What are the operative possibilities?
Surgical treatment for acromioclavicular dislocation depends on the degree of injury and the activities of the patient. If all ligaments of the acromioclavicular joint are torn, this form of injury is called Tossy 3. Then the therapy can be performed conservatively as well as surgically.
The advantage of surgery is the possibility of restoring the actual anatomy of the shoulder. The risks and pain are also relatively low with this operation. One argument against the operation is that the remaining joint damage is often not too great and tolerable, so that in some cases no improvement can be achieved by the operation.
Whether or not the operation is performed depends on the individual case and should be discussed individually with the doctor. The operation consists mainly of restoring the actual anatomy. In order to have a good view of the joint and the ligaments, in some cases a relatively large incision above the shoulder joint is necessary first, leaving a large scar.
The torn ligaments can then be sutured together again. In more recent procedures, the ligaments can be restored by arthroscopy (joint endoscopy). The procedure and the scar left behind are then significantly smaller.
The shoulder joint itself is initially supported in its position by screws, a plate or wires. In addition, the ligaments themselves are stabilized, as the individual ligament suture would not be able to withstand the forces acting on the joint. To ensure that the ligaments and capsule have sufficient time to heal after the operation, the shoulder joint is immobilized for 6 weeks in a Gilchrist bandage. Afterwards, the joint can be slowly accustomed to increasing loads. In some cases, the stabilizing material must be removed after some time in another operation.
Surgical Techniques
Kirschner wire: With the help of this procedure, wire pins of varying thickness can be inserted through the skin (percutaneously) into the bone. The advantage is that this procedure causes only minor tissue trauma. In most cases, however, this form of therapy does not lead to sufficient stabilization, so that further immobilization with a Gilchrist bandage is necessary.
Furthermore, this minor operation does not allow the ligaments to be sutured again. Plate osteosynthesis:A plate is used to compress the fracture gap and only needs to be inserted if there is a fracture in addition to the ligament rupture. The plate is then placed on the fracture gap and fixed in the bone with screws.
This allows the fracture ends to heal together again. The plate does not have to be removed in principle, but in some cases it can be disruptive because it is attached to muscles and tendons. In this case, the plate is removed in a further operation after the fracture has healed.
TightRope System:In this system, a suture system is inserted into the shoulder joint arthroscopically (during arthroscopy) to stabilize the torn ligaments. The purely arthroscopic therapy (shoulder joint endoscopy) means that the access route is very small, leaving hardly any scars and keeping tissue trauma to a minimum. For this form of therapy to lead to healing, the ligaments must be surgically treated within 2 weeks of the injury.
After these 2 weeks, there is talk of a chronic acromioclavicular dislocation and the ligaments can no longer grow together. Tendon replacement:If the surgical treatment can only be carried out a few weeks after the injury, the tendons often have to be reconstructed. This can also be carried out as part of a joint endoscopy (arthroscopy). In this procedure, the patient’s own tendon (usually from the calf) is removed and inserted into the shoulder joint as a tendon replacement.
