Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium.
Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium.
Am J Sports Med. 2022 Jun;50(7):1971-1982. doi: 10.1177/03635465221095231. Epub 2022 May 9.
Although the coracoclavicular (CC) ligaments are classically reconstructed after acromioclavicular (AC) joint injuries, biomechanical studies over the past decade have indicated the importance of an additional reconstruction of the AC ligaments. To date, no kinematic study has investigated the kinematic differences between these reconstruction strategies.
To evaluate the restoration of shoulder motion after an AC injury using a CC ligament, an AC ligament, or a combined reconstruction technique.
Controlled laboratory study.
After creating a Rockwood grade V lesion in 14 cadaveric shoulders, the AC joint injury was treated with either a CC ligament reconstruction using a suspension device, an in situ AC ligament reconstruction using 2 coupled soft tissue anchors, or a combination of these 2 techniques. Joint motions were registered during humerothoracic elevation in the coronal plane and protraction in the intact shoulder in a Rockwood V lesion and after the 3 reconstruction strategies. An optical navigation system measured 3-dimensional rotation in the sternoclavicular and scapulothoracic joints, and both rotation and translation were analyzed in the AC joint.
In the sternoclavicular joint, the CC and combined reconstruction techniques adequately restored clavicular axial rotation, while the AC reconstruction technique showed a better correction of clavicular elevation. Scapulothoracic joint rotations were best restored by reconstructing the AC ligaments. In the AC joint, the relative tilting position and the lateral rotation of the scapula compared with the clavicle were best restored by the suspension device and combined reconstruction. The AC ligament reconstruction technique demonstrated a better restoration of the relative protracted position and resulted in a better correction of the translation of the scapula relative to the clavicle.
This study illustrates that there are kinematic differences between AC, CC, or combined ligament reconstruction strategies. Although each technique was able to restore different elements of the joint kinematics, none of the strategies completely restored the shoulder girdle to its preinjured state.
Humerothoracic movements after Rockwood V lesions are best restored using the CC reconstruction technique, and scapulothoracic movements are best restored using the AC ligament reconstruction technique.
尽管喙锁（CC）韧带在肩锁（AC）关节损伤后通常被重建，但过去十年的生物力学研究表明，AC 韧带的重建也很重要。迄今为止，尚无运动学研究调查这些重建策略之间的运动学差异。
使用 CC 韧带、AC 韧带或联合重建技术评估 AC 损伤后的肩部运动恢复情况。
对照实验室研究。
在 14 个尸体肩部造成 Rockwood 等级 V 损伤后，AC 关节损伤分别采用 CC 韧带重建（使用悬吊装置）、AC 韧带原位重建（使用 2 个耦合的软组织锚钉）或这两种技术的联合治疗。在完整肩部的冠状面和前向牵引中，在 Rockwood V 损伤和 3 种重建策略后，测量肩胸抬高时关节运动。光学导航系统测量胸锁关节和肩胛胸关节的三维旋转，分析 AC 关节的旋转和平移。
在胸锁关节中，CC 和联合重建技术足以恢复锁骨的轴向旋转，而 AC 重建技术显示出更好的锁骨抬高矫正。AC 韧带重建最能恢复肩胛胸关节旋转。在 AC 关节中，与锁骨相比，悬吊装置和联合重建最能恢复肩胛骨的相对倾斜位置和外旋。AC 韧带重建技术对肩胛骨的相对前伸位置的恢复更好，并且可以更好地矫正相对于锁骨的肩胛骨的平移。
本研究表明，AC、CC 或联合韧带重建策略之间存在运动学差异。尽管每种技术都能够恢复关节运动学的不同元素，但没有一种策略能够完全将肩部恢复到受伤前的状态。
Rockwood V 损伤后，胸锁关节运动最好采用 CC 重建技术恢复，肩胛胸关节运动最好采用 AC 韧带重建技术恢复。
