• Acromioclavicular dislocation
• Dermal allograft
• Hook plate
• Superior acromioclavicular ligament reconstruction

• Humans
• Acromioclavicular Joint/surgery
• Male
• Female
• Acellular Dermis
• Bone Plates
• Adult
• Retrospective Studies
• Treatment Outcome
• Ligaments, Articular/surgery
• Middle Aged
• Plastic Surgery Procedures/methods
• Joint Dislocations/surgery
• Range of Motion, Articular
• Allografts
• Clavicle/surgery
• Clavicle/injuries

• acromioclavicular joint
• clavicular hook plate
• endobutton
• implant failure
• joint dislocation
• postoperative infection
• subacromial erosion
• articulation acromio-claviculaire
• plaque à crochets claviculaire
• endobouton
• échec implantaire
• luxation articulaire
• infection postopératoire
• érosion sous-acromiale

• Female
• Humans
• Male
• Acromioclavicular Joint/surgery
• Bone Plates/adverse effects
• Clavicle/surgery
• Fracture Fixation, Internal/adverse effects
• Fracture Fixation, Internal/instrumentation
• Fracture Fixation, Internal/methods
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Range of Motion, Articular
• Treatment Outcome

• Humans
• Acromioclavicular Joint/injuries
• Acromioclavicular Joint/surgery
• Joint Dislocations/surgery
• Osteoarthritis/epidemiology
• Osteoarthritis/etiology
• Osteoarthritis/prevention & control

• Clavicular hook plate
• acromioclavicular dislocation
• meta-analysis
• subacromial osteolysis

• Humans
• Acromioclavicular Joint/surgery
• Acromioclavicular Joint/injuries
• Bone Plates/adverse effects
• Joint Dislocations/surgery
• Osteolysis/etiology
• Osteolysis/epidemiology
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology

• AC joint reconstruction
• Acromioclavicular joint injuries
• Biomechanical
• High grade injuries
• Innovating strategies
• Surgical techniques

• coracoclavicular
• hook plate
• joint dislocation
• kirschner wire
• ligament allograft tendon

• Humans
• Joint Dislocations/surgery
• Acromioclavicular Joint/surgery
• Treatment Outcome
• Shoulder Dislocation/surgery
• Bone Plates
• Sutures
• Pain

• Acute acromioclavicular joint dislocation
• Coracoclavicular distance
• Non-weighted panorama views
• Pseudoelevation of the clavicle
• Rockwood classification
• Vertical displacement
• Weighted panorama views

• Acromioclavicular joint
• Distal clavicle
• Hardware removal
• Stabilization
• Suture button

• Humans
• Clavicle/surgery
• Clavicle/injuries
• Acromioclavicular Joint/surgery
• Acromioclavicular Joint/injuries
• Fractures, Bone/surgery
• Fracture Fixation, Internal/methods
• Sutures

• Acromioclavicular joint
• Acute dislocation
• Clavicle hook plate
• Clinical outcomes
• Double-button repair
• Meta-analysis
• Systematic review

• Humans
• Clavicle/surgery
• Acromioclavicular Joint/surgery
• Shoulder Dislocation/surgery
• Joint Dislocations/surgery
• Bone Plates
• Treatment Outcome
• Randomized Controlled Trials as Topic
• Observational Studies as Topic

• University of Pretoria

• AC joint
• Acromioclavicular
• Shoulder
• Shoulder stabilization

• Humans
• Young Adult
• Acromioclavicular Joint/injuries
• Acromioclavicular Joint/surgery
• Arthroscopy/methods
• Joint Dislocations/surgery
• Shoulder Dislocation/surgery
• Treatment Outcome

• Private Universität Witten/Herdecke gGmbH (3128)

• Acromioclavicular joint dislocations
• Sports medicine
• Surgical techniques
• Trauma

• ACJ
• Acromioclavicular separation
• Acute
• Direct fixation
• High-grade
• Tendon graft

• Acromioclavicular Joint
• Clavicle
• Joint Dislocations
• Surgical Procedures

• Acromioclavicular injury
• Acromioclavicular joint
• Acromioclavicular ligament
• Coracoclavicular ligament
• Reconstruction
• Stabilization

• Acromioclavicular joint dislocation
• Arthroscopic treatment
• Minimally invasive treatment
• Three-incision

• AC joint
• Acromioclavicular joint
• Acromioclavicular joint reconstruction
• Anatomic acromioclavicular joint reconstruction
• Horizontal instability
• Vertical instability

• Acromioclavicular joint dislocation
• Acromioclavicular joint reconstruction
• Coracoclavicular ligament reconstruction
• Hook plate fixation

