Is coracoclavicular reconstruction necessary in hook plate fixation for acute unstable acromioclavicular dislocation?
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Abstract Background: Acromioclavicular joint (ACJ) dislocation is a relatively common shoulder injury. For the treatment of cases of severe ACJ dislocation (Rockwood type III–V), hook plate fixation is a neasy-to-master and minimally-invasive approach to surgical intervention. Over stress on the acromion following hook plate fixation often leads to acromial complications such as osteolysis and loss of reduction. We hypothesized that suspensory reconstruction a longside hook plate fixation might provide a superior stability and reduce complications as compared with hook plate fixation alone. The purpose of the study was to assess the clinical and radiographic outcomes of these two surgical modalities. Methods: We retrospectively enrolled 49 patients with acute ACJ dislocation from May 2010 to December 2018. Among them, nineteen patients received hook plate fixation only (HP group), and 19 underwent concomitant hook plate fixation and loop suspension fixation with two mersilene sutures (HM group). The demographic data of the patients were recorded and analyzed. All patients underwent a shoulder x-ray initially, immediately postoperatively, and at 1, 3, 6 and12 months to measure the relative coracoclavicular distance (rCCD). Clinical assessment of shoulder function outcome was conducted using the Constant Murley Score (CMS); the University of California at Los Angeles (UCLA) Shoulder Score was also measured at the latest follow-up. Results: There were no significant differences in the demographic data between the two groups. With regards to the CMS and the UCLA score, the HM group and HP group both had excellent outcomes, and no significant differences in scores were observed between groups (CMS: 93.90±6.16 versus 94.47±7.26, p=0.47; UCLA score: 32.84±2.91 versus 34.32±1.16, p=0.07). However, the HM group demonstrated substantial superiority in terms of maintenance of the rCCD over the HP group (91.47±27.47 versus 100.75±48.70, p=0.015). In addition, there was less subacromial osteolysis in the HM group than the HP group (52.6% versus 15.8%, p=0.038). Conclusion: Both fixations yielded excellent functional outcomes. However, concomitant hook plate fixation with loop suspensory reconstruction demonstrated the fewer acromion complications and statistical differences in reduction maintenance with less clinical significance.Keywords:
Hook
Acromioclavicular dislocation
Acromion
Background: Acromion fractures are rare injuries that may occur because of shoulder trauma. This may be associated with distal clavicle fractures, which can be an indication for surgery. There are several methods, which are used for fixation of this type of fractures.
Case Presentation: In this paper, we presented a 34 years old man with acromion fracture in contribution with acromioclavicular (AC) joint dislocation. We applied a new method for fixation of this fracture. The fracture was fixed by 2 screws and AC Joint was fixed by a 4-hole hook plate.
Conclusions: It is important to be aware of acromial fracture to not miss them and also for early management, so that early recovery and satisfactory results can be gained
Acromion
Acromioclavicular dislocation
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Acromion
Rotator cuff injury
Etiology
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Objective To study the curative effect of surgical treatment of fracture of the acromion end of clavicle and degree Ⅲ acromioclavicular joint dislocation by clavicular hook-plate.Methods 84 patients with fracture of the acromion end of clavicle and degree Ⅲ acromioclavicular joint dislocation were treated with the clavicular hook-plate,and all ruptured acromioclavicular ligament was repaired without reconstruction of coracoclavicular ligament in operation.The differences of curative effect between the Kirschner wire,Screw,K-wire tension band and clavicular hook-plate on these diseases were analyzed retrospectively.Results The postoperative function of patients was assessed by Lazzcano criteria,and the excellent and good rate of the clavicular hookplate group was more than that of other 3 groups,all patients had no infectious complications and no loosening of the plates and screws.Conclusion The surgical treatment of fracture of the acromion end of clavicle and acromioclavicular joint dislocation by using the clavicular hook-plate is characterized by simple operation,good reduction,dynamic action immobilization,reliable fixation,fast in shoulder joint functional recovery,higher excellent good rate,less complication rate and difficult to recur,which is the first choice for the treatment of fracture of the acromion end of clavicle and acromioclavicular joint dislocation.
Acromion
Coracoclavicular ligament
Kirschner wire
Acromioclavicular dislocation
Tension band wiring
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We evaluated the available English literature for cases of acromion non-union and rotator cuff tear, looking at surgical methods of treatment as well as at functional results. As expected, the literature regarding rotator cuff pathology was found to be abundant, and a good number of articles were found regarding acromion non-union, but articles concerning the association of the two were scarce. Treatment recommendations varied, and were made on a case-to-case fashion. The accepted treatment methods for acromion non-union consist of non-surgical management, open or arthroscopic fragment removal, open or arthroscopic reduction and fixation (bone grafting may be used), while the rotator cuff witll be reinserted with anchors. In this rare occurence, a large rotator cuff tear with retracted tendons combined with an acromion non-union are usually repaired by an open technique in an one-stage surgery, with good results. In order to chose the right treatment option scapular kinematics must be taken into consideration especially when acromial fractures are associated with rotator cuff tears.
