Clinical Outcomes of Arthroscopy‐Assisted Modified Triple Endobutton Plate Fixation in Rockwood Type III Acute Acromioclavicular Joint Dislocation: A Retrospective Study

ObjectiveThe common triple Endobutton plate (CTEP) fixation is a lengthy procedure that is associated with high failure rates. Therefore, we used arthroscopy to improve the Endobutton fixation method by shortening the duration of surgery and reducing operative complications. This study explored the safety and effectiveness of arthroscopy‐assisted modified triple Endobutton plate (MTEP) fixation in Rockwood type III managing acute acromioclavicular joint (ACJ) dislocation.MethodsThis was a retrospective single‐center study involving 73 patients with Rockwood type III acute ACJ dislocation treated between January 2016 and January 2021. The 73 patients were classified into three groups, the acromioclavicular hook plate (ACHP) group (22 cases), CTEP group (24 cases) and MTEP group (27 cases), based on the type of surgical treatment they received. Clinical outcome data from the patient records, including the Constant–Murley score (CMS), American Shoulder and Elbow Surgeons score (ASES) and University of California at Los Angeles shoulder rating scale score (UCLA), were retrospectively reviewed. The scores were assessed before surgery and at the third and twelfth month after surgery. The clavicle‐coracoid (CC) distance on the affected side was estimated from imaging scans taken before surgery, on the second day after surgery, and within the third and twelfth month after surgery. The student''s t‐test was used to compare normally distributed data for independent samples, while homogeneity of variance test was used to compare normally distributed data among multiple groups. Non‐normally distributed data were compared using Mann–Whitney rank‐sum tests.ResultsThere were no differences in age, gender, body mass index (BMI), dislocated side, trauma etiology, and duration of follow‐up among the three groups. There was also no significant difference in the duration of surgery between the ACHP and MTEP groups, although the duration in the two groups was shorter than in the CTEP group (P < 0.05). The duration of hospitalization for the MTEP group was significantly shorter than for the CTEP group which was in turn shorter than for the ACHP group (both P < 0.05). There was no significant difference in postoperative CMS, ASES, and UCLA scores between the CTEP and MTEP groups but the score for the two groups differed significantly from those of the ACHP group (all Ps < 0.05). In addition, there was no significant difference in CC distance among the three groups after surgery (P > 0.05).ConclusionArthroscopic reconstruction of the coracoclavicular ligament using MTEP fixation to manage acute Rockwood type III ACJ dislocation is minimally invasive, and is associated with rapid functional recovery, few complications and satisfactory early clinical results.     

保守治疗与锁骨钩钢板内固定手术治疗Rockwood Ⅲ型肩锁关节脱位的中长期疗效对比研究

目的通过对比评估分析保守治疗与锁骨钩钢板内固定手术治疗Rockwood Ⅲ型肩锁关节脱位的中长期临床疗效,为临床上该类型肩锁关节脱位的治疗方式的选择提供依据。 方法回顾性分析自2015年9月至2016年9月在中山市中医院关节科诊治为Roockwood Ⅲ型肩锁关节脱位的患者,入选72例,成功随访47例,采用锁骨钩钢板内固定治疗（钩钢板组）23例、采用保守治疗方法（保守治疗组）24例。随访观察比较两组术后（损伤后）1年、3年、5年视觉模拟评分法（visual analogu scale,VAS）、肩关节功能评分以及并发症发生率。 结果术后1年随访锁骨钩钢板组VAS评分稍优于保守治疗组,但两组差异无统计学意义（P>0.05）;而术后3年以及5年锁骨钩钢板组VAS评分均明显优于保守治疗组,且差异具有统计学意义（P<0.05）。术后1年、3年以及5年随访锁骨钩钢板组肩关节功能评分均明显优于保守治疗组,且差异具有统计学意义（P<0.05）;锁骨钩钢板组并发症发生率明显低于保守治疗组,且差异具有统计学意义（P<0.05）。 结论采用锁骨钩钢板内固定手术治疗Rockwood Ⅲ型肩锁关节脱位,治疗效果较好,是治疗肩锁关节Rockwood Ⅲ型肩锁关节脱位较好的方法。     

