title: Vascular graft employment in the surgical treatment of acute and chronic acromio-clavicular dislocation.
abstract: OBJECTIVE
  To show the efficiency and safety of a surgical treatment in both acute and chronic acromio-clavicular junction (ACJ) dislocations.
  
  
  METHODS
  Retrospective.
  
  
  METHODS
  Department of Orthopedics and Traumatology at IRCCS San Raffaele Hospital.
  
  
  METHODS
  This study was performed on 37 subjects classified as Rockwood grade III-V or Tossy III ACJ dislocation.
  
  
  METHODS
  The surgical treatment was carried out by placing a vascular graft (GorePropaten(®)) between the tip of the coracoid process and the mid-lateral side of the clavicle with two temporary percutaneous K-wires positioned in a parallel manner in the AC ligament through the acromion and clavicle for 30 days to improve stability.
  
  
  METHODS
  Outcomes were assessed using the Constant Shoulder (CS) score, DASH score, subjective satisfaction, and stability of AC joint at 24 months. UCLA scores taken preoperatively and at 15-month follow-up were used to perform statistical analysis significance using a control group treated conservatively. Postoperative X-rays were examined to assess joint stability after 24 months.
  
  
  RESULTS
  Preoperative CS score was 51 ± 12 in the acute group and 55 ± 15 in the chronic group. Follow-up mean CS score was 88 ± 11 in the acute group and 82 ± 20 in the chronic group at 24 months. Preoperative DASH score was 19 ± 3 in the acute group and 14 ± 5 in the chronic group. Mean DASH score was 3.60 ± 7 in the acute group and 6.42 ± 6 in the chronic group. Preoperative UCLA scores were 14.6 ± 2 and 15 ± 7 in the acute group and chronic group, respectively. At 15-month follow-up, UCLA scores of 28.1 ± 1.9 and 27.7 ± 1 in the acute and chronic group, respectively, showed a significant improvement (p < 0.05) compared with UCLA scores taken preoperatively and at 15 months in the control group treated conservatively of 15.8 ± 0.9 and 16.2 ± 0.9, respectively. Results were good to excellent in 10 patients from the acute group and 23 patients from the chronic group who presented clinical stability of the AC joint without pain. Postoperative radiography showed anatomical repositioning of the ACJ and joint stability in 35 cases, but only two patients showed a partial re-dislocation at the 24-month X-ray follow-up. No infections, either deep or superficial, or nerve palsies were reported.
  
  
  CONCLUSIONS
  Given the results obtained during the study and the response of the patients in both acute and chronic groups, the authors found that the employment of a vascular graft combined with temporary percutaneous K-wires is able to improve the patient's clinical outcome following an acromio-clavicular joint dislocation.
authors.affiliation: Department of Orthopedics and Traumatology, San Raffaele Hospital, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Vitali
authors.affiliation: Department of Orthopedics and Traumatology, San Raffaele Hospital, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Pedretti
authors.affiliation: Department of Orthopedics and Traumatology, San Raffaele Hospital, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy. nadim.naim@gmail.com.
authors.forename: Nadim
authors.initials: N
authors.lastname: Naim Rodriguez
authors.affiliation: Department of Orthopedics and Traumatology, San Raffaele Hospital, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Franceschi
authors.affiliation: Department of Orthopedics and Traumatology, San Raffaele Hospital, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Fraschini
mesh_terms: D000173:Acromioclavicular Joint / Q000601:surgery*; D000208:Acute Disease; D000328:Adult; D001864:Bone Wires; D002908:Chronic Disease; D005260:Female; D006801:Humans; D004204:Joint Dislocations / Q000601:surgery*; D008297:Male; D019637:Orthopedic Procedures / Q000379:methods*; D016059:Range of Motion, Articular / Q000502:physiology*; D020127:Recovery of Function / Q000502:physiology*; D012189:Retrospective Studies; D016896:Treatment Outcome; D058017:Vascular Grafting / Q000379:methods*
keywords: Acromioclavicular disclocation; Acromioclavicular joint; Acute; Chronic; Disclocation; Vascular graft