Acromioclavicular Reconstruction Using the Lockdown Technique: A Case Series and Systematic Review
Abstract
:1. Introduction
2. Materials and Methods
2.1. Methods of the Case-Series Study
2.1.1. Patient Selection
2.1.2. Data Extraction, Data Types, and Measures
2.1.3. Surgical Technique
2.1.4. Outcomes
2.1.5. Statistical Methods
2.2. Methods of the Systematic Review
2.2.1. Information Sources and Search Strategy
2.2.2. Selection Process
2.2.3. Eligibility Criteria
2.2.4. Data Collection Process and Data Items
2.2.5. Evaluation of the Studies and Study Risk of Bias Assessment
3. Results
3.1. Case-Series Study
3.1.1. Case-Series Study, Basic Characteristics
3.1.2. Case-Series Study, Outcomes
3.2. Systematic Search
3.2.1. Systematic Search, Basic Characteristics
3.2.2. Systematic Search, Outcomes
3.2.3. Systematic Search, Complications
3.2.4. Systematic Search, Risk of Bias Assessment
4. Discussion
4.1. Strength and Limitation
4.2. Implications for Research and Practice
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
AC | acromioclavicular |
CC | coracoclavicular |
OSS | Oxford shoulder score |
LD | Linear dichroism |
ORTSD | open reduction and suspensory device fixation |
UCLA | University of California-Los Angeles shoulder score |
ASES | American shoulder and elbow surgeons |
SST | simple shoulder test |
DASH | disabilities of the arm, shoulder, and hand |
NRS | numerical Rating Scale |
vs. | versus |
spf. | superficial |
SR | systematic review |
MA | meta-analysis |
K-wire | Kirschner wire |
MCID | minimal clinically important difference |
NA | not available |
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Basic Characteristics | All Patient | Time | Surgery | |||
---|---|---|---|---|---|---|
Acute <3 Weeks | Chronic >3 Weeks | Primary (Non-Previously Operated) | Non-Primary Operation (Revision) | |||
No. of patients | 39 | 27 | 12 | 32 | 7 | |
Primary/Revision | 32/7 | 25/2 | 7/5 | - | - | |
Acute/chronic | - | - | 25/7 | 2/5 | ||
Gender (M/F) | 36/3 | 25/2 | 11/1 | 29/3 | 7/0 | |
Mean age at op. (years) | 38.90 ± 12.68 | 35.52 ± 9.46 | 46.5 ± 15.2 | 36.69 ± 12.08 | 36.91 ± 14.33 | |
Mean time of interval (injury—op) (weeks) | 26.69 ± 84.36 | 1.07 ± 0.65 | 84.33 ± 139.11 | 25.44 ± 87.90 | 23.62 ± 87.86 | |
Mean time to return to work | 7.73 ± 9.95 | 6.87 ± 10.49 | 9.66 ± 8.73 | 8.57 ± 11.68 | 8.84 ± 11.73 | |
Follow-up (months) | 24.51 ± 10.12 | 23.18 ± 8.98 | 27.53 ± 12.19 | 23.84 ± 10.45 | 22.76 ± 9.72 | |
Rockwood classification: | ||||||
III | 21 (54%) | 15 (55%) | 6 (50%) | 18 (56%) | 3 (43%) | |
IV | 6 (15%) | 4 (15%) | 2 (17%) | 5 (16%) | 1 (14%) | |
V | 12 (31%) | 8 (30%) | 4 (23%) | 9 (28%) | 3 (43%) |
Acute | Chronic | Difference | p Value | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Preop | Postop | Preop | Postop | Acute | Chronic | (diff. Acute -diff.chr) | |||||||
Mean | SD | Mean | SD | Mean | SD | Mean | SD | Mean | SD | Mean | SD | ||
OSS | 12.93 | ±7.14 | 44.56 | ±9.08 | 29.11 | ±12.60 | 45.83 | ±2.29 | −31.63 | ±9.62 | −16.67 | ±12.42 | 0.0017 |
IMITANI | 26.11 | ±16.78 | 91.67 | ±19.22 | 52.08 | ±30.41 | 91.67 | ±9.13 | −65.56 | ±22.12 | −39.58 | ±27.26 | 0.0096 |
CONSTANT | 18.22 | ±15.37 | 91.11 | ±17.33 | 47.83 | ±25.66 | 88.17 | ±9.53 | −72.89 | ±22.07 | −40.33 | ±26.96 | 0.0017 |
