Imaging of degenerative and posttraumatic disease in the shoulder joint with ultrasound.

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Abstract

[Indexed for MEDLINE] 10. Arthroscopy. 2019 May;35(5):1324-1335. doi: 10.1016/j.arthro.2018.11.058. All-Arthroscopic Reconstruction of Severe Chronic Acromioclavicular Joint Dislocations. Boileau P(1), Gastaud O(2), Wilson A(2), Trojani C(2), Bronsard N(2). Author information: (1)iULS (Institut Universitaire Locomoteur et du Sport), Hôpital Pasteur 2, University Côte d'Azur, Nice, France. Electronic address: boileau.p@chu-nice.fr. (2)iULS (Institut Universitaire Locomoteur et du Sport), Hôpital Pasteur 2, University Côte d'Azur, Nice, France. Comment in Arthroscopy. 2019 May;35(5):1336-1338. doi: 10.1016/j.arthro.2019.01.038. PURPOSE: To report the outcomes of all-arthroscopic coracoclavicular (CC) ligament reconstruction and simultaneous diagnosis and treatment of glenohumeral pathologies in patients with symptomatic, chronic (>6 weeks), complete (Rockwood type III-V) acromioclavicular joint (ACJ) separations. METHODS: We prospectively followed up 57 consecutive patients treated arthroscopically for chronic Rockwood type III (n = 11), type IV (n = 19), and type V (n = 27) ACJ dislocations. Previous ACJ surgery failed in 11 (19%). The mean delay between injury and surgery was 39 months (range, 6 months to 17 years). The mean age at surgery was 42 years (range, 19-71 years). After glenohumeral exploration, an arthroscopic modified Weaver-Dunn procedure with CC suture button fixation (Twinbridge) was performed. The CC reduction and tunnel position were analyzed with radiographs and computed tomography. The mean follow-up period was 36 months (range, 12-72 months). RESULTS: Intra-articular pathology was treated arthroscopically in 27 patients (48%): 17 labral tears, 8 rotator cuff tears (3 partial and 5 complete), and 15 biceps lesions (4 SLAP lesions and 11 subluxations). At last follow-up, 7 patients (12%) experienced recurrent ACJ instability: 2 frank dislocations (1 trauma and 1 infection) and 5 ACJ subluxations. There was no significant correlation between subluxation and clinical outcome. The rate of recurrent ACJ instability was significantly higher in patients with higher-grade ACJ dislocations (P < .01) and/or previous failed surgery (P < .001). Recurrent subluxation was observed in 3 cases of lateral migration of the coracoid button with lateral tunnel placement, as well as 2 cases of anterior migration of the clavicular button with anterior tunnel placement. The Constant score increased from 67 (range, 28-89) to 85.5 (range, 66-100), and the mean Subjective Shoulder Value increased from 54% to 85% (P < .001). At last follow-up, 95% of patients (54 of 57) were satisfied. CONCLUSIONS: All-arthroscopic treatment allows successful CC ligament reconstruction and simultaneous diagnosis and treatment of frequently associated (48%) glenohumeral lesions. Higher-grade ACJ dislocations, previous ACJ surgery, and misplacement of bone tunnels are risk factors for recurrent instability. LEVEL OF EVIDENCE: Level IV, case series. Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved. DOI: 10.1016/j.arthro.2018.11.058