Reconstruction of the Coracoclavicular Ligament With Palmaris Longus Tendon and Mersilene Tape for Acromioclavicular Dislocations

2021 ◽  
Author(s):  
Yoon Min Lee ◽  
Joo Dong Yeo ◽  
Zin Ouk Hwang ◽  
Seok Whan ◽  
Yoo Joon Sur
Keyword(s):  
Ligament Reconstruction ◽  
Ac Joint ◽  
Joint Dislocation ◽  
Longus Tendon ◽  
Palmaris Longus ◽  
Ac Joint Dislocation ◽  
Mersilene Tape ◽  
Palmaris Longus Tendon ◽  
The Mean

Abstract Background Acromioclavicular (AC) joint dislocation is common among shoulder injuries, and various surgical methods have been introduced for effective ligament reconstruction. Reconstruction of the coracoclavicular (CC) ligament in the anatomical position using autologous tendons is a recent surgical trend. This study is to report clinical and radiologic results of reconstruction of the CC ligament using an autologous palmaris longus tendon interweaved with Mersilene tape (PLMT) with a minimum 2-year follow-up. Methods This retrospective study analyzed 76 patients (mean age, 43.4 ± 11.2 years) with AC joint dislocation treated by reconstruction of the CC ligament with PLMT, from March 2004 to February 2017. The mean follow-up period was 28 ± 6.7 months (range, 24–66 months). The Visual Analog Scale (VAS) for pain assessment, American Shoulder and Elbow Surgeons rating scale (ASES), and Constant Score (CS) were used to evaluate clinical outcomes at the final follow-up. CC and AC distances were measured using anteroposterior (AP) X-ray preoperatively, 6 weeks postoperatively, and at the final follow-up for radiologic outcomes. Complications were also assessed. Results The mean preoperative VAS, ASES, CS were 5.7 ± 0.7, 77.1 ± 6.2, and 61.5 ± 5.2, respectively. These scores at the last follow-up improved to 2.1 ± 0.5, 90.9 ± 4.3, and 94 ± 7.0, respectively (p = 0.043, p < 0.001, p < 0.001). The mean preoperative CC and AC distances were 16.49 ± 3.73 mm and 13.84 ± 3.98 mm, respectively. They were 7.16 ± 1.22 mm and 3.86 ± 2.34 mm at 6 weeks postoperative, and became 9.29 ± 2.72 mm and 5.30 ± 2.09 mm at the final follow-up. The mean CC and AC distances decreased significantly at the final follow-up (p < 0.001, p < 0.001). Although a slight re-widening of the CC distance occurred in 10 patients (13.1%), most patients regained full range of motion of the affected shoulder at the final follow-up. Conclusion The CC ligament reconstruction with PLMT for the treatment of AC joint dislocation showed good clinical and radiological results. This technique could be a good alternative treatment for AC dislocations.

Lunotriquetral Ligament Reconstruction Utilizing a Palmaris Longus Autograft

2017 ◽  
Vol 22 (04) ◽  
pp. 544-547 ◽  
Author(s):  
Carl M. Harper ◽  
Matthew L. Iorio
Keyword(s):  
Range Of Motion ◽  
Grip Strength ◽  
Ligament Reconstruction ◽  
Longus Tendon ◽  
Palmaris Longus ◽  
Lunotriquetral Ligament ◽  
Palmaris Longus Tendon ◽  
Tendon Autograft

Injury to the lunotriquetral ligament can result in midcarpal instability, with resultant alterations in normal wrist kinematics and subsequent arthrosis. We performed a previously undescribed technique of lunotriquetral ligament reconstruction in two patients utilizing a palmaris longus tendon autograft. Average age at presentation was 24 years old with a mean follow up of 10 months. Average range of motion was 62.5° of flexion and 57.5° of extension. Total arc of motion was 83% of the contralateral uninvolved extremity. Average grip strength was 31 kg which was 91% of the contralateral extremity. Average Quick Disability of Arm, Shoulder and Hand score was 12.5 and Modern Activity Subjective Survey of 2007 was 1.5. No complications were noted.