UCLA | 8.52 | ±4.85 | 32.59 | ±6.20 | 17.00 | ±6.86 | 32.58 | ±3.63 | −24.07 | ±7.78 | −15.58 | ±8.27 | 0.0069 |
DASH | 73.64 | ±16.35 | 7.65 | ±17.41 | 41.90 | ±21.55 | 6.97 | ±8.69 | 65.98 | ±20.24 | 34.93 | ±22.85 | 0.0004 |
SST (%) | 6.47 | ±17.51 | 88.59 | ±19.65 | 34.74 | ±27.72 | 86.12 | ±10.26 | −82.12 | ±25.91 | −51.38 | ±32.54 | 0.0099 |
ASES | 26.63 | ±15.07 | 90.44 | ±20.09 | 52.08 | ±26.12 | 93.25 | ±6.55 | −63.81 | ±20.83 | −41.17 | ±25.67 | 0.0151 |
NRS (1–10) | 6.78 | ±1.76 | 0.85 | ±2.38 | 4.58 | ±2.81 | 0.92 | ±0.94 | 5.93 | ±2.34 | 3.66 | ±2.42 | 0.0131 |
No. of Group | Patient ID | Previous Surgery | Proud Metalwork | Implant Loosening | Discharge | Trauma | Reoperation | Reason of Reoperation | Time Until Reoperation (Days) | Lockdown Implant Extracted | Result of Bacteriogram | |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Acute | 27 | 1 | 2 | 1 | 4 | 3 | 5 | 525.6 ± 613.48 | 4 | |||
H1 | 1 | 0 | 0 | 1 | 0 | 1 | discharge | 18 | 1 | S. aureus | ||
H7 | 0 | 0 | 1 | 1 | 1 | 1 | trauma | 1045 | 1 | 0 | ||
H8 | 0 | 0 | 0 | 1 | 0 | 1 | discharge | 58 | 0 | 0 | ||
H27 | 0 | 0 | 0 | 0 | 1 | 1 | trauma | 1326 | 1 | 0 | ||
P4 | 0 | 0 | 0 | 1 | 1 | 1 | trauma | 181 | 1 | S. aureus | ||
H13 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | ||
H22 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | ||
Chronic | 12 | 1 | 1 | 1 | 3 | 1 | 3 | 141.33 ± 216.23 | 2 | |||
O3 | 0 | 0 | 1 | 1 | 0 | 1 | discharge | 19 | 1 | C. acnes | ||
O4 | 1 | 0 | 0 | 1 | 1 | 1 | trauma | 391 | 1 | 0 | ||
P5 | 0 | 0 | 0 | 1 | 0 | 1 | discharge | 14 | 1 | S. aureus | ||
O2 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Year of Publication | Origin of Authors | No. of Cases | Study Design | Male | Female | Mean Age (Year) | Rockwood Classification | Mean Interval (Months) | Mean Follow Up (Months) | |
---|---|---|---|---|---|---|---|---|---|---|
Narang et al. [10] | 2023 | UK | 42 | RCS | 39 | 3 | 42.2 | 8:III; 4:IV; 30:V; | 71.1 | 68 |
Jeon et al. [13] | 2007 | South Korea | 11 | RCS | 11 | 0 | 39 | 9:III; 1: IV; 1:V; | 18 | 55 |
Bhattacharya et al. [27] | 2008 | UK | 11 | PCS | 10 | 1 | 35.1 | >III | 21 | 24 |
Wood et al. [31] | 2009 | UK | 10 | RCS | NA | NA | NA | >III | NA | 6 |
Carlos et al. [5] | 2011 | UK | 45 | PCS | 32 | 13 | 37.6 | >III | 7.2 | 26.9 |
Cetinkaya et al. [28] | 2018 | Turkey | 16 | RCS | 16 | 0 | 38.5 | >III | NA | 20 |
Kumar et al. [29] | 2014 | UK | 24 | RCS | NA | NA | 42 | 13:III; 4:IV; 7:V; | 39 | 30 |
Saraglis et al. [30] | 2022 | UK | 25 | RCS | 22 | 3 | 36 | IV: 19; V:6 | NA | NA |
Wright et al. [32] | 2015 | UK | 21 | RCS | 21 | 0 | 43 | 12:III; 1:IV; 8:V; | 6.80 | 30 |
No. of patients | 205 | |||||||||
No. of studies | 9 |
Oxford | ASES | Nottingham | Imitani | Constant | |
Preop. | 2 | 0 | 1 | 0 | 0 |
Postop. | 5 | 0 | 1 | 2 | 5 |
UCLA | Simple | Pain (NRS) | Deformity | Complications | |
Preop. | 0 | 0 | 2 | 1 | |
Postop. | 1 | 1 | 4 | 0 | 8 |
Article | Number of Patients | Implant Loosening, Osteolysis | Subluxation | Other (Stiffness, Graft Rupture, Subacromial Impingement) | Proud/Prominence Metalwork | Superficial Infection, Discharge | Trauma | Previous Surgery | # of Reoperation | Reoperation Due to Non Re-Injury | Reasons for Reop | Previous Surgery | Time Until Reoperation (Months) | Lockdown Implant Extracted | Result of Bacteriogram |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Narang et al. [10] | 42 | 0 | 8 (X-ray) | 3 (stiffness) | 5 (proud) | 1 | 0 | 0 | 2 | 2 | Proud metal. | NA | NA | 2 | NA |
