Braun S, Martetschläger F, Imhoff A B
Abteilung für Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland,
Oper Orthop Traumatol. 2014 Jun;26(3):228-36. doi: 10.1007/s00064-013-0276-x. Epub 2014 Jun 14.
The surgical procedure aims at anatomic reduction and stabilization of the acromioclavicular joint in vertical and horizontal planes for acute separations using a trans-clavicular and trans-coracoidal suture tape fixation with additional acromioclavicular joint augmentation with a PDS cord cerclage. For chronic instability adding a tendon graft is essential for sustainable stability.
Acute und chronic acromioclavicular joint separations type Rockwood III-VI. Recurrent AC-joint instability with intact coracoid process (with tendon graft).
Acromioclavicular joint separations type Rockwood I-II. Asymptomatic chronic AC-separations type Rockwood III-IV. Fracture close to base of coracoid process General contraindications for (elective) surgery.
Vertical reconstruction of the coraco-clavicular ligaments using a drill-guide for trans-clavicular and trans-coracoidal tunnel placement for high-strength suture tapes over titanium buttons. Additional stabilization of the AC-joint with a transosseus figure of 8 PDS suture cord cerclage.
Postoperatively the arm is put in a regular sling for 6 weeks. Free active range of motion of wrist and elbow. Shoulder range of motion is limited to 30° of flexion and abduction and 80° internal and 0° external rotation for 2 weeks. Extended to active-assisted 45° flexion and abduction in weeks 3 and 4 and advanced to 60° flexion/abduction and free internal/external rotation in weeks 5 and 6. Range of motion is unlimited from week 7. Full daily life activities after 3 months, high-impact sports after 5-6 months postoperatively.
The presented surgical technique reliably stabilizes the acromioclavicular joint. It's biomechanical properties with only the single-tunnel coracoclavicular suture tapes is on the level of the native vertical stability, which can be additionally improved for better horizontal stability with the cerclage over the AC-joint.
该手术旨在通过经锁骨和经喙突缝合带固定，并附加聚对二氧环己酮（PDS）缝线环扎增强肩锁关节，在垂直和水平平面上对急性肩锁关节分离进行解剖复位和稳定。对于慢性不稳定，添加肌腱移植对于实现可持续稳定至关重要。
Rockwood III - VI型急性和慢性肩锁关节分离。喙突完整的复发性肩锁关节不稳定（需进行肌腱移植）。
Rockwood I - II型肩锁关节分离。无症状的Rockwood III - IV型慢性肩锁关节分离。靠近喙突基部的骨折。（择期）手术的一般禁忌症。
使用钻孔导向器垂直重建喙锁韧带，用于在钛纽扣上放置高强度缝合带的经锁骨和经喙突隧道。通过经骨8字PDS缝线环扎对肩锁关节进行额外稳定。
术后将手臂置于常规吊带中6周。手腕和肘部进行自由主动活动。肩部活动范围在2周内限制为屈曲和外展30°、内旋80°和外旋0°。在第3周和第4周扩展到主动辅助下的45°屈曲和外展，在第5周和第6周进展到60°屈曲/外展和自由内/外旋。从第7周开始活动范围不受限。术后3个月恢复全部日常生活活动，5 - 6个月后可进行高强度运动。
所介绍的手术技术能可靠地稳定肩锁关节。仅使用单隧道喙锁缝合带时其生物力学性能与天然垂直稳定性相当，通过在肩锁关节上进行环扎可进一步改善水平稳定性。
