Complications from the use of adjustable loop fixation for AC joint separation
New research published in the Journal of Arthroscopy illustrates the challenges of achieving stable repair and avoiding complications when surgically repairing an AC joint separation. Sang-Jin Shin, MD, et al reports on complications using an adjustable loop fixation device in repairing acute AC joint separations (separated shoulder). Shim’s study reports on a series of 18 patients undergoing an arthroscopic repair for an acute dislocation of the AC joint. They found that the adjustable loop device placed arthroscopically resulted in partial or complete loss of fixation in 33% of cases and 44% of patients had complications associated with this approach.
While the arthroscopic approach is appealing because of smaller incisions, it does not allow for a repair of the AC joint capsule, which is one of the three main areas of initial injury. In addition the arthroscopic procedure does not permit any direct way to control stability in the horizontal plane, an important component of instability. Two patients sustained fractures of the coracoid bone due to inaccurately placed drill holes, underscoring the challenges of placing accurate drill holes in the bones when the drilling is done arthroscopically instead of directly.
Double Endobutton Technique – Better alternative than Adjustable Loop
The patented procedure that Dr. Steven Struhl favors avoids all of these potential problems and allows for consistent long-term stability and minimizes the chance of complications. The loop is continuous and of fixed length and therefore retains its length even under the heavy cyclic loads that the patient experiences during the recovery process.
Several documented research studies have shown that the continuous loop is twice as strong and is at least as stiff as the native ligaments and more importantly allows for only 1 mm of “creep” after sustained periods of cyclical loads. Dr. Struhl’s limited open approach allows for a direct view of the drill holes, minimizing inaccurate drilling. In addition his open approach allows for a surgical repair of the AC joint capsule itself and also allows for placement of an additional suture to control movement in the horizontal plane.
For more information on Dr. Struhl’s technique please visit either his ac joint separation publications or video on the technique and the results. For more information on Dr. Sang-Jin Shin’s article.
Posted on behalf of Steven Struhl MD