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Anatomic ligament consolidation of the superior acromioclavicular ligament and the coracoclavicular ligament complex after acute arthroscopically assisted double coracoclavicular bundle stabilization

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The consolidation of the acromioclavicular (AC) and coracoclavicular (CC) ligament complex after arthroscopically assisted stabilization of acute acromioclavicular joint (ACJ) separation is still under consideration.

Methods

Fifty-five consecutive patients after arthroscopically assisted double-CC-bundle stabilization within 14 days after acute high-grade ACJ separation were studied prospectively. All patients were clinically analysed preoperatively (FU0) and post-operatively (FU1 = 6 months; FU2 = 12 months). The structural MRI assessments were performed at FU0 (injured ACJ) and at FU2 bilateral (radiologic control group) and assessed separately the ligament thickness and length at defined regions for the conoid, trapezoid and the superior AC ligament.

Results

Thirty-seven patients were assessed after 6.5 months and after 16.0 months. The 16-month MRI analysis revealed for all patients continuous ligament healing for the CC-complex and the superior AC ligament with in the average hypertrophic consolidation compared to the control side. Separate conoid and trapezoid strands (double-strand configuration) were detected in 27 of 37 (73%) patients, and a single-strand configuration was detected in 10 of 37 (27%) patients; both configurations showed similar CCD data. The ligament healing was not influenced by the point of surgery, age at surgery and heterotopic ossification. The clinical outcome was increased (FU0–FU2): Rowe, 47.7–97.0 pts.; TAFT, 3.9–10.6 pts.; NAS pain, 8.9–1.4 pts. (all P < 0.05).

Conclusion

The arthroscopically assisted double-CC-bundle stabilization within 14 days after acute high-grade ACJ separation showed 16 months after surgery sufficient consolidations of the AC and double-CC ligament complex in 73%.

Level of evidence

III, Case series.

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Acknowledgements

The authors appreciate the assistance of Dr. rer. med. Hanns Ackermann for analysing the data.

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Authors and Affiliations

  1. Department of Sporttraumatology – Knee- and Shoulder-Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstraße 430, 60389, Frankfurt am Main, Germany

    S. Jobmann, J. Buckup, F. Welsch & T. Stein

  2. Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany

    C. Colcuc & R. Hoffmann

  3. Department of Sports medicine, University of Bielefeld, Bielefeld, Germany

    E. Zimmermann & T. Stein

  4. Department of Orthopaedics and Rheumatology, University Hospital Marburg, Marburg, Germany

    P. P. Roessler & K. F. Schüttler

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  1. S. Jobmann
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Correspondence to T. Stein.

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Conflict of interest

The authors declare that they have no conflict of interest.

Funding

The Magnetic Resonance Imaging were partially financed by third-party funds (Fa. Arthrex, Naples, FL/USA). There was no grant number.

Ethical approval

The institutional ethics committee gave the approval to all data collections and randomizing procedures.

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Jobmann, S., Buckup, J., Colcuc, C. et al. Anatomic ligament consolidation of the superior acromioclavicular ligament and the coracoclavicular ligament complex after acute arthroscopically assisted double coracoclavicular bundle stabilization. Knee Surg Sports Traumatol Arthrosc 27, 3168–3179 (2019). https://doi.org/10.1007/s00167-017-4717-1

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