Evolution AC Area Of The Radiographic And A Biomechanical Study Of A Triple Endobutton Technique In Acromioclavicular Joint Dislocations

Capter One Coracoclavicular Ligament Reconstruction: a Systematic Review and a Biomechanical Study of a Triple Endobutton Technique in Acromioclavicular Joint DislocationsObjective: Operative intervention is recommended for complete AC joint dislocation to restore AC stability, but the best operative technique is still controversial.Methods: Twelve fresh-frozen male cadaveric shoulders(average age: 62.8±7.8 years)were equally divided into endobutton vs. modified Weaver-Dunn groups. Each potted scapula and clavicle was fixed in a custom made jig to allow translation and load to failure testing using a Zwick BZ2.5/TS1 S material testing machine.A systematic review of 21 studies evaluating reconstructive methods for CC or acromioclavicular joints using a cadaveric model was also performed.Results: From our biomechanical study, after ligament reconstruction, the triple endobutton technique demonstrated superior, anterior and posterior displacements similar to that of the intact state(P>0.05).In the modified Weaver-Dunnreconstruction group, however,there was significantly greater anterior(P< 0.001) and posterior(P = 0.003)translation after ligament reconstruction. In addition, there was no significant difference after reconstruction between failure load of the triple endobutton group and that of the intact state(686.88 vs. 684.9 N, P >0.05), while the failure load after modified Weaver-Dunn reconstruction was decreased compared with the intact state(171.64 vs. 640.86 N, P < 0.001).From our systematic review of 21 studies, in those studies which involved comparison of the modified Weaver-Dunn technique with other methods, the majority showed that the modified Weaver-Dunn procedure had significantly(P <.05) greater laxity than the other methods including the endobutton technique.Conclusion: The triple endobutton reconstruction proved superior to the modified Weaver-Dunn techniquein restoration of AC joint stability and strength. Triple endobutton reconstruction of the CC ligament is superior to modified Weaver-Dunn reconstruction in controlling both superior and the anteroposterior displacements with a failure load that approximates the intact ligament.Chapter Two Evolution AC Area of the Radiographic for the Diagnosis in Acromioclavicular Joint DislocationsObjective: To analyze the acromioclavicular area(AC area) and the acromioclavicular angle(AC angle) by means of the application Rockwood classification in X-ray report of patients might can verify the classification system and introduce the relevance of the acromioclavicular joint.Methods: The 56 patients with acromioclavicular joint dislocations admitted to the Shanghai Jiao Tong University affiliated sixth people’s Hospital during 2009.4-2014.7 were chosen as the subject in this study. According to the Rockwood classification of acromioclavicular joint dislocations, there are 9 people in type II, 9 people in type III, 13 people in type IV and 25 people in type V; there are 45 males and 11 females. The average age is 42.2 years old. Compared in the first group, the patients in type II/III/IV, then got rid of the patients in type IV. In addition, it might can be defined the patient in type IV whose coracoclavicular interval is increasing <100% and the posterior dislocation is increasing >50% for the deficiency of the Rockwood classification, and compared the second group, the patients in type IV and not in type IV. To Measure all as above and analysis its significance.Results: The correlation analysis in first group(type II/III/V), the coefficient of association(r value) is weak correlation in 0.36( coracoclavicular interval),0.024( acromioclavicularangle),0.337(acromioclavicular length),0.318(acromioclavicular width).There are statistical significances in acromioclavicular length(%, p<0.05) by comparing the second group. There are statistical significances of the acromioclavicular length of the acromioclavicular joint dislocations in ROC curve, the critical value of diagnose is 23%, the sensitivity is 67.6%, the specificity is 76.7% and the area under the curve(AUC)is 0.699(P<0.05).Conclusion: To identify the acromioclavicular joint dislocations, there is no diagnostic basis in acromioclavicular area except for the acromioclavicular length in the Rockwood classification. There are diagnosis significances in type IV, if the the acromioclavicular length is ≥ 23%. It might be able to choose the AP view radiographs of the shoulder to observation the acromioclavicular length for patient who cannot or do not axillary view radiographs of the shoulder, and there are some advantages in decreasing the pain of patients, much simpler, and more inexpensive.