Effect of a modified double-bundle fixation technique in the treatment of acute acromioclavicular joint dislocation

LIU Yi-jun; GUO Biao; MA Wei; YANG Dong-qiang; FU Peng-fei; CUI Hong-lin

doi:10.3969/j.issn.2095-252X.2024.11.008

Abstract：Objective To observe the clinical results and radiographic findings of the fine bone channel combined with the modified nice knot double-bundle fixation in the treatment of acute acromioclavicular joint dislocations of Rockwood grade Ⅲ B and above,and to assess its stability in the vertical and horizontal directions.Methods Twenty-eight patients(19 males,9 females)with acute Rockwood grade Ⅲ B to grade Ⅴ acromioclavicular dislocations were retrospectively analyzed.All had rostral clavicular ligament reconstruction using a fine bone channel combined with modified nice knot double-bundle fixation.The mean age of the patients at the time of surgery was(42.7±8.7)years(range:28-54 years).All patients took bilateral contrast AP radiographs and cross-thoracic medial retraction films.The vertical distance between the rostral and clavicle(CC distance)and the anteroposteriorly oriented horizontal distance between the acromion and clavicle(AC distance)were measured.The shoulder Constant score,American Shoulder and Elbow Surgeons'Form(ASES)and VAS scores were recorded.Evaluations were performed preoperatively,1,3,6,12 months postoperatively,and annually thereafter.Complications such as postoperative infection,recurrent dislocation,implant loosening and medically induced fracture were also recorded and evaluated.Results At a mean follow-up of 18 months(range:12-24 months),the results showed that the mean Constant score of the affected shoulder at the last follow-up was(94.50±2.87)(range:85-98)and the mean ASES score was(92.68±3.36)(range:85-97),which were significant improved compared with the preoperative data(P＜0.05);and there was no statistically significant difference when compared with that of the healthy shoulder(Constant score 95.07±2.55,ASES score 93.64±3.00)(P＞0.05).At the final follow-up,the rostral-clavicular distance(CC distance)decreased from(15.20±3.81)mm preoperatively to(7.33±2.11)mm(P＜0.05),and the horizontally anterior-posterior distance of the acromioclavicular joint(AC distance)decreased from(15.49±2.81)mm preoperatively to(6.82±1.40)mm at the final follow-up(P＜0.05),which were comparable to that of the healthy shoulder joint.There was no statistically significant difference compared to the healthy shoulder.There was no statistically significant difference compared to the healthy shoulder.No complications such as recurrent dislocation,infection,implants loosening,rostral fracture or clavicle fracture were seen,and all patients reported satisfaction with the postoperative recovery.Conclusions Fine bone channels combined with modified nice knot double-bundle fixation provides vertical and horizontal stability and good short-term clinical results without significant increase in the incidence of complications for the treatment of acute high acromioclavicular dislocations.