The treatment of Grade III acromioclavicular joint (ACJ) dislocations has been a subject of much controversy, even as early as Hippocrates. We hypothesized that this surgical technique would improve patient functional outcome. We present a case series of 17 patients all of whom have had grade III dislocations of the ACJ. The patient population was young active adults. Surgery was performed within four weeks in all cases. One Surgeon in the Queen Elizabeth hospital, University of Birmingham, performed the same procedure on all 17 patients. A standard technique was used for tight rope fixation. The fixation device is comprised of no. 5 fibrewire suture and 2 metal buttons, joined by a continuous loop. This is a low-profile double-metallic button technique. Postoperatively all patients remained in a polysling for three weeks and postoperative rehabilitation was commenced after that point including physiotherapy supervised pendular exercises and gentle passive movements. They were all seen six weeks and three months post operatively. Clinical and radiographic assessment was performed to assess the fixation. Of our cohort of patients, one required revision open stabilization after sustaining a mechanical fall on the affected operated side. There was a failure of fixation in a patient who was non-compliant with postoperative instructions. At three months postoperatively all patients were satisfied with the functional outcome and were able to return to pre injury level of activity. Bar the two failures the average OSS was 45.2 (range 40–48). 14 patients returned to their pre injury occupation and sports fitness. This technique provides a simple, reproducible, minimally invasive technique for acute ACJ dislocation, which expedites a functional recovery of this acute injury. It is a non-rigid fixation of the AC joint that maintains reduction yet allowing for normal movement at the joint.Methods and Results
Conclusion
Most common current surgical treatment options for cuff tear arthropathy (CTA) are hemiarthroplasty and reverse total shoulder replacement. At our unit we have been using Reverse Total shoulder replacement (TSR) for CTA patients since 2001. We present our results of Reverse TSR in 64 patients (single surgeon) with a mean follow up of 2 years (Range 1 to 8 years). There were 45 males and 19 females in the study with a mean age of 70 years. Preoperative and postoperative Constant scores were collected by a team of specialist shoulder physiotherapists. Preoperatively plain radiographs were used to evaluate the severity of arthritis and bone stock availability. 90% patients showed an improvement in the Constant score post operatively. The mean improvement in Constant score was 25 points. The mean Pain Score (max 15) improved from 6.3 to 11.8; the mean ADL Score (max 20) improved from 6.8 to 12.3; the mean Range of Motion score (max 40) improved from 10.8 to 20.2; but the mean Power Score (max 25) only improved from 0.9 to 4.9. The differences in improvement were statistically significant in each category. A total 6 patients (10%) required 10 revision surgeries for various reasons. Two patients dislocated anteriorly who were treated by open reduction. Two patients required revision of the glenoid component due to loosening after a mean of 2 years. One patient required revision of the humeral component with strut grafting secondary to severe osteolysis. Only one patient required revision of both humeral and glenoid components secondary to malpositioning. Three patients died for reasons unconnected with their shoulder problems and surgery. Radiographic analysis at the latest follow up (mean 24 months) showed inferior glenoid notching in 40% cases. Heterotrophic ossification was not seen in our series. We conclude that reverse TSR is a viable option for treatment of cuff tear arthropathy however glenoid loosening and scapular notching remains an issue.