• AC joint dislocation
• Acromioclavicular joint dislocation
• acromioclavicular joint separation
• hook plate
• physiotherapy
• randomized study
• surgery

• Acromioclavicular separation
• Alexander view
• Double button
• Dynamic horizontal instability
• Single tunnel
• Vertical stability

• Humans
• Acromioclavicular Joint/surgery
• Treatment Outcome
• Arthroscopy/methods
• Shoulder Dislocation/surgery
• Joint Instability/surgery
• Joint Dislocations/surgery
• Ligaments, Articular

• AC joint
• AC joint repair
• AC joint separation
• Acromioclavicular joint
• Return to play criteria
• Shoulder

• AC joint stabilization
• Acromioclavicular joint injury
• Acromioclavicular joint instability
• Arthroscopically assisted
• Hardware removal
• Loss of reduction

• Acromioclavicular joint
• Acromioclavicular ligament
• Acute dislocation
• Dynamic horizontal instability
• Ligament healing

Purpose: Operative therapy for unstable lateral clavicle fractures is necessary to reduce the risk of bony non-union. Irritation and restriction during sportive activities due to the implanted materials are a common reason for impaired function and implant removal. The aim of this study was to gain information on functional outcome and time until return to sport (RTS) after surgical treatment of unstable lateral clavicle fractures, comparing two coracoclavicular button techniques. Methods: A retrospective chart review of patients who were consecutively treated for unstable lateral clavicle fractures at our level one trauma center from 2014 to 2018 was conducted. Two different surgical techniques were evaluated and compared. Group 1 was treated using a locking compression plate and knotted DogBone™ Button, while group 2 received an LCP and knotless DogBone™ Button. Functional outcome (ASES (American Shoulder and Elbow Score), Constant-Score, DASH (Disability of Arm, Shoulder and Hand), MSQ (Munich Shoulder Questionnaire) and SPADI (Shoulder Pain and Disability Index) and time until RTS were investigated and compared between both groups, 1 year postoperatively. Results: A total of 56 patients (n = 35 group 1, n = 21 group 2) with a mean age of 45.1 ± 14.6 years met the inclusion criteria. Functional outcome reached good to excellent results (ASES 94.7 ± 9.8, Constant Score 85.1 ± 8.1, DASH 5.5 ± 8.4, MSQ 90.9 ± 7.2, SPADI 96.1 ± 5.7). Implant removal rates were higher in group 1 (48.3% vs. 35.3%) yet without statistical significance (p = 0.122). All patients returned to sports postoperatively with a mean time period until return to sport of 4.6 (3–9) months. Conclusion: Locking compression plating and coracoclavicular fixation using a knotless Dogbone™ technique provides good to excellent functional outcomes, a high and fast rate of return to sport and lower irritation rates compared to the knotted DogBone™ technique.

• ORIF
• arthroscopy
• clavicle
• fracture
• lateral
• return to sport

• AC dislocation
• Acromioclavicular joint
• TightRope system
• clavicle fracture
• coracoclavicular ligament
• surgery

• Acromiohumeral distance
• functional outcome
• massive rotator cuff tear
• rotator cuff healing
• rotator cuff repair
• stress radiography

• Acromioclavicular
• Acromioclavicular ligament
• Biologic
• Coracoclavicular ligament
• Dislocation
• Instability
• Plate
• Reconstruction
• Screws
• Synthetic
• Tendon graft

The treatment of Rockwood Grade-III acromioclavicular (AC) joint separation has been widely disputed since the introduction of the classification system. The present literature does not reach consensus on whether operative or nonoperative management is more advantageous, nor does it effectively distinguish between operative measures. We hypothesized that nonoperative treatment of Rockwood Grade-III AC joint separation would be more cost-effective when compared with surgical options.

We created a decision-tree model outlining the treatment of Rockwood Grade-III separations using nonoperative management or hook-plate, suture-button, or allograft fixation. After nonoperative intervention, the possible outcomes predicted by the model were uneventful healing, delayed operative management, a second round of sling use and physical therapy, or no reduction and no action; and after operative intervention, the possible outcomes were uneventful healing, loss of reduction and revision, and depending on the implant, loss of reduction and no action, or removal of the implant. A systematic review was conducted, and probabilities of each model state were averaged. A cost-effectiveness analysis was conducted both through rollback analysis yielding net monetary benefit and through incremental cost-effectiveness ratios (ICERs). Thresholds of $50,000/quality-adjusted life-year (QALY) and $100,000/QALY were used for ICER analysis. Furthermore, a sensitivity analysis was utilized to determine whether differential probabilities could impact the model.

