Kotsalis Giannis, Giatroudakis Kostantinos, Ladogianni Maria, Fandridis Emmanouil
A Orthopedic Department, General Hospital of Athens G. Gennimatas, Athens, Greece.
Upper Limb & Microsurgery Department, KAT General Hospital, Athens, Greece.
Eur J Orthop Surg Traumatol. 2024 Apr;34(3):1635-1645. doi: 10.1007/s00590-024-03850-9. Epub 2024 Feb 18.
We present the functional and clinical results of a combined surgical technique that functionally restores chronic Acromioclavicular Joint Instability (AJI). The method combines a double-looped suture fixation augmented with a semitendinosus autograft.
Between 2017 and 2021, 15 patients were treated using the surgical technique. All patients suffered an Acromioclavicular Joint Separation that remained untreated for at least 6 (6-16) weeks after the initial injury. Four Ethibond sutures were passed below the coracoid process and through a 4.5 drill hole in the clavicle. The sutures provided adequate horizontal and vertical reduction and stabilization of the clavicle. A semitendinosus autograft was passed below the coracoid process and looped around the clavicle. The remaining graft limbs were used to reconstruct the acromioclavicular capsule. Patients were radiologically evaluated with bilateral anteroposterior (AP), Zanca, and Alexander views. The clinical evaluation was based on the Acromioclavicular Joint Instability Score and the Constant-Murley Score.
The mean follow-up period was 31.2 months (17-61). The mean last ACJIS and CMS scores were 96 (90-100) and 97.67 (87-100), respectively. Reduction of the clavicle was radiologically confirmed in all cases throughout the follow-up period. AC arthritis was reported in 1 case without associated clinical symptoms. No significant complications were reported, and all patients returned to the pre-injury activity level.
The presented functional reconstruction of the AC joint disruption in chronic cases is an effective and secure method with low complication rates and good clinical results.
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我们展示一种联合手术技术的功能和临床结果，该技术能功能性地恢复慢性肩锁关节不稳定（AJI）。该方法结合了双环缝线固定并辅以半腱肌自体移植。
2017年至2021年期间，15例患者采用该手术技术进行治疗。所有患者均发生肩锁关节分离，在初次损伤后至少6（6 - 16）周未接受治疗。4根Ethibond缝线从喙突下方穿过并通过锁骨上的4.5毫米钻孔。这些缝线提供了足够的水平和垂直复位以及锁骨的稳定。一根半腱肌自体移植肌腱从喙突下方穿过并环绕锁骨。剩余的移植肌腱肢体用于重建肩锁关节囊。患者通过双侧前后位（AP）、赞卡（Zanca）和亚历山大（Alexander）位片进行影像学评估。临床评估基于肩锁关节不稳定评分和康斯坦特 - 默里（Constant - Murley）评分。
平均随访期为31.2个月（17 - 61个月）。末次随访时肩锁关节不稳定评分（ACJIS）和康斯坦特 - 默里评分（CMS）的平均值分别为96（90 - 100）和97.67（87 - 100）。在整个随访期间，所有病例经影像学证实锁骨均已复位。有1例报告有肩锁关节炎，但无相关临床症状。未报告重大并发症，所有患者均恢复到伤前的活动水平。
所展示的慢性病例肩锁关节脱位的功能性重建是一种有效且安全的方法，并发症发生率低，临床效果良好。
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