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

Cho, Nam Su; Bae, Sung Ju; Lee, Joong Won; Seo, Jeung Hwan; Rhee, Yong Girl

doi:10.5397/cise.2019.22.2.93

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

Clinics in shoulder and elbow, v.22 no.2, 2019년, pp.93 - 99

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)

Abstract ▼ AI-Helper

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.

주제어

표/그림 (6)

표 Table 1. Patients Demographics
그림 Fig. 1. Intraoperative radiographs. (A) Suture anchor was fixed at the original site of the coracoclavicular ligament in the coracoid process. (B) Looped wires were passed through the holes created in the insertion site of coracoclavicular ligament in the clavicle. (C) Reduction of acromioclavicular joint with two Kirschner wires transfixation. (D) Sutures were tied over the clavicle and the radiograph shows anatomical reduction of the acromioclavicular joint.
그림 Fig. 2. Intraoperatve photographs. (A) The lateral end of the clavicle, the acromion, and the acromioclavicular joint were exposed. (B) The looped wires were passed through the two created holes. (C) One suture anchor was placed into the base of the coracoid process. (D) When a satisfactory reduction and K-wires fixation were achieved, the joint was stabilized with sutures passing through the created holes.
표 Table 2. Clinical Outcomes of Modified Phemister Operation with Coracoclavicular Ligament Augmentation Using Suture Anchor
표 Table 3. Radiologic Outcomes of Modified Phemister Operation with Coracoclavicular Ligament Augmentation Using Suture Anchor
표 Table 4. Radiological Outcomes in Comparison to Unaffected Side

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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)

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