Forty-five papers were selected from a potential 768 papers identified through our literature review. Nonoperative treatment was used as our reference case and showed dominance over all 3 of the operative measures at both the $50,000 and $100,000 ICER thresholds. Nonoperative treatment also showed the greatest net monetary benefit. Nonoperative management yielded the lowest total cost ($6,060) and greatest utility (0.95 QALY). Sensitivity analysis showed that allograft fixation became the favored technique at a willingness-to-pay threshold of $50,000 if the rate of failure of nonoperative treatment rose to 14.6%. Similarly, at the $100,000 threshold, allograft became dominant if the probability of failure of nonoperative treatment rose to 22.8%.

The cost-effectiveness of nonoperative treatment is fueled by its notably lower costs and overall high rates of success in Grade-III separations. It is important to note that, in our analysis, the societal cost (measured in lost productivity) of nonoperative treatment neared that of surgical treatment, but the cost from the health-care system perspective was minimal. Physicians should bear in mind the sensitivity of these conclusions and should consider cost-effectiveness analyses in their decision-making guidelines.

Economic and Decision Analysis Level IV. See Instructions for Authors for a complete description of levels of evidence.

• Shoulder
• acromioclavicular joint dislocation
• coracoclavicular reconstruction
• instability
• outcome
• treatment

Acromioclavicular (AC) separation can be treated with the use of a hook plate. Some studies have reported that coracoclavicular (CC) ligament augmentation is necessary to reduce the complications of hook plate fixation, whereas others recommend hook plate fixation alone without augmentation. The aim of this study was to compare the results and complications between these two groups.

This was an observational case-control study. Patients with acute (less than 2 weeks) Rockwood type V AC separation were treated with a hook plate at our hospital. A total of 105 cases received hook plate fixation with CC ligament augmentation (group I), and 112 cases received hook plate fixation without augmentation (group II). Constant-Murley scores were used to evaluate the function before and after implant removal, and radiographs were taken to evaluate the complications. The results and complications were compared between groups.

Before removal, the Constant-Murley score was significantly higher in group I (mean, 50.1) than in group II (mean, 42.6) (p = 0.004); however, there was no significant difference between groups at 3 and 6 months after removal. The incidence of significant acromion osteolysis was higher in group II (65/112) than in group I (25/105). Before removal, the patients with significant acromion osteolysis had worse Constant-Murley scores than those of the patients without osteolysis in both groups. The incidence of peri-implant fracture of the hook plate was higher in group II (8/112) than in group I (1/105).

The patients without CC ligament augmentation had worse functional results before hook plate removal, a higher incidence of radiographic acromion osteolysis, and a higher incidence of peri-implant fractures than those patients with CC ligament augmentation. Therefore, CC ligament augmentation is highly recommended to improve short-term outcomes and decrease complications for Rockwood type V AC separation treated by hook plate.

• Acromioclavicular separation
• Augmentation
• Coracoclavicular ligament
• Hook plate

To reconstruct the acromioclavicular (AC) joint using an adjusted closed‐loop double Endobutton technique via a guiding locator that was applied using three‐dimensional (3D) printing technology. At the same time, the reliability and safety of the novel double Endobutton (NDE) were tested by comparing the biomechanics of this technique with the TightRope (TR) approach.

This retrospective study was conducted between January 2017 and January 2019. The Department of Anatomy at Southern Medical University obtained 18 fresh‐frozen specimens (8 left and 10 right; 12 men and 6 women). First, the guiding locators were applied using 3D printing technology. After preparation of materials, specimens were divided into an NDE group, a TR group, and a normal group. In the NDE and TR groups, the navigation module was used to locate and establish the bone tunnels; after that, the NDE or TR was implanted. However, the Endobuttons were fixed while pressing the distal clavicle downwards and the length of the loop could be adjusted by changing the upper Endobutton in the NDE group while the suture button construct was tensioned and knotted after pressing down the distal clavicle in the TR. Finally, load testing in anterior–posterior (AP), superior–inferior (SI), and medial–lateral (ML) directions as well as load‐to‐failure testing in the SI direction were undertaken to verify whether the NDE or TR had better biomechanics.