Management of acute acromioclavicular joint dislocations: current concepts

Acromioclavicular joint (ACJ) injuries represent a common injury to the shoulder girdle. In the management algorithm of acute ACJ injuries complete radiological evaluation represents the key to a successful therapy. According to the classification of Rockwood the presence of a horizontal component in addition to vertical instability has to be detected. Using axillary functional views or Alexander views dynamic horizontal ACJ instability can be diagnosed in a simple, efficient and cost-effective manner reducing the number of mis-/underdiagnosed ACJ injuries. MRI should not be the imaging modality of first choice. The treatment of ACJ dislocations must consider two aspects. In addition to the correct type of injury therapy strategies should be adapted to patient’s demands and compliance. Low grade AC injuries types I and II are treated non-operatively in terms of “skilful-neglect”. High-grade injuries types IV–VI should be treated operatively within a time frame of 2–3 weeks after injury. A certain debate is still ongoing regarding type III injuries. Out from the literature, non-operative treatment of type III injuries results to provide at least equal functional outcomes as compared to surgical treatment associated with less complications and earlier return to professional and sports activities. If surgical treatment is indicated, open surgical procedures using pins, PDS-slings or hook plates are still widely used concurring with recently raising minimally invasive, arthroscopic techniques using new implants designed to remain in situ. Combined coracoclavicular and acromioclavicular repair are gaining in importance to restore horizontal as well as vertical ACJ stability.     

关节镜辅助下三束重建治疗急性Rockwood Ⅲ型肩锁关节脱位

目的探讨关节镜辅助下三束重建治疗急性Rockwood Ⅲ型肩锁关节脱位的临床疗效。 方法回顾性分析上海交通大学医学院附属新华医院骨科采用关节镜辅助下三束重建治疗21例急性Rockwood Ⅲ型肩锁关节脱位患者的资料,均为闭合性损伤。术后3、6、12个月对所有患者进行术后临床效果和影像学评价。根据术后影像学资料评估复位再丢失情况,采用Constant评分和上肢功能（disabilities of arm,shoulder and hand,DASH）评分评估患者肩关节功能。探讨术中关节镜辅助治疗的意义和价值。 结果术中关节镜探查发现4例合并软组织损伤,并进行一期镜下修复。所有患者术后均未发生喙突骨折和襻断裂。影像学评估提示术后6~12个月有6例患者（28.6%）出现轻度复位丢失,但与Constant评分和DASH评分无显著相关性,没有患者要求取出内固定。 结论关节镜辅助下三束重建治疗急性Rockwood Ⅲ型肩锁关节脱位是一种创伤小、安全、临床效果确切的手术方法。急性肩锁关节脱位通常由高能量损伤造成,在手术中关节镜探查肩关节能发现合并的软组织损伤,并进行一期修复,有利于肩关节功能的恢复,避免二次手术。     

Instabilitätsmuster bei Akromioklavikulargelenkverletzungen vom Typ Rockwood III

Background

There is no evidence-based treatment algorithm established for acromioclavicular joint (AC joint) dislocation classified as type Rockwood III injury. Recent meta-analyses revealed no advantage of surgical treatment compared to the non-operative approach. Both surgical and non-surgical approaches have been reported with inconsistent results. Therefore, the hypothesis of the current study was that patients classified as having Rockwood grade III injury may have different degrees of horizontal AC joint instability.

Material and methods

A total of 18 consecutive patients who had sustained a dislocation of the AC joint classified as Rockwood III were evaluated radiologically to quantify the horizontal instability of the AC joint. The specific radiological investigation included lateral stress x-rays (Alexander view) und axial stress x-rays with the affected arm in a horizontal adduction position.

Results

The dynamic horizontal instability of the AC joint was found to be independent of the vertical dislocation measured in the Rockwood classification.

Conclusion

For further treatment studies Rockwood III injuries should be distinguished in patients presenting with or without a substantial horizontal AC joint instability.     

