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*

Acromioclavicular Joint/pathology* ; Humans ; Joint Dislocations/pathology*

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

OBJECTIVE: To explore the method and effect of small incision TightRope fixation in the treatment of fresh acromioclavicular joint dislocation. METHODS: From January 2016 to May 2018, 28 cases of fresh acromioclavicular dislocation were treated, including 20 males and 8 females, aged 26 to 87 years with an average age of 51.3 years. The modified Rockwood classification included 1 case of typeⅡ, 22 cases of typeⅢand 4 cases of type V. The average time from injury to operation was 2.4 days. The operative time, shoulder function recovery time and postoperative complications were recorded, and the immediate reduction effect and Karlsson function of shoulder joint were evaluated. RESULTS: In 28 patients, only one Rockwood typeⅡ was used to reconstruct the pyramidal ligament, and the other 27 were used to reconstruct the pyramidal ligament and the trapezoid ligament. The average operation time was (66.50±12.62) min (including intraoperative fluoroscopy time). Twenty-eight cases were followed up for 11 to 20 (16.7±4.6) months. The recovery time of shoulder function was 2 to 7 months with an average of 4 months. During the follow-up period, 1 case had osteolysis and loss of reduction at the clavicular plate site, and the rest had no complications such as re-dislocation and button plate prolapse. Immediate reduction effect after operation:6 cases with reduction insufficiency, 17 cases with complete reduction and 5 cases with excessive reduction;Karlsson function evaluation of shoulder joint in the last follow-up:excellent in 21 cases, good in 6 cases and poor in 1 case;Pearson analysis =0.060, suggesting that the immediate reduction effect of fresh acromioclavicular dislocation operation has no significant correlation with Karlsson function evaluationof shoulder joint in the last follow-up. CONCLUSION TightRope fixation through a small incision in the base of coracoid process is a simple and effective method for the treatment of dislocation of acromioclavicular joint. There was no significant correlation between the slight difference of immediate reduction effect within 5 mm and Karlsson function evaluation of shoulder joint in the last follow-up. It is suggested to pay attention to the loss of reduction and osteolysis of clavicular plate in clinical follow-up.
Acromioclavicular Joint ; Adult ; Aged ; Aged, 80 and over ; Clavicle ; Coracoid Process ; Female ; Humans ; Joint Dislocations ; Male ; Middle Aged ; Shoulder Dislocation ; Treatment Outcome

OBJECTIVE: To explore the clinical effect of the modified double Endobutton technique combined with Nice node in the treatment of Rockwood Ⅲ-Ⅴ acromioclavicular joint dislocation. METHODS: From March 2016 to January 2019, 23 patients with Rockwood Ⅲ-Ⅴ acromioclavicular joint dislocation were treated with modified double Endobutton technique to reconstruct coracoclavicular ligament and Nice node to repair acromioclavicular ligament, including 18 males and 5 females, aged 31 to 53 (43.2±5.4) years, 9 on the left and 14 on the right, and the time from injury to operation was 1 to 10 days. Before operation, X-ray films and CT three-dimensional reconstruction of bilateral shoulder joint were performed. Postoperative complications were observed. Six months after operation, DASHand Constant-Murley scores were used to evaluate the treatment effect. RESULTS: The incision healed in one stage after operation, and no complications such as vascular and nerve injury and stress fracture occurred. All patients were followed up for 6 to 24 (12.0±4.9) months. At 6 months follow-up, the DASH score was 0.40±0.10 lower than that of 19.80±4.50 before operation, and the Constant-Murley score was 94.20±4.20 higher than that of 38.60±3.90 before operation. CONCLUSION The treatment of Rockwood Ⅲ-Ⅴ dislocation of acromioclavicular joint with double Endobutton technique and nice knot is satisfactory in the early stage. The long-term effect and complications need further follow-up.
Acromioclavicular Joint ; Adult ; Female ; Humans ; Joint Dislocations ; Ligaments, Articular ; Male ; Middle Aged ; Shoulder Dislocation ; Treatment Outcome

OBJECTIVE: To investigate the clinical effect of arthroscopic assisted TightRope plate, Triple-Endobutton plate and Double Endobutton plate in treating of Rockwood type Ⅲ-Ⅴ acromioclavicular dislocation. METHODS: From January 2014 to January 2018, 128 patients with acromioclavicular dislocation were treated by operation. According to the operation plan, the patients were divided into three groups:Double Endobutton group, Triple-Endobutton group and TightRope group. All patients with acromioclavicular dislocation were operated by the same operation team, and the chief surgeon was the same chief physician. General baseline data such as gender, age, operation time, incision length, intraoperative blood loss, VAS score of pain and Constant-Murley shoulder function score were recorded. RESULTS: The wound healed well and no recent complications occurred. One hundred and eleven patients were followed up for 6 to 12(9.1±3.1) months. There was no significant difference on general data among three groups (P >0.05). Among three groups, the operation time of Triple -Endobutton group was the longest, significantly higher than that of other two groups(<0.05);the operation time of TightRope group was the shortest, significantly lower than that of other two groups (<0.05). At 1 month after operation, VAS score comparison of three groups, TightRope group was significantly lower than other two groups, with statistical difference (<0.05). At 12 months after operation of three groups, the Constant-Murley score of TightRope group was significantly higher than that of two group (<0.05). The incidence of incision infectionin TightRope group was significantly lower than that of other two groups(<0.05); the incidence of reduction loss in Double Endobton group was significantly higher than that of other two groups(<0.05), the incidence of reduction loss in TightRope group was significantly higher than that of Triple endobton group(<0.05);the incidence of joint adhesion in TightRope group was significantly lower than that of other two groups(<0.05). CONCLUSION TightRope plate fixation with arthroscopy is more advantageous than Double Endobutton plate fixation and Triple-Endobutton plate fixation.
Acromioclavicular Joint ; Arthroscopy ; Bone Plates ; Humans ; Joint Dislocations ; Shoulder Dislocation ; Treatment Outcome