Department of Orthopaedic Surgery, Lenox Hill Hospital, 130 E 77th Street, Black Hall 11th Floor, New York, New York, 10075, USA.
Am J Sports Med. 2010 Nov;38(11):2313-9. doi: 10.1177/0363546510374447. Epub 2010 Aug 10.
Recently, some have suggested that the acromioclavicular articulation confers stability to the construct after coracoclavicular ligament reconstruction for acromioclavicular joint separation. Therefore, it has been suggested that distal clavicle excision should not be performed in this context to protect the graft during healing.
Sectioning the acromioclavicular ligaments would significantly increase in situ forces of a coracoclavicular ligament graft, whereas performing a distal clavicle resection would not further increase in situ graft forces.
Controlled laboratory study.
A simulated coracoclavicular reconstruction was performed on 5 cadaveric shoulders. Static loads of 80 N and 210 N were applied directly to the clavicle in 5 directions: anterior, anterosuperior, superior, posterosuperior, and posterior. The in situ graft force was measured using a force transducer under 3 testing conditions: (1) intact acromioclavicular ligaments, (2) sectioned acromioclavicular ligaments, and (3) distal clavicle excision.
For both magnitudes of load, in all directions, in situ graft force with intact acromioclavicular ligaments was significantly less than that with sectioned acromioclavicular ligaments (P < .001). Distal clavicle excision did not further increase the in situ graft forces with load applied to the clavicle in an anterior, anterosuperior, or superior direction. However, in situ graft forces were increased with distal clavicle excision when the clavicle was loaded with 210 N in the posterosuperior direction (60.4 ± 6.3 N vs 52.5 ± 7.1 N; P = .048) and tended to be increased with posterior loading of the clavicle (71.8 ± 6.2 N vs 53.1 ± 8.8 N; P = .125).
Intact acromioclavicular ligaments protect the coracoclavicular reconstruction by decreasing the in situ graft force. The slight increase in the in situ graft force only in the posterosuperior and posterior direction after distal clavicle excision suggests only a marginal protective role of the acromioclavicular articulation. Further, the peak graft forces observed represent only a small fraction of the ultimate failure strength of the graft.
Distal clavicle excision can perhaps be safely performed in the context of coracoclavicular ligament reconstruction without subjecting the graft to detrimental in situ force. Although the acromioclavicular articulation serves only a marginal role in protecting the coracoclavicular ligament graft, reconstruction of the acromioclavicular ligaments may serve an important role in decreasing in situ graft force during healing.
最近，有人提出肩锁关节分离后，喙锁韧带重建后，肩锁关节的喙锁关节突关节为结构提供稳定性。因此，有人建议在这种情况下不应进行锁骨远端切除，以在愈合过程中保护移植物。
切断肩锁韧带会显著增加喙锁韧带移植物的原位力，而进行锁骨远端切除不会进一步增加原位移植物的力。
对照实验室研究。
对 5 具尸体肩部进行模拟喙锁重建。在 5 个方向（前、前上、上、后上和后）直接向锁骨施加 80 N 和 210 N 的静态载荷。在 3 种测试条件下使用力传感器测量原位移植物力：（1）完整的肩锁韧带，（2）切断的肩锁韧带，（3）锁骨远端切除。
在两种负荷大小下，在所有方向上，带有完整肩锁韧带的原位移植物力明显小于带有切断的肩锁韧带的移植物力（P <.001）。当向锁骨施加前、前上或上方向的负荷时，锁骨远端切除并没有进一步增加原位移植物的力。然而，当锁骨在后上方向加载 210 N 时，通过锁骨远端切除增加了原位移植物力（60.4 ± 6.3 N 对 52.5 ± 7.1 N；P =.048），并且在向锁骨施加后向负荷时倾向于增加原位移植物力（71.8 ± 6.2 N 对 53.1 ± 8.8 N；P =.125）。
完整的肩锁韧带通过降低原位移植物力来保护喙锁重建。锁骨远端切除后，仅在后上和后方向上原位移植物力略有增加，表明肩锁关节突关节仅起到轻微的保护作用。此外，观察到的峰值移植物力仅占移植物最终失效强度的一小部分。
在喙锁韧带重建的情况下，锁骨远端切除也许可以安全进行，而不会使移植物承受有害的原位力。尽管肩锁关节突关节仅在保护喙锁韧带移植物方面发挥很小的作用，但重建肩锁韧带可能在愈合过程中降低原位移植物力方面发挥重要作用。
