K Takase1, K Yamamoto2. 1. Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku Shinjuku-ku, 160-0023 Tokyo, Japan. Electronic address: k.takase@muf.biglobe.ne.jp. 2. Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku Shinjuku-ku, 160-0023 Tokyo, Japan.
Abstract
BACKGROUND: Surgical treatment is recommended for type 5 acromioclavicular joint dislocation on Rockwood's classification. We believe that anatomic repair of the coracoclavicular ligaments best restores the function of the acromioclavicular joint. We attempted to correctly reconstruct the anatomy of the coracoclavicular ligaments under arthroscopy, and describe the minimally invasive arthroscopic procedure. MATERIALS AND METHODS: There were 22 patients; mean age at surgery, 38.1 years. Mean time to surgery was 13.2 days. Mean follow-up was 3 years 2 months. The palmaris longus tendon was excised from the ipsilateral side to replace the conoid ligament, while artificial ligament was used for reconstructing the trapezoid ligament. Both ligament reconstructions were performed arthroscopically. No temporary fixation of the acromioclavicular joint was performed. RESULTS: On postoperative radiographic evaluation, 4 patients showed subluxation and 2 showed dislocation of the acromioclavicular joint; the other 16 patients had maintained reduction at the final consultation. MR images 1year after surgery clearly revealed the reconstructed ligaments in 19 patients. Only 1 patient showed osteoarthritis of the acromioclavicular joint. CONCLUSION: Although it requires resection of the ipsilateral palmaris longus for grafting, we believe that anatomic reconstruction of both coracoclavicular ligaments best restores the function of the acromioclavicular joint. LEVEL OF EVIDENCE: 4.
BACKGROUND: Surgical treatment is recommended for type 5 acromioclavicular joint dislocation on Rockwood's classification. We believe that anatomic repair of the coracoclavicular ligaments best restores the function of the acromioclavicular joint. We attempted to correctly reconstruct the anatomy of the coracoclavicular ligaments under arthroscopy, and describe the minimally invasive arthroscopic procedure. MATERIALS AND METHODS: There were 22 patients; mean age at surgery, 38.1 years. Mean time to surgery was 13.2 days. Mean follow-up was 3 years 2 months. The palmaris longus tendon was excised from the ipsilateral side to replace the conoid ligament, while artificial ligament was used for reconstructing the trapezoid ligament. Both ligament reconstructions were performed arthroscopically. No temporary fixation of the acromioclavicular joint was performed. RESULTS: On postoperative radiographic evaluation, 4 patients showed subluxation and 2 showed dislocation of the acromioclavicular joint; the other 16 patients had maintained reduction at the final consultation. MR images 1year after surgery clearly revealed the reconstructed ligaments in 19 patients. Only 1 patient showed osteoarthritis of the acromioclavicular joint. CONCLUSION: Although it requires resection of the ipsilateral palmaris longus for grafting, we believe that anatomic reconstruction of both coracoclavicular ligaments best restores the function of the acromioclavicular joint. LEVEL OF EVIDENCE: 4.
Authors: Carlos Maia Dias; Maria João Leite; Manuel Ribeiro da Silva; Pedro Granate; José Manuel Teixeira Journal: Orthop Surg Date: 2022-02-09 Impact factor: 2.071