Surgical Treatment Of Acromioclavicular Dislocations: A Comparative Study Of Suture Ethiband N:5 With Semitendinosus Autograft Tendon Mohsen Mardani-Kivi M.D. Orthopedic Surgeon, Fellowship of Knee and Shoulder Arthroscopy and Sport Traumatology. Associated Professor of Guilan University of Medical Sciences.

Second most common form of shoulder instability More common in males Typically affect young athletes

Direct force most common Indirect force Continuum of ligament injuries

 Initial Views:  Anteroposterior view  Zanca view (15 degree cephalic tilt)  Other views:  Axillary view: demonstrates anterior-posterior displacement

 Initially classified by both Allman and Tossy et al. into three types (I, II, and III).  Rockwood later added types IV, V, and VI, so that now six types are recognized.  Classified depending on the degree and direction of displacement of the distal clavicle. Allman FL Jr. Fractures and ligamentous injuries of the clavicle and its articulation. JBJS 49A: , Rockwood CA Jr and Young DC. Disorders of the acromioclavicular joint, In Rockwood CA, Matsen FA III: The Shoulder, Philadelphia, WB Saunders, 1990, pp

 Type III injuries in highly active patients  Type IV, V, and VI injuries

Over than 60 methods and techniques are applied for treatment while NO GOLD STANDARD surgical procedure has been identified Grutter PW, Petersen SA. Anatomical acromioclavicular ligament reconstruction: a biomechanical comparison of reconstructive techniques of the acromioclavicular joint. Am J Sports Med 2005;33: Bhattacharya R, Goodchild L, Rangan A. Acromioclavicular joint reconstruction using the Nottingham Surgilig: a preliminary report. Acta Orthop Belg 2008;74:

 Coracoid process transfer to distal transfer (Dynamic muscle transfer)  Primary AC joint fixation  Primary Coracoclavicular Fixation  Distal Clavicle Excision with CC ligament reconstruction  ……

The purpose of this study was To Compare Suture Ethiband N:5 With Semitendinosus Autograft Tendon In Treatment Of Acromioclavicular Dislocations

 Study Design: Analytical Cross- sectional study  Sample Volume: 39 patients with complete AC joint (III-VI) dislocation  Gender: 35 males and 4 females  Age: 32.6±11.8 (range 21 to 47)

 Group A (suture Ethiband n:5 ) : 21 patients  Group B (semitendinosus autograft tendon) : 18 paitients

Variables: ACJ Radiographs, Constant Score, VAS score and Infection Mean follow up Time: 25.7 months (12-49 months)

Two weeks: Immobilization 6 th week: Routine daily activities, Full mobilizations 6 th week: Pin removal, Physiotherapy After 3 month: intense activities Follow up: 3, 6, 12 months post up and final visit.

 Mean age: Group A: 31.9±10.4, Group B: 33.4±11.2 (p>0.05)  Time lags: Group A: 5.7±2 days, Group B: 5.5±3.1 days (p>0.05)  None had acute infection

Surgery procedure Constant score 3 months6 months12 months Group A Ethiband Suture Excellent %66.6%71.3%71.4% Good %23.8%19.4% Fair %9.5%9.3%9.2% Group B Semitendinosus autograft Excellent %61.4%66.6% Good %33.3%29.3% Fair %5.3%4.1%3.7%

Results In The Final F/U

 Postoperative Radiographic Evaluation  Zanca view  Reduction of the AC ligaments: Group A: 15 patients, Group B: 12 patients (p>0.05)  25% Subluxations: Group A: 6 patients, Group B: 5 patients (p>0.05)  Dislocation more than 25% => One patient in group B (p>0.05)

 VAS score (final visit)  During Rest  Group A: 0.01 ±0.2, Group B: 0.1±0.8 (p>0.05)  During Routine Daily Activities  Group A: 0.7±0.21, Group B: 0.5±0.3 (p>0.05)  During Intense Activities  Group A: 1.2±0.03, Group B: 0.6±0.31 (P=0.041)

Tauber et al (2009): Semitendinosus autograft vs. Modified Weaver-Dunn. Mean Constant scores of 81±8 and 93±7 respectively Choi et al (2008): Suture Anchors. Constant score of 89.5 Mardani-Kivi et al (2012): Semitendinosus autograft vs. Ethiband suture no.5. Mean Constant scores of 92±2.1 and 91±1 respectively.

No. 5 Ethiband suture technique could be recommended as the treatment of choice due to the absence of morbidity in removing semitendinosus autograft tendon.

Use The Cheapest And The Simplest Technique For AC Joint Reduction!