Tulane University School of Medicine, New Orleans, Louisiana, USA.
Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, New Jersey, USA.
Am J Sports Med. 2020 Feb;48(2):504-510. doi: 10.1177/0363546519831013. Epub 2019 Apr 23.
Injuries to the acromioclavicular (AC) joint are common and should be suspected in patients who have shoulder pain in the region of the acromion and clavicle. Injuries to the AC ligament can cause horizontal instability and are often neglected or underdiagnosed, which can lead to poor patient outcomes.
To perform a systematic review of the literature on the diagnosis and treatment of horizontal instability of the AC joint.
Systematic review.
The authors performed a systematic review using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed and EMBASE were searched for studies that investigated diagnosis, treatment, and failure of operative management of acute and chronic AC separations. Studies that did not specifically evaluate AC joint injuries, were not written in English, or were specific only to vertical instability of the AC joint were excluded.
Overall, 23 articles met the inclusion criteria and were therefore included in this systematic review. Diagnosing horizontal AC instability is difficult using plain radiographs; dynamic views were shown in some cases to better detect horizontal instability than with static views. More than 60 procedures for treating AC joint injuries have been published, but many focus on vertical rather than horizontal instability. Modifications to current surgical procedures to incorporate reconstruction of the horizontal component showed improved patient outcomes. Such modifications included additional AC joint suture cord cerclage, combined AC and coracoclavicular ligament reconstruction, and the Twin Tail TightRope triple button technique. Failure after surgical stabilization of AC joint separation has been reported to occur in 15% to 80% of cases.
No consensus is available regarding the best practices for diagnosis, evaluation, and treatment of acute or chronic horizontal instability of the AC joint. Moreover, horizontal instability injuries are often neglected or poorly understood, making diagnosis difficult, which may lead to high complication rates and failure after surgical stabilization.
肩锁关节（AC）损伤较为常见，当患者出现肩峰和锁骨区域的肩部疼痛时，应怀疑有 AC 关节损伤。AC 韧带损伤可导致水平不稳定，常被忽视或漏诊，导致患者预后不良。
对 AC 关节水平不稳定的诊断和治疗进行系统评价。
系统评价。
作者按照 PRISMA（系统评价和荟萃分析的首选报告项目）指南进行了系统评价。检索 PubMed 和 EMBASE 以查找评估急性和慢性 AC 分离的诊断、治疗和手术管理失败的研究。排除未专门评估 AC 关节损伤、未用英文撰写或仅针对 AC 关节垂直不稳定的研究。
总体而言，有 23 篇文章符合纳入标准，因此被纳入本系统评价。使用普通 X 线片诊断水平 AC 不稳定较为困难；在某些情况下，动态视图比静态视图更能发现水平不稳定。已经发表了超过 60 种治疗 AC 关节损伤的方法，但许多方法侧重于垂直而非水平不稳定。对现有手术程序进行修改以纳入水平部分重建，显示出改善的患者结局。这些修改包括附加 AC 关节缝线 cord 环扎、AC 和喙锁韧带联合重建以及 Twin Tail TightRope 三纽扣技术。AC 关节分离手术后的固定失败报告发生率为 15%至 80%。
目前对于急性或慢性 AC 关节水平不稳定的最佳诊断、评估和治疗方法尚未达成共识。此外，水平不稳定损伤常被忽视或理解不佳，导致诊断困难，这可能导致高并发症发生率和手术后固定失败。
