Acta Scientific Orthopaedics (ISSN: 2581-8635)

Research Article Volume 3 Issue 11

Arthroscopic Versus Conservative Treatment of Degenerative Meniscal Tear in Middle Aged Patients in Regard to Pain and Knee Function

Marc Banerjee1,2*, Carolin Spüntrup3, Bertil Bouillon1, Ann-Kathrin Singer1,4, Rolf Lefering5, Arasch Wafaisade1 and Maurice Balke1,6

1Department of Trauma and Orthopedic Surgery, University of Witten/Herdecke, Cologne Merheim Medical Center, Germany
2Department of Orthopedic Surgery and Sports Traumatology, Atos MediaPark Clinic, Cologne, Germany
3Pelvic School Saarbrücken, Germany
4Department of Trauma, Orthopaedic and Plastic Surgery, University of Göttingen, Germany
5IFOM, Institute for Research in Operative Medicine, University of Witten/Herdecke, Cologne Merheim Medical Center, Germany
6Sportsclinic Cologne, Cologne, Germany

*Corresponding Author: Marc Banerjee, Department of Trauma and Orthopedic Surgery, University of Witten/Herdecke, Cologne Merheim Medical Center and Department of Orthopedic Surgery and Sports Traumatology, Atos MediaPark Clinic, Cologne, Germany

Received: September 28, 2020; Published: October 30, 2020

×

Abstract

Introduction: Hook plates and arthroscopic flip button techniques are currently the most commonly used procedures for AC-joint reconstruction. Minimally invasive AC-joint reconstruction (MINAR), a mini open flip button technique was introduced as an alternative to the arthroscopic technique as it is a straight forward procedure and no experience in arthroscopy is needed.

Methods: Between 2011 and 2015, 53 patients with acute AC-joint separations Type Rockwood III, IV and V were stabilized by MINAR. 45 were available for follow-up. In 15 patients a 1m m polyester suture was used, in the remaining 30 patients a No. 5 Fiberwire. All patients had a follow-up examination at a minimum one year after surgery. The Constant score (CS), the American Shoulder Elbow score (ASES) and the subjective shoulder value (SSV) were evaluated. All patients had a calibrated bilateral stress view of the AC-joints and a bilateral axial view. The coraco-clavicular (cc) distance was measured on the injured and contralateral side. Furthermore, the width of the clavicular tunnel was measured and compared with the initial diameter (4.5 mm).

Results: The mean age of the patients was 37.6 years (range 17 - 64), patients were operated after an average of 7.2 (range 1 - 20) days after trauma. After a mean of 25.3 months (range 12 - 53 months) the mean absolute CS was 96.6 (range 87 - 100), the mean ASES 98.0 (range 60 - 100) and the mean SSV was 92.3 (range 60 - 100). The cc-distance was 10.0 mm on the injured side and 8.1 mm on the uninjured side (p < 0.001). Only 14 patients (31.1%) had a perfect reduction in the vertical plane defined as a cc-distance on the injured side of ± 10% compared to the contralateral side. 20% of the patients with polyester suture and 56.7% of patients with Fiberwire had a widening of the clavicular tunnel with an average tunnel of 3.5 mm and 5.0 mm, p = 0.016.

Conclusion: Despite excellent clinical results and an average side-to-side difference of the cc-distance comparable to other techniques MINAR failed to restore the AC joint anatomically in the vertical plane. Therefor a modification of the originally described technique is advisable.

Keywords: Acromioclavicular Joint Dislocation; Acromioclavicular Joint Reconstruction; Coracoclavicular Stabilization; MINAR

