Clinical and radiographical results after double flip button stabilization of acute grade III and IV acromioclavicular joint separations

Introduction

Persistent horizontal instability after acute acromioclavicular (AC) joint separation may provoke unsatisfactory results of conservative treatment. Hypothesis: the arthroscopically assisted double flip button stabilization of acute horizontally unstable grade III and IV AC joint disruptions results in full functional restoration and stable radiological reposition.

Materials

21 patients treated for an acute grade III or IV AC joint separation were enrolled. Clinical assessment at least 2-year postoperative included the constant score (CS) and the simple shoulder test. A panorama stress view, bilateral axial view and an AC view were obtained for radiographic evaluation.

Results

19 individuals (mean 37 years; 17 men) with 16 Rockwood type III and 3 type IV injuries were available for examination 24–51 months postoperatively. The mean CS was 90.2 points (SD 6.5) with no statistically significant difference between CS and age-adjusted normative values. The mean Simple Shoulder Test scored 11.5 points (range 8–12). Loss of reduction of more than 2 mm in the coronal plane stress views was present in 6 patients (32 %) with no associated loss of functional outcome. Two of four reported complications in four patients were treated surgically (one open revision with graft augmentation for coracoid implant break out, one arthroscopic capsular release for persistent glenohumeral stiffness).

Conclusion

Arthroscopically assisted double flip button stabilization for acute grade III and IV AC joint separation restores fully horizontal stability and age-expected shoulder function, resulting in high patient satisfaction, despite a loss of reduction observed radiographically in approximately one-third of patients.

Level of evidence

IV.     

Surgical outcome following arthroscopic fixation of acromioclavicular joint disruption with the tightrope device

The objective of this study was to evaluate the preliminary radiographic and clinical results of grade IV and V acromioclavicular joint disruption repair using the arthroscopic Arthrex acromioclavicular TightRope (Naples, Florida) fixation technique. Numerous procedures have been described for surgical management of acromioclavicular joint disruption. The TightRope device involves an arthroscopic technique that allows nonrigid anatomic fixation of the acromioclavicular joint. A cohort of 10 men and 2 women with a mean age of 43 years (range, 25-61 years) underwent the acromioclavicular joint TightRope procedure between April 2007 and October 2009. Eleven patients had either Rockwood grade IV or V disruptions and 1 sustained a distal third clavicle fracture with acromioclavicular joint disruption. Data was collected from a chart review. Patients were evaluated clinically, radiographically, by the simple shoulder test, and by overall satisfaction. There were 2 failures of reduction and 1 loss of reduction at final radiographic follow-up. The rate of fixation failure was 16.6%. All patients had >110° of total elevation. The majority of patients obtained satisfactory functional results according to the Simple Shoulder Test averaging 11 of 12 questions answered positively (range, 7-12; standard deviation, 1.50) and 11 of 12 patients were satisfied with the procedure. At final phone interview at approximately 2 years postoperatively, 6 patients were lost to follow-up. The remaining patients were all satisfied with the procedure and no patients reported subjective loss of reduction or deterioration of function. Simple Shoulder Test average was maintained with 11 of 12 positively answered questions (range, 7-12; standard deviation, 2.0) This case series revealed a high rate of fixation failure with the TightRope system. Still, most patients were satisfied with the procedure and achieved high functional shoulder results.     

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。     

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。     

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。     

Arthroskopisch assistierte Stabilisierung bei akuter und chronischer Akromioklavikulargelenksprengung

Objective

The surgical procedure aims at anatomic reduction and stabilization of the acromioclavicular joint in vertical and horizontal planes for acute separations using a trans-clavicular and trans-coracoidal suture tape fixation with additional acromioclavicular joint augmentation with a PDS cord cerclage. For chronic instability adding a tendon graft is essential for sustainable stability.

Indications

Acute und chronic acromioclavicular joint separations type Rockwood III–VI. Recurrent AC-joint instability with intact coracoid process (with tendon graft).

Contraindications

Acromioclavicular joint separations type Rockwood I–II. Asymptomatic chronic AC-separations type Rockwood III–IV. Fracture close to base of coracoid process General contraindications for (elective) surgery.

Surgical technique

Vertical reconstruction of the coraco-clavicular ligaments using a drill-guide for trans-clavicular and trans-coracoidal tunnel placement for high-strength suture tapes over titanium buttons. Additional stabilization of the AC-joint with a transosseus figure of 8 PDS suture cord cerclage.

