Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, Maryland, MD 21218, USA.
Am J Sports Med. 2013 Jul;41(7):1684-8. doi: 10.1177/0363546513488750. Epub 2013 May 22.
Acromioclavicular (AC) joint separation is a common injury, usually affecting young adults. Controversy exists regarding whether to excise the distal clavicle when surgical intervention is required.
To evaluate the biomechanical strength of AC and coracoclavicular (CC) ligament reconstruction with and without concurrent distal clavicle excision.
Controlled laboratory study.
Nine matched pairs of cadaver shoulders were used. All shoulders were tested with intact CC and AC ligaments, and the ligaments were sectioned. For 1 shoulder in each pair, a 7-mm distal clavicle excision was performed. The contralateral distal clavicle was left intact. Single-tunnel CC ligament reconstruction was performed, and excess graft length was extended and secured across the AC joint to reconstruct the superior AC joint ligaments in all specimens. Specimens were then potted and cyclically loaded for 500 cycles in the anterior-posterior and superior-inferior planes using an MTS Minibionix load frame to evaluate displacement across the AC joint.
Regarding the clavicle-intact reconstructed versus the intact state, there was significantly greater AC joint translation in the reconstructed state in the anterior-posterior (20.2 ± 7.0 mm vs 6.0 ± 1.5 mm; P < .001) and superior-inferior directions (12.3 ± 3.3 mm vs 4.2 ± 1.2 mm; P < .001). In the clavicle-excised reconstructed versus the intact state, there was also significantly greater translation in the reconstructed state in the anterior-posterior (21.7 ± 5.1 mm vs 8.9 ± 4.3 mm; P < .001) and superior-inferior directions (12.3 ± 6.1 mm vs 5.8 ± 3.1 mm; P < .001). When the difference in translation between the reconstructed and intact groups in the clavicle-intact versus the clavicle-excised group was compared, no statistically significant difference was noted in anterior-posterior (14.2 ± 7.8 mm vs 12.8 ± 5.0 mm; P = .67) or superior-inferior translation (8.1 ± 2.9 mm vs 6.6 ± 3.9 mm; P = .39).
Excision of the distal clavicle did not have a significant effect on anterior-posterior or superior-inferior motion at the AC joint following single-tunnel CC and AC ligament reconstruction.
The study suggests that excision of the distal clavicle in this procedure is not associated with increased anterior-posterior or superior-inferior instability in this model.
肩锁关节（AC）分离是一种常见的损伤，通常发生在年轻人身上。对于需要手术干预时是否切除锁骨远端，存在争议。
评估 AC 和喙锁（CC）韧带重建术联合和不联合锁骨远端切除的生物力学强度。
对照实验室研究。
使用 9 对匹配的尸体肩膀。所有肩膀均进行了完整 CC 和 AC 韧带的测试，并对韧带进行了切割。每对中的 1 个肩膀进行了 7mm 的锁骨远端切除。对侧锁骨远端保持完整。对所有标本进行单隧道 CC 韧带重建，延长多余的移植物长度并固定在 AC 关节上，以重建所有标本的 AC 关节上韧带。然后将标本放入盆中，使用 MTS Minibionix 加载框架在前-后和上-下平面上循环加载 500 次，以评估 AC 关节处的位移。
与重建状态下的锁骨完整状态相比，重建状态下的 AC 关节在前-后（20.2±7.0mm 比 6.0±1.5mm；P<.001）和上-下方向（12.3±3.3mm 比 4.2±1.2mm；P<.001）的平移明显更大。在锁骨切除的重建状态与完整状态相比，重建状态下的平移在前-后（21.7±5.1mm 比 8.9±4.3mm；P<.001）和上-下方向（12.3±6.1mm 比 5.8±3.1mm；P<.001）也明显更大。当比较锁骨完整的重建组与锁骨切除的重建组之间的重建组与完整组之间的平移差异时，在前-后方向（14.2±7.8mm 比 12.8±5.0mm；P=.67）或上-下平移（8.1±2.9mm 比 6.6±3.9mm；P=.39）没有统计学显著差异。
在单隧道 CC 和 AC 韧带重建后，切除锁骨远端对 AC 关节的前-后或上-下运动没有显著影响。
该研究表明，在该模型中，该手术中切除锁骨远端与前-后或上-下不稳定无关。
