Melbourne Orthopaedic Group, Melbourne, Victoria, Australia.
Melbourne Orthopaedic Group, Melbourne, Victoria, Australia; Department of Surgery, Monash Medical Centre, Monash University, Melbourne, Victoria, Australia.
J Shoulder Elbow Surg. 2019 Oct;28(10):2031-2038. doi: 10.1016/j.jse.2019.03.005. Epub 2019 Jul 23.
To date, no gold-standard technique exists for the treatment of chronic acromioclavicular joint (ACJ) instability. We systematically reviewed the clinical results of 3 main categories of ACJ reconstruction for high-grade chronic instability.
A literature search was performed according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The inclusion criteria were clinical studies involving patients with ACJ instability (Rockwood grades III-VI) for at least 6 weeks, managed with ACJ stabilization, with a minimum 1-year follow-up. Depending on the surgical technique, patients were divided into 1 of 3 groups: nonbiological fixation between the coracoid and clavicle, for example, suture loops and synthetic ligaments (group 1); biological reconstruction of the coracoclavicular ligaments, for example, allograft or autograft ligament reconstruction (group 2); and ligament and/or tendon transfer, for example, the Weaver-Dunn procedure (group 3). Patient demographic characteristics, functional scores, radiographic outcomes, and complications were compared.
Two independent investigators reviewed 960 articles. A total of 27 studies met the inclusion criteria, comprising 590 patients divided into 1 of 3 groups. The complication rates were similar among the 3 groups: 15% for nonbiological fixation, 15% for biological reconstruction, and 17% for ligament and/or tendon transfer, with failure rates of 8%, 7%, and 5%, respectively. In terms of functional results, the mean Constant score was 87.2 points for nonbiological fixation (n = 89), 92.4 points for biological reconstruction (n = 86), and 87.4 points for ligament and/or tendon transfer (n = 49).
On comparison of the results of 3 different ACJ reconstruction methods, all techniques showed similar complication rates. Among the level II studies, ACJ reconstruction with a tendon graft showed superior results.
迄今为止，尚无治疗慢性肩锁关节（ACJ）不稳定的金标准技术。我们系统地回顾了 3 种主要的 ACJ 重建方法治疗高等级慢性不稳定的临床结果。
根据系统评价和荟萃分析的首选报告项目（PRISMA）指南进行文献检索。纳入标准为：至少有 6 周的 ACJ 不稳定（Rockwood 等级 III-VI）病史的临床研究，采用 ACJ 稳定治疗，随访时间至少 1 年。根据手术技术的不同，患者分为 3 组之一：喙锁骨之间的非生物固定，例如缝线环和合成韧带（组 1）；喙锁韧带的生物重建，例如同种异体或自体韧带重建（组 2）；以及韧带和/或肌腱转移，例如 Weaver-Dunn 手术（组 3）。比较患者的人口统计学特征、功能评分、影像学结果和并发症。
2 名独立的研究者回顾了 960 篇文章。共有 27 项研究符合纳入标准，共 590 例患者分为 3 组。3 组的并发症发生率相似：非生物固定组为 15%，生物重建组为 15%，韧带和/或肌腱转移组为 17%，失败率分别为 8%、7%和 5%。在功能结果方面，非生物固定组的平均 Constant 评分为 87.2 分（n = 89），生物重建组为 92.4 分（n = 86），韧带和/或肌腱转移组为 87.4 分（n = 49）。
在比较 3 种不同的 ACJ 重建方法的结果时，所有技术的并发症发生率相似。在 II 级研究中，肌腱移植物的 ACJ 重建显示出更好的结果。
