The Basic And Clinical Study Of Acromioclavicular Joint Dislocation

Acromioclavicular joint dislocation injury is more common, accounting for 9-12% of the shoulder injury. Because the acromioclavicular joint is not only involved in the connection between the shoulder blades and the trunk, but also in the shoulder joint movement, when the integrity of the shoulder joint is damaged, it often causes a variety of shoulder pain and dysfunction of the shoulder joint.This study will be divided into the following three parts, and then discuss the acromioclavicular joint dislocation anatomy and biomechanics and clinical treatment methods. The first part: through the study of the anatomy and biomechanics of the ligament of acromioclavicular joint to judge the role of the relevant ligament in maintaining the stability of the acromioclavicular joint, so as to guide the clinical treatment. The second part: to discuss the therapeutic effect of arthroscopic coracoacromial ligament augmentation and suture in the treatment of acromioclavicular joint dislocation. In the third part, through the comparative study of coracoacromial ligament augmentation and clavicular hook plate for the treatment of acute acromioclavicular joint dislocation to discuss the advantages of arthroscopic technique. PartⅠ The Study of Anatomy and Biomechanics of AcromioclavicularJoint LigamentObjective: To study the effect of relevant acromioclavicular ligament in maintaining stability through investigating the anatomy and biomechanicals of ligament around the acromioclavicular joint and to direct clinical treatment.Methods: Methods 20 specimens of the acromioclavicular joint were divided randomly into two groups, the acromioclavicular ligament and the coracoclavicular ligament were kept in group A. The acromioclavicular ligament was only kept in group B. The coracoclavicular ligament were observed and the difference of mechanical test between the two groups was compared.Results: The trapezoid ligament(TL) is located in the center of the clavicle and the conoid ligament(CL) in the back. The distance from the center of the articular surface of the clavicle to the the TL and CL insertions were(18.42±1.38) mm,(35.48±2.42) mm respectively. The average strain was 610.04±51.24 N in group A,and 560.41±44.63 N in group B. The statistically difference was significant between the two groups(P <0.05).Conclusions: The acromioclavicular ligament has higher intensity than the coracoclavicular ligament. Application of coracoclavicular ligament reconstruction is of anatomic and biomechanical basis.。PartⅡArthroscopic treatment of acute acromioclavicular jointdislocations by coracoacromial ligament augmentation and sutureObjective: Back ground Acromioclavicular joint dislocation is commonly seen in shoulder joint injuries. Dysfunction as well as pain and discomfort usually occurred when the integrity of shoulder is damaged, for the acromioclavicular(AC) joint is involved in the connection between the scapula and the body as well as the activities of shoulder joint. Therefore, a consensus has been reached to treat severe AC joint dislocation by surgery. Based on different anatomical and functional cognition, methods for AC joint dislocation are various, which are typically performed by incision to reconstruct its stability and restore function. Attempts had been made by many doctors in there construction of AC joint dislocation with the development of arthroscopy. From March2010 to March 2011, obvious therapeutic effect was obtained in treating Rockwood type Ⅲ and Ⅴ AC joint dislocation arthroscopically with the suture plate used for the reconstruction of ligaments of knee joint to augment the reconstructed CC ligaments(conoid ligament and trapezoid ligament).Methods: From March 2010 to March2011, nine patients with acute AC joint Abstract The basic and clinical study of acromioclavicular joint dislocation dislocation type Ⅲ and three patients with type V were treated arthroscopically to augment the reconstructed CC ligaments(conoid ligament and trapezoid ligament) by the suture plate(ASCULAP Company,Germany, B′Braun) used to reconstruct ligaments of knee joint. Patients were pre- and postoperatively evaluated with X-ray examinations, American Shoulder and Elbow Surgeons′ Form(ASES) and Constant-Murley Score(CMS).Results: All patients were followed up for at least 12 months(range,12 to18 months). The average ASES score significantly increased from 28.7 preoperatively to 86.9 postoperatively,And the mean CMS score from 24 to 91, respectively. X-ray data showed a good reduction of the AC joint in the treated group. 91.7% of patients(11patients) obtained an obvious therapeutic effect after operation. 83.3% of patients(10patients)returned to their pre-injury level of athletics. Acromioclavicular subluxation Was only found in one case.Conclusions: Augmentation of CC ligaments with the suture to restore the anatomy of AC joint is an effective method in treating the dislocation. Minimal injury, reliable reduction of AC joint, less complication and rapid recovery of the shoulder joint function are found after the arthroscopic operation.Whether AC joint structure is stabilized and its biomechanic features are self-repaired to restore the norma lanatomy and function or not,which required longt erm follow-up.PartⅢ Comparative study of coracoacromial ligament augmentationand clavicular hook plate for the treatment of acute acromioclavicularjoint dislocationObjective: Acute acromioclavicular(AC) joint dislocations usually were treated by open procedure. With the development of arthroscopic technique, there is a tendency to treat it in this minimal invasive method. We developed a coracoacromial(CC) ligaments augmentation and suture technique to treat type Ⅲ-Ⅴ acute AC joint dislocations. We want to evaluate and compare the outcomes of CC ligaments augmentation and clavicular hook plate for the treatment of Rockwood type Ⅲ~Ⅴ AC ioint dislocation in this paper.Methods: From March 2008 to March 2012, 47 patients with acute type Ⅲ~V AC joint dislocation were treated arthroscopically by CC ligaments augmentation and suture(23 patients) and AO clavicular hook plate(24 patients)respectively.The difference between the 2 groups was not significant in preoperative evaluation and comparability existed. The postoperative outcome was assessed and compared through physical examination after 6 weeks, 3 months, 6 months, 1year, radiographic examination, and American Shoulder and Elbow Surgeon(ASES) Score between two groups.Results: All patients have anatomical reduction of the AC joint dislocation after operation. No intraoperative complications occurred. At a mean fellow-up of 18 months(rang from 12-24 months), the mean ASES score significantly improved from(28.7±7.3)points preoperatively to(96.3±6.9)points postoperatively(t=51.34,p<0.05), and(29.3±7.6) points to(83.6±8.5)points(t=43.78,p<0.05)respectively. The good/excellent rate of arthroscopic ligaments augmentation group and hook plate were 95.7% and 70.8%% respectively.There was significant difference between two groups(χ2=9.05,P<0.05). No neurovascular complications or secondary AC joint degenerative changes were detected in all patients.Conclusions: Considering the nearly anatomical repair, the CC ligaments augmentation and suture method is a safe and reliable technique for treating acute type Ⅲ~Ⅴ AC joint dislocation. The overall efficacy of CC ligaments augmentation and suture for the treatment of acromioclavicular joint dislocation was better than clavicular hook plate.The CC ligaments augmentation and suture had the advantages of coracoclavicularligament reconstruction, hard internal fixation and early activities, as well as the low incidence of shoulder pain and shoulder activity limitation, shorter recovery time and fewer complications postoperatively.