title: Arthroscopically assisted stabilization of acute high-grade acromioclavicular joint separations.
abstract: BACKGROUND
  The purpose of this study was to evaluate the clinical and radiological results after arthroscopically assisted and image intensifier--controlled stabilization of high-grade acromioclavicular (AC) joint separations using the double TightRope technique with the first-generation implant.
  
  
  OBJECTIVE
  The double TightRope technique using the first-generation implant leads to good clinical and radiological results by re-creating the anatomy of the AC joint.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  Thirty-seven consecutive patients (4 women and 33 men; mean age, 38.6 years) who sustained an acute AC joint dislocation grade V according to Rockwood were included in this prospective study. The Subjective Shoulder Value (SSV), the Constant Score (CS), the Taft Score (TS), and a newly developed Acromioclavicular Joint Instability Score (ACJI) were used for final follow-up. Bilateral stress views and bilateral Alexander views were taken to evaluate radiographic signs of recurrent vertical and horizontal AC joint instability.
  
  
  RESULTS
  Twenty-eight patients (2 women and 26 men; mean age, 38.8 years [range, 18-66 years]) could be evaluated after a mean follow-up of 26.5 months (range, 20.1-32.8 months). The interval from trauma to surgery averaged 7.3 days (range, 0-18 days). The mean SSV reached 95.1% (range, 85%-100%), the mean CS was 91.5 points (range, 84-100) (contralateral side: mean, 92.6 points), the mean TS was 10.5 points (range, 7-12), and the ACJI averaged 79.9 points (range, 45-100). The final coracoclavicular distance was 13.6 mm (range, 5-27 mm) on the operated versus 9.4 mm (range, 4-15 mm) on the contralateral side (P < .05). Radiographic signs of posterior instability were noted in 42.9% of cases. Patients with evidence of posterior instability had significantly inferior results in the TS and the ACJI (P < .05). Neither coracoid fractures nor early (within 6 weeks postoperatively) loss of reduction due to tunnel malpositioning or implant loosening was observed.
  
  
  CONCLUSIONS
  The combined arthroscopically assisted and image intensifier--controlled double TightRope technique using implants of the first-generation represents a safe technique and yields good to excellent early clinical results despite the presence of partial recurrent vertical and horizontal AC joint instability.
authors: Center for Musculoskeletal Surgery, Campus Virchow, Charité -Universitaetsmedizin Berlin, Berlin, Germany. markus.scheibel@charite.de
authors: Markus
authors: M
authors: Scheibel
authors: Silvia
authors: S
authors: Dröschel
authors: Christian
authors: C
authors: Gerhardt
authors: Natascha
authors: N
authors: Kraus
mesh_terms: D000173:Acromioclavicular Joint / Q000000981:diagnostic imaging / Q000293:injuries* / Q000503:physiopathology / Q000601:surgery; D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D001178:Arthroplasty / Q000379:methods*; D001182:Arthroscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016268:Internal Fixators; D004204:Joint Dislocations / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology; D010146:Pain; D011446:Prospective Studies; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology; D012399:Rotation; D016896:Treatment Outcome; D055815:Young Adult