Schöbel Tobias, Wendler Toni, Heilmann Robin, Fischer Jean-Pierre, Schleifenbaum Stefan, Theopold Jan, Hepp Pierre
Department of Orthopedic, Trauma, and Plastic Surgery, University of Leipzig, Leipzig, Germany.
Department of Orthopedic, Trauma, and Plastic Surgery, University of Leipzig, Leipzig, Germany; ZESBO - Center for Research on Musculoskeletal Systems, University of Leipzig, Leipzig, Germany.
J Shoulder Elbow Surg. 2025 Apr;34(4):928-936. doi: 10.1016/j.jse.2024.07.041. Epub 2024 Sep 21.
Various techniques are available for the reconstruction of acromioclavicular joint (ACJ) dislocations, with the main focus being on restoration of the AC capsule or coracoclavicular ligaments. Recent research has underlined the significance of the deltotrapezial fascia (DTF) and related muscles as dynamic stabilizers of the ACJ. The Hypothesis was that a reconstruction of the DTF increases the stability of the ACJ in the horizontal plane more than a complete transection of the fascia, while not restoring the stability of the native state.
Reconstruction of the DTF increases the stability of the ACJ in the horizontal plane more than a complete transection of the fascia, while not restoring the stability of the native state.
Five pairs of human cadaveric shoulders including the torsos were included in the study and underwent cyclic anterior-posterior loading using an electromechanical testing machine. The shoulders were put into 3 groups: group N (n = 10): native ACJ; group T (n = 10): ACJ with transected DTF; group R (n = 10): ACJ with reconstruction of the DTF after transection. The dislocation was recorded with a 3D optical measuring system.
Group N showed a mean horizontal displacement of 2.94 mm (±1.26), group T showed a mean anterior displacement of 3.33 mm (±1.37), and group R showed a mean anterior displacement of 2.95 mm (±1.08). The mean anterior displacement for group T was significantly higher after every measured number of cycles compared with groups N and R. There was no significant difference in mean anterior displacement between groups N and R.
The transection of the DTF results in significantly reduced stability in the horizontal plane of the ACJ. A reconstruction of the DTF restores the stability of the native ACJ in the horizontal plane. Further clinical and biomechanical investigations should focus on reconstruction techniques of the DTF.
肩锁关节（ACJ）脱位的重建有多种技术，主要重点在于恢复肩锁关节囊或喙锁韧带。最近的研究强调了三角肌斜方肌筋膜（DTF）及相关肌肉作为肩锁关节动态稳定器的重要性。研究假设为，与完全横断该筋膜相比，重建DTF能在水平面增加肩锁关节的稳定性，但无法恢复至原始状态的稳定性。
与完全横断该筋膜相比，重建DTF能在水平面增加肩锁关节的稳定性，但无法恢复至原始状态的稳定性。
本研究纳入五对包含躯干的人体尸体肩部标本，使用机电测试机对其进行前后循环加载。将肩部标本分为三组：N组（n = 10）：正常肩锁关节；T组（n = 10）：肩锁关节伴DTF横断；R组（n = 10）：肩锁关节横断后重建DTF。使用三维光学测量系统记录脱位情况。
N组平均水平位移为2.94毫米（±1.26），T组平均向前位移为3.33毫米（±1.37），R组平均向前位移为2.95毫米（±1.08）。在每个测量的循环次数后，T组的平均向前位移显著高于N组和R组。N组和R组之间的平均向前位移无显著差异。
DTF横断导致肩锁关节水平面稳定性显著降低。重建DTF可恢复肩锁关节在水平面的原始稳定性。进一步的临床和生物力学研究应聚焦于DTF的重建技术。