×

References

  1. Gowd AK., et al. “Current concepts in the management of acromioclavicular dislocations. A systematic review and meta-analysis of operative techniques”. American Journal of Sports Medicine 47 (2019): 2745-2758.
  2. Moatshe G., et al. “Acromioclavicular and coracoclavicular Ligament reconstruction for acromioclavicular joint instability: a systematic review of clinical and radiographic outcomes”. Arthroscopy 34 (2018): 1979-1995.
  3. Balke M., et al. “Acute acromioclavicular joint injuries: Changes in diagnoses and therapy over the last 10 years”. Unfallchirurg 18 (2015): 851-857.
  4. Eschler A., et al. “Hook plate fixation for acromioclavicular joint separations restores coracoclavicular distance more accurately than PDS augmentations, however represents with a high rate of acromial osteolysis”. Archives of Orthopaedic and Trauma Surgery 132 (2012): 33-39.
  5. Francesco AD., et al. “The use of hook plate in type III and V acromio-clavicular Rockwood dislocation: Clinical and radiological midterm results and MRI evaluation in 42 patients”. Injury 43 (2012): 147-152.
  6. Heideken J., et al. “Acute surgical treatment of acromioclavicular dislocation type V with a hook plate: superiority to late reconstruction”. Journal of Shoulder and Elbow Surgery 22 (2013): 9-17.
  7. Glanzmann MC., et al. “Clinical and radiological results after double flip button stabilization of acute grade III and IV acromioclavicular joint separations”. Archives of Orthopaedic and Trauma Surgery 133 (2013): 1699-1707.
  8. Salzmann GM., et al. “Arthroscopically assisted 2-bundle anatomical reduction of acute acromioclavicular joint separations”. American Journal of Sports Medicine 38 (2010): 1179-1187.
  9. Scheibel M., et al. “Arthroscopically assisted stabilisation of high-grade acromioclavicular joint separations”. American Journal of Sports Medicine 39 (2011): 1507-1516.
  10. Petersen W., et al. “Minimally invasive acromioclavicular joint reconstruction (MINAR)”. Operative Orthopädie und Traumatologie 22 (2010): 52-61.
  11. Rosslenbroich SB., et al. “Minimally invasive acromioclavicular ligament reconstruction with a flip button technique (MINAR)”. American Journal of Sports Medicine 43 (2015): 1751-1757.
  12. Metzlaff S., et al. “Surgical treatment of acute acromioclavicular joint dislocations: hook plate versus minimally invasive reconstruction”. Knee Surgery, Sports Traumatology, Arthroscopy 24 (2016): 1972-1978.
  13. Schliemann B., et al. “Why does minimally invasive coracoacromial ligament reconstruction using a flip button repair technique fail? An analysis of risk factors and complications”. Knee Surgery, Sports Traumatology, Arthroscopy 23 (2015): 1419-1425.
  14. Rockwood C. “Injuries in the acromioclavicular joint: subluxations and dislocations around the shoulder”. In: Rockwood C jr, Green D, eds. Fractures in adults. Philadelphia: JB Lippincott (1984): 860-910.
  15. Vascellari A., et al. “Clinical and radiological results after coracoclavicular ligament reconstruction for type III acromioclavicular joint dislocation using three different techniques: a retrospective study”. Joints 3 (2015): 54-61.
  16. Takase K and Yamamoto K. “Arthroscopic procedures and therapeutic results of anatomical reconstruction of the coracoclavicular ligaments for acromioclavicular joint dislocation”. Orthopaedics and Traumatology: Surgery and Research 102 (2016): 583-587.
  17. Breuer R., et al. “Minimally Invasive AC Joint Reconstruction System (MINAR) in modified triple-button technique for the treatment of acute AC Joint dislocation”. Journal of Clinical Medicine 10 (2019).
  18. Hann C., et al. “Combined arthroscopically assisted coraco- and acromioclavicular stabilization of acute high-grade acromioclavicular joint separations”. Knee Surgery, Sports Traumatology, Arthroscopy 26 (2018): 212-220.
  19. Aliberti G., et al. “Horizontal instability of the acromioclavicular joint. A systematic review”. American Journal of Sports Medicine 48 (2020): 504-510.
×

Citation

Citation: Marc Banerjee., et al. “High Rate of Radiological Failure Despite Excellent Clinical Results of Minimally Invasive Acromio-Clavicular Joint Reconstruction (MINAR)".Acta Scientific Orthopaedics 3.11 (2020): 58-64.




Metrics

Acceptance rate33%
Acceptance to publication20-30 days

Indexed In



News and Events


  • Certification for Review
    Acta Scientific certifies the Editors/reviewers for their review done towards the assigned articles of the respective journals.
  • Submission Timeline for Upcoming Issue
    The last date for submission of articles for regular Issues is December 25, 2024.
  • Publication Certificate
    Authors will be issued a "Publication Certificate" as a mark of appreciation for publishing their work.
  • Best Article of the Issue
    The Editors will elect one Best Article after each issue release. The authors of this article will be provided with a certificate of "Best Article of the Issue"

Contact US