Haber Daniel B, Golijanin Petar, Stone Genevra L, Sanchez Anthony, Murphy Colin P, Peebles Liam A, Ziegler Connor G, Godin Jonathan A, Fox Jake A, Provencher Matthew T
Harvard Combined Orthopaedic Residency Program, Massachusetts General Hospital, Boston, Massachusetts, U.S.A.
Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, U.S.A.
Arthrosc Tech. 2019 Jan 21;8(2):e147-e152. doi: 10.1016/j.eats.2018.10.006. eCollection 2019 Feb.
Acromioclavicular (AC) joint injuries are a common cause of shoulder pain, particularly among young athletes participating in contact sports. Injuries to the AC joint most commonly occur from direct impact at the acromion and are classified as types I to VI. Although most AC joint injuries can be treated nonoperatively, types IV to VI are best treated with surgery, with type III being controversial and most surgeons recommending an initial trial of nonoperative treatment. Although numerous surgical techniques have been described, no gold standard technique has been established. Biomechanical testing suggests that anatomic reconstruction of both the AC and coracoclavicular ligaments results in a superior surgical construct. The objective of this Technical Note is to describe our preferred technique for the primary treatment of AC joint instability in the acute and chronic setting. Using 2 free tendon grafts in combination with a cortical button suspensory device combines the advantages of a nonrigid biologic and anatomic AC and coracoclavicular ligament reconstruction while benefiting from the strength of a cortical suspensory device in resisting displacement of the AC joint.
肩锁关节（AC）损伤是肩部疼痛的常见原因，尤其在参与接触性运动的年轻运动员中。AC关节损伤最常见于肩峰受到直接撞击，损伤分为I至VI型。虽然大多数AC关节损伤可采用非手术治疗，但IV至VI型最好通过手术治疗，III型存在争议，大多数外科医生建议先进行非手术治疗试验。尽管已经描述了多种手术技术，但尚未确立金标准技术。生物力学测试表明，对AC和喙锁韧带进行解剖重建可形成更优的手术结构。本技术说明的目的是描述我们在急性和慢性情况下对AC关节不稳定进行初次治疗的首选技术。使用2条游离肌腱移植物并结合皮质纽扣悬吊装置，结合了非刚性生物和解剖学AC及喙锁韧带重建的优点，同时受益于皮质悬吊装置抵抗AC关节移位的强度。
