Comparative study of surgical treatment of acromioclavicular luxation

Abstract

Background/Aim. Acromioclavicular (AC) luxations most often affect athletes. The published results regarding the treatment of AC joint luxations vary. Each method has its advantages and disadvantages, so there is still no consensus on the best method of treatment. The aim of this study was to review the results of a number of surgical approaches to stabilization of AC joint recorded over the span of five years. Methods. This study was based on the data acquired from the analysis of 28 patients with AC luxation surgically treated in the Clinical Center of Montenegro. One group of 16 patients underwent the traditional AO method (with transfixation of AC joint with Kirschner wire and Zuggurtung tension bands) or the Bosworth method (using the coracoclaviculartransfixation screw - Zugg-Bosw group). The second group of 12 patients underwent a newer techinque with the Hook plate (Hook plate group). Results. All the patients had AC luxation of higher degree, stage IV-VI acording to the Rockwood scale. The average age of the two groups was very similar, with 28 being the average age of the Zugg-Bosw group, and 25 of the Hook plate group. Most patients were males (82%), injured mostly during athletic activity (75%-83%). Complications were more common and more complex in the Zugg-Bosw group, with 2 early and 8 late comlications. There are only 3 late complications in the Hook plate group, but with no significant statistical difference (p = 0.19; t = -1.34; df = 27). With respect to the subjective patient satisfaction following the treatment, the Hook plate group gave significantly better evaluations (4.4 ? 0.19)(p = 0.007; t = 2.95; df = 27). Constant score showed no significant statistical difference (p = 0.078; t = 1.8; df = 27). The Hook plate group had a better median score (90 ? 0.18) with respect to the Zugg-Bosw group (85 ? 0.40). Conclusion. The Hook plate method achieved somewhat better results, which indicate that this method is one of the ways to ensure a strong, stable fixation of the AC joint without transfixation. At the same time, this method does not inhibit the ligament healing and allows an early mobilisation.Uvod/Cilj. Akromioklavikularne (AC) luksacije najcesce se dogadjaju kod sportista. Objavljeni rezultati lijecenja luksacije AC zgloba variraju, svaki metod ima svoje slabosti i nedostake, pa jos uvijek ne postoji konsenzus o najboljem nacinu lijecenja. Cilj rada bio je prikaz petogodisnjeg pracenja rezultata operativnog lijecenja razlicitim operativnim tehnikama astabilizacije AC zgloba. Metode. Studija je uradjena na osnovu podataka koji su dobijeni analiziranjem svih 28 operativno lecenih bolesnika sa AC luksacijom tokom petogodisnjeg perioda u Klinici za ortopediju i traumatologiju Klini ckog centra Crne Gore. Prva grupa (16 osoba) operisana je ustaljenom AO metodom (transfiksacija AC zgloba sa Kirschnerovim iglama i zicanom svezom ?Zuggurtung?) i korakoklavikularnom transfiksacijom srafom, Bosworth-ovim metodom (Zugg-Bosw grupa). Drugu grupu (12 osoba) cinili su bolesnici, koji su operativno leceni novijom tehnikom sa plocom Hook (Hook plate grupa). Rezultati. Svi bolesnici imali su AC luksaciju tezeg stepena, stadijum IV-VI prema Rockwood-u. Prosjecna starost bila je ujednacena, u prvoj grupi 28 godina, u drugoj 25 godina. Zastupljeniji su bili muskarci (82%), a najcesce su se povredjivali prilikom sportskih aktivnosti (75-83%). Komplikacije su bile brojnije i ozbiljnije u prvoj grupi (Zugg-Bosw) - 2 rane i 8 kasnih, a u grupi Hook plate samo 3 kasne, ali bez statisticki znacajne razlike (p = 0,19; t = -1,34; df = 27). Kad je u pitanju bila subjektivna satisfakcija bolesnika nakon zavrsenog lijecenja, grupa Hook plate imala je znatno povoljnije i statisticki znacajno razlicite ocjene (4,4 ? 0,19) (p = 0,007; t = 2,95; df = 27). Constant skor pokazao je da nije bilo statisticki znacajne razlike (p = 0,078; t = 1,8; df = 27). Grupa Hook plate imala je bolji srednji skor (90 ? 0,18) u odnosu na pacijente iz grupe Zugg-Bosw (85 ? 0,40). Zakljucak. Nesto povoljniji rezultati dobijeni su kod bolesnika operisanih Hook plate metodom, te se ovaj metod preporucuje kao jedan od nacina koji obezbjedjuje stabilanu i cvrstu fiksaciju AC zgloba bez transfiksacije. Istovremeno, ne sprijecava se zarastanje ligamenata, a omogucava se rana mobilizacija.