Arthroscopic acromioclavicular joint reconstruction using a synthetic ligament device

Purpose

To describe an all-arthroscopic treatment of acromioclavicular joint (ACJ) dislocation and report the clinical results of the procedure.

Methods

This study consisted of 54 patients of whom 49 were men and 5 were women. The age of the patients averaged 39?years (range 16–69?years). All the symptomatic acute and chronic acromioclavicular joint dislocations classified according to Rockwood type III–IV were included in the study. All of them underwent standard clinical and radiological examination.

Result

All the patients were regularly followed up at the institute with the average follow-up being 15.09?months (range 5–30?months). The results were assessed using the shoulder subjective value (SSV) and the Modified rating of the University of California Los Angeles (UCLA) for acromioclavicular joint. The mean pre-operative SSV improved from 35.65 to the post-operative value of 88.6. According to the UCLA scale, 40 excellent, 8 good, 4 fair and 2 poor results were achieved. There were few problems encountered with the procedure like failure of ligament, incomplete reduction, capsulitis, and migration of sleeve and fracture clavicle.

Conclusion

ACJ dislocations can effectively be treated with arthroscopy-assisted procedure. Since this procedure has given uniformly good to excellent results comparable to open reconstructive procedures, it can be a good treatment option for symptomatic ACJ dislocations.

Level of evidence

IV, therapeutic series.     

Operative versus non-operative management following Rockwood grade III acromioclavicular separation: a meta-analysis of the current evidence base

Background  

Whilst there is little debate over the treatment of Rockwood grade V and VI acromioclavicular dislocation, the management of grade III acromioclavicular dislocation remains less clear. The purpose of this study was to compare the clinical outcomes of patients managed operatively and non-operatively following grade III acromioclavicular dislocation.     

Operative or conservative treatment in patients with Rockwood type III acromioclavicular dislocation: a systematic review and update of current literature

Purpose

Despite previous studies the management of Rockwood type III acromioclavicular (AC) dislocations remains controversial and the debate continues about whether patients with Rockwood type III AC injuries should be treated conservatively or operatively. In this study, we will review the current literature and present an overview of the outcome of conservative versus operative treatment of Rockwood type III dislocations.

Methods

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was used to conduct this review. A systematic search was performed in the Pubmed, Cochrane library, Embase, Scopus and Cumulative Index to Nursing and Allied Health Literature databases. Titles and abstracts were screened using predefined criteria and articles were critically appraised on relevance and validity.

Results

After critical appraisal eight articles were included in the study. The objective and subjective shoulder function outcome was better in the operative group, especially in young adults, though the rate of complications and radiographic abnormalities were higher. The rehabilitation time was shorter in the conservative group, however the cosmetic outcome was worse.

Conclusions

This review showed no conclusive evidence for the treatment of Rockwood type III AC dislocations. Overall, physically active young adults seem to have a slight advantage in outcome when treated operatively.     

Clinical and radiological outcome of acute high-grade acromioclavicular joint dislocation: A retrospective cohort study on Hook plate versus arthroscopic assisted single coracoclavicular tunnel with DogBone™ button dual FiberTape® construct

PurposeHook plate (HP) is a popular implant of choice in the management of highgrade acute acromioclavicular joint (ACJ) dislocations. Recently, suspensory loop systems have drawn significant interest with comparable results and additionally does not warrant implant removal. However, no studies have compared the outcomes of HP vis-a-vis Dog Bone TM Button with dual FiberTape® (DB).Methods38 patients who underwent HP or Arthroscopic assisted single tunnel DB fixation to stabilize high-grade ACJ dislocations were retrospectively included in study for clinically and radiological evaluation at a minimum follow up of one year. American Shoulder and Elbow Society and Constant Murley scores were used for clinical assessment. The radiological evaluation was done by assessing quality of reduction, measuring coracoclavicular distance (CCD), and extent of subacromial erosion.ResultsFor final follow up evaluation, both HP and DB group had 16 patients each. The mean follow-up was 55.38 ± 10.9 and 32.88 ± 14.0 months in HP and DB group, respectively. No significant difference in mean ASES (p=0.71) and CM score (p=0.62) was found between the two groups. The DB group revealed higher CCD at the final follow-up compared to the HP group (p=0.01). Although statistically insignificant, there were more subluxations and dislocations in the DB group (37.5%) compared to the HP group (25%). The subacromial erosion was noted in all cases of the HP group at time of implant removal.ConclusionBoth groups revealed satisfactory functional and radiological outcome. However, the DB group showed a higher tendency of loss of reduction.     

