Braeckevelt Thomas, Peeters Ian, Palmans Tanneke, De Wilde Lieven, Van Tongel Alexander
Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium.
Knee Surg Sports Traumatol Arthrosc. 2025 Jul;33(7):2614-2625. doi: 10.1002/ksa.12621. Epub 2025 Feb 20.
In acromioclavicular (AC) joint injuries, the kinematical interplay between the AC ligament, coracoclavicular (CC) ligaments and deltotrapezial fascia (DTF) during motions of the shoulder complex is disturbed. This study assessed kinematic alterations of sternoclavicular (SC), scapulothoracic (ST) and AC joint motion during humerothoracic and ST movements in AC injuries.
Shoulder girdle motion was evaluated in 14 cadaveric shoulders in 4 conditions, consisting of an intact state and AC injuries of increasing severity by sequentially sectioning the AC and CC ligaments and DTF. Joint motions were registered during humerothoracic elevation and protraction. An optical navigation system measured three-dimensional rotations and translations in the SC, ST and AC joints.
Sectioning of the AC ligament increased inferior and anterior AC translation with a concomitant increase of scapular protraction. The clavicle rotated to an overall more posteriorly rotated position. Sectioning of the CC ligaments increased lateral rotation and protraction of the scapula relative to the clavicle with a concomitant inferior translation of the acromion. Also, manifest overriding of the clavicle is noted due to instability in the superoinferior and anteroposterior axes. The clavicle rotated back to an overall more anteriorly rotated position, similar to the native condition. Sectioning of the DTF further increased protraction of the scapula relative to the clavicle, while a further medial translation of the acromion under the clavicle is observed.
The AC ligament affects anteroposterior stability, while the CC ligaments disturb stability in a superoinferior and mediolateral direction. All ligaments influence clavicular axial rotation. The DTF exacerbates alterations caused by the CC ligaments. Multiplanar decoupling results in overriding of the clavicle observed after sectioning the CC ligaments. Each sectioned ligament significantly increases scapular protraction. These findings guide further advancements in (non)surgical treatment of AC injuries to restore optimal function.
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在肩锁关节（AC）损伤中，肩锁韧带、喙锁韧带（CC）和三角肌斜方肌筋膜（DTF）在肩部复合体运动过程中的运动学相互作用受到干扰。本研究评估了在AC损伤中，胸锁关节（SC）、肩胸关节（ST）和AC关节在肱胸和ST运动过程中的运动学改变。
在14具尸体肩部上评估肩胛带运动，共4种情况，包括完整状态以及通过依次切断AC韧带、CC韧带和DTF来模拟不同严重程度的AC损伤。在肱胸抬高和前伸过程中记录关节运动。使用光学导航系统测量SC、ST和AC关节的三维旋转和平移。
切断AC韧带会增加AC关节的下向和前向平移，同时伴随肩胛骨前伸增加。锁骨整体旋转至更靠后的位置。切断CC韧带会增加肩胛骨相对于锁骨的外旋和前伸，同时伴随肩峰向下平移。此外，由于上下和前后轴的不稳定，可观察到锁骨明显重叠。锁骨旋转回整体更靠前的位置，类似于原始状态。切断DTF会进一步增加肩胛骨相对于锁骨的前伸，同时观察到肩峰在锁骨下方进一步向内侧平移。
AC韧带影响前后稳定性，而CC韧带在上下和中外侧方向干扰稳定性。所有韧带均影响锁骨的轴向旋转。DTF加剧了由CC韧带引起的改变。多平面解耦导致切断CC韧带后观察到锁骨重叠。每条切断的韧带都会显著增加肩胛骨前伸。这些发现为AC损伤的（非）手术治疗进一步恢复最佳功能提供了指导。
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