Clinical and Radiological Outcomes of Modified Phemister Operation with Coracoclavicular Ligament Augmentation Using Suture Anchor for Acute Acromioclavicular Joint Dislocation원문보기
Cho, Nam Su
(Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University)
,
Bae, Sung Ju
(Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University)
,
Lee, Joong Won
(Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University)
,
Seo, Jeung Hwan
(Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University)
,
Rhee, Yong Girl
(Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University)
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 an...
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 $164.6^{\circ}$, external rotation at the side was $61.2^{\circ}$ 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.
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 $164.6^{\circ}$, external rotation at the side was $61.2^{\circ}$ 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.
* AI 자동 식별 결과로 적합하지 않은 문장이 있을 수 있으니, 이용에 유의하시기 바랍니다.
가설 설정
In addition, the clinical and radiological outcomes were evaluated retrospectively. We hypothesized that modified Phemister operation and coracoclavicular ligament augmentation using suture anchors provide satisfactory restoration of shoulder function and radiological outcomes.
제안 방법
Anteroposterior radiographs of the affected and contralateral unaffected AC joint in neutral rotation made with the patient in a standing position were obtained immediately postoperatively and at each follow-up examination. Acromioclavicular interval (ACI) was defined as the perpendicular distance between the clavicle distal end and acromion, while coracoclavicular distance (CCD) was defined as the perpendicular distance between the upper border of the coracoids process and the inferior cortex of the clavicle, and acromioclavicular distance (ACD) was defined as the perpendicular distance between the line passing the upper border of the acromion and the line parallel to the upper border of the lateral part of the clavicle.
Therefore, this study was conducted to evaluate the clinical and radiological outcomes of modified Phemister operation and additional coracoclavicular ligament augmentation using suture anchors for acute AC joint dislocation. In addition, the clinical and radiological outcomes were evaluated retrospectively. We hypothesized that modified Phemister operation and coracoclavicular ligament augmentation using suture anchors provide satisfactory restoration of shoulder function and radiological outcomes.
The clinical and radiological outcomes are presented in Table 2. The VAS, ROM, Constant, and KSS score were evaluated as clinical factors at the last follow-up. The mean VAS score while resting was 1.
Therefore, this study was conducted to evaluate the clinical and radiological outcomes of modified Phemister operation and additional coracoclavicular ligament augmentation using suture anchors for acute AC joint dislocation. In addition, the clinical and radiological outcomes were evaluated retrospectively.
대상 데이터
A total of 72 males and two females with a mean age of 48.0 years (range, 17–68 years) were included in this study.
성능/효과
Specifically, an additional polydioxanone cord was passed around the base of the coracoids and formed into a figure8-shaped sling through a hole drilled in the lateral clavicle. After a follow-up of 53 months (range, 20 to 92 months), the authors showed clinical results statistically favoring the early treatment of injuries. Corella et al.
At the final follow-up, the mean VAS score was 1.7 ± 0.5 points, the Constant score was 82.7 ± 6.6 points, and the KSS score was 84.2 ± 3.6 points.
21) conducted a retrospective study of 14 patients who underwent a modified Phemister procedure with a suture anchor added for augmentation of the conoid ligament in cases of acute dislocation of the AC joint. At the mean follow-up (14 months), functional results were good/excellent with a Constant score of 90.8 and KSS score of 91. In our study, we observed good clinical and functional results at the follow-up examination with respect to the ROM, strength and pain discomfort.
Comparison of the ACI, CCD, and ACD values of the contralateral unaffected shoulder and affected shoulder at the last follow-up revealed that the affected shoulders had significantly higher average ACI (3.21 ± 1.67 mm vs. 5.89 ± 2.58 mm, p<0.001), CCD (8.11 ± 2.83 mm vs. 11.86 ± 3.83 mm, p<0.001), and ACD (7.73 ± 3.01 mm vs. 10.58 ± 3.91 mm, p=0.004) values (Table 4).
The principal finding of the present study was that modified Phemister operation using augmentation of the coracoclavicular ligament by suture anchor for the treatment of acute AC joint dislocation successfully restored the stability of the AC joint. Satisfactory clinical and radiologic outcomes were simultaneously achieved in this study.
