Acromioclavicular and coracoclavicular PDS augmentation for complete AC joint dislocation showed insufficient properties in a cadaver model

Authors:

Frank Martetschlager, Arne Buchholz, Gunther Sandmann, Sebastian Siebenlist, Stefan Dobele, Alexander Hapfelmeier, Ulrich Stockle, Peter J. Millett, Florian Elser, Andreas Lenich

Abstract:

Acromioclavicular joint dislocation represents a common injury of the superior shoulder suspensory complex comprising different injuries to the acromioclavicular and coracoclavicular ligaments. Most commonly, the mechanism of this injury is a direct force from a fall on the lateral aspect of the shoulder with the arm in an abducted position. Thereby, different forces are responsible for a different type of injury. These injuries have been classified by Rockwood into type I through VI. Typically, type I and II injuries are treated non-operatively, and the vast majority of these patients return to pre-injury status. For acute type III injuries, the favourable treatment is still controversially discussed in the literature, while clinical studies showed similar results for surgical and non-operative treatment. However, in young and active patients as well as high-level athletes and manual workers, surgical intervention is often preferred to allow more rapid rehabilitation and to enable an early return to daily activity. In terms of acute high-grade injuries, typically types Rockwood IV through VI, most authors recommend surgical treatment, as non-operative treatment may lead to residual symptoms like pain, stiffness or decreased range of motion and weakness.

The literature is replete with surgical techniques to address acromioclavicular dislocations, including ligament reconstruction or transfer, augmentation with absorbable/non-absorbable sutures or tendon grafts as well as with rigid materials like plates or CC screws. Since arthroscopic surgery has highly advanced in recent years, several minimally invasive techniques with suture anchors or suture buttons have been invented. Furthermore, combinations of these techniques are also described in the literature.

However, despite modern minimally invasive and arthroscopically assisted treatment options for anatomic reconstruction of the coracoclavicular ligaments, there is still no well-defined gold standard treatment for acromioclavicular joint separations.

Since 1972, when Weaver and Dunn published their popular technique, several biomechanical studies have reported on the latest fashion of AC joint augmentation providing an increasing stability of the reconstructed complex and finally equal or even more stability than native ligaments.

Therefore, it seems that future belongs to recently described, minimal invasive techniques, using anchors or buttons with or without tendon grafts, even though long-term results that might point out unknown complications are still missing. To date, open techniques like reconstructions with absorbable or non-absorbable suture cerclages are still in use for acute AC joint separations and show reliable and good to excellent clinical results, even though slight re-dislocations are reported.

The purpose of the current study was to evaluate the vertical stability of our AC joint reconstruction technique for acute AC joint injuries, using coracoclavicular PDS cerclages and an additional acromioclavicular PDS cerclage augmentation. We hypothesized that this technique provided sufficient vertical stability to prevent a vertical re-dislocation during the healing process.

For the complete study: Acromioclavicular and coracoclavicular PDS augmentation for complete AC joint dislocation showed insufficient properties in a cadaver model

Peter Millett, MD

Average rating:

39 reviews

Alexandra Thompson

Mar 23, 2024

by Alexandra Thompson on Peter Millett, MD

110%

Dr. Millett and his team did a SLAP tear repair and bicep tenodesis on my left shoulder. I use my arms as an artist, and love to swim in the ocean, surf, paddle, and telemark ski. So regaining full use of my shoulder and keeping my bicep attached was very important to me. Now, over two years later, my shoulder has the equivalent range of motion as my other arm and as before the injury, and no pain. After the first three months it felt so good and was so strong that - to my horror - I completely forgot my six-month follow-up.

Not only did Dr. Millett and his team make my arm as good as new, but having had the experience of such kindness and expertise throughout the process of surgery and recovery is like an added shoulder superpower.

Thank you Rita, Brooke, Jason, Sarah, Camille, Olivia, Dr. Millett and everyone! And see you soon when my husband comes in for his knee...

Jeff Chandler

Jan 31, 2022

by Jeff Chandler on Peter Millett, MD

Flawless procedure, Easy recovery

Dr. Millet's repaired my knee and tibia, following a botched operation by a different surgeon. That procedure was virtually pain free and I was weight bearing within a few days. That was 18 years ago and the knee is still strong. A few years after the knee incident, Dr Millet repaired my shoulder. My insurance company approved me for 3 months of disability following that surgery. I was off pain medication in 2 days and had 90% range of motion within a week. I withdrew my disability claim and returned to work within two weeks of surgery. I’m not a famous athlete—just a regular guy. Nonetheless, I was treated like an NFL at the Steadman clinic. Most notable was the time for recovery. Other surgeons perform their hour-long task in the OR and don’t involve themselves in the other functions. Peter and his team manages the entire process from diagnosis, anesthesia, nursing care, and therapy. He takes a holistic approach to patient care and doesn’t skip any steps.

Jenn West

Jul 2, 2021

by Jenn West on Peter Millett, MD

Saved My Life

I went to Dr. Millett after 7 knee surgeries (6 on my right and 1 on my left) and had seen 11 different surgeons who all refused to remove femur metal from my right leg. I am highly allergic to metal and the chronic pain was leaving me bedridden for 3.5wks out of a month. He personally wrote me back on my inquiry, listened to my concerns, scheduled my surgery within a week (due to insurance issues) and personally followed up with my recovery. The level of patient care from Dr. Millett and his ENTIRE team is above any care I have ever received in my 20 years of dealing with orthopedic surgeons. There are not enough words to describe the level of care, dedication and professionalism you receive from Dr. Millett and his staff.
My only disappointment is that I did not find him sooner!!!

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