Abstract
Purpose
This study was to compare the two-year clinical and radiological outcomes of an arthroscopic-assisted
bidirectional stabilization procedure using single low-profile (LPSB) or double suture
button (DSB) techniques with additional percutaneous acromioclavicular (AC) cerclage
fixation for patients with acute high-grade AC joint dislocation.
Methods
This retrospective cohort study compared male patients aged between 18-56 years with
acute high-grade AC joint dislocation fixed with either a LPSB or DSB technique. Patients
were examined at least 24 months post-surgery. Subjective Shoulder Value (SSV), Taft
(TF) and Acromioclavicular Joint Instability scores (ACJI) were evaluated. Coracoclavicular
difference, ossification, AC joint osteoarthritis and dynamic posterior translation
(DPT) were assessed on bilateral anteroposterior stress radiographs and modified Alexander
views. The revision rate due to implant conflict and duration of surgery were reported.
Group outcome differences were analyzed using standardized hypothesis tests.
Results
28 patients aged 39.2 (LPSB) and 36.4 years (DSB) (p=0.319; CI -2.77 – 8.34) were
eligible per cohort. The follow-up was 30.5 (LPSB) and 37.4 months (DSB) (p=0.02;
CI -12.73 – -1.08). LPSB patients rated a significantly higher SSV (93.2% vs. 81.9%
(DSB); p=0.004). TF and ACJI scores were similar between groups. Coracoclavicular
difference markedly decreased from 12 mm to 3 mm for both cohorts (p<0.001). Ossification
was identified in over 85% in both cohorts (p=0.160; CI -0.77 – 0.13) and osteoarthritis
in 21.4% (LPSB) and 39.3% (DSB) (p=0.150). Persistent DPT was found in around 30%
for both cohorts (p=0.561; CI -0.26 – 0.48). The revision rates were 0% (LPSB) and
7% (DSB) (p=0.491). LPSB surgery was shorter (59.7 vs. 71.5 mins [DSB]) (p=0.011).
Conclusion
The results of the LPSB and DSB techniques with additional percutaneous AC cerclage
fixation showed comparable outcomes with excellent clinical and satisfactory radiological
results. The assessment of the subjective patients satisfaction was in favor of the
LPSB technique and no postoperative revision event was observed following this procedure.
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Article info
Publication history
Accepted:
May 11,
2023
Received in revised form:
May 8,
2023
Received:
November 22,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Acknowledgement
The authors thank Laurent Audigé, Marije de Jong, Martina Wehrli, Daniela Brune, Tim Schneller and Beatrice Weber for data administration. The authors thank Melissa Wilhelmi for copyediting this article.
Level of Evidence: Level III, retrospective comparative therapeutic trial.
Identification
Copyright
© 2023 Published by Elsevier on behalf of the Arthroscopy Association of North America
