quantitative assessment of the coracoacromial and the coracoclavicular ligaments with 3-dimensional mapping of the coracoid process anatomy: A cadaveric study of surgically relevant structures.
        Arthroscopy. 2018; 34: 1403-1411