OBJECTIVE: This study aims to examine the biomechanical effects of different reconstruction methods, including single-bundle, double-bundle anatomical reconstruction, and double-bundle truly anatomical reconstruction of the coracoclavicular ligament on the acromioclavicular joint using finite element analysis, to provide a theoretical basis for the clinical application of truly anatomical coracoclavicular ligament reconstruction. METHODS: One volunteer, aged 27 years old, with a height of 178 cm and a weight of 75 kg, was selected for CT scanning of the shoulder joint. Three-dimensional finite element models of single-bundle reconstruction, double-bundle anatomical reconstruction, and double-bundle truly anatomical reconstruction of coracoclavicular ligament were established by using Mimics17.0, Geomagic studio 2012, UG NX 10.0, HyperMesh 14.0 and ABAQUS 6.14 software. The maximum displacement of the middle point of the distal clavicle in the main loading direction and the maximum equivalent stress of the reconstruction device under different loading conditions were recorded and compared. RESULTS: The maximum forward displacement and the maximum backward displacement of the middle point of the distal clavicle in the double-bundle truly anatomic reconstruction were the lowest, which were 7.76 mm and 7.27 mm respectively. When an upward load was applied, the maximum displacement of the distal clavicle midpoint in the double-beam anatomic reconstruction was the lowest, which was 5.12 mm. Applying three different loads forward, backward, and upward, the maximum equivalent stress of the reconstruction devices in the double-beam reconstruction was lower than that in the single-beam reconstruction. The maximum equivalent stress of the trapezoid ligament reconstruction device in the double-bundle truly anatomical reconstruction was lower than that in the double-bundle anatomical reconstruction, which was 73.29 MPa, but the maximum equivalent stress of the conoid ligament reconstruction device was higher than that of the double-bundle anatomical reconstruction. CONCLUSION The truly anatomical reconstruction of coracoclavicular ligament can improve the horizontal stability of acromioclavicular joint and reduce the stress of the trapezoid ligament reconstruction device. It can be a good method for the treatment of acromioclavicular joint dislocation.
Humans ; Adult ; Acromioclavicular Joint/surgery* ; Finite Element Analysis ; Ligaments, Articular/surgery* ; Shoulder Joint/surgery* ; Plastic Surgery Procedures ; Joint Dislocations/surgery*

OBJECTIVE: To evaluate the efficacy and prognosis of double button plate combined with strengthened anchor technique and clavicular hook plate internal fixation for complete acromioclavicular joint dislocation. METHODS: From July 2017 to September 2020, a total of 42 patients with acromioclavicular joint dislocation treated by surgery were choosen as study objects and divided into observation group (21 cases) and control group (21 cases). In the observation group, there were 14 males and 7 females, aged 21 to 63 years old, with an average of (45.05±8.70) years old. In the control group, there were 16 males and 5 females, aged 25 to 68 years old, with an average of(45.00±9.44) years old. The patients in the observation group were treated with double button plate combined with strengthened anchor technique, whereas those in the control group received clavicular hook plate internal fixation. The two groups were compared in terms of operating time, intraoperative blood loss, postoperative hospital stay, shoulder pain(visual analogue scale, VAS) score, shoulder function Constant-Murley score and postoperative complications. RESULTS: There was no significant difference between the two groups in intraoperative blood loss or postoperative hospital stay(P>0.05). The operating time of double button plate combined with strengthened anchor technique group (65.24±5.36) min was significantly longer than that of the clavicular hook plate group (48.81±4.72) min, and the difference was statistically significant (P<0.05). There was no significant difference in shoulder function or pain degree between the two groups before operation (P>0.05). After 1 month, 3 months and 6 months, the Constant-Murley score of the observation group was 73.29±2.15, 85.43±1.47, 93.86±1.24 separately, which were significantly higher than those of the control group;and the VAS score was 2.76±0.62, 1.71±0.64, 0.57±0.51 separately, which were significantly lower than those of the control group (P<0.05). One instance of shoulder discomfort was found in the observation group, while 5 cases of shoulder pain, 2 cases of restricted shoulder mobility, and 1 case of subacromial bone absorption were found in the control group. In both group, there was no loss of reduction. CONCLUSION In the treatment of complete acromioclavicular joint dislocation double button plate combined with strengthened anchor technique achieves favorable clinical result. Internal fixation does not need to be removed. The recovery of shoulder joint function and pain relief are superior than clavicular hook plate internal fixation, which is more worthy of clinical promotion.
Acromioclavicular Joint/surgery* ; Adult ; Aged ; Bone Plates ; Clavicle/surgery* ; Female ; Humans ; Male ; Middle Aged ; Shoulder Dislocation/surgery* ; Treatment Outcome ; Young Adult