Postoperative management

Postoperatively the arm is put in a regular sling for 6 weeks. Free active range of motion of wrist and elbow. Shoulder range of motion is limited to 30° of flexion and abduction and 80° internal and 0° external rotation for 2 weeks. Extended to active-assisted 45° flexion and abduction in weeks 3 and 4 and advanced to 60° flexion/abduction and free internal/external rotation in weeks 5 and 6. Range of motion is unlimited from week 7. Full daily life activities after 3 months, high-impact sports after 5–6 months postoperatively.

Results

The presented surgical technique reliably stabilizes the acromioclavicular joint. It’s biomechanical properties with only the single-tunnel coracoclavicular suture tapes is on the level of the native vertical stability, which can be additionally improved for better horizontal stability with the cerclage over the AC-joint.     

TightRope治疗Rockwood Ⅲ型肩锁关节脱位失败病例分析

目的分析TightRope治疗肩锁关节脱位失败病例的原因,总结相关经验教训。 方法自2014年1月至2018年4月收治肩锁关节脱位RockwoodⅢ型77例,均采用TightRope重建喙锁韧带治疗,术后发生钢板脱出、松动共6例,分析其手术失败原因。 结果所有患者均获随访,随访时间3~32个月,平均14.30个月,术后3个月Constant评分（93.86±5.59）分。失败病例6例,术后3个月Constant评分（79.17±7.33）分。失败原因包括隧道建立偏斜3例,手术操作不当2例,肩锁关节过度复位1例。 结论TightRope治疗肩锁关节脱位导致失败的因素：严重的骨质疏松,隧道建立偏斜,过度复位等。     

Acute Rockwood type III ACJ dislocation: Conservative vs surgical approach. A systematic review and meta-analysis of current concepts in literature

BackgroundThe most appropriate approach, surgical or conservative, for acute Rockwood type III acromioclavicular joint (ACJ) dislocation is still under debate. In literature, similar results have been reported with both treatments. This review aims to analyze the operative and conservative outcomes of acute Rockwood type III ACJ dislocation to guide orthopedics in daily practice.Material/methodsA systematic review and meta-analysis were performed according to PRISMA guidelines. A PICOS template was developed. Four databases (Pubmed, Scopus, Embase, and Medline) were searched, and eligible articles were evaluated according to the Levels of Evidence. The methodological quality of the articles was assessed through the ROBINS-I and the RoB-2. This review was registered in PROSPERO.ResultsFive studies were included, with 73 and 110 patients treated with conservative and surgical approaches, respectively. Three outcomes, Constant Score (CS), coracoclavicular distance (CCD), and acromioclavicular distance (ACD) were analyzed. Only the acromioclavicular distance was statistically significant in the surgical group over the conservative one (p < 0.05); instead, the other two outcomes demonstrated no statistical difference between the two groups.ConclusionsThis study demonstrated statistically significant superiority of the mean ACD score in the radiological follow-up of the surgical group compared to the conservative one. A tendency for better radiological and clinical results, mean CCD and CS scores, respectively, although non statically significant, was reported in the surgical group. High-quality randomized controlled clinical trials should help determine the most appropriate treatment for acute Rockwood type III ACJ dislocations.     

Arthroskopisch gestützte Techniken zur Versorgung der akuten und chronischen AC-Gelenk-Verletzung

Acute and chronic acromioclavicular (AC) joint dislocation is frequently encountered in the routine clinical practice. This injury can lead to significant impairment of shoulder girdle function. Therapy based on the severity of injury is recommended to re-establish correct shoulder function. The static radiographic Rockwood classification is used to define the degree of dislocation but the clinical aspects and functional x-ray imaging of horizontal AC joint instability should also be considered for selection of the appropriate procedure. Rockwood grades I and II injuries are treated non-operatively with early functional exercise. The approach for Rockwood grade III injuries should be individual and patient-specific, with non-surgical procedures for low functional requirement patients with a high risk for surgical interventions. For patients with high demands on shoulder function surgery is recommended. A detailed diagnostic assessment frequently reveals Rockwood grade III injuries to be type IV injuries. Rockwood types IV and V AC joint dislocations require surgery for sustained stability. Treatment of acute injuries is recommended within 1-3 weeks after trauma but there is no clear evidence of a cut-off for the presence of chronic injuries. Various surgical techniques have been described in the literature. This article presents an arthroscopically assisted technique that addresses both vertical and horizontal instability of the AC joint.     

