A Self-Designed Endobutton Installation Device for Coracoclavicular Stabilization in Acute Rockwood Type III Acromioclavicular Joint Dislocation

Abstract

Objective: Endobutton technique could provide flexible coracoclavicular (CC) stabilization for acromioclavicular joint (ACJ) dislocation and achieved good clinical outcomes. However, the difficult part of this technique was placement of the Endobutton to the coracoid base. In this study, we designed an Endobutton installation device to place the Endobutton at the coracoid base. And we examined the clinical and radiographic outcomes of patients with acute Rockwood type III ACJ dislocation repaired with Endobutton using this device.

Methods: We designed an Endobutton installation device to place the Endobutton at the coracoid base to achieve CC stabilization. We retrospectively reviewed 42 patients with acute Rockwood type III ACJ dislocation who underwent CC stabilization with Endobuttons placed either using this novel device (group I, n = 19) or the traditional technique (CC stabilization without using special device, group II, n = 23) from January 2015 to April 2020. The two groups were compared regarding the operative time, intraoperative blood loss, and clinical and radiologic outcomes at final follow-up. The operation-related complications were also evaluated. The Student's t test and the Mann-Whitney U-test were used to compare differences in continuous variables. Differences in categorical variables were assessed with either the Pearson's chi-squared test or Fisher's exact test.

Results: Forty-two patients were clinically followed up for a minimum of 12 months. Compared with group II, group I had a significantly shorter mean operative time (56.05 ± 7.82 min vs. 65.87 ± 7.43 min, p < 0.01) and significantly lesser mean intraoperative blood loss (67.89 ± 14.75 mL vs. 94.78 ± 25.01 mL, p < 0.01). At final follow-up, there were no significant differences between the two groups in the visual analog scale score for pain, Oxford Shoulder Score, Disabilities of the Arm, Shoulder, and Hand score, and postoperative CC distance of the affected side. Loss of reduction occurred in four patients in group I and three patients in group II (p = 0.68); there were no other operation-related complications in either group.

Conclusions: The Endobutton installation device makes placement of the Endobutton at the coracoid base easier and achieves satisfactory clinical and radiologic outcomes without additional complications in acute Rockwood type III ACJ dislocation.

Keywords: Acromioclavicular Joint; Coracoclavicular Ligament; Dislocation; Endobutton; Stabilization.

FIGURE 1

Illustration of the self‐designed Endobutton installation device. (A) The cannula is 100 mm long and its outer and inner diameters are 4.3 mm and 4.1 mm, respectively. (B) The pushing rod is 150 mm long and is composed of a 30 mm long, 10 mm wide, and 2.0 mm thick rectangular handle; a 110 mm long cylindrical part with a 2.0 mm diameter; and a 10 mm long, 2.5 mm wide, and 1.5 mm thick rectangular end.

FIGURE 2

The self‐designed Endobutton installation device used to place an Endobutton at the coracoid base. (A) Lateral view of the cannula, Endobutton, and pushing rod. (B) Transverse view of the cannula and Endobutton. (C) Lateral view of the Endobutton being passed through the cannula using the pushing rod.

FIGURE 3

A 42‐year‐old woman with Rockwood type III ACJ dislocation. (A) Preoperative radiographs. (B) The ACJ is reduced and maintained by temporary K‐wires and a director is placed from the middle of the clavicle to the middle of the coracoid base. (C) A 4.6‐mm bony tunnel is drilled through the director. (D) The cannula is inserted through the bony tunnel from the clavicle to the coracoid. (E) A suture was placed through the Endobutton loop, and the Endobutton was then put into the cannula. (F) The Endobutton was placed at the coracoid base by the pushing rod. (G) The Endobutton gradually closed to the coracoid base by pulling the suture. (H) The second Endobutton plate without loops is placed in the loop above the clavicle. (I) Postoperative radiograph obtained to assess the reduction.

FIGURE 4

A 46‐year‐old man with Rockwood type III ACJ dislocation. (A) Preoperative radiographs. (B) The ACJ reduction is achieved and maintained by the placement of temporary K‐wires across the ACJ. (C) A director is placed from the middle of the clavicle to the middle of the coracoid base. (D) Illustration showing the stainless steel suture folded into double strands. A 4.2‐mm bony tunnel is drilled through the director and the middle fold of the steel suture is passed through the bony tunnel to the coracoid base. (E) Illustration of the middle fold of the steel suture being taken to the incision site by the vascular forceps. (F) Illustration showing the No. 1 Ethibond suture passing through the loop of the Endobutton and through the middle fold of the steel suture. (G) Illustration of the Endobutton placed at the coracoid base and the loop brought to the surface of clavicle by pulling the middle fold of the steel suture and the Ethibond suture. (H) The second Endobutton plate without loops is placed in the loop above the clavicle. (I) Postoperative radiograph obtained to assess the reduction.