Acromioclavicular Joint/diagnostic imaging* ; Clavicle/diagnostic imaging* ; Fracture Fixation, Internal ; Fractures, Bone/surgery* ; Humans ; Joint Dislocations/diagnostic imaging* ; Missed Diagnosis

OBJECTIVE: To compare the clinical efficacy of titanium cable biomimetic reconstruction of coracoclavicular ligament and clavicular hook plate in the treatment of acromioclavicular joint dislocation. METHODS: The clinical data of 39 patients with severe acute acromioclavicular joint dislocation from January 2017 to December 2018 were retrospectively analyzed, 19 patients in double strand titanium cable group, including 13 males and 6 females, aged from 26 to 67 years old; Rockwood classification:10 cases of type Ⅲ, 4 cases of type Ⅳ and 5 cases of type Ⅴ;8 cases of traffic injury and 11 cases of fall injury;the time from injury to operation was 3 to 6 days. There were 20 patients in steel plate group, including 15 males and 5 females, aged from 25 to 71 years old. Rockwood classification:11 cases of type Ⅲ, 4 cases of typeⅣ, 5 cases of type Ⅴ;7 cases of traffic injury, 13 cases of fall injury;the time from injury to operation was 2 to 7 days. The length of incision, operation time, intraoperative blood loss, cost, VAS score before and after operation, and Constant-Murley score before and after operation were compared between two groups. Postoperative X-ray films were taken to observe the reduction and maintenance of acromioclavicular joint dislocation. Complications were recorded. RESULTS: Thirty-six patients were followed up for 12 to 14 months. The amount of intraoperative blood loss in the two groups was basically the same. The operation incision in double strand titanium cable group was shorter, the operation time in steel plate group was shorter, and the operation cost in double strand titanium cable group was less. One week and one year after operation, the pain of double strand titanium cable group was less than that of steel plate group. One year after operation, the Constant-Murley score of double strand titanium cable group was higher than that of steel plate group. The postoperative X-ray showed that the acromioclavicular joint in double strand titanium cable group was well reduced, and there was 1 case with slight reduction loss. In the plate group, there was no reduction loss after removal of the clavicular hook plate, and 8 patients had distal clavicular bone atrophy or acromion bone resorption. In steel plate group, 4 cases had long-term postoperative pain, postoperative dysfunction and other complications. CONCLUSION The clinical effect of coracoclavicular ligament reconstruction with double strand titanium cable is better than that of clavicular hook plate in the treatment of severe acute acromioclavicular joint dislocation, with less trauma (no secondary operation) and lower cost.
Acromioclavicular Joint/surgery* ; Adult ; Aged ; Bone Plates ; Female ; Humans ; Joint Dislocations/surgery* ; Male ; Middle Aged ; Retrospective Studies ; Titanium ; Treatment Outcome

OBJECTIVE: To study the clinical efficacy and complications of Endobutton titanium plate and clavicle hook plate in the treatment of acromioclavicular dislocation. METHODS: Total 48 patients with Rockwood Ⅲ to Ⅴ acromioclavicular joint dislocation from March 2015 to May 2019 were retrospectively divided into two groups according to different surgical methods. Among the patients, 23 patients were treated with Endobutton loop titanium plate fixation (observation group), including 15 males and 8 females, ranging in age from 23 to 59 years old, with an average of(36.2±8.1) years old;Rockwood type Ⅲ in 6 cases, type Ⅳ in 11 cases and type Ⅴ in 6 cases. Twenty-five patients were treated with clavicular hook plate(control group), including 17 males and 8 females, ranging in age from 22 to 54 years old, with an average of (34.7±6.4) years old; Rockwood type Ⅲ in 6 cases, type Ⅳ in 14 cases and type Ⅴ in 5 cases. The operation time, intraoperative bleeding, hospitalization time, visual analogue scale (VAS) of pain, Constant-Murley score of shoulder function and postoperative complications were compared between the two groups. RESULTS: All the patients were followed up, and the duration ranged from 24 to 51 months, with a mean of (30.5±6.5) months. The amountof bleeding and hospitalization time in the observation group were (71.9±4.0) ml and(8.2±1.6) d respectively;and those in the control group were (97.6±13.4) ml and (12.8±1.2) d respectively. There was significant difference between the two groups ( CONCLUSION Compared with clavicular hook plate internal fixation in the treatment of acromioclavicular joint dislocation, Endobutton loop titanium plate internal fixation technology has the advantages of less surgical bleeding, shorter hospitalization time, less postoperative pain, good recovery of shoulder joint function and less complications.
Acromioclavicular Joint/surgery* ; Adult ; Bone Plates ; Case-Control Studies ; Female ; Humans ; Joint Dislocations/surgery* ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Young Adult