关节镜下喙锁和肩锁韧带重建治疗陈旧性Rockwood III型肩锁关节脱位

目的探讨关节镜下喙锁+肩锁韧带重建治疗陈旧性Rockwood III型肩锁关节脱位的疗效。 方法选取2016年1月至2020年12月北京大学人民医院收治的14例确诊为陈旧性肩锁关节脱位患者,其中男8例、女6例,平均年龄（37.2±10.1）岁,平均受伤时间（13.4±3.5）个月,累及优势侧肩关节7例,均行关节镜下喙锁+肩锁韧带重建手术。术后所有患者分别于不同时间点随访（术后1、3、6、12个月）,进行视觉模拟评分（visual analogue scale,VAS）和美国加州大学洛杉矶分校（University of California, Los Angeles,UCLA）评分。 结果14例确诊为陈旧性肩锁关节脱位患者（均为Rockwood III型）进入研究并完成手术,12例获得完全随访,平均随访（26.3±8.6）个月（12~36个月）。患者术前和术后1个月、3个月、6个月、12个月VAS评分分别为（5.667±0.414）分、（5.583±0.288）分、（4.583±0.229）分、（2.833±0.271）分、（0.538±0.193）分,与术前相比,所有患者在术后3个月、6个月和12个月随访时均显示疼痛减轻,术后6个月和12个月疼痛减轻的程度与术前相比（VAS评分变化）差异有统计学意义（P<0.001）。患者术前和术后1个月、3个月、6个月、12个月UCLA评分分别为（19.083±0.468）分、（18.583±0.434）分、（21.000±0.628）分、（25.750±0.579）分、（32.750±0.509）分,与术前相比,所有患者在术后3个月、6个月和12个月随访时UCLA评分与术前相比均有提高,术后6个月、12个月随访时UCLA评分改善的程度与术前相比,差异有统计学意义（P<0.001）。 结论关节镜下喙锁+肩锁韧带重建可以用较小的创伤达到帮助陈旧性肩锁关节脱位患者减轻疼痛和改善肩关节功能的目的。     

Arthroscopically assisted stabilization of chronic AC-joint instabilities in GraftRope™ technique with an additive horizontal tendon augmentation

Purpose

A chronic symptomatic acromioclavicular joint (ACJ) instability is a possible consequence of an acute ACJ separation. Besides vertical instability a horizontal component of the instability is common in high-grade ACJ separation and clinically relevant; especially, in chronic cases. A new technique of horizontal biologic ACJ augmentation with a transacromial gracilis tendon loop as an addition to the arthroscopically assisted stabilization with the GraftRope? device is described and first clinical and sonographical results are shown.

Hypothesis

The results after arthroscopically assisted single bundle reconstruction of the coracoclavicular (CC) ligaments with an additional horizontal tendon augmentation are comparable to the results of other stabilizing techniques in chronic ACJ instabilities.

Methods

A consecutive series of 20 patients with chronic symptomatic ACJ instability was stabilized with this new technique. 16 patients were followed-up clinically and sonographically. Patient satisfaction, visual analogue scale (VAS), simple shoulder test (SST), Constant score (CS) and Taft score (TS) were assessed. Bilateral sonographic measurements were performed to evaluate recurrent instabilities. Complications and concomitant glenohumeral injuries were analyzed.

