Summary

We evaluate clinical outcomes of ACJ stabilization after acute clavicle dislocations with dynamic system using two methods - arthroscopy and mini-open technic.

Abstract

Objectives. The aim of the present study was to evaluate clinical outcomes of ACJ stabilization after acute clavicle dislocations with dynamic system using two methods - arthroscopy and mini-open technic.

Material and methods. We performed retrospective analysis of 40 patients (39 male, 1 female) who had distal clavicle stabilization with DogBone (Arthrex) system for the period from 2014 to 2017 years in our clinic. In study group 12 surgery was performed using mini-open technic, 28 under arthroscopy control. The average age in the study group was 32±1.49 years (range 15 - 59 years). For postoperative evaluation we use UCLA, ASES and CSS orthopaedic scales. Median CCD calculated in 23 patient before surgery and 35 patients after surgery. Median CDD in preoperative and postoperative x-ray calculated in 15 patients. Median CTD on postoperative x-ray calculated in 35 patients.

Results. 26 patients were available for follow up, 18 in arthroscopy group and 8 in mini-open. We received good and excellent results in both groups (arthroscopy and mini-open) according to UCLA questionnaire in 100% available cases (26/26). According to ASES questionnaire in mini-open group we receive 25% (2/8) good results and in 75% (6/8) – excellent. In arthroscopy group – 100% of excellent results (18/18). According to CSS questionnaire in mini-open group we receive 38% (3/8) good results and in 62% (5/8) – excellent results. In arthroscopy group – 33% of good results (6/18) and 67% - excellent results (12/18). We haven’t receive satisfied and not satisfied results in both groups according to UCLA, ASES and CSS orthopedic scales. Median CCD before surgery was 15.5 mm (interquartile range 11.9 – 18.3).
Median CCD after surgery was 6.12 mm (interquartile range 4.8 – 8.5).
Decrease of CCD after surgery was statistically significant (p=0,0003).
Median of CTD was 28.9 mm (interquartile range 27 – 32.9). We received statistically significant difference (p=0,0009) between CDD with and without axial load on x-rays. We didn’t received statistically significant difference between two groups (arthroscopy and mini-open).

Conclusion. Acromio-clavicular joint stabilization using dynamic systems is

Method

of choice in case of distal clavicle dislocation. Dynamic system shows good and excellent long-term results after the operation according to the orthopedic scales data. Advantage of dynamic systems is absence of need for metal fixator’s removal. Standard x-rays with and without axial loads in comparison with the contralateral side indicates acromio-clavicular joint injury. It is necessary to continue evaluation of the acromio-clavicular joint stabilization results at longer term. In addition, it is important to know preservation of the distal clavicle reposition using dynamic system in the prolonged period after the operation.