No significant benefit of triple vs. double Endobutton fixation after AC joint dislocation

Study Type: Therapy
OE Level of Evidence: 2
Journal Level of Evidence: 2
Synopsis
80 patients with moderate to severe acromioclavicular joint dislocation scheduled for coracoclavicular ligament reconstruction were randomized to either triple Endobutton fixation or double Endobutton fixation. The purpose of this study was to determine if triple Endobutton fixation was beneficial over double Endobutton fixation with respect to surgical outcomes, patient-reported functional outcomes, and radiographic outcomes over a minimum 12-month follow-up. Results demonstrated no Please login to view the rest of this report. Please login to view the rest of this report.
Funding: Not Reported
Conflicts: None disclosed
CONTENT IS LOCKED
Why was this study needed now?
Coracoclavicular ligament reconstruction has emerged as a standard operative procedure for the management of acute acromioclavicular joint dislocations, commonly though Endobutton fixation. Double or triple Endobutton fixation can be used in these procedures. There is debate as to whether the extra mechanical strength afforded by triple Endobutton fixation results in relevant clinical benefits.
What was the principal research question?
In coracoclavicular ligament reconstruction for acute acromioclavicular dislocation, does triple Endobutton fixation result in a significantly lower rate of rupture and significantly better radiographic and functional outcomes compared to double Endobutton fixation when assessed over a minimum 12-month follow-up?
Population: 80 patients, 18-50 years of age, with Rockwood types III-V acromioclavicular joint dislocations presenting within 2 weeks of injury. Cases of open dislocation, previous shoulder injury or surgery, concurrent nerve or vascular injury, or polytrauma were excluded. Following reconstruction, all patients were placed in a sling for 4 weeks. Return to daily activities was allowed at 3 months, and return to sports was allowed at 6 months.
Intervention: Triple Endobutton fixation: Following reduction under C-arm visualization, a guide wire was drilled through the clavicle approximately 3cm medial to the AC joint, and down through the midpoint of the coracoid. An EndoButton loaded with five Ethibond sutures was passed through the coracoid tunnel while bound within one end of a closed loop, and locked to the underside of the coracoid. The other end of the closed loop was pulled enough through the clavicle tunnel to fit a second Endobutton between the loop and the tunnel, locking the Endobutton on the topside of the clavicle. Two sutures for the coracoid Endobutton were then passed and tied to the clavicular Endobutton. A second hole was drilled through the clavicle approximately 1cm lateral to the first. The remaining three strands of Ethibond sutures were used to tie a third Endobutton on the topside of the clavicle through the lateral hole.
Comparison: Double Endobutton fixation: Following reduction under C-arm visualization, a guide wire was drilled through the clavicle approximately 3cm medial to the AC joint, and down through the midpoint of the coracoid. An EndoButton loaded with five Ethibond sutures was passed through the coracoid tunnel while bound within one end of a closed loop, and locked to the underside of the coracoid. The other end of the closed loop was pulled enough through the clavicle tunnel to fit a second Endobutton between the loop and the tunnel, locking the Endobutton on the topside of the clavicle. Two sutures for the coracoid Endobutton were then passed and tied to the clavicular Endobutton. A second hole was drilled through the clavicle approximately 1cm lateral to the first. The remaining three strands of Ethibond sutures were pulled through the hole and tied
Outcomes: Surgical outcomes included incision length, blood loss, operative time, and fluoroscopy time. Patient-reported outcome measures included a visual analog scale and the Constant score. Anteroposterior radiographs were used to measure the coracoclavicular distance, defined as the vertical distance between the anterior-inferior border of the clavicle and the superior border of the coracoid process. Complications, including coracoid fracture, redislocation, loss of reduction, and heterotopic ossification were documented.
Methods: RCT
Time: Follow-up was scheduled for 2 weeks, 4 weeks, 8 weeks, 12 weeks, 6 months, and 12 months. Mean final follow-up was >24 months in both groups.
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The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.