Results

Sixteen patients (n = 2 female, n = 14 male, median age 40 (21–61) years, follow-up rate 84 %) were evaluated median 13 months (range 4–27 months) after indexed operation. 11 patients had a chronic ACJ instability after Rockwood type III, and 5 patients after Rockwood type V lesion. 6 patients suffered a recurrent symptomatic instability after operative treatment. 10 patients of the group were primary stabilized with the new technique. 15 of 16 patients were satisfied with the result of the operation at the follow-up examination. The VAS was median 4.6 of 10 points (range 1.1–7.4 points). The SST reached 9 points (range 5–12 points). The adjusted CS was median 84 % (range 46–93 %) and TS median 9 points (range 5–12 points). The sonographic measurements showed a significant difference in the CC distance between the unaffected and the affected side (21.7 vs. 24.8 mm, p = 0.009). The acromioclavicular distance was median 11 mm (range 7–17 mm) after resection of the lateral clavicle. Concomitant glenohumeral injuries were arthroscopically detected in seven patients. Postoperative complications occurred in one patient (wound infection). In one case, the clavicular washer was removed due to local paresthesia after healing of the graft.

Conclusions

The arthroscopically assisted stabilization of chronic ACJ instabilities with the GraftRope? device and an additive horizontal tendon augmentation technique leads to good short-term results with a supplementary horizontal stabilization.     

Comparison of the Tight Rope Technique and Clavicular Hook Plate for the Treatment of Rockwood Type III Acromioclavicular Joint Dislocation

Aim: Acromioclavicular joint dislocation is one of the most common shoulder problems and may lead to instability or degenerative changes. The aim of this study was to compare the clinical outcomes of the Tight Rope system and clavicular hook plate for Rockwood type III acromioclavicular joint dislocation in adults. Materials and Methods: This was a prospective, randomized study in a hospital setting. From January 2012 to December 2014, 69 patients with type III injury were reviewed. Patients were randomly divided into two groups: Group A was treated using the TightRope system and Group B with the clavicular hook plate. All participants were followed up for 12 months. Clinical outcomes, radiological results and postoperative complications were recorded. Results: The length of incision was significantly shorter in Goup A than that in Group B. The blood loss of surgery was significantly less in the Group A. Significant difference could be found between the two groups regarding the Visual Analogue Scale scores one day after surgery, at the 3 and 12 months follow-up. There were no differences according to the improvement of the Constant–Murley score and the coracoclavicular distance between the groups. Conclusions: The two groups have similar clinical and radiological outcomes. Both treatments could relieve the pain of dislocation, improve the function of Acromioclavicular joint and rectify the coracoclavicular distance measured in plain films. However, the TightRope system exhibited some advantages in terms of length of incision, blood loss of surgery, the pain postoperatively and no need for a second surgery.     

Short-term outcomes of arthroscopic TightRope<Superscript>®</Superscript> fixation are better than hook plate fixation in acute unstable acromioclavicular joint dislocations

Aim

The aim of this study was to compare the short-term outcomes of arthroscopic TightRope^® fixation with that of hook plate fixation in patients with acute unstable acromioclavicular joint dislocations.

Patients and methods

We conducted a prospective case–control study of twenty-six patients with an acute ACJ dislocation who underwent surgical repair with either an arthroscopic TightRope^® fixation or a hook plate from 2013 to 2016. Clinical and radiological data were collected prospectively. Clinical outcomes were evaluated using the Constant Score, the University of California at Los Angeles (UCLA) Shoulder Score, Oxford Shoulder Score as well as the visual analogue scale. Radiological outcomes were assessed with the coracoclavicular distance (CCD).

Results

Sixteen patients underwent arthroscopic TightRope^® fixation, while 10 patients underwent hook plate fixation. There were no significant differences in the preoperative variables except for the mean UCLA 4b infraspinatus score (TightRope^® 2.8 vs. hook plate 3.8; p = 0.030). Duration of surgery was significantly longer in the TightRope^® group. At 1 year post-operatively, the TightRope^® group had a significantly better Constant Score and CCD with no complications. All patients with hook plate fixation had to undergo a second procedure for removal of implant, and 3 patients had complications.

Conclusions

Arthroscopic TightRope^® fixation is a good option for the treatment of acute unstable ACJ dislocations. It has better short-term clinical and radiological outcomes as well as lesser complications when compared to hook plate fixation.