Acromion
Non union
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Background: Shoulder pain is frequently caused by subacromial impingement or rotator cuff injuries and forms the major indications for presurgical evaluation using MRI. Rotator cuff tears are caused by either internal degenerative changes or extrinsic compression of the acromion on the rotator cuff tendons. Reduction in subacromial space and abnormal acromial morphologies contribute to rotator cuff damage. Hence identifying these acromial abnormalities forms an essential part of evaluation since these forms the main indication for corrective acromioplasty. Methods: This institution-based MRI study was evaluated in three groups as follows: Group1-15 patients with rotator cuff tear; Group 2-15 patients with subacromial impingement; Group 3-10 controls without subacromial impingement pathology and rotator cuff tear and assessed for type of acromion, Lateral Acromial Angle (LAA), Acromion Index (AI), and Acromio-humeral Interval. Results: The type II Acromion showed significant association with rotator cuff tear and subacromial impingement followed by Type III and Type I respectively in our study. However, Type II acromion is relatively commoner in the control study and showed 26.92%, subacromial impingement showed 30.7% and rotator cuff tear showed 42.31%. The distribution of Lateral Acromial Angles differed significantly between the three groups. In comparison to controls, patients with low lateral acromial angle had significant association with subacromial impingement and rotator cuff tears. The age distribution of the Acromial Index differed significantly between the three groups with higher predilection to rotator cuff tear and impingement as age advanced and higher acromial index. Between the three groups, the subjects with low acromio-humeral distance had significant association with rotator cuff tears and impingement. Conclusions: Low lateral acromial angle, larger acromial index, and smaller acromio-humeral interval are related with a higher incidence of subacromial impingement and rotator cuff tears on MRI assessment of the shoulder.
Acromion
Subacromial impingement
Acromioplasty
Shoulder Impingement Syndrome
Rotator cuff injury
Impingement syndrome
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One hundred consecutive magnetic resonance imaging (MRI) studies of the shoulder obtained for the purpose of evaluating rotator cuff symptoms were retrospectively reviewed to assess the relationship between acromion morphologic appearance and rotator cuff disease. The studies were reviewed simultaneously by two authors. Each cuff was assigned a tendon grade and an overall cuff score with MRI criteria previously described in the literature. A newly described "lateral acromion angle" was measured from a specified oblique coronal cut on each MRI study and was correlated with the corresponding MRI-determined rotator cuff score and supraspinatus tendon grade. Observed correlations were analyzed by using statistical methods. The average measured lateral acromion angle was 78°, with a range from 64° to 99°. Eight shoulders had angles less than or equal to 70°, and all eight of these patients were found to have full-thickness rotator cuff tears. As the lateral acromion angle decreased, a statistically significant increase in rotator cuff disease was noted (p<0.0001). A significant correlation between increasing age and rotator cuff disease was also observed (p<0.0001). Multiple regression analysis confirmed that both the lateral acromion angle and the age of the patient were independent predictors of rotator cuff score. Finally, although a trend was noted suggesting a correlation between acromion type (I-flat, II-curved, and III-hooked) and MRI-determined rotator cuff disease, this trend did not reach statistical significance (p=0.12). Surgical correlation with MRI rotator cuff findings in 35 patients showed an MRI sensitivity of 100% and specificity of 83%. A statistically significant correlation between the lateral acromion angle and MRI-determined rotator cuff disease has been noted. The described angle may be a useful adjuvant in the evaluation and management of rotator cuff disease. One hundred consecutive magnetic resonance imaging (MRI) studies of the shoulder obtained for the purpose of evaluating rotator cuff symptoms were retrospectively reviewed to assess the relationship between acromion morphologic appearance and rotator cuff disease. The studies were reviewed simultaneously by two authors. Each cuff was assigned a tendon grade and an overall cuff score with MRI criteria previously described in the literature. A newly described "lateral acromion angle" was measured from a specified oblique coronal cut on each MRI study and was correlated with the corresponding MRI-determined rotator cuff score and supraspinatus tendon grade. Observed correlations were analyzed by using statistical methods. The average measured lateral acromion angle was 78°, with a range from 64° to 99°. Eight shoulders had angles less than or equal to 70°, and all eight of these patients were found to have full-thickness rotator cuff tears. As the lateral acromion angle decreased, a statistically significant increase in rotator cuff disease was noted (p<0.0001). A significant correlation between increasing age and rotator cuff disease was also observed (p<0.0001). Multiple regression analysis confirmed that both the lateral acromion angle and the age of the patient were independent predictors of rotator cuff score. Finally, although a trend was noted suggesting a correlation between acromion type (I-flat, II-curved, and III-hooked) and MRI-determined rotator cuff disease, this trend did not reach statistical significance (p=0.12). Surgical correlation with MRI rotator cuff findings in 35 patients showed an MRI sensitivity of 100% and specificity of 83%. A statistically significant correlation between the lateral acromion angle and MRI-determined rotator cuff disease has been noted. The described angle may be a useful adjuvant in the evaluation and management of rotator cuff disease.