In the load testing, the displacements of the NDE and TR groups in the AP, SI, and ML direction were significantly shorter than those of the normal group (P < 0.05). In the load‐to‐failure testing, the ultimate load of the NDE and TR groups had significantly higher increases than the normal group (722.16 ± 92.04 vs 564.63 ± 63.05, P < 0.05; 680.20 ± 110.29 vs 564.63 ± 63.05, P < 0.05). However, there was no statistically significant difference between the two techniques for these two tests (P > 0.05). In the NDE group, four of six failures were a result of tunnel fractures of the coracoid, while two of six were due to suture breakage. In the TR, three failures were due to coracoid tunnel fractures, one was a result of a clavicle tunnel fracture, and the rest were due to suture breakage. In the normal group, half of the failures were a result of avulsion fractures of the conical ligament at the point of the coracoid process, and the other three were due to rupture of the conical ligament, fracture of the distal clavicle, and fracture of the scapular body.

As for the TR technique, the stability and strength of the AC joint were better in patients who underwent reconstruction using the NDE technique than in the intact state.

• Acromioclavicular joint dislocation
• Guiding locator
• Novel double Endubutton technique
• TightRope technique

• Aromioclavicular joint dislocation
• Coracoclavicular ligament augmentation
• Coracoclavicular ligaments
• Highgrade ac-joint dislocation
• Minimal-invasive repair
• Rockwood’s classification

The aim of this study was to investigate the effect of reduction loss of more than 3 mm on clinical and radiological results after at least 2 years of follow-up after arthroscopic fixation of acute acromioclavicular joint dislocations using a double-button device.

Thirty-six patients who had acute (< 3 weeks old), type III or V acromioclavicular (AC) joint dislocations underwent arthroscopic fixation of the AC joint using a double-button device. Clinical and radiological evaluations were performed at preoperative, postoperative first day, 3 months and last follow-up. When the coracoclavicular (CC) distances of patients at the last follow-up were compared to the early postop CC distances, those with a difference of 3 mm or less were grouped as group A and those with a difference of more than 3 mm were grouped as group B.

There was no statistically significant difference between the groups in terms of age, gender, follow-up time, time from injury to surgery, return to work, and distribution of Rockwood classification. Pre-operative CC distance was reduced from 18.7 ± 3.5 to 8.5 ± 0.6 in the early postoperative period. Anatomic reduction was achieved in all patients compared with the unaffected side (CC distance 8.6 ± 0.7). However, the CC distance increased to 9.9 ± 1.5 at the third-month follow-up and increased to 11 ± 2.7 at the last follow-up. There were no significant Constant score differences between the groups in the preoperative and last follow-up periods (p > 0.05). At the last follow-up, the mean Acromioclavicular Joint Instability (ACJI) score of group A was 84.4 ± 8, whereas it was 68.3 ± 8.3 for group B, and the difference was statistically significant (p < 0.01). Furthermore, the subjective evaluation and aesthetic subjective satisfaction values of group B were lower than group A (p < 0.01).

Reduction loss of more than 3 mm was observed in 25% of patients after arthroscopic fixation of acute acromioclavicular dislocations using a double-button device. Although this loss did not create a statistically significant difference in Constant scores, AC joint-specific tests such as ACJI, subjective evaluation, and aesthetic subjective satisfaction values were significantly impaired.

• Acromioclavicular joint
• Arthroscopy
• Coracoclavicular distance
• Dislocation
• Endobutton

• acromioclavicular joint dislocation
• arthroscopy
• hook plate
• meta-analysis
• suture button

• AC joint injury
• AC joint reconstruction
• acromioclavicular joint

• acromioclavicular joint
• acromioclavicular reconstruction
• complications
• loss of reduction
• operative procedure

There is no standard method for the surgical treatment of acromioclavicular (AC) joint separations. Current techniques have associated complications, including need for device removal, coracoid fracture, and inadequate reduction.

To evaluate the clinical outcomes of an internal splint technique without graft augmentation or rigid fixation to treat acute Rockwood type IV and V AC joint injuries.

Case series; Level of evidence, 4.

A retrospective analysis was performed of 26 patients who underwent a novel internal splint fixation technique between 2011 and 2016. Patients had type IV (n = 2) and type V (n = 24) acute AC separations. The mean time to surgery was 13.7 days (range, 1-28 days). The surgical technique included an open approach with coracoclavicular suture and tape fixation and AC suture fixation. Range of motion, strength, and radiographs were evaluated after surgery. Patient follow-up included the DASH (Disabilities of the Arm, Shoulder and Hand) questionnaire at a mean 3.3 years postoperatively (range, 6 months–8.6 years). DASH questionnaires were obtained for all patients via email. Patients were also surveyed on cosmetic appearance and willingness to undergo the operation again.

All patients regained full strength and range of motion following surgery. All postoperative radiographs demonstrated well-maintained reduction of the AC joint. The mean DASH score was 3.4 at final follow-up, and 23 of 26 respondents were satisfied with their postoperative shoulder appearance. There were no reoperations, and all patients stated that they would have the operation again given the same circumstances.

