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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 coracoid or clavicle fracture.
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f5-oajsm-6-097: Pooled rate of coracoid or clavicle fracture.

Mentions: A total of nine studies reported on coracoid or clavicle fractures. The pooled rate of fracture was 5.3% (95% CI: 2.5%–9.1%; I2=6.2%)(Figure 5). This included seven coracoid fractures and one clavicle fracture. The single clavicle fracture was described by Kany et al20 who attributed this to technical error resulting from multiple passes of the drill through the clavicle during implant positioning. The procedure was converted to an open procedure and the clavicle was plated. A total of seven coracoid fractures were reported (Table 1); the majority (n=6; 87%) of these occurred in patients treated with coracoid tunnel techniques. These occurred in both single and double tunnel techniques. Tomlinson et al17 reported the only coracoid fracture following a coracoid loop fixation technique. This fracture occurred 7-months postoperatively in an active baseball player while pitching.


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 coracoid or clavicle fracture.
© Copyright Policy
Related In: Results  -  Collection

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

f5-oajsm-6-097: Pooled rate of coracoid or clavicle fracture.
Mentions: A total of nine studies reported on coracoid or clavicle fractures. The pooled rate of fracture was 5.3% (95% CI: 2.5%–9.1%; I2=6.2%)(Figure 5). This included seven coracoid fractures and one clavicle fracture. The single clavicle fracture was described by Kany et al20 who attributed this to technical error resulting from multiple passes of the drill through the clavicle during implant positioning. The procedure was converted to an open procedure and the clavicle was plated. A total of seven coracoid fractures were reported (Table 1); the majority (n=6; 87%) of these occurred in patients treated with coracoid tunnel techniques. These occurred in both single and double tunnel techniques. Tomlinson et al17 reported the only coracoid fracture following a coracoid loop fixation technique. This fracture occurred 7-months postoperatively in an active baseball player while pitching.

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