Level of evidence

Therapeutic, Level III.

     

Treatment of acute grade III acromioclavicular dislocation: a lack of evidence

Background  Although nonoperative treatment is considered the standard of care for the treatment of grade I and II acromioclavicular joint injuries, the treatment of grade III injuries is controversial. There are as many methods of nonoperative treatment as there are for operative stabilization. That is why we conducted a literature research to find out the best evidence regarding the treatment of acute grade III acromioclavicular dislocation. Method  The research was limited to RCTs, systematic review and meta-analysis in the most representative databases. Even if research identifies more than 600 articles, only five were included in the study because there were RCTs, and systematic reviews, but no meta-analysis articles were found. Moreover, no meta-analysis was performed because of differences of data published in the three RCTs (different type of surgical treatments and different outcome measures). Results  From the literature evaluation, clinical results seem to be comparable between the operative and the conservative treatments, but complications are more evident in the surgery group. Since there is not a preponderance of positive papers showing the benefits of a surgical technique over conservative therapy, the nonoperative treatment is still considered a valid procedure in the grade III acromioclavicular separation. Conclusion  More prospective randomized studies using validated outcome measures are needed to identify the suitable operation techniques for the acute injuries.     

Acromioclavicular reconstruction using autogenous semitendinosus tendon graft: results of revision surgery in chronic cases

Revision surgery of acromioclavicular dislocation is challenging owing to the altered anatomic relationships and the lack of stabilizing structures. In this study, an autogenous semitendinosus tendon graft was used for revision acromioclavicular stabilization, aiming at anatomic coracoclavicular reconstruction, as these patients had previously undergone a Weaver-Dunn procedure, which failed. Twelve patients were followed up clinically and radiographically for a mean of 49.5 months. The primary diagnosis was acromioclavicular joint dislocation Rockwood type III in 6, type IV in 4, and type V in 2 cases. At follow-up, the mean Constant score averaged 76.4 points. Pain relief was statistically significant (P < .01). Radiologic coracoclavicular distance and posterior displacement of the lateral clavicle in the Rockwood type IV cases decreased significantly (P < .01). We conclude that with this new technique of autogenous semitendinosus tendon graft replicating the anatomic ligamentous properties, good to excellent results can be achieved in revision cases of acromioclavicular reconstruction.     

关节镜下Twin Tail TightRope带袢钛板Y型固定治疗急性RockwoodⅢb型以上肩锁关节脱位的早期疗效

目的评价Twin Tail TightRope带袢钛板Y型固定术治疗急性肩锁关节脱位的早期临床疗效。 方法回顾性分析2015年6月至2017年6月昆明市第一人民医院采用Twin Tail TightRope带袢钛板内固定系统在关节镜下行Y型固定治疗急性肩锁关节脱位患者共16例。采用视觉模拟评分法（visual analogue scale，VAS）及Constant-Murley评分评估手术效果。 结果所有患者获得随访，随访时间3~12个月，平均（6.48±1.51）个月。术后无血管、神经损伤及切口感染，末次随访时均未发生复位丢失、锁骨应力性骨折、喙突切割等并发症。末次随访时VAS评分（0.36±0.04）分较术前（7.46±1.24）分降低，Constant-Murley评分（90.07±3.13）分较术前（46.13±3.25）分提高。 结论采用Twin Tail TightRope带袢钛板Y型固定术治疗急性肩锁关节脱位可有效解决术后水平、前后方向不稳定问题，此技术具有较低的锁骨、喙突骨折发生率，关节镜下操作可以减少手术损伤、提高精准度。     

Acromioclavicular joint dislocations: radiological correlation between Rockwood classification system and injury patterns in human cadaver species

Introduction

The classification system of Rockwood and Young is a commonly used classification for acromioclavicular joint separations subdividing types I?VI. This classification hypothesizes specific lesions to anatomical structures (acromioclavicular and coracoclavicular ligaments, capsule, attached muscles) leading to the injury. In recent literature, our understanding for anatomical correlates leading to the radiological-based Rockwood classification is questioned. The goal of this experimental-based investigation was to approve the correlation between the anatomical injury pattern and the Rockwood classification.