Jeon et al. [13] | 11 | 1 (loosening) | 11 (X-ray) | 2 (sub) | 0 | 0 | 1 | 3 (Weaver Dunn) | 2 | 2 | Subacr. Burs. | 0 | 6–10 | 1 | NA |
Bhattacharya et al. [27] | 11 | 4 (lysis) | 0 | 1 (graft) | 4 (prom.) | 0 | NA | 0 | 1 | 1 | Graft rupture | 0 | 6 | 1 | NA |
Wood et al. [31] | 10 | 0 | 0 | 0 | 0 | 0 | 0 | NA | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Carlos et al. [5] | 45 | 1 (loosenin)g | 13 migration = sublux (X-ray) | 0 | 6 (skin irritation) | NA | 0 | NA | 7 | 7 | 6 inf., 1 loosening | NA | 9 | 6 | 0 |
Cetinkaya et al. [28] | 16 | 1 (lysis) | 1 (X-ray) | 0 | 0 | 0 | 0 | 1 (K-wire) | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Kumar et al. [29] | 24 | 0 | 0 | 0 | 0 | 4 | 1 | NA | 1 | 0 | 0 | 0 | NA | 0 | 0 |
Saraglis et al. [30] | 25 | 1 (osteolysis) | 0 | 0 | 0 | 3 | 0 | 0 | 1 | 1 | infection | 0 | NA | 1 | 0 |
Wright et al. [32] | 21 | 0 | 0 | 1 (subacrom. imp.) | 0 | 0 | 1 | NA | 1 | 1 | Subacr. Burs. | 0 | NA | 0 | 0 |
205 | 8 | 33 | 7 | 15 | 8 | 3 | 4 | 15 | 14 | 6–10 | 11 | 0 | |||
100% | 3.9% | 16.1% | 3.4% | 7.3% | 3.9% | 1.5% | 2.0% | 7.3% | 6.8% | 5% |
Complication Differences | ||||
---|---|---|---|---|
Our Results | Sys Search | |||
No. of patients | 39 | 205 | ||
No. of complications (without trauma) | 12 | 30.8% | 71 | 34.6% |
Time interval (from injury to surgery, weeks) | 26.69 ± 84.36 (0.5–510) | 108.72 ± 98.04 (27.2–284.4) | ||
Stiffness, subacromial imp, graft failure | 0 | 0.0% | 7 | 3.4% |
Subluxation | 0 | 0.0% | 33 | 16.1% |
Proud metalwork, graft rupture, bursitis, stiffness | 3 | 7.7% | 15 | 7.3% |
Implant loose | 2 | 5.1% | 8 | 3.9% |
Spf. infection | 7 | 17.9% | 8 | 3.9% |
Re-injury | 4 | 10.3% | 3 | 1.5% |
Previous surgery | 7 | 17.9% | 4 | 2.0% |
Re-op. | 8 | 20.5% | 15 | 7.3% |
Implant remove | 6 | 15.4% | 11 | 5.4% |
Implant failure | 2 | 5.1% | 11 | 5.4% |
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Kovacs, K.; Váncsa, S.; Abonyi-Tóth, Z.; Hegyi, P.; Soos, G.; Rabai, K.; Bogosi, T.; Kocsis, G. Acromioclavicular Reconstruction Using the Lockdown Technique: A Case Series and Systematic Review. J. Clin. Med. 2025, 14, 4046. https://doi.org/10.3390/jcm14124046
Kovacs K, Váncsa S, Abonyi-Tóth Z, Hegyi P, Soos G, Rabai K, Bogosi T, Kocsis G. Acromioclavicular Reconstruction Using the Lockdown Technique: A Case Series and Systematic Review. Journal of Clinical Medicine. 2025; 14(12):4046. https://doi.org/10.3390/jcm14124046
Chicago/Turabian StyleKovacs, Krisztian, Szilárd Váncsa, Zsolt Abonyi-Tóth, Peter Hegyi, Gergely Soos, Kalman Rabai, Tibor Bogosi, and Gyorgy Kocsis. 2025. "Acromioclavicular Reconstruction Using the Lockdown Technique: A Case Series and Systematic Review" Journal of Clinical Medicine 14, no. 12: 4046. https://doi.org/10.3390/jcm14124046
APA StyleKovacs, K., Váncsa, S., Abonyi-Tóth, Z., Hegyi, P., Soos, G., Rabai, K., Bogosi, T., & Kocsis, G. (2025). Acromioclavicular Reconstruction Using the Lockdown Technique: A Case Series and Systematic Review. Journal of Clinical Medicine, 14(12), 4046. https://doi.org/10.3390/jcm14124046