Saraglis Georgios, Prinja Aditya, To Kendrick, Khan Wasim, Singh Jagwant
Department of Trauma and Orthopaedics, Lewisham and Greenwich NHS Trust, London SE13 6LH, UK.
Upper Limb Unit, Wrightington Hospital, Lancashire, UK.
SICOT J. 2022;8:38. doi: 10.1051/sicotj/2022038. Epub 2022 Sep 7.
Surgical treatment is usually recommended for acute, high-grade acromioclavicular joint (ACJ) injuries. A wide variety of surgical techniques exist, and the literature does not strongly support one over the other. In this literature review, we describe and compare the results of different surgical treatments for the management of acute unstable ACJ dislocation and aim to guide surgeons on optimal treatment.
A literature review was performed by searching PubMed, Medline, Cochrane, and Embase databases. Seventeen studies met the inclusion criteria and were analyzed. Only studies with comparative data were included. The clinical and radiological outcomes of these studies were reviewed.
Seventeen studies were included in this literature review. We found no difference in outcomes between open and arthroscopic procedures. Coracoclavicular ligament (CCL) reconstruction techniques provide better results than the more rigid hook plate fixation. There is no evidence that biologic repair with tendon graft is superior to synthetic grafts. Furthermore, an autograft is not shown to be better than an allograft. Rigid fixation between the clavicle and coracoid and the non-anatomic Weaver-Dunn technique appears less popular in recent literature. The hook plate is associated with subacromial osteolysis, acromial erosion, and the morbidity of a secondary procedure.
There is a recent increase in publications on the reconstruction of the ACJ after injury, with new techniques focusing on the anatomic reconstruction of the CCLs aiming to restore both vertical and horizontal plane stability of the ACJ using synthetic/biological grafts. Despite the plethora of new techniques introduced, meaningful comparisons are difficult to draw due to the heterogeneity of the treatments used and the outcome measure used to assess the results.
对于急性、高级别肩锁关节（ACJ）损伤，通常建议进行手术治疗。存在多种手术技术，而文献并未强烈支持其中一种技术优于另一种。在本综述中，我们描述并比较了不同手术治疗急性不稳定ACJ脱位的结果，旨在为外科医生提供最佳治疗指导。
通过检索PubMed、Medline、Cochrane和Embase数据库进行文献综述。17项研究符合纳入标准并进行了分析。仅纳入有比较数据的研究。对这些研究的临床和影像学结果进行了综述。
本综述纳入了17项研究。我们发现开放手术和关节镜手术的结果没有差异。喙锁韧带（CCL）重建技术比更刚性的钩钢板固定提供更好的结果。没有证据表明肌腱移植的生物修复优于合成移植物。此外，自体移植物并未显示比同种异体移植物更好。锁骨和喙突之间的刚性固定以及非解剖学的Weaver-Dunn技术在最近的文献中似乎不太受欢迎。钩钢板与肩峰下骨溶解、肩峰侵蚀以及二次手术的发病率相关。
最近关于损伤后ACJ重建的出版物有所增加，新技术侧重于CCL的解剖重建，旨在使用合成/生物移植物恢复ACJ在垂直和水平平面的稳定性。尽管引入了大量新技术，但由于所用治疗方法的异质性以及用于评估结果的结局指标，难以进行有意义的比较。