Materials and methods

In four human cadavers (seven shoulders), the acromioclavicular and coracoclavicular ligaments were transected stepwise. Radiological correlates were recorded (Zanca view) with 15-kg longitudinal tension applied at the wrist. The resulting acromio- and coracoclavicular distances were measured.

Results

Radiographs after acromioclavicular ligament transection showed joint space enlargement (8.6 ± 0.3 vs. 3.1 ± 0.5 mm, p < 0.05) and no significant change in coracoclavicular distance (10.4 ± 0.9 vs. 10.0 ± 0.8 mm). According to the Rockwood classification only type I and II lesions occurred. After additional coracoclavicular ligament cut, the acromioclavicular joint space width increased to 16.7 ± 2.7 vs. 8.6 ± 0.3 mm, p < 0.05. The mean coracoclavicular distance increased to 20.6 ± 2.1 mm resulting in type III?V lesions concerning the Rockwood classification.

Conclusions

Trauma with intact coracoclavicular ligaments did not result in acromioclavicular joint lesions higher than Rockwood type I and II. The clinical consequence for reconstruction of low-grade injuries might be a solely surgical approach for the acromioclavicular ligaments or conservative treatment. High-grade injuries were always based on additional structural damage to the coracoclavicular ligaments. Rockwood type V lesions occurred while muscle attachments were intact.     

急性RockwoodⅠ、Ⅱ型肩锁关节脱位非手术治疗疗效分析

目的评估急性RockwoodⅠ、Ⅱ型肩锁关节脱位非手术治疗的疗效。方法对自2009年1月~2010年10月收治的急性RockwoodⅠ、Ⅱ型肩锁关节脱位38例采用非手术治疗。结果 30例平均随访19个月(8～28个月)。最后一次随访平均VAS由(4.4±1.5)分降低到(0.8±0.1)分,Constant评分由(64.9±27.9)分上升到(91.6±14.8)分,按Constant评分优良率为89%。最后随访时9例(30%)有肩锁关节疼痛,3例(10%)有活动受限;影像学上8例(27%)显示肩锁关节半脱位;10例(33%)有肩锁关节退化性改变。结论Ⅰ、Ⅱ型肩锁关节不完全脱位采用非手术治疗可获得满意的临床结果。但同时也有较高的并发症发生率,有必要对影响治疗效果的相关因素进行探索,以取得更好的临床疗效。     

Arthroscopic resection of the distal clavicle in osteoarthritis of the acromioclavicular joint

Background:Symptomatic acromioclavicular joint (ACJ) lesions are a common cause of shoulder complaints that can be treated successfully with both conservative and surgical methods. There are several operative techniques, including both open and arthroscopic surgery, for excising the distal end of the clavicle. Here, we present a new modified arthroscopic technique for painful osteoarthritis of the ACJ and evaluate its clinical outcomes. Our hypothesis was that 4- to 7-mm resection of the distal clavicle in an en bloc fashion would have several advantages, including no bony remnants, maintenance of stability of the ACJ, and reduced prevalence of heterotopic ossification, in addition to elimination of the pathologic portion of the distal clavicle.Results:The overall UCLA score was 13.7 preoperatively, which improved to 33.4 postoperatively. All subscores were improved significantly (P < 0.001). There were no specific complications at the latest followup.Conclusion:It is critical in this procedure to resect the distal clavicle evenly from superior to inferior in an en bloc fashion without any small bony remnants and to preserve the capsule and acromioclavicular ligament superoposteriorly. This arthroscopic procedure is a reliable and reproducible technique for painful osteoarthritis of the ACJ lesions in active patients engaged in overhead throwing sports and heavy labor.     

关节镜下重建喙锁韧带合并修复肩锁韧带治疗肩锁关节脱位的临床疗效分析

目的：回顾性分析关节镜下重建喙锁韧带并修复肩锁韧带治疗RockwoodⅢ型肩锁关节脱位的临床疗效。