OBJECTIVES: To explore the safety and effectiveness of arthroscopic reconstruction of coracoclavicular ligament by suspensory fixation to manage the acute acromioclavicular joint dislocation. METHODS: From January 2016 to December 2017, 18 cases of acute acromioclavicular joint dislocation were carried out with arthroscopic reconstruction of coracoclavicular ligament by double Endobutton plate suspensory fixation. Anteroposterior view X-ray plain radiographs were obtained on the second day, 6 months and 12 months after the surgery, MRI was performed in 1 year after operation. Meanwhile, subjective and objective scoring were obtained by Vsual Analogue Scale (VAS), Rating Scale of the American Shoulder and Elbow Surgeons (ASES) and University of California at Los Angeles Shoulder Rating Scale (UCLA). RESULTS: All patients were followed up for 12 to 30 months (an average of 18 months). There was no patient with infection, neurovascular injury, loosening and breakage of internal fixation, re-dislocation of acromioclavicular joint, clavicular fracture, coracoid process fracture, etc. Postoperative X-ray showed that all acromioclavicular joints were completely relocated. The follow-up of MRI after 1 year showed no obvious dislocation of acromioclavicular joint and good recovery of acromioclavicular space. Postoperative shoulder joint function, VAS, ASES, UCLA and acromioclavicular distance were significantly improved compared with those before surgery, with statistically significant differences (all <0.05). CONCLUSIONS Arthroscopic reconstruction of coracoclavicular ligament by suspensory fixation to manage the acute acromioclavicular joint dislocation has the advantages of minimal invasive, rapid functional recovery and less complications and satisfactory early clinical results.
Acromioclavicular Joint ; diagnostic imaging ; surgery ; Follow-Up Studies ; Humans ; Joint Dislocations ; diagnostic imaging ; surgery ; Magnetic Resonance Imaging ; Shoulder Dislocation ; diagnostic imaging ; surgery ; Treatment Outcome

Acromioclavicular joint (ACJ) injury is a common shoulder injury. There are various techniques of ACJ reconstruction. Superficial infection after ACJ reconstruction is not an uncommon complication. However, osteomyelitis post ACJ reconstruction has never been highlighted as a possible complication. Our patient is a 31-year-old male who sustained a Rockwood 5 ACJ dislocation and had anatomical ACJ reconstruction with autogenous gracilis and semitendinosus graft. Our technique involved the anatomical reconstruction of the ACJ and the coracoclavicular ligament with the usage of two bioscrews and the temporary stabilisation of the ACJ with two k-wires. As in any orthopaedic surgery, infection is often disastrous especially when the surgery involves implants. It can be disastrous with high morbidity to the patient as well as a costly complication to treat. Therefore, we wish to highlight this case as despite its rarity, osteomyelitis can be devastating to the patient and should be prevented if possible.
Acromioclavicular Joint ; injuries ; surgery ; Adult ; Anti-Bacterial Agents ; administration & dosage ; Bone Screws ; adverse effects ; Bone Wires ; adverse effects ; Gracilis Muscle ; transplantation ; Hamstring Muscles ; transplantation ; Humans ; Joint Dislocations ; surgery ; Male ; Orthopedic Procedures ; adverse effects ; methods ; Osteomyelitis ; etiology ; prevention & control ; therapy ; Postoperative Complications ; etiology ; prevention & control ; therapy ; Prognosis ; Reconstructive Surgical Procedures ; adverse effects ; methods