참고문헌 (34)
1 Bontempo NA Mazzocca AD Biomechanics and treatment of acromioclavicular and sternoclavicular joint injuries Br J Sports Med 2010 44 5 361 9 doi: 10.1136/bjsm.2009.059295 20371562
3 Mazzocca AD Arciero RA Bicos J Evaluation and treatment of acromioclavicular joint injuries Am J Sports Med 2007 35 2 316 29 doi: 10.1177/0363546506298022 17251175
5 Beitzel K Cote MP Apostolakos J Current concepts in the treatment of acromioclavicular joint dislocations Arthroscopy 2013 29 2 387 97 doi: 10.1016/j.arthro.2012.11.023 23369483
6 Phemister DB The treatment of dislocation of the acromioclavicular joint by open reduction and threaded-wire fixation J Bone Joint Surg 1942 24 1 166 8
7 Winkler H Schlamp D Wentzensen A [Treatment of acromioclavicular joint dislocation by tension band and ligament suture] Aktuelle Traumatol 1994 24 4 133 9 German 7942307
8 Garcia NM Bermejo FT Modified Phemister procedure for the treatment of type III Rockwood acromioclavicular joint dislocation. Results after five-years follow-up Rev Esp Cir Ortop Traumatol 2010 54 5 294 300 doi: 10.1016/S1988-8856(10)70249-2
9 Bosworth BM Acromioclavicular separation: new method of repair Surg Gynecol Obstet 1974 76 866 71
10 Weaver JK Dunn HK Treatment of acromioclavicular injuries, especially complete acromioclavicular separation J Bone Joint Surg Am 1972 54 6 1187 94 4652050
11 Balser D Eine neue methode zur operativen behandlung der akromioklavikularen luxation Chir Prax 1976 24 275
12 Horst K Dienstknecht T Christoph Pape H Surgical treatment of acromioclavicular joint separation OP J 2013 29 1 24 30 doi: 10.1055/s-0032-1328234
13 Salzmann GM Walz L Schoettle PB Imhoff AB Arthroscopic anatomical reconstruction of the acromioclavicular joint Acta Orthop Belg 2008 74 3 397 400 18686468
14 Chun CH Lee SH Lee BC Cho YW The surgical treatment of acromioclavicular joint dislocation using modified phemister and modified Weaver-Dunn operation Clin Shoulder Elbow 1998 1 2 180 5
15 Leidel BA Braunstein V Kirchhoff C Pilotto S Mutschler W Biberthaler P Consistency of long-term outcome of acute Rockwood grade III acromioclavicular joint separations after K-wire transfixation J Trauma 2009 66 6 1666 71 doi: 10.1097/TA.0b013e31818c1455 19509629
16 Rhee YG Park JG Cho NS Song WJ Clinical and radiologic outcomes of acute acromioclavicular joint dislocation: comparison of Kirschner’s wire transfixation and locking hook plate fixation Clin Shoulder Elbow 2014 17 4 159 65 doi: 10.5397/cise.2014.17.4.159
17 Larsen E Bjerg-Nielsen A Christensen P Conservative or surgical treatment of acromioclavicular dislocation. A prospective, controlled, randomized study J Bone Joint Surg Am 1986 68 4 552 5 3514625
18 Lyons FA Rockwood CA Jr Migration of pins used in operations on the shoulder J Bone Joint Surg Am 1990 72 8 1262 7 2204634
19 Breslow MJ Jazrawi LM Bernstein AD Kummer FJ Rokito AS Treatment of acromioclavicular joint separation: suture or suture anchors J Shoulder Elbow Surg 2002 11 3 225 9 doi: 10.1067/mse.2002.123904 12070493
20 Su EP Vargas JH 3rd Boynton MD Using suture anchors for coracoclavicular fixation in treatment of complete acromioclavicular separation Am J Orthop (Belle Mead NJ) 2004 33 5 256 7 15195920
21 Moon GH Nam IH Lee YH Kim KC Lee JH Ahn GY The modified phemister operation with the suture anchor added for the augmentation of conoid ligament in acute acromioclavicular dislocation Clin Shoulder Elbow 2010 13 1 34 9 doi: 10.5397/CiSE.2010.13.1.034
22 Rockwood C Williams G Young D Disorders of the acromioclavicular joint Rockwood CA The shoulder 3rd ed Philadelphia Saunders 2004 521 95
23 Constant CR Murley AH A clinical method of functional assessment of the shoulder Clin Orthop Relat Res 1987 214 160 4 3791738
24 Tae SK Rhee YG Park TS The development and validation of an appraisal method for rotator cuff disorders: the Korean Shoulder Scoring System J Shoulder Elbow Surg 2009 18 5 689 96 doi: 10.1016/j.jse.2008.11.019 19278871
25 Lizaur A Sanz-Reig J Gonzalez-Parreno S Long-term results of the surgical treatment of type III acromioclavicular dislocations: an update of a previous report J Bone Joint Surg Br 2011 93 8 1088 92 doi: 10.1302/0301-620X.93B8.26775 21768634
26 Fraser-Moodie JA Shortt NL Robinson CM Injuries to the acromioclavicular joint J Bone Joint Surg Br 2008 90 6 697 707 doi: 10.1302/0301-620X.90B6.20704 18539661
27 Tomlinson DP Altchek DW Davila J Cordasco FA A modified technique of arthroscopically assisted AC joint reconstruction and preliminary results Clin Orthop Relat Res 2008 466 3 639 45 doi: 10.1007/s11999-007-0085-3 18264852
28 Choi SW Lee TJ Moon KH Cho KJ Lee SY Minimally invasive coracoclavicular stabilization with suture anchors for acute acromioclavicular dislocation Am J Sports Med 2008 36 5 961 5 doi: 10.1177/0363546507312643 18272797
29 Rolf O Hann von Weyhern A Ewers A Boehm TD Gohlke F Acromioclavicular dislocation Rockwood III-V: results of early versus delayed surgical treatment Arch Orthop Trauma Surg 2008 128 10 1153 7 doi: 10.1007/s00402-007-0524-3 18038141
30 Corella F Ortiz A Lo D Ocampos M Calvo JA Vaquero J [Surgical treatment of acromioclavicular dislocations with the Phemister method: the long-term results] Patol Apar Locomot 2006 4 157 66 Spanish
31 Verdano MA Pellegrini A Zanelli M Paterlini M Ceccarelli F Modified Phemister procedure for the surgical treatment of Rockwood types III, IV, V acute acromioclavicular joint dislocation Musculoskelet Surg 2012 96 3 213 22 doi: 10.1007/s12306-012-0221-4 23011984
33 Mayr E Braun W Eber W Ruter A [Treatment of acromioclavicular joint separations. Central Kirschner-wire and PDSaugmentation] Unfallchirurg 1999 102 4 278 86 German 10355343
34 Calvo E Lopez-Franco M Arribas IM Clinical and radiologic outcomes of surgical and conservative treatment of type III acromioclavicular joint injury J Shoulder Elbow Surg 2006 15 3 300 5 doi: 10.1016/j.jse.2005.10.006 16679228
※ AI-Helper는 부적절한 답변을 할 수 있습니다.