Boutsiadis Achilleas, Baverel Laurent, Lenoir Hubert, Delsol Philippe, Barth Johannes
Department of Orthopaedic Surgery, Centre Osteoarticulaire des Cèdres, Grenoble, France.
Tech Hand Up Extrem Surg. 2016 Dec;20(4):172-178. doi: 10.1097/BTH.0000000000000142.
Chronic acromioclavicular (AC) instability is a rare posttraumatic shoulder condition that can lead to undesirable symptoms like persistent pain, muscle fatigue, loss of strength, or even scapular dyskinesis. It is well known that in these cases the superior functional results depend on the restoration of the anatomy and stability of the AC joint in both vertical and horizontal planes. Considering the ligaments degeneration and atrophy in chronic AC joint dislocations, we present an arthroscopic-assisted reconstruction of both the coracoclavicular and AC ligaments using autograft augmentation. In details the coracoclavicular ligaments component is reconstructed using the Tightrope suspension device augmented with a palmaris longus autograft and by the nonanatomic coracoacromial ligament transfer (modified Weaver-Dunn). The AC part is restored by suturing the remainder palmaris longus autograft on the acromion and on the deltotrapezial fascia. Using the construct provided by this technique all the possible ruptured ligaments are reconstructed, optimizing the vertical and horizontal stability of the area, and promising excellent long-term radiologic and functional results.
慢性肩锁关节（AC）不稳定是一种罕见的创伤后肩部疾病，可导致诸如持续疼痛、肌肉疲劳、力量丧失甚至肩胛运动障碍等不良症状。众所周知，在这些情况下，良好的功能结果取决于肩锁关节在垂直和水平平面上的解剖结构和稳定性的恢复。考虑到慢性肩锁关节脱位时韧带的退变和萎缩，我们采用自体移植增强技术，在关节镜辅助下重建喙锁韧带和肩锁韧带。具体而言，喙锁韧带部分采用Tightrope悬吊装置并辅以掌长肌自体移植进行重建，同时采用非解剖学的喙肩韧带转移（改良Weaver-Dunn法）。肩锁部分通过将剩余的掌长肌自体移植缝合在肩峰和三角肌斜方肌筋膜上进行修复。利用该技术构建的结构可以重建所有可能断裂的韧带，优化该区域的垂直和水平稳定性，并有望获得优异的长期影像学和功能结果。
