Olsen Brittany A, Rollins Joshua W, Ngo Daniel H, Gregory James M
Department of Orthopaedic Surgery, UTHealth Houston McGovern Medical School, Houston, TX, USA.
JSES Rev Rep Tech. 2023 Sep 4;3(4):519-523. doi: 10.1016/j.xrrt.2023.08.002. eCollection 2023 Nov.
Many surgical techniques have been described for acromioclavicular (AC) joint reconstruction. Creation of bone tunnels through the clavicle or coracoid has been shown to be a risk factor for fracture. Use of an AC reconstruction technique that does not create bone tunnels may obviate this risk. This study aims to evaluate clinical outcomes of AC joint reconstruction using a tunnel-free technique compared to reconstruction using a cortical button and clavicular drill holes.
Consecutive patients who underwent AC joint reconstruction by a single surgeon in a subspecialty referral practice were included. One group of patients received cortical button fixation (button group), in which sutures were passed around the coracoid, brought up through a drill hole in the clavicle, and tied over a cortical button. The other group of patients received tunnel-free fixation, in which a self-locking tape suture was passed in a cerclage fashion around the base of the coracoid and the clavicle and tensioned with a tensioning device (cerclage group). Both groups underwent reconstruction of the coracoclavicular (CC) ligament and AC joint capsule using tibialis anterior allograft. Patient-reported outcome scores and satisfaction were collected and compared between groups. Radiographs were reviewed to evaluate CC ligament distance and loss of reduction.
Twenty-two patients were included in the study (button n = 10, cerclage n = 12). Preoperative demographics and injury characteristics were not different between groups. Average radiographic follow-up was not different between groups (button: 231 days, cerclage: 105 days). Postoperative American Shoulder and Elbow Surgeons, visual analog scale, and Single Assessment Numeric Evaluation scores were similar between groups. Two postoperative clavicle fractures were sustained in the button group. These occurred through clavicular drill holes and were preceded by tunnel widening. No fractures occurred in the cerclage group. CC distance at initial follow-up was significantly less in the cerclage group (button: 11.2 ± 4.5 mm, cerclage: 7.0 ± 2.9 mm, =.023). Loss of reduction was similar throughout the postoperative period (button: 4.3 ± 2.6 mm, cerclage: 4.8 ± 4.1 mm, >.05. Forty percent of patients were unsatisfied with their clavicle after button fixation (n = 4/10), compared with zero after cerclage fixation (n = 0/12, =.03). Reasons for dissatisfaction were fracture (n = 2) and persistent cosmetic deformity (n = 2).
Tunnel-free AC joint reconstruction is associated with improved initial radiographic appearance and patient satisfaction compared to single cortical button fixation. Postoperative clavicle fracture and persistent cosmetic deformity drive patient dissatisfaction, which may be minimized by avoiding clavicular drill holes and using a tensioned self-locking cerclage suture to improve initial reduction.
针对肩锁关节（AC）重建，已有多种手术技术被描述。通过锁骨或喙突制作骨隧道已被证明是骨折的一个危险因素。使用不制作骨隧道的AC重建技术可能会消除这种风险。本研究旨在评估与使用皮质纽扣和锁骨钻孔进行重建相比，采用无隧道技术进行AC关节重建的临床效果。
纳入在专科转诊机构由同一位外科医生进行AC关节重建的连续患者。一组患者接受皮质纽扣固定（纽扣组），即缝线绕过喙突，从锁骨上的钻孔穿出，在皮质纽扣上打结。另一组患者接受无隧道固定，即使用自锁带缝线以环扎方式绕过喙突基部和锁骨，并使用张紧装置进行张紧（环扎组）。两组均使用胫骨前肌同种异体移植物重建喙锁（CC）韧带和AC关节囊。收集并比较两组患者报告的结局评分和满意度。复查X线片以评估CC韧带距离和复位丢失情况。
本研究共纳入22例患者（纽扣组n = 10，环扎组n = 12）。两组术前人口统计学和损伤特征无差异。两组的平均影像学随访时间无差异（纽扣组：231天，环扎组：105天）。两组术后美国肩肘外科医师协会评分、视觉模拟量表评分和单项评估数字评价评分相似。纽扣组术后发生2例锁骨骨折。这些骨折发生在锁骨钻孔处，且之前有隧道增宽。环扎组未发生骨折。环扎组初始随访时的CC距离明显更小（纽扣组：11.2±4.5mm，环扎组：7.0±2.9mm，P = 0.023）。术后整个期间复位丢失情况相似（纽扣组：4.3±2.6mm，环扎组：4.8±4.1mm，P>0.05）。40%的患者在纽扣固定后对其锁骨不满意（n = 4/10），而环扎固定后为零（n = 0/12，P = 0.03）。不满意的原因是骨折（n = 2）和持续的外观畸形（n = 2）。
与单皮质纽扣固定相比，无隧道AC关节重建的初始影像学表现和患者满意度更高。术后锁骨骨折和持续的外观畸形导致患者不满意，通过避免锁骨钻孔并使用张紧的自锁环扎缝线来改善初始复位，这种情况可能会降至最低。