scholarly journals Clinical and Radiological Outcomes of Modified Phemister Operation with Coracoclavicular Ligament Augmentation Using Suture Anchor for Acute Acromioclavicular Joint Dislocation

2019 ◽  
Vol 22 (2) ◽  
pp. 93-99
Author(s):  
Nam Su Cho ◽  
Sung Ju Bae ◽  
Joong Won Lee ◽  
Jeung Hwan Seo ◽  
Yong Girl Rhee
Keyword(s):  
Suture Anchor ◽  
External Rotation ◽  
Constant Score ◽  
Acromioclavicular Joint Dislocation ◽  
Ac Joint ◽  
Joint Dislocation ◽  
Ligament Augmentation ◽  
Ac Joint Dislocation ◽  
The Mean

Background: Modified Phemister operation has been widely used for the treatment of acute acromioclavicular (AC) joint dislocation. Additionally, the use of suture anchor for coracoclavicular (CC) fixation has been reported to provide CC stability. This study was conducted to evaluate the clinical and radiological results of a modified Phemister operation with CC ligament augmentation using suture anchor for acute AC joint dislocation.Methods: Seventy-four patients underwent the modified Phemister operation with CC ligament augmentation using suture anchor for acute AC joint dislocation and were followed-up for an average of 12.3 months. The visual analogue scale (VAS), range of motion, Constant score, and Korean shoulder scoring system (KSS) were used for clinical assessment. Acromioclavicular interval (ACI), coracoclavicular distance (CCD), and acromioclavicular distance (ACD) were obtained to evaluate the radiological assessments.Results: At the last follow-up, the mean VAS Score was 1.7 points, the mean joint range of the forward flexion was 164.6°, external rotation at the side was 61.2°, and internal rotation to the posterior was a level of T12. The mean Constant score and the mean KSS was 82.7 points and 84.2 points, respectively. At the mean ACI, CCD, and ACD, significant differences were found preoperatively and at the last follow-up. When the ACI, CCD, and ACD were compared with the contralateral unaffected shoulder at the last follow-up, the affected shoulders had significantly higher values.Conclusions: The modified Phemister operation with CC ligament augmentation using suture anchor is clinically and radiologically effective at acute AC joint dislocation.

scholarly journals The Infinity-Lock System for Chronic Grade III AC Joint Dislocation: A Novel Technique, Rehabilitation Protocol and Short Term Results

2020 ◽  
Vol 9 (8) ◽  
pp. 2519
Author(s):  
Alfonso Maria Romano ◽  
Pasquale Casillo ◽  
Monica De Simone ◽  
Guglielmo Nastrucci ◽  
Donatella Risorto ◽  
...  
Keyword(s):  
Constant Score ◽  
Surgical Techniques ◽  
Nonoperative Treatment ◽  
Modified Technique ◽  
Ac Joint ◽  
Joint Dislocation ◽  
Ac Joint Dislocation ◽  
Choice Of Treatment ◽  
Grade Iii

Background: the choice of treatment of chronic grade III acromioclavicular (AC) joint dislocation is controversial. Several surgical techniques have been described in the literature, responding differently to nonoperative treatment. The aim of this study is to describe a modified technique of stabilizing an AC joint dislocation with the new Infinity-Lock Button System, in order to demonstrate that it is effective in optimizing outcomes and decreasing complications. Methods: this is a retrospective study of 15 patients who underwent surgical stabilization of the AC joint dislocation between 2018 and 2019, through modified surgical technique using the Infinity-Lock Button System. Active range of motion (ROM), Specific Acromio Clavicular Score (SACS) and Constant Score (CS) were evaluated preoperatively and postoperatively at last 18 months follow up. Patients rated their outcomes as very good, good, satisfactory, or unsatisfactory. Results: a total of twelve patients rated their outcome as very good and three as good; no patients were dissatisfied with surgery. The mean Constant Score increased from 38 points preoperatively to 95 postoperatively, the average SACS score decreased from 52 points preoperatively to 10 postoperatively, both significantly. No complications were detected. Conclusion: the described technique is effective for treatment of chronic grade III AC joint dislocation, resulting in elevated satisfaction ratings and predictable outcomes. Nevertheless, further longer term follow-up studies are required.

