Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California 90033, USA.
Arthroscopy. 2009 Sep;25(9):968-74. doi: 10.1016/j.arthro.2009.04.072.
The purpose of this study was to analyze the capsular and ligamentous insertions about the acromioclavicular (AC) joint to determine the amount of bone that can be removed without destabilizing the joint.
We dissected 28 cadaveric shoulders. The AC ligament insertions were measured under loupe magnification with a digital caliper on the acromial and clavicular sides on the anterior, posterior, superior, and inferior edges. We measured the distance to the coracoacromial (CA) and coracoclavicular ligaments. In addition, the axial and coronal angle of the AC joint was measured.
The AC joint capsular insertion on the acromion begins, on average, 2.8 mm (range, 2.3 to 3.3 mm) from the medial acromion and begins on the lateral clavicle a mean of 3.5 mm (range, 2.9 to 3.9 mm) from the distal clavicle. The mean capsular width ranged from 1.6 to 2.9 mm. The mean distance from the medial acromion to the CA ligament insertion was 3.5 mm. The mean axial angle of the AC joint was 51 degrees , with a 12 degrees coronal angle. The mean distance from the lateral clavicle to the start of the trapezoid ligament was 14.7 mm, and that to the conoid ligament was 32.1 mm.
An anatomic-based recommendation for safe AC joint resection is that 2 to 3 mm of the medial acromion and 3 to 4 mm of the distal clavicle can be resected without removing the AC capsular insertions. The trapezial and CA attachments are in close proximity to the AC capsular insertions. Medial resections greater that 15 mm will begin to take down the trapezoid ligament. Arthroscopic bone resection should be directed into the AC joint at approximately 50 degrees in the axial plane and 12 degrees in the coronal plane for safe symmetric resection.
These anatomic measurements suggest that AC joint resections (5 to 7 mm) with 2 to 3 mm from the acromial side and 3 to 4 mm from the clavicular side will not disrupt the stabilizing ligaments of the AC joint after distal clavicle resection.
本研究旨在分析肩锁关节（AC）关节的囊状和韧带附着处，以确定在不使关节不稳定的情况下可以切除多少骨。
我们解剖了 28 具尸体的肩部。使用数字卡尺在放大镜下测量 AC 韧带在肩峰和锁骨侧的前、后、上、下边缘的附着处。我们测量了与肩峰喙突（CA）和喙锁韧带的距离。此外，还测量了 AC 关节的轴向和冠状角。
AC 关节囊状附着在肩峰上，平均距离内侧肩峰 2.8 毫米（范围 2.3 至 3.3 毫米），从远端锁骨开始，平均距离外侧锁骨 3.5 毫米（范围 2.9 至 3.9 毫米）。囊状宽度平均为 1.6 至 2.9 毫米。从内侧肩峰到 CA 韧带附着处的平均距离为 3.5 毫米。AC 关节的轴向角度平均为 51 度，冠状角度为 12 度。从外侧锁骨到梯形韧带起点的平均距离为 14.7 毫米，到锥形韧带的距离为 32.1 毫米。
基于解剖学的安全 AC 关节切除建议是，在不切除 AC 关节囊附着处的情况下，可以切除 2 至 3 毫米的内侧肩峰和 3 至 4 毫米的远端锁骨。梯形和 CA 附着处与 AC 关节囊附着处紧密相邻。内侧切除超过 15 毫米将开始破坏梯形韧带。关节镜下骨切除应在轴向平面约 50 度和冠状平面 12 度的角度进入 AC 关节，以进行安全的对称切除。
这些解剖学测量表明，在远端锁骨切除后，AC 关节切除（5 至 7 毫米），在肩峰侧切除 2 至 3 毫米，在锁骨侧切除 3 至 4 毫米，不会破坏 AC 关节的稳定韧带。
