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Complications following arthroscopic fixation of acromioclavicular separations: a systematic review of the literature.

Woodmass JM, Esposito JG, Ono Y, Nelson AA, Boorman RS, Thornton GM, Lo IK - Open Access J Sports Med (2015)

Bottom Line: While these techniques have been reported to provide excellent functional results with minimal complications, discrepancies exist within the literature.Loss of AC joint reduction occurred in 26.8% of patients.Fractures of the coracoid/clavicle remain a significant complication occurring predominately with techniques utilizing bony tunnels.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Section of Orthopaedic Surgery, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada.

ABSTRACT

Purpose: Over the past decade, a number of arthroscopic or arthroscopically assisted reconstruction techniques have emerged for the management of acromioclavicular (AC) separations. These techniques provide the advantage of superior visualization of the base of the coracoid, less soft tissue dissection, and smaller incisions. While these techniques have been reported to provide excellent functional results with minimal complications, discrepancies exist within the literature. This systematic review aims to assess the rate of complications following these procedures.

Methods: Two independent reviewers completed a search of Medline, Embase, PubMed, and the Cochrane Library entries up to December 2013. The terms "Acromioclavicular Joint (MeSH)" OR "acromioclavicular* (text)" OR "coracoclavicular* (text)" AND "Arthroscopy (MeSH)" OR "Arthroscop* (text)" were used. Pooled estimates and 95% confidence intervals were calculated assuming a random-effects model. Statistical heterogeneity was quantified using the I(2) statistic.

Level of evidence: IV.

Results: A total of 972 abstracts met the search criteria. After removal of duplicates and assessment of inclusion/exclusion criteria, 12 articles were selected for data extraction. The rate of superficial infection was 3.8% and residual shoulder/AC pain or hardware irritation occurred at a rate of 26.7%. The rate of coracoid/clavicle fracture was 5.3% and occurred most commonly with techniques utilizing bony tunnels. Loss of AC joint reduction occurred in 26.8% of patients.

Conclusion: Arthroscopic AC reconstruction techniques carry a distinct complication profile. The TightRope/Endobutton techniques, when performed acutely, provide good radiographic outcomes at the expense of hardware irritation. In contrast, graft reconstructions in patients with chronic AC separations demonstrated a high risk for loss of reduction. Fractures of the coracoid/clavicle remain a significant complication occurring predominately with techniques utilizing bony tunnels.

No MeSH data available.


Related in: MedlinePlus

Pooled rate of coracoclavicular calcification.
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f4-oajsm-6-097: Pooled rate of coracoclavicular calcification.

Mentions: A total of four studies described CC calcification with a pooled rate of 31.6% (95% CI: 10.1%–58.4%; I2=85.1%) (Figure 4). There was significant variation amongst the different studies ranging from 0% to 85%. Salzmann et al25 identified CC calcification in seven (30.4%) patients. The calcification was present at 6 months and appeared stable with no change at either the 12-month or the 24-month follow-up. Scheibel et al27 reported 19 (67.9%) patients had evidence of calcification in the area of one or both former ligaments. The calcification was graded as mild in five patients, moderate in eleven patients, and severe in three. Patients with severe calcification showed significantly lower CC distance (P<0.05). Patients with mild ossification scored an average of 93% on subjective shoulder value (SSV), 88.4 points in the Constant score (CS), 9.6 points in the Taft score (TF), and 73 points in the acromioclavicular joint instability score (ACJI). Patients with severe ossification scored 96.1% in the SSV, 91.8 points in the CS, 11.3 points in the TF, and 88.9 points in the ACJI. Only ACJI scores were statistically significantly higher (P<0.05).


Complications following arthroscopic fixation of acromioclavicular separations: a systematic review of the literature.

Woodmass JM, Esposito JG, Ono Y, Nelson AA, Boorman RS, Thornton GM, Lo IK - Open Access J Sports Med (2015)

Pooled rate of coracoclavicular calcification.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4401206&req=5

f4-oajsm-6-097: Pooled rate of coracoclavicular calcification.
Mentions: A total of four studies described CC calcification with a pooled rate of 31.6% (95% CI: 10.1%–58.4%; I2=85.1%) (Figure 4). There was significant variation amongst the different studies ranging from 0% to 85%. Salzmann et al25 identified CC calcification in seven (30.4%) patients. The calcification was present at 6 months and appeared stable with no change at either the 12-month or the 24-month follow-up. Scheibel et al27 reported 19 (67.9%) patients had evidence of calcification in the area of one or both former ligaments. The calcification was graded as mild in five patients, moderate in eleven patients, and severe in three. Patients with severe calcification showed significantly lower CC distance (P<0.05). Patients with mild ossification scored an average of 93% on subjective shoulder value (SSV), 88.4 points in the Constant score (CS), 9.6 points in the Taft score (TF), and 73 points in the acromioclavicular joint instability score (ACJI). Patients with severe ossification scored 96.1% in the SSV, 91.8 points in the CS, 11.3 points in the TF, and 88.9 points in the ACJI. Only ACJI scores were statistically significantly higher (P<0.05).

Bottom Line: While these techniques have been reported to provide excellent functional results with minimal complications, discrepancies exist within the literature.Loss of AC joint reduction occurred in 26.8% of patients.Fractures of the coracoid/clavicle remain a significant complication occurring predominately with techniques utilizing bony tunnels.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Section of Orthopaedic Surgery, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada.

ABSTRACT

Purpose: Over the past decade, a number of arthroscopic or arthroscopically assisted reconstruction techniques have emerged for the management of acromioclavicular (AC) separations. These techniques provide the advantage of superior visualization of the base of the coracoid, less soft tissue dissection, and smaller incisions. While these techniques have been reported to provide excellent functional results with minimal complications, discrepancies exist within the literature. This systematic review aims to assess the rate of complications following these procedures.

Methods: Two independent reviewers completed a search of Medline, Embase, PubMed, and the Cochrane Library entries up to December 2013. The terms "Acromioclavicular Joint (MeSH)" OR "acromioclavicular* (text)" OR "coracoclavicular* (text)" AND "Arthroscopy (MeSH)" OR "Arthroscop* (text)" were used. Pooled estimates and 95% confidence intervals were calculated assuming a random-effects model. Statistical heterogeneity was quantified using the I(2) statistic.

Level of evidence: IV.

Results: A total of 972 abstracts met the search criteria. After removal of duplicates and assessment of inclusion/exclusion criteria, 12 articles were selected for data extraction. The rate of superficial infection was 3.8% and residual shoulder/AC pain or hardware irritation occurred at a rate of 26.7%. The rate of coracoid/clavicle fracture was 5.3% and occurred most commonly with techniques utilizing bony tunnels. Loss of AC joint reduction occurred in 26.8% of patients.

Conclusion: Arthroscopic AC reconstruction techniques carry a distinct complication profile. The TightRope/Endobutton techniques, when performed acutely, provide good radiographic outcomes at the expense of hardware irritation. In contrast, graft reconstructions in patients with chronic AC separations demonstrated a high risk for loss of reduction. Fractures of the coracoid/clavicle remain a significant complication occurring predominately with techniques utilizing bony tunnels.

No MeSH data available.


Related in: MedlinePlus