Treatment of Complete Acromioclavicular Dislocation: Present Indications and Surgical Technique with Biodegradable Cords

We report a retrospective study of 48 patients with complete acromioclavicular dislocation (Tossy III). All patients (38 male; 10 female) with an average age of 33.4 years underwent surgery including PDS-augmentation. More than half of the injuries were caused by sport accidents. There were no complications during surgery. 87 % of the patients were free of complaints and subjectively very satisfied with the surgical results. By radiological examination we diagnosed a subluxation of the clavicula in 25 % of the cases and arthrosis in 17 % of the cases. Assessment of subjective complaints, the clinical examination, and the radiological diagnostic according to the Taft Score (0 - 12 points) resulted in an average value of 10.2 points. The surgical intervention using PDS-cord augmentation in cases of complete acromioclavicular separation is a safe and economic method with a low complication rate. Advantages are possible early-functional treatment, no risk of movement of implants, and avoidance of metal removal.

Acromioclavicular dislocation - PDS-cords - Tossy III - biodegradable material

References

• 1 Bannister G C. The management of acute acromioclavicular dislocation. A randomised prospective controlled trial.  J Bone Joint Surg B. 1989;  71 848-850
• 2 Fenkl R, Gotzen L. Ultrasound diagnosis of the injured acromio-clavicular joint.  Unfallchirurg. 1992;  95 393-400
• 3 Fremerey R W, Lobenhoffer P, Bosch U, Freudenberg E, Tscherne H. Operative treatment for acute, complete acromioclavicular dislocations: indication, technique and results.  Unfallchirurg. 1996;  99 341-345
• 4 Göhring U, Matusewicz A, Friedl W, Ruf W. Behandlungsergebnisse nach unterschiedlichen Operationsverfahren zur Versorgung einer Schultereckgelenksprengung.  Chirurg. 1993;  64 565-571
• 5 Gollwitzer M. Surgical management of complete acromioclavicular joint dislocation with PDS cord cerclage.  Akt Trauma. 1993;  23 366-370
• 6 Haas N, Blauth M. Verletzungen des Akromio- und Sternoklavikulargelenkes - operative oder konservative Therapie?.  Orthopäde. 1989;  18 234
• 7 Hessmann M. Reconstruction of complete acromioclavicular seperations using PDS-banding as augmentation: experience in 64 cases.  Acta Chir Belg. 1995;  95 147-151
• 8 Keller H W, Rehm K E. Treatment of acromioclavicular dislocation without metallic implants.  Unfallchirurg. 1991;  94 511-513
• 9 Larsen E, Bjerg-Nielsen A, Christensen P. Conservative or surgical treatment of AC dislocation.  J Bone Joint Surg. 1986;  68-A 552-555
• 10 Pfahler M, Krödel A, Refior H J. Surgical treatment of acromioclavicular dislocation.  Arch Orthop Trauma Surg. 1994;  113 308-311
• 11 Rawes M L, Dias J J. Surgical treatment of acromioclavicular dislocation.  Bone Joint Surg. 1996;  78-B 410-412
• 12 Rehm K E. Versorgung der Schultereckgelenksprengung ohne metallisches Implantat. In: Refior HJ, Plitz W, Jäger M, Hackenbroich MH (eds) Biomechanik der gesunden und kranken Schulter. Stuttgart, New York; Thieme 1985: 47-48
• 13 Rehm K E, Schultheis K H. Bandersatz mit Polydioxanon (PDS®).  Unfallchirurgie. 1985;  11 264
• 14 Rockwood C A, Young D C. Disorders of the acromioclavicular joint. In: Rockwood CA, Matsen FA (eds) The shoulder. Philadelphia, London, Toronto; Saunders 1990: 413-476
• 15 Rüstemeyer M, Kulenkampf H A. Surgical treatment of acromioclavicular separation with a self-resorbing cord of polydioxane.  Unfallchirurgie. 1990;  16 70-74
• 16 Sim E, Schwarz N, Höcker K, Berzlanovich A. Repair of complete acromioclavicular separations using the acromioclavicular-hook-plate.  Clin Orthop. 1995;  314 134-142
• 17 Taft T N, Wilson F C, Oglesby J W. Dislocation of the acromioclavicular joint. An end-result study.  J Bone Joint Surg. 1987;  69-A 1045-1051
• 18 Thelen E, Rehn J. Akromioklavikularsprengungen - Ergebnisse nach operativer und konservativer Versorgung in 162 Fällen.  Unfallheilkunde. 1976;  79 417-422
• 19 Tossy J D, Sigmond H M. Acromioclavicular separations: useful and practical classification for treatment.  Clin Orthop. 1963;  28 111-119
• 20 Weinstein D M. Surgical treatment of complete acromioclavicular dislocations.  Am J Sports. 1995;  23 324-331