Acromion
Cuff
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Background: The etiopathogenesis of rotator cuff tears remains debatable. Among the many causes, abnormal scapular morphology has been found to accelerate the degenerative process of rotator cuff tears. The morphology and lateral extension of the acromion process were assessed indetail by Nyffeler et al. and the Acromion Index (AI) was introduced, which measures the lateral extension of the acromion. It was theorized that a large lateral extension of the acromion increased the chances of the supraspinatus tendon to degenerate because of impingement between the acromion and the deltoid muscle. The AI was compared between patients with rotator cuff tears and patients with an intact rotator cuff. Methods: 21 Indian patients presenting to the orthopaedics OPD, Yenepoya Medical College, with rotator cuff tears were taken up for this study between August 2020 and February 2021. Another 21 patients with intact rotator cuff and other shoulder diseases such as frozen shoulder were included in this study. Patients with rotator cuff tears were included in group A, and patients with intact rotator cuff were included in group B. Both groups had the AI measured on radiographs, and their values were compared. Results: The mean Acromial Index (AI) in the rotator cuff tear group was 0.74 and in the intact rotator cuff group it was 0.59, which was statistically significant. There was no statistical difference in AI between male and female patients. The mean age of the patients in the rotator cuff group was 50.8 years, and in non rotator cuff tear group, it was 50.2 years. Conclusion: Acromial Index is a useful predictive tool for detecting rotator cuff tears in the Indian population. Further studies are required to assess its usefulness in predicting the progression of a rotator cuff tear. Keywords: Rotator cuff tear; Acromial Index; Shoulder.
Acromion
Rotator cuff injury
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Acromion
Acromioplasty
Cuff
Rotator cuff injury
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Rotator cuff tears usually cause a grinding facet in the undersurface of the acromion, called facies articularis acromialis, which is observable in dried scapulas. Some authors have related the pathogenesis of rotator cuff tears to an intrinsic degeneration of the cuff, while others have indicated that this pathology would be due to subacromial impingement. Some of the latter suggest that rotator cuff tears are associated with a narrowing of the subacromial space, mainly related to variations in the anatomy of the acromion. In order to obtain more information about the pathogenesis of rotator cuff tears we studied several anatomical parameters related to the architecture of the subacromial space in 112 human scapulas, divided into a healthy group and a pathological group depending on the lack or presence of a facies articularis acromialis in the undersurface of the acromion. The results obtained have not allowed us to identify significant differences in the different parameters studied in the two groups, not even in those related to the anatomy of the acromion. Our results, however, do allow us to suggest that rotator cuff tears seem to be more related to a primary degeneration of the cuff itself rather than to the anatomical characteristics of the subacromial space.
Acromion
Rotator cuff injury
Cuff
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Background Anatomic parameters, such as the critical shoulder angle and acromion index, have emerged as methods to quantify scapular anatomy and may contribute to rotator cuff pathology. The purpose of this paper is to investigate the published literature on influences of scapular morphology on the development of re-tears and patient-reported outcomes following rotator cuff repair. Methods A systematic review of the Embase and PubMed databases was performed to identify published studies on the potential influence of scapular bony morphology and re-tear rates and patient-reported outcomes after rotator cuff repair. Studies were reviewed by two authors. Results A total of 615 unique titles and 49 potentially relevant abstracts were reviewed, with eight published manuscripts identified for inclusion. Two of three papers reported no relationship between these acromion index and rotator cuff re-tear rate, while one paper found an increased re-tear rate. All three studies on critical shoulder angle found a significant association between critical shoulder angle and cuff re-tear rate. There was no clear relationship between any bony morphologic measurement and patient-reported outcomes after rotator cuff repair. Conclusions Rotator cuff re-tear rate appears to be significantly associated with the critical shoulder angle and glenoid inclination, while not clearly associated with acromial morphologic measurements.
Acromion
Rotator cuff injury
Cuff
Acromioplasty
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