Stabilization of acromioclavicular joint using DogBone dynamic system (Arthrex):a literature review and long-term follow-up

Ryazantsev M.S., Ilʼin D.O., Rybin K.E., Magnitskaya N.E., Afanasyev A.P., Logvinov A.N., Korolev A.V.

Abstract


Objectives
The purpose of the study was to evaluate long-term follow-ups of stabilized acromioclavicular joint (ACJ) dislocations using button dynamic system applied via arthroscopic technique or mini-open.
Material and methods
The review included follow-ups of 40 patients (39 males, 1 female) who underwent 40 ACJ stabilization procedures with Arthrex DogBone button between 2014 and 2017 using arthroscopy (n = 28) or mini-open technique (n = 12). The mean age of the patients was 34 years (range, 15 to 59 years). Patient reported outcomes were evaluated with UCLA shoulder rating scale, American Shoulder and Elbow Surgeons (ASES) shoulder score and the Constant Shoulder Score (CSS). Coraco-Clavicular Distance (ССD) was measured on preand postoperative anteroposterior views. Postoperative AP view was used to measure Clavicular Tunnel Distance (CTD). Arthroscopy patients had available preoperative radiographs (n = 21), postoperative radiographs (n = 26) and patient reported outcomes (n = 18). Mini open group had available preoperative radiographs (n = 2), postoperative radiographs (n=8) and patient reported outcomes (n = 8).
Results
One hundred percent of Arthroscopy/Mini open (26/26) cases were rated as excellent and good on UCLA shoulder rating scale at a long-term follow-up. One hundred percent of Arthroscopy patients (18/18) were rated as excellent and good; 75 % (6/8) of Mini-open cases evaluated as excellent and 25 % (2/8) as good on ASES shoulder score. Sixty seven percent of Arthroscopy (12/18) patients were rated as excellent and 33 % (6/18) as good; 62 % (5/8) of Mini open cases evaluated as excellent and 38 % (3/8) as good. Neither fair nor poor results were observed in both groups. No statistically significant differences were detected in median scores between Arthroscopy and Miniopen groups (p > 0.05). Preoperative radiographs showed Tossy grade IV dislocation (n = 3) and Tossy grade III (n = 20). Distal clavicle fracture was diagnosed in 2 cases. Median preoperative CCD radiologically measured 15.5 mm in both groups (n = 23). Median postoperative CCD and CTD radiologically measured 6.12 mm and 28.9 mm in both groups (n = 35), correspondingly. Decrease in postoperative CCD was significantly different (p = 0.0003). No statistically significant differences in postoperative CCD were detected between Arthroscopy and Miniopen groups (p > 0.05). Statistically significant differences in preoperative CCD were observed in both groups (n = 15) using weight-bearing/no weight-bearing AP views (P = 0.0009).
Conclusion
Stabilization of dislocated ACJ with dynamic systems is the method of choice providing excellent and good outcomes rated by UCLA rating scale, ASES shoulder score and CSS at long-term follow-up. One-stage surgical treatment is an advantage of dynamic systems with no need of construct removal. Standard and weighted stress radiographs of the involved side indicate to ACJ injury in comparison with contralateral side. Further research is needed for a longer term follow-up with the bone reduction maintained with dynamic system.

Keywords


acromioclavicular joint, injury, fixation, DogBone, dynamic system

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DOI: http://dx.doi.org/10.18019/1028-4427-2018-24-4-530-537

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