双Endobutton钢板与锁骨钩钢板内固定治疗Rockwood Ⅲ、Ⅴ型肩锁关节脱位的疗效比较

目的比较双Endobutton钢板与锁骨钩钢板内固定治疗RockwoodⅢ、Ⅴ型肩锁关节脱位的远期疗效。方法回顾性分析自2009-05—2014-06诊治的40例RockwoodⅢ、Ⅴ型肩锁关节脱位,采用双Endobutton钢板内固定治疗12例(双Endobutton钢板组),采用锁骨钩钢板内固定治疗28例(锁骨钩钢板组)。比较2组手术时间、术中出血量、并发症情况,以及末次随访时肩关节疼痛VAS评分、肩关节功能Constant-Murley评分。结果双Endobutton钢板组手术时间较锁骨钩钢板组长,且术中出血量大于锁骨钩钢板组,差异有统计学意义(P0.05)。40例均获得随访24~84个月,平均41.4个月。末次随访时2组肩关节疼痛VAS评分及肩关节功能Constant-Murley评分差异无统计学意义(P0.05)。双Endobutton钢板组术后1例复位丢失,1例异位骨化,3例肩部疼痛;锁骨钩钢板组术后11例肩部疼痛,2例肩关节活动受限,2例肩峰下骨质吸收,未出现复位丢失。结论双Endobutton钢板与锁骨钩钢板内固定治疗RockwoodⅢ、Ⅴ型肩锁关节脱位疗效满意,且双Endobutton钢板内固定对肩关节功能影响小,术后肩痛发生率低,无需取出内固定,但手术技术要求较高。     

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。     

Minimalinvasive Akromioklavikulargelenkrekonstruktion (MINAR)

Objective

Reduction and retention of an acromioclavicular (AC) joint dislocation with a button/suture augmentation cerclage (Flip tack, Karl Storz, Tuttlingen, Germany).

Indications

Dislocation of the AC joint (Rockwood III and V). Chronic instabilities in combination with autogenous replacement of the coracoclavicular ligaments. Lateral clavicular fracture with rupture of the coracoclavicular ligaments.

Contraindications

Patients in poor general condition. Local soft-tissue infection. Low-degree dislocation of AC joint (Rockwood I und II). Fracture of the clavicular shaft. Chronic instabilities without ligament replacement.

Surgical Technique

The coracoid process is exposed by a 3 cm long skin incision. A hole is drilled through the coracoid process with the help of a specific aiming device. The suture cerclage is connected to two buttons. One of the buttons is then pushed through the coracoid process. The button is flipped and the suture thereby fixed to the coracoid process. The other anchor is pulled through a hole in the clavicle and the cerclage is secured with a surgical knot after reduction of the AC joint.

Postoperative Management

Application of an abduction splint for 4 weeks (15°).

Results

23 patients with an acute luxation of the AC joint were operated with a minimally invasive coracoclavicular cerclage (five patients with Rockwood type III and 18 patients with Rockwood type V). Mean operative time was 28.6 min. Perior postoperative complications such as nerve and vascular injuries, thoracic injuries, infection, thrombosis, and embolism did not occur. The mean Constant Score was 94.1 points (73–100 points) after a mean of 23.3 months (18–28 months). In two cases, a slight loss of reposition of less than half of the clavicle width in comparison with the contralateral side was observed.     

纽扣钢板与带袢钢板治疗肩锁关节脱位的疗效比较

目的比较应用纽扣钢板与带袢钢板两种内固定方法治疗新鲜RockwoodⅢ型以上肩锁关节脱位的临床疗效。方法选取60例RockwoodⅢ型以上肩锁关节脱位患者,均为新鲜单纯肩锁关节脱位,不合并肩关节周围其他损伤。按单、双号分为纽扣钢板组(A组)和带绊钢板组(B组),每组30例。记录两组的切口长度、手术时间、术中出血量;采用Constant评分评价两组术前、术后6个月后的患肩功能;术后第3天及术后6个月测定喙锁距离分析复位丢失量。结果患者均获得随访,时间7~24个月。两组切口长度比较差异无统计学意义(P0.05)。手术时间、术中出血量A组均少于B组,差异均有统计学意义(P0.05)。术后6个月Constant评分两组与术前比较差异均有统计学意义(P0.05),两组间比较差异无统计学意义(P0.05)。术后复位丢失量两组比较差异无统计学意义(P0.05)。结论应用纽扣钢板内固定治疗肩锁关节脱位复位丢失较小,固定安全、可靠,是治疗RockwoodⅢ型以上肩锁关节脱位较为理想的方法。     

