Saier Tim, Venjakob Arne J, Minzlaff Philipp, Föhr Peter, Lindell Filip, Imhoff Andreas B, Vogt Stephan, Braun Sepp
Department for Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany.
Berufsgenossenschaftliche Unfallklinik Murnau, Prof.-Küntscher-Str. 8, 82418, Murnau, Germany.
Knee Surg Sports Traumatol Arthrosc. 2015 May;23(5):1498-1505. doi: 10.1007/s00167-014-2895-7. Epub 2014 Feb 21.
To evaluate whether isolated anatomical coracoclavicular (CC) ligament reconstruction with two suture-button devices provides equal horizontal acromioclavicular joint (ACJ) stability compared to additional ACJ suture tape cerclage.
A servohydraulic testing machine was used to assess horizontal ACJ translation in 12 fresh-frozen human shoulders during 5,000 cycles of dynamic anteroposterior directed loading (70 N). Horizontal ACJ stability was assessed for native specimen (n = 6) and compared to specimen with dissected AC ligaments but intact CC ligaments (n = 6). After complete AC/CC dissection, an anatomical CC reconstruction was performed with two suture-button devices (n = 6) and compared to the additional ACJ suture tape cerclage (n = 6).
Native specimen showed an mean horizontal amplitude of 10.8 mm [standard deviation (SD) 3.29]. After 5,000 cycles of horizontal loading (70 N), mean amplitude increased by 1.5 mm (SD 0.75, p = 0.005). Specimen with dissected AC ligaments started at an mean amplitude of 14.1 mm (SD 4.11), which was increased by 0.9 mm (SD 0.56, n.s.) after loading. Initially, amplitude of specimen with anatomical CC reconstruction was 13.2 mm (SD 2.75), which increased by 2.9 mm (SD 1.45, p = 0.001) after loading. The specimen with additional AC cerclage initially showed an amplitude of 10.6 mm (SD 2.35). After loading, translation was increased by 3.0 mm (SD 0.97, p = 0.001). There was no failure of any surgical reconstruction in the tests.
The results of this study suggest that only combined AC and CC reconstruction can adequately re-establish physiological horizontal ACJ stability. Therefore, it is likely that a combined surgical procedure with double suture-button devices and AC suture tape cerclage can adequately re-establish horizontal AC joint stability in case of an acute injury (≥type Rockwood IV and may allow superior clinical outcomes for patients, especially if early functional rehabilitation is intended).
评估使用两个缝线纽扣装置进行孤立的解剖学喙锁韧带重建与额外的肩锁关节缝线带环扎相比，是否能提供同等的肩锁关节水平稳定性。
使用伺服液压试验机在12个新鲜冷冻的人体肩部上进行5000次动态前后向加载（70 N）循环，评估肩锁关节水平平移。对正常标本（n = 6）评估肩锁关节水平稳定性，并与肩锁韧带切断但喙锁韧带完整的标本（n = 6）进行比较。在完全切断肩锁关节/喙锁韧带后，使用两个缝线纽扣装置进行解剖学喙锁韧带重建（n = 6），并与额外的肩锁关节缝线带环扎（n = 6）进行比较。
正常标本的平均水平位移幅度为10.8 mm [标准差（SD）3.29]。在进行5000次水平加载（70 N）循环后，平均幅度增加了1.5 mm（SD 0.75，p = 0.005）。肩锁韧带切断的标本起始平均幅度为14.1 mm（SD 4.11），加载后增加了0.9 mm（SD 0.56，无统计学意义）。最初，解剖学喙锁韧带重建标本的幅度为13.2 mm（SD 2.75），加载后增加了2.9 mm（SD 1.45，p = 0.001）。额外进行肩锁关节环扎的标本最初显示幅度为10.6 mm（SD 2.35）。加载后，位移增加了3.0 mm（SD 0.97，p = 0.001）。测试中任何手术重建均未失败。
本研究结果表明，只有联合肩锁关节和喙锁韧带重建才能充分重建生理性肩锁关节水平稳定性。因此，在急性损伤（≥Rockwood IV型）时，使用双缝线纽扣装置和肩锁关节缝线带环扎的联合手术方法可能能够充分重建肩锁关节水平稳定性，并可能为患者带来更好的临床结果，特别是如果打算进行早期功能康复。