The results of this study demonstrate a reliable new technique for acute fixation of type IV or V AC joint injuries via an internal splint construct. This technique enables reduction in the coronal and sagittal planes without the need for graft augmentation or a rigid implant, allowing healing of the coracoclavicular and AC ligaments.

• DASH
• acromioclavicular separation
• acute repair
• coracoclavicular repair
• internal splint
• operative technique
• patient-reported outcomes
• types IV/V

Acute acromioclavicular (AC) dislocation is classified according to Rockwood (RW). Although of clinical relevance, dynamic horizontal translation (DHT) is not listed in this classification or in frequently used clinical evaluation tools. The aim of this study was (a) to evaluate vertical and horizontal AC joint instabilities and assess their combined occurrence and clinical appearance in a consecutive group of patients, as well as (b) to develop a new classification of acute AC joint dislocation.

A consecutive group of 61 patients (seven female, 54 male) with a mean age of 34.5 years (18.9–60.1) were included in the study. All patients underwent posttraumatic clinical—Taft Score (TF), Acromioclavicular Joint Instability Score (ACJI), Constant Score (CS), Subjective Shoulder Value (SSV)—and radiological (bilateral anteroposterior stress and bilateral Alexander views) evaluation.

According to the RW classification, the following AC dislocations were present: eight (13.1%) type I, nine (14.8%) type II, 22 (36.1%) type III, and 22 (36.1%) type V. Based on the clinical and radiographic results, a new classification is proposed: Type I instabilities show only a partial vertical displacement (≤30% coracoclavicular distance [CCD]) and type II a complete vertical displacement (>30% CCD). Both type I and II are further graded into none or partial (A) and complete DHT (B) as seen on bilateral Alexander views.

DHT can be found in low-grade instabilities and lead to inferior clinical results in the posttraumatic situation.

• Acromioclavicular joint instability score
• Acute dislocation
• Joint instability
• Rockwood classification
• Shoulder

• Acromioclavicular
• allograft
• coracoclavicular
• outcomes
• reconstruction
• single tunnel

• Acromioclavicular Joint/diagnostic imaging
• Acromioclavicular Joint/physiopathology
• Acromioclavicular Joint/surgery
• Adult
• Arthroplasty/adverse effects
• Arthroplasty/methods
• Athletic Injuries/diagnostic imaging
• Athletic Injuries/physiopathology
• Athletic Injuries/surgery
• Female
• Follow-Up Studies
• Humans
• Joint Dislocations/diagnostic imaging
• Joint Dislocations/surgery
• Ligaments, Articular/surgery
• Male
• Middle Aged
• Muscle Strength
• Postoperative Complications/etiology
• Postoperative Complications/surgery
• Radiography
• Range of Motion, Articular
• Return to Sport

• Acromioclavicular joint
• Bipod
• Dislocation
• Hook plate
• Instability
• Rockwood classification
• TightRope

• Acromioclavicular Joint/diagnostic imaging
• Acromioclavicular Joint/injuries
• Acromioclavicular Joint/surgery
• Arthroscopy/methods
• Athletic Injuries/classification
• Athletic Injuries/diagnostic imaging
• Athletic Injuries/surgery
• Bone Plates
• Bone Wires
• Humans
• Joint Instability/classification
• Joint Instability/diagnostic imaging
• Joint Instability/surgery
• Magnetic Resonance Imaging
• Shoulder Dislocation/classification
• Shoulder Dislocation/diagnostic imaging
• Shoulder Dislocation/surgery

• AC joint
• AC joint separation
• AC–DC
• Acromioclavicular joint
• Dislocation
• GC–PC
• Horizontal instability
• Instability
• Intra- and interobserver reliability
• Radiographic parameters
• Rockwood classification
• Validity
• Vertical instability

• Acromioclavicular Joint/diagnostic imaging
• Acromioclavicular Joint/injuries
• Acromion/diagnostic imaging
• Clavicle/diagnostic imaging
• Humans
• Joint Dislocations/classification
• Joint Dislocations/diagnostic imaging
• Joint Instability/classification
• Joint Instability/diagnostic imaging
• Models, Anatomic
• Reproducibility of Results
• Tomography, X-Ray Computed

• Acromioclavicular dislocation
• Arthroscopically assisted acromioclavicular reconstruction
• Conoid and trapezoid ligaments
• Coracoclavicular ligament reconstruction
• Hookplate
• Rockwood classification
• Weaver and Dunn procedure