A Self-Designed Endobutton Installation Device for Coracoclavicular Stabilization in Acute Rockwood Type III Acromioclavicular Joint Dislocation

Abstract

Objective: Endobutton technique could provide flexible coracoclavicular (CC) stabilization for acromioclavicular joint (ACJ) dislocation and achieved good clinical outcomes. However, the difficult part of this technique was placement of the Endobutton to the coracoid base. In this study, we designed an Endobutton installation device to place the Endobutton at the coracoid base. And we examined the clinical and radiographic outcomes of patients with acute Rockwood type III ACJ dislocation repaired with Endobutton using this device.

Methods: We designed an Endobutton installation device to place the Endobutton at the coracoid base to achieve CC stabilization. We retrospectively reviewed 42 patients with acute Rockwood type III ACJ dislocation who underwent CC stabilization with Endobuttons placed either using this novel device (group I, n = 19) or the traditional technique (CC stabilization without using special device, group II, n = 23) from January 2015 to April 2020. The two groups were compared regarding the operative time, intraoperative blood loss, and clinical and radiologic outcomes at final follow-up. The operation-related complications were also evaluated. The Student's t test and the Mann–Whitney U-test were used to compare differences in continuous variables. Differences in categorical variables were assessed with either the Pearson's chi-squared test or Fisher's exact test.

Results: Forty-two patients were clinically followed up for a minimum of 12 months. Compared with group II, group I had a significantly shorter mean operative time (56.05 ± 7.82 min vs. 65.87 ± 7.43 min, p < 0.01) and significantly lesser mean intraoperative blood loss (67.89 ± 14.75 mL vs. 94.78 ± 25.01 mL, p < 0.01). At final follow-up, there were no significant differences between the two groups in the visual analog scale score for pain, Oxford Shoulder Score, Disabilities of the Arm, Shoulder, and Hand score, and postoperative CC distance of the affected side. Loss of reduction occurred in four patients in group I and three patients in group II (p = 0.68); there were no other operation-related complications in either group.

Conclusions: The Endobutton installation device makes placement of the Endobutton at the coracoid base easier and achieves satisfactory clinical and radiologic outcomes without additional complications in acute Rockwood type III ACJ dislocation.

Keywords

Acromioclavicular Joint / Coracoclavicular Ligament / Dislocation / Endobutton / Stabilization

References

[1] Haugaard KB, Bak K, Seem K, Holmich P, Barfod KW. Rockwood type III is the most common type of acromioclavicular joint dislocation: a prospective cohort study investigating the incidence and epidemiology of acute acromioclavicular joint dislocations in an urban population. Shoulder Elbow. 2023;15(5):505–512.

[2] Skjaker SA, Enger M, Engebretsen L, Brox JI, Boe B. Young men in sports are at highest risk of acromioclavicular joint injuries: a prospective cohort study. Knee Surg Sports Traumatol Arthrosc. 2021;29(7):2039–2045.

[3] Cook JB, Shaha JS, Rowles DJ, Bottoni CR, Shaha SH, Tokish JM. Clavicular bone tunnel malposition leads to early failures in coracoclavicular ligament reconstructions. Am J Sports Med. 2013;41(1):142–148.

[4] Ferreira JV, Chowaniec D, Obopilwe E, Nowak MD, Arciero RA, Mazzocca AD. Biomechanical evaluation of effect of coracoid tunnel placement on load to failure of fixation during repair of acromioclavicular joint dislocations. Arthroscopy. 2012;28(9):1230–1236.

[5] Giai Via R, Bosco F, Giustra F, Lavia AD, Artiaco S, Risitano S, et al. Acute Rockwood type III ACJ dislocation: conservative vs surgical approach. A systematic review and meta-analysis of current concepts in literature. Injury. 2022;53(10):3094–3101.

[6] De Rooij PP, Van Lieshout EMM, Schurink IJ, Verhofstad MHJ, group ACJis. Current practice in the management of acromioclavicular joint dislocations; a national survey in The Netherlands. Eur J Trauma Emerg Surg. 2021;47(5):1417–1427.

[7] Korsten K, Gunning AC, Leenen LP. Operative or conservative treatment in patients with Rockwood type III acromioclavicular dislocation: a systematic review and update of current literature. Int Orthop. 2014;38(4):831–838.

[8] Beris A, Lykissas M, Kostas-Agnantis I, Vekris M, Mitsionis G, Korompilias A. Management of acute acromioclavicular joint dislocation with a double-button fixation system. Injury. 2013;44(3):288–292.

[9] Yoo YS, Khil EK, Im W, Jeong JY. Comparison of hook plate fixation versus arthroscopic coracoclavicular fixation using multiple soft anchor knots for the treatment of acute high-grade acromioclavicular joint dislocations. Arthroscopy. 2021;37(5):1414–1423.

[10] Nolte PC, Lacheta L, Dekker TJ, Elrick BP, Millett PJ. Optimal Management of Acromioclavicular Dislocation: current perspectives. Orthop Res Rev. 2020;12:27–44.

