Brachial plexus injury is also possible especially as coracoid is adjacent to the brachial Plexus. As early as BC Hippocrates — BC , commented that acromioclavicular dislocation often was misdiagnosed as a glenohumeral injury [ 1 ]. The most common complaint in the late setting is a nagging medial scapular pain. Postoperative left AC joint reconstruction Zenca view. This is preventable by adding an AC ligament reconstruction to the surgery.
Stam L, Dawson I. They reported that the graft sutured on to itself with supplemental sutures was the most secure method of fixation. This review of AC joint dislocations intends to analyze the available surgical options, a critical analysis of existing literature, actual technique of anatomic repair, and also accompanying complications. The tied ends of the tendon are reinforced with supplemental Ethibond 2 suture. A semitendinoses graft is harvested and prepared by the standard technique.
A significant number of patients have been treated conservatively for type III dislocations and hence, the recommendations for treating type III AC joint are controversial. Conclusions An intact CC ligament after reconstruction with biological graft offers long-term stability. It is not uncommon to expect collateral injuries of the Gleno humeral joint. Under general anesthesia, with the patient in a beach chair position, the shoulder and arm is draped free.
Horizontal displacement can also be measured [ 10 ]. Failure of surgery or redislocation or implant failure is likely when the implant is not supplemented with a biological graft.
Acromioclavicular joint dislocations
Same patient as Fig. Repair of complete acromioclavicular separations using the acromioclavicular-hook plate.
Mechanism of injury The mechanism of injury usually involves a direct blow to the lateral aspect of the shoulder with the arm in an adducted position, leading to downward displacement of the scapula opposed by impaction of the clavicle onto the first rib [ 3 ].
After 6 weeks all restrictions are discarded. Infections after surgical repair of acromioclavicular separations with nonabsorbable tape or suture. Stam L, Dawson I.
The argument appears flawed, as the AC joint dislocates with plastic deformation of the CC ligament followed by eventual rupture. Abstract Acromioclavicular AC dislocation is a common injury especially among sportsmen. The posterior and superior ligaments are the strongest and are invested by the deltotrapezial fascia.
Radiographic features Anteroposterior, lateral, and axial views are standard views taken for the shoulder; however, a Zanca view [ 12 ] is the most accurate view to look at the AC joint. When the clavicle drill hole is made lateral to the coracoid, the 2 strands of the graft chart a different vector, with each strand charting different course—mimicking the conoid and trapezoid path.
Semitendinosus tendon graft versus a modified Weaver-Dunn procedure for acromioclavicular joint reconstruction in chronic cases: Complications of this technique includes suture cut-out, aseptic foreign-body reaction, and clavicle osteolysis, which can result in failure. Complications Across the board, each technique has its typical fault lines. Most common is type III. During this step the surgeon must ensure not to detach the deltoid from the anterior clavicle. Visualization of the acromion anterior to the clavicle will indicate a type IV lesion.
A prospective controlled randomized study.
So it is advisable acromooclavicular have a biologic graft around the coracoid. This procedure was initially described inutilized the Coraco-Acromial CA ligament to substitute the torn CC ligament; this procedure involved the release of the Coraco-Acromial ligament from the acromion, resection of the distal end of the clavicle, and transfer of the CA ligament to the lateral end of the clavicle, more closely replicating the CC ligaments.
The tied ends of the tendon are reinforced with supplemental Ethibond 2 suture. The evaluation and treatment of thesks injured acromioclavicular joint in athletes.
Acromioclavicular joint dislocations
Operative management Various surgical procedures have been described, but there is no clear agreement on any one of them. Cosmetic deformity is only one of the aspects of this condition.
An intact CC ligament after reconstruction with biological graft offers long-term stability. There have been athletes from national teams who have happily carried out with their activity.
J Bone Joint Surg Am. Repair of acromioclavicular separations with knitted Dacron graft. K-wire and Steinman pin migrations can create more injury and also embarrassing evidence on postoperative radiographs [ 31 — 37 ]. Bipolar clavicular dislocation treated surgically.