Mid to long-term results of open acromioclavicular-joint reconstruction using polydioxansulfate cerclage augmentation

S Greiner, J Braunsdorf, C Perka, S Herrmann, S Scheffler
Archives of Orthopaedic and Trauma Surgery 2009, 129 (6): 735-40

INTRODUCTION: There is still controversy about the optimal operative treatment of acromioclavicular (AC)-joint dislocations. However, in the current literature, only few studies are available on mid- to long-term results of different stabilization methods. This retrospective study presents the clinical and radiographical results after open reduction and stabilization of AC-joint dislocations using polydioxanesulfate (PDS) cerclage augmentation.

METHODS: Fifty patients with a mean age of 35 years were treated with open reduction and PDS cerclage augmentation. Rockwood classification showed 44 type V, 5 type III and 1 type IV AC-joint dislocation. The clinical and radiographic follow-up (Constant Score, DASH Score, subjective shoulder value and stress radiographs of the shoulder girdle) were performed postoperatively at an average of 70 months.

RESULTS: Clinical scores were good to excellent with a mean constant score of 91.7 +/- 8.7 points. The mean DASH Score was 5 +/- 8.8 points and the mean subjective shoulder value was 92 +/- 10.7. Radiographically, 80% showed a difference of coracoclavicular distance in comparison to the contralateral side of <5 mm, 14% of 5-10 mm and 6% of >10 mm. Radiographical signs of osteoarthritis were present in 37 and in 6% of all patients also evident during clinical examination. Coracoclavicular calcifications were seen in 68%. Complications were: one superficial wound infection, one extensive coracoclavicular calcification and two complete secondary redislocations.

CONCLUSIONS: Treatment of AC-joint dislocation using PDS cerclage augmentation leads to good to excellent clinical results. However, mid- to long-term follow-up reveals a high incidence of radiographic signs of osteoarthritis of the AC-joint. Whether this is due to the surgical technique and could be reduced using other, more anatomical fixation techniques or whether the injury itself leads to these changes, need to be shown.

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