Anatomical Acromioclavicular Ligament Reconstruction

2005 ◽  
Vol 33 (11) ◽  
pp. 1723-1728 ◽  
Author(s):  
Paul W. Grutter ◽  
Steve A. Petersen
Keyword(s):  
Ligament Reconstruction ◽  
Acromioclavicular Joint ◽  
Tendon Graft ◽  
Longus Tendon ◽  
Flexor Carpi Radialis ◽  
Palmaris Longus ◽  
Fresh Frozen ◽  
Palmaris Longus Tendon ◽  
Mechanism Of Failure ◽  
Surgical Treatments

Background Current surgical treatments for acromioclavicular separations do not re-create the anatomy of the acromioclavicular joint. Hypothesis Anatomical acromioclavicular reconstruction re-creates the strength of the native acromioclavicular joint and is stronger than a modified Weaver-Dunn repair. Study Design Controlled laboratory study. Methods The native acromioclavicular joint in 6 fresh-frozen cadaveric upper extremities was stressed to failure under uniaxial tension in the coronal plane. A modified Weaver-Dunn procedure, anatomical acromioclavicular reconstruction using a palmaris longus graft, and anatomical acromioclavicular reconstruction using a flexor carpi radialis graft were then performed sequentially. Each repair was stressed to failure. Load-displacement curves and mechanism of failure were recorded for each. Results Loads at failure for the native acromioclavicular joint complex, modified Weaver-Dunn procedure, anatomical acromioclavicular reconstruction using a palmaris longus tendon graft, and anatomical acromioclavicular reconstruction using a flexor carpi radialis tendon graft were 815 N, 483 N, 326 N, and 774 N, respectively. The strength of the native acromioclavicular joint complex was significantly different from the modified Weaver-Dunn repair (P <. 001) and the anatomical acromioclavicular reconstruction using a palmaris longus tendon graft (P <. 001) but not from the anatomical acromioclavicular reconstruction using a flexor carpi radialis tendon graft (P =. 607). Conclusion The strength of the described anatomical acromioclavicular reconstruction is limited by the tendon graft used. Anatomical acromioclavicular reconstruction with a flexor carpi radialis tendon graft re-creates the tensile strength of the native acromioclavicular joint complex and is superior to a modified Weaver-Dunn repair.

scholarly journals Comparative Outcome of Loop Suspensory Reconstruction and Hook Plate Fixation for Acute Type III-V Acromioclavicular Joint Dislocation

2020 ◽  
Author(s):  
Yu-Jui Chang ◽  
Wen-Yi Chou ◽  
Jih-Yang Ko ◽  
Hao-Chen Liu ◽  
Ya-Ju Yang ◽  
...  
Keyword(s):  
Plate Fixation ◽  
Hook Plate ◽  
Ac Joint ◽  
Joint Dislocation ◽  
Constant Murley Score ◽  
Group I ◽  
Ac Joint Dislocation ◽  
Group Ii ◽  
Reconstruction Group