[11] Hachem AI, Rondanelli R, Costa G, Verdalet I, Ezzeddine H, Rius X. Arthroscopically assisted comprehensive double cerclage suture fixation technique for acute acromioclavicular joint separation. Arthrosc Tech. 2020;9(10):e1495–e1504.

[12] Stucken C, Cohen SB. Management of acromioclavicular joint injuries. Orthop Clin North Am. 2015;46(1):57–66.

[13] Filho RB, Freitas MM, Nunes RHR, Tenor Junior AC, Costa MPD, Roberto RA. Acromioclavicular, coracoclavicular and medial Coracoclavicular ligaments assessment in acromioclavicular dislocation. Rev Bras Ortop. 2021;56(6):777–783.

[14] Torkaman A, Bagherifard A, Mokhatri T, Haghighi MH, Monshizadeh S, Taraz H, et al. Double-button fixation system for Management of Acute Acromioclavicular Joint Dislocation. Arch Bone Jt Surg. 2016;4(1):41–46.

[15] Pan Z, Zhang H, Sun C, Qu L, Cui Y. Arthroscopy-assisted reconstruction of coracoclavicular ligament by Endobutton fixation for treatment of acromioclavicular joint dislocation. Arch Orthop Trauma Surg. 2015;135(1):9–16.

[16] Hu F, Han S, Liu F, Wang Z, Jia H, Wang F, et al. A modified single-endobutton technique combined with nice knot for treatment of Rockwood type III or V acromioclavicular joint dislocation. BMC Musculoskelet Disord. 2022;23(1):15.

[17] Mori D, Yamashita F, Kizaki K, Funakoshi N, Mizuno Y, Kobayashi M. Anatomic coracoclavicular ligament reconstruction for the treatment of acute acromioclavicular joint dislocation: minimum 10-year follow-up. JBJS Open Access. 2017;2(3):e0007.

[18] Yoon JP, Lee BJ, Nam SJ, Chung SW, Jeong WJ, Min WK, et al. Comparison of results between hook plate fixation and ligament reconstruction for acute unstable acromioclavicular joint dislocation. Clin Orthop Surg. 2015;7(1):97–103.

[19] Zhu Y, Hsueh P, Zeng B, Chai Y, Zhang C, Chen Y, et al. A prospective study of coracoclavicular ligament reconstruction with autogenous peroneus longus tendon for acromioclavicular joint dislocations. J Shoulder Elbow Surg. 2018;27(6):e178–e188.

[20] Baunach D, Eid K, Ricks M, Borbas P. Long-term clinical and radiological results after hook plate osteosynthesis of lateral clavicle fractures. J Orthop Trauma. 2021;35(7):378–383.

[21] Manohara R, Reid JT. Percutaneous endobutton fixation of acute acromioclavicular joint injuries and lateral clavicle fractures. J Clin Orthop Trauma. 2019;10(3):492–496.

[22] Yagnik GP, Porter DA, Jordan CJ. Distal clavicle fracture repair using cortical button fixation with coracoclavicular ligament reconstruction. Arthrosc Tech. 2018;7(4):e411–e415.

[23] Civan O, Atmaca H, Ugur L. Biomechanical comparison of double versus triple button reconstruction techniques in patients with acromioclavicular joint dislocation. Int J Med Robot. 2020;16(1):e2057.

[24] Wang YC, Yong M, Wei-zhong Y, Wang H. Surgical treatment of acute Rockwood III acromioclavicular dislocations-comparative study between two flip-button techniques. Sci Rep. 2020;10(1):4447.

[25] Spoliti M, De Cupis M, Via AG, Oliva F. All arthroscopic stabilization of acute acromioclavicular joint dislocation with fiberwire and endobutton system. Muscles, Ligaments Tendons J. 2014;4(4):398–403.

[26] Struhl S, Wolfson TS. Continuous loop double Endobutton reconstruction for acromioclavicular joint dislocation. Am J Sports Med. 2015;43(10):2437–2444.

[27] Wellmann M, da Silva G, Lichtenberg S, Magosch P, Habermeyer P. Instability pattern of acromioclavicular joint dislocations type Rockwood III: relevance of horizontal instability. Orthopade. 2013;42(4):271–277.

[28] Salzmann GM, Walz L, Buchmann S, Glabgly P, Venjakob A, Imhoff AB. Arthroscopically assisted 2-bundle anatomical reduction of acute acromioclavicular joint separations. Am J Sports Med. 2010;38(6):1179–1187.

[29] Grantham C, Heckmann N, Wang L, Tibone JE, Struhl S, Lee TQ. A biomechanical assessment of a novel double endobutton technique versus a coracoid cerclage sling for acromioclavicular and coracoclavicular injuries. Knee Surg Sports Traumatol Arthrosc. 2016;24(6):1918–1924.

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2024 2024 The Authors. Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.