BACKGROUND: In the present study, we aimed to compare clinical and radiographic outcomes between hook plate fixation and coracoclavicular (CC) ligament reconstruction for the treatment of acute unstable acromioclavicular (AC) joint dislocation. METHODS: Forty-two patients who underwent surgery for an unstable acute dislocation of the AC joint were included. We divided them into two groups according to the treatment modality: internal fixation with a hook plate (group I, 24 cases) or CC ligament reconstruction (group II, 18 cases). We evaluated the clinical outcomes using a visual analog scale (VAS) for pain and Constant-Murley score, and assessed the radiographic outcomes based on the reduction and loss of CC distance on preoperative, postoperative, and final follow-up plain radiographs. RESULTS: The mean VAS scores at the final follow-up were 1.6 +/- 1.5 and 1.3 +/- 1.3 in groups I and II, respectively, which were not significantly different. The mean Constant-Murley scores were 90.2 +/- 9.9 and 89.2 +/- 3.5 in groups I and II, respectively, which were also not significantly different. The AC joints were well reduced in both groups, whereas CC distance improved from a mean of 215.7% +/- 50.9% preoperatively to 106.1% +/- 10.2% at the final follow-up in group I, and from 239.9% +/- 59.2% preoperatively to 133.6% +/- 36.7% at the final follow-up in group II. The improvement in group I was significantly superior to that in group II (p < 0.001). Furthermore, subluxation was not observed in any case in group I, but was noted in six cases (33%) in group II. Erosions of the acromion undersurface were observed in 9 cases in group I. CONCLUSIONS: In cases of acute unstable AC joint dislocation, hook plate fixation and CC ligament reconstruction yield comparable satisfactory clinical outcomes. However, radiographic outcomes based on the maintenance of reduction indicate that hook plate fixation is a better treatment option.
Acromioclavicular Joint/injuries/radiography/*surgery ; Acute Disease ; Adult ; Arthroscopy ; Bone Plates ; Dislocations/radiography/*surgery ; Female ; Humans ; Ligaments, Articular/surgery ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo explore therapeutic effects of reconstructing coracoclavicular ligament for the treatment of Rockwood-III Acromioclavicular dislocation by palmaris longus muscle with polyester suture.

METHODSFrom August 2011 to November 2013,37 cases with Rockwood-III acromioclavicular dislocation were treated with reconstructing coracoclavicular ligament by palmaris longus muscle with polyester suture. Among patients, 24 were males and 13 were females, ranging the age from 19 to 46 years old, with an average of 32 years old. There were 11 cases on the left side and 26 cases on the right side. Twenty-nine cases were fresh dislocation and 8 cases were old dislocation. Blood loss, operative time were observed, and Karlsson evaltae standard were applied for assessing postoperative recovery of shoulder joint function.

RESULTSAll patients were followed up from 2.5 to 5 months with an average of 3.5 months. Operative time ranged from 52 to 98 (meaned 72) min, blood loss ranged from 50 to 180 (meaned 75) ml. All operative incision were healed at the satge I . According to Karlsson standard, 32 cases obtained excellent results and 5 cases were moderate.

CONCLUSIONFor Rockwood-III acromioclavicular dislocation,reconstructing coracoclavicular ligament by palmaris longus muscle with polyester suture has advantages of simple operation, and rapid recovery of shoulder joint function.

Acromioclavicular Joint ; injuries ; surgery ; Adolescent ; Adult ; Female ; Humans ; Ligaments, Articular ; surgery ; Male ; Middle Aged ; Reconstructive Surgical Procedures ; instrumentation ; Shoulder Dislocation ; surgery ; Sutures ; Young Adult

OBJECTIVETo explore clinical efficacy of double Endobutto reconstituting coracoclavicular ligament combined with repairing acromioclavicular ligament in stage I in treating acromioclavicular dislocation with Rockwood type III - V .

METHODSFrom January 2010 to September 2013, 56 patients with Rockwood type III - V acromioclavicular dislocation were treated by operation, including 20 males and 36 femlaes, aged from 32 to 52 years old with an average of 38.5 years old. Twenty-five patients were on the left side and 31 cases on the right side. The time from injury to operation was from 3 to 14 days, averaged 7 days. All patients were diagnosed as acromioclavicular dislocation with Rockwood type III - V, and double Endobutto were used to reconstituting coracoclavicular ligament, line metal anchors were applied for repairing acromioclavicular ligament. Postoperative complications were observed, Karlsson and Constant-Murley evaluation standard were used to evaluate clinical effects.

RESULTSAll patients were followed up from 8 to 24 months with average of 11 months. According to Karlsson evaluation standard at 6 months after operation,42 cases were grade A, 13 were grade B and 1 was grade C. Constant-Murley score were improved from (42.80±5.43) before operation to (91.75±4.27) at 6 months after operation. All items at 6 months after operation were better than that of preoperative items. Forty-eight patients got excellent results, 7 were moderate and only 1 with bad result. No shoulder joint adhesion, screw loosening or breakage were occurred during following up.

CONCLUSIONDouble Endobutto reconstituting coracoclavicular ligament combined with repairing acromioclavicular ligament in stage I for the treatment of acromioclavicular dislocation with Rockwood type III - V could obtain early staisfied clinical effects, and benefit for early recovery of shoulder joint function.

Acromioclavicular Joint ; injuries ; surgery ; Adult ; Bone Plates ; Bone Screws ; Female ; Humans ; Ligaments, Articular ; injuries ; surgery ; Male ; Middle Aged ; Reconstructive Surgical Procedures ; Shoulder Dislocation ; surgery ; Treatment Outcome