Abstract Background Treatment options of acromioclavicular (AC) joint dislocation depend on the injury severity and the functional demand of the patient. Common surgical options include fixation across the AC joint, coracoclavicular (CC) fixation, and AC joint or CC reconstruction. However, the clinical superiority of these various procedures is controversial. This study aimed to compare the clinical and radiological outcomes of loop suspensory reconstruction and hook plate fixation for acute unstable AC joint dislocation.Methods We retrospectively included patients with acute unstable AC joint dislocation who were treated with loop suspensory reconstruction (group I, 23 cases) or hook plate fixation (group II, 14 cases) in our hospital from January 2010 to December 2016 with a minimum follow-up period of 1 year after surgery. We assessed the clinical outcomes of blood loss during surgery, surgical duration, duration of medication required for pain relief after the primary operation, occurrence of complications, and the Constant-Murley score; radiological analysis included postoperative arthritic change and the CC distance discrepancy ratio (CCDR) on preoperative and final follow-up plain films.Results The average follow-up duration was17.0±6.1 months. The mean duration of pain-control medication usage was 121.7±174.1 and 235.4±251.8 days in groups I and II, respectively, significantly lower in the CC reconstruction group (p=0.031). Group I revealed a superior Constant-Murley score at the final outpatient follow-up as compared with group II (71.7±15.8 vs 61.1±6.7, p=0.009). Regarding radiographic analysis, the hook plate group had a superior residual CCDR (group I vs II = 30% vs 80±40%, p<0.001). In addition, there were 9 cases of subluxation noted in group I and 2 cases in group II; however, 4 cases of acromion osteolysis were observed in group II.Conclusions The principle finding of the present study was that hook plate fixation was superior to loop suspensory reconstruction in terms of CC distance maintenance. However, the loop suspensory reconstruction group demonstrated superior clinical functional outcomes and less painkiller usage. A further randomized controlled trial with a long-term follow-up period is required.

scholarly journals A retrospective comparative study of arthroscopic fixation for acute acromioclavicular joint dislocation: coracoid sling technique versus single-tunnel technique

2021 ◽  
Author(s):  
Liangquan Peng ◽  
Yizi Zheng ◽  
Greg Zhang ◽  
Zhenhan Deng
Keyword(s):  
Clinical Outcomes ◽  
Acromioclavicular Joint Dislocation ◽  
Return To Sports ◽  
Ac Joint ◽  
Joint Dislocation ◽  
Ac Joint Dislocation ◽  
Significant Difference ◽  
Tunnel Technique ◽  
Arthroscopic Fixation

Abstract Background Arthroscopic fixation in acute acromioclavicular (AC) joint dislocation has become more popular and shown good clinical outcomes. This study aims to evaluate and compare the efficacy of single-tunnel technique (SST) and coracoid sling technique (CST) for the treatment of acute AC joint dislocation in order to provide more suitable treatment options and clinical recommendations for orthopaedic surgeons. Methods We retrospectively reviewed the charts of patients with acute Rockwood type IV and V AC joint dislocation who had undergone arthroscopic fixation procedure with SST or CST fixation between June 2009 and June 2018. A total of 90 consecutive patients identified from chart review were picked and divided into SST and CST groups, with 45 members in each group. The Visual Analog Scale (VAS) pain score, Constant shoulder functionality score, Karlsson AC joint score, the time of return to sports and activity, and plain radiographs of the affected shoulder at different time points of follow-up were all recorded for a minimum of 2 years postoperatively. Results The majority of the patients in both groups recovered to their preoperative activity levels with few complications. The average postoperative AC and coracoclavicular (CC) distances were significantly narrower than preoperative measurements in both groups, and no significant difference was observed between the two groups at 2 years post-op. The CST group had reduced operative time, shorter time of recovery of shoulder movements, higher Constant functionality scores and Karlsson AC joint scores, and fewer complications than the STT group at the last clinical follow-up. Conclusions CST technique achieved superior clinical outcomes with fewer complications compared to the traditional STT technique in arthroscopic treatment of acute AC joint dislocation. This technique could be considered as a reliable method for AC joint reconstruction.

Trapeziometacarpal Instability Treated with Modified Brunelli Ligamentoplasty

2001 ◽  
Vol 26 (2) ◽  
pp. 145-147 ◽  
Author(s):  
J. C. BOTELHEIRO
Keyword(s):  
Ligament Reconstruction ◽  
Surgical Techniques ◽  
Trapeziometacarpal Joint ◽  
Longus Tendon ◽  
Palmaris Longus ◽  
Palmaris Longus Tendon

Seventeen cases of instability of the trapeziometacarpal joint were treated surgically using either the original Brunelli technique or one of two modifications. Six patients achieved very good, nine achieved good and two achieved poor results. The results of the three surgical techniques were similar and we recommend the use of the palmaris longus tendon for the ligament reconstruction, as it is the easiest to perform.

Sign in / Sign up

Export Citation Format

Share Document