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Failure After Arthroscopic Acromioclavicular Fixation Using Tight Rope; Is It Related To Coracoid Tunnel Dilatation! A Ct Based Study

Failure After Arthroscopic Acromioclavicular Fixation Using Tight Rope; Is It Related To Coracoid Tunnel Dilatation! A Ct Based Study

Begad H. M. Z. Abdelrazek, M.Sc., MD, FRCS Trauma and Orthopedics, EGYPT Mohamed Refaat Waly, MD,MRCS, EGYPT Ahmed Fouad Seifeldin , MD, MRCS, EGYPT Ahmed Samir Samir Elkalyoby, MD, EGYPT Ahmed Rezk, EGYPT Khaled As Shohayeb, MD, Prof., EGYPT

Faculty of Medicine Cairo University, Kasr Alainy, Cairo, EGYPT

2021 Congress   ePoster Presentation     Not yet rated


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Summary: Radiological Failure after ACJ reconstruction, a CT based study


acromioclavicular joint (ACJ) injuries are common shoulder injuries amounting to around 1.8 per 1000 per year. According to the Rockwood classification; grade 1 and 2 are managed non-operatively, grade 4 and 5 require ACJ stabilization while grade 3 injuries are controversial. There is no gold standard technique or fixation device, but fixation should provide a stable ACJ and good functional results. Arthroscopic techniques are gaining popularity, however despite of good functional results, radiological loss of reduction is an issue. Aim to detect and report radiological failure after ACJ reconstruction using arthroscopic double tight-rope technique. We relied on CT measurements to quantify tunnel widening. Patients and Methods From July 2016, through Dec 2018, a prospective study was performed at our hospital. Twenty-five patients with acute grade III-VI ACJ dislocation were included in the study. Patients with associated coracoid fracture, associated rotator cuff tears or gleno-humeral arthritis were excluded. Arthroscopic double tight-rope repair of the ACJ was performed under general anesthesia in the beach-chair position. Post-operatively; the arm is immobilized in a broad arm sling for three weeks. Then pendular exercises are allowed for 3 weeks. From 6 weeks post-operative onwards; active-assisted followed by active Range of motion (ROM) exercises are perfomed. Results There was significant reduction of VAS score at 6 months in comparison of VAS score at 3 months (1.35 ± 1.50 versus 2.8 ± 1.3, p=0.001). The coracoid tunnel diameter to horizontal coracoid diameter ratio increased from 22.8 ± 3.66 % immediately postoperative to 38.52 ± 5.46 % after 12 months (p<0.001) (Table-2). This demonstrates significant coracoid tunnel widening. The reported complications included infection (4.3 %), ACJ arthritis (21.7 %) and breech of lateral coracoid cortex (13.0 %) Conclusion: arthroscopic ACJ by tight rope technique is technically challenging and demanding. Yet in the hands of experts, risk of coracoid tunnel blow out is there. Significant tunnel widening as quantified by CT may lead to loss of reduction, inferior functional results and patient dissatisfacion

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