Evaluation of arthroscopic stabilization of acute acromioclavicular joint dislocation using the TightRope system

The purpose of this study was to evaluate the results of the arthroscopic treatment of acute acromioclavicular dislocation using the TightRope system (Arthrex, Naples, Florida). Between January 2006 and May 2007, ten shoulders in 10 patients with acute acromioclavicular joint dislocation (Rockwood types IV and V) underwent arthroscopic acromioclavicular joint stabilization using the TightRope. Average patient age was 30 years (range, 22-42 years), and mean follow-up was 24 months (range, 18-30 months). Follow-up occurred at 2 and 6 weeks, 3 months, and then every 6 months postoperatively. The shoulders were evaluated radiologically by comparing the acromioclavicular joint with the normal side and clinically by assessing the pain, function, and range of joint motion using the Constant score.Ten patients returned to work without pain 10 to 12 weeks postoperatively. Average Constant score was 96.3 (range, 94-99) at last follow-up. Because of technical error, 1 patient experienced TightRope fixation failure on the coracoid side, and the acromioclavicular joint was redislocated, which was treated by an open technique. The 10 patients were satisfied with their functional results and cosmetic appearance.The arthroscopic treatment of acute acromioclavicular dislocation using the TightRope is a minimally invasive surgical technique that has been proven effective for the treatment of these lesions. It is characterized by less morbidity, less hospitalization, excellent cosmoses, and early rehabilitation.     

Retrospective review of outcome post open reduction and K-wire fixation for grade III acromioclavicular joint subluxations

There is controversy about the therapy for grade III acromioclavicular dislocation according to Tossy and Rockwood’s classification. We identified 25 patients who underwent acromioclavicular joint wiring for grade III subluxations under the care of a single consultant in the last 5-year period. All patients were asked to fill in a DASH (Disabilities of the Arm, Shoulder and Hand) questionnaire to assess outcome following acromioclavicular joint repair, and their clinical notes were reviewed. Our results show that open reduction and Kirschner- (K) wire fixation of grade III AC joint disruptions results in good strength and range of motion of the affected shoulder. It is associated with DASH scores, which are comparable to those of the general population for the same age, indicating little residual disability. All patients returned to their pre-injury occupation, and all but one returned to previous sporting activities. Complications occurred in four patients, but only one required K-wire repositioning.     

Akute AC-Gelenksprengung – operative oder konservative Therapie?

42 patients with complete acromioclavicular dislocation treated operatively and 38 patients managed non-operatively were examined retrospectively with a mean follow-up of 6.3 +/- 2.5 years. The dislocations in both groups included type III and type V injuries according to the Rockwood-classification. The operative technique was suturing of the tom ligaments and stabilization of the acromioclavicular joint using resorbable coracoclavicular PDS-banding. In non-operative treatment, early physiotherapy accepting the deformity was performed in most of the patients. The clinical results using the UCLA- and the Constant-Murley score as well as evaluation of pain, function and strength were similar in both groups. Those patients suffering from a more severe dislocation type Rockwood V who were treated non-operatively had as good results as those patients with grade III dislocation. Posttraumatic osteoarthritis developed mainly in those patients whose acromioclavicular joint healed in partial dislocation. Non-operative treatment was equal even in less severe dislocations in the subgroup of type Rockwood V injuries. The persisting deformity which must be expected in non-operative treatment did not affect the patient's outcome regarding pain, function and strength of the shoulder.     

Triple-Endobutton钢板置入治疗Rochwood Ⅲ-Ⅴ型肩锁关节脱位

目的：探讨Triple-Endobutton 钢板置入治疗Rochwood分型Ⅲ-Ⅴ型肩锁关节脱位的临床疗效。方法：2008年3月至2010年6月,对28例Rochwood Ⅲ-Ⅴ型肩锁关节脱位的患者进行Triple-Endobutton 钢板置入治疗,男18例,女10例;年龄20～60岁,平均38岁;左侧20例,右侧8例;均为闭合性损伤。肩关节功能按Constant标准进行疗效分析。结果：28例获随访,时间18～24个月,平均20个月。所有患者肩关节活动良好,未出现再脱位及疼痛等症状。X线检查肩锁关节均完全复位。肩关节功能按Constant标准,术前评分25.4±2.0,术后1个月65.9±3.0,术后3个月87.2±3.2,术后6个月95.7±1.6.结论：利用Triple-Endobutton 钢板置入治疗Rochwood Ⅲ-Ⅴ型肩锁关节脱位固定牢靠,操作简单,并发症少,无须二次取出,术后可早期进行功能锻炼,疗效满意。     

Editorial Commentary: Double Bundle the Coracoclavicular Ligaments for Success: The More the Better?

Injuries to the acromioclavicular joint are common across all levels of sport and activity. Overall, a consensus exists regarding Rockwood grade I and II injuries (conservative approach) and Rockwood grades IV to VI (best treated surgically). However, grade III injuries are heterogeneous and thus respond differently to nonoperative and operative treatment. Regardless of the acromioclavicular injury grade, these are widely prevalent injuries, and there is a lack a consensus as to which operative fixation methods yield the best outcomes for patients. Although K-wires and plates were historically used to achieve rigid fixation, recent evidence supports the use of soft tissue grafts to reconstruct the coracoclavicular ligaments and restore vertical and anteroposterior and rotational stability with a more biological approach.     

Stabilization of the Dislocated Acromioclavicular Joint with Ligament Suture and Balser Hook Plate

Objective Reduction of dislocation and reconstruction of acromioclavicular joint by suturing the torn capsuloligamentous structures, temporary fixation with a Balser plate. Goal: restitution of form and function of shoulder girdle. Indications Primary acromioclavicular dislocation of Tossy type III or Rockwood type III in physically active patients. Acromioclavicular dislocations with additional muscle injuries of Rockwood type IV-VI. Remote painful dislocations without osteoarthritis. Here, consider patient's physical and occupational requirements. Lateral clavicle fractures with damage to clavicular ligaments. Contraindications Poor local skin condition or wounds. Symptomatic, moderate or severe osteoarthritis of acromioclavicular joint. Elevated surgical risk, poor health. Patient not agreeing to surgery. Cosmetic objections. Surgical Technique Anterior saber cut incision medial to acromioclavicular joint. Notching of insertion of deltoid muscle to expose the acromioclavicular ligaments. Placement of U-sutures in these ligaments. Refixation of intraarticular disk to clavicle with sutures. Selection of plate and subacromial insertion of its hook in close bony contact posterior to acromioclavicular joint. Radiographic control of hook and plate and of acromioclavicular joint. Plate fixation with cortex screws. Tying of the ligament sutures already in situ. Suture of joint capsule and of concomitant soft tissue disruptions. Drain. Wound closure. Results In a prospective study, 57/68 patients (62 men, six women, average age 40.3 [19-84] years) operated between 9/94 and 12/97 could be followed up clinically and sonographically after an average of 24.6 (12-49) months. Implant removal after 12 weeks. A full, painless shoulder mobility was seen in 50 patients. Sonography comparing both shoulders showed an average cranial clavicular subluxation of 0.3 mm and under a 10-kg load of 0.6 mm. Limitation of sports was reported seven times. A good to excellent result was obtained in 50 patients.     

关节镜辅助喙锁悬吊固定联合改良Weaver-unn手术治疗陈旧性肩锁关节脱位

目的探讨关节镜辅助喙锁悬吊固定联合改良Weaver-Dunn手术治疗陈旧性肩锁关节脱位的疗效。 方法2016年3月至2017年3月,对8例陈旧性肩锁关节脱位的患者采用关节镜下喙锁间隙悬吊固定联合改良Weaver-Dunn手术,术后随访6~18个月。测量术后即刻与末次随访时的喙锁间隙差值,评估复位丢失情况,采用疼痛视觉模拟（VAS）评分及加州大学洛杉矶分校（UCLA）评分评价患者肩关节功能。 结果术后末次随访时患者喙锁间隙与术后即刻喙锁间隙差值为（0.41±0.26）mm,VAS评分为2.88分,UCLA评分为（173.6±11.3）分,患者肩锁关节丢失率低、术后疼痛及功能均得到明显改善。 结论关节镜辅助喙锁固定联合改良Weaver-Dunn技术治疗陈旧性肩锁关节脱位有较好的疗效。