Objective To determine the change in humeral head anterosuperior migration after releasing the coracoacromial l igament in shoulders from cadavers with simulated intact or irreparable teared rotator cuff, to provide biomechanical basis for preserving the coracoacromial l igament or not during hemiarthroplasty. Methods Twelve freshfrozen cadaveric glenohumeral joints of adult preserving the scapula, upper 2/3 of the humerus, articular capsule and the coracoacromial l igament, were divided into 2 groups. The suprascapularis was preserved in group A (6 shoulders) and excised in group B (6 shoulders). Positioning the joint in a combination of 30° extension, 0° abduction and 30° external rotation, and imposing a 50 N axial compressive load to the humeral shaft, the anterosuperior displacement of the humeral head weremeasured before and after excising the coracoacromial l igament. Results In group A, the displacement of the humeral head was (5.96 ± 0.77）mm with intact coracoacromial l igament and (6.83 ± 0.84）mm after transecting the l igament. In group B, the displacement of the humeral head was (8.07 ± 2.46）mm with intact coracoacromial l igament and (9.92 ± 3.29）mm after transecting the coracoacromial l igament. So the mean increase of anterosuperior migration of the humeral head was (0.88 ± 0.34) mm (P lt; 0.01) in group A, and (1.85 ± 0.99) mm (P lt; 0.01) in group B, which was greater than the former (P lt; 0.05). Conclusion The coracoacromial l igament restrained anterosuperior translation of the humeral head, especially for patients with rotator cuff deficiency, so it should be preserved as far as possible during hemiarthroplasty.
To explore the operative method and the cl inical outcomes of repairing acromioclavicular dislocation by clavicular hook plate internal fixation and coracoacromial l igament transposition. Methods From August 2004 to December 2007, 12 cases of acromioclavicular dislocation were repaired with the internal fixation of clavicular hook plate and the transposition of coracoacromial l igament. There were 9 males and 3 females aged 22-56 years old (average 32 yearsold). Causes of injury: 6 cases from fall ing injury, 4 cases from crush injury and 2 cases from traffic accident. There were 5 cases of the left acromioclavicular dislocation, and 7 cases of the right. According to acromioclavicular dislocation classification set by WANG Yicong, 8 cases were graded as type III, 3 cases as type IV, and 1 case as type V. The time from injury to operation was 3-28 days (average 6 days). The injured arm was hung after operation, and the function training was started 3-5 days after operation. Results All wounds healed by first intention, and the X-ray films showed complete reposition of acromioclavicular joints was achieved in all cases 1 week after operation. Over the follow-up period of 12-30 months, no plate and screw loosening, hook break and acromion fracture occurred. At 2 months after operation, 2 patients had sl ight pain when moving the shoulder, and the symptom disappeared when removing the plate. No re-dislocation was observed in all cases after removing the plate at 6-10 months after operation. The function of shoulder joint was assessed by Karlsson evaluation standard 1 year after operation, 11 cases were graded as excellent and 1 case was good. Conclusion For the repair of acromioclavicular dislocation, the method of combining clavicular hook plate internal fixation with coracoacromial l igament transposition has the advantages of minor wound, easy operation, l ittle influence on the function of shoulder joints, and rel iable restoration of the stabil ity of shoulder joint.
Objective To simulate anterosuperior instabil ity of the shoulder by a combination of massive irreparable rotator cuff tears and coracoacromial arch disruption in cadaveric specimens, use proximally based conjoined tendon transfer forcoracoacromial l igament (CAL) reconstruction to restrain against superior humeral subluxation, and investigate its feasibility and biomechanics property. Methods Nine donated male-adult and fresh-frozen cadaveric glenohumeral joints were applied to mimic a massive irreparable rotator cuff tear in each shoulder. The integrity of the rotator cuff tendons and morphology of the CAL were visually inspected in the course of specimen preparation. Cal ipers were used to measure the length of the CAL’s length of the medial and the lateral bands, the width of coracoid process and the acromion attachment, and the thickness in the middle, as well as the length, width and thickness of the conjoined tendon and the lateral half of the removed conjoined tendon. The glenohumeral joints were positioned in a combination of 30° extension, 0° abduction and 30° external rotation. The value of anterosuperior humeral head translation was measured after the appl ication of a 50 N axial compressive load to the humeral shaft under 4 sequential scenarios: intact CAL, subperiosteal CAL release, CAL anatomic reattachment, entire CAL excision after lateral half of the proximally based conjoined tendon transfer for CAL reconstruction. Results All specimens had an intact rotator cuff on gross inspection. CAL morphology revealed 1 Y-shaped, 4 quadrangular, and 4 broad l igaments. The length of the medial and lateral bands of the CAL was (28.91 ± 5.56) mm and (31.90 ± 4.21) mm, respectively; the width of coracoid process and acromion attachment of the CAL was (26.80 ± 10.24) mm and (15.86 ± 2.28) mm, respectively; and the thickness of middle part of the CAL was (1.61 ± 0.36) mm. The length, width, and thickness of the proximal part of the proximally based conjoined tendon was (84.91 ± 9.42), (19.74 ± 1.77), and (2.09 ± 0.45) mm, respectively. The length and width of the removed lateral half of the proximally conjoined tendon was (42.67 ± 3.10) mm and (9.89 ± 0.93) mm, respectively. The anterosuperior humeral head translation was intact CAL (8.13 ± 1.99) mm, subperiosteal CAL release (9.68 ± 1.97) mm, CAL anatomic reattachment (8.57 ± 1.97) mm, and the lateral half of the proximally conjoined tendon transfer for CAL reconstruction (8.59 ± 2.06) mm. A significant increase in anterosuperior migration was found after subperiosteal CAL release was compared with intact CAL (P lt; 0.05). The translation after CAL anatomic reattachment and lateral half of the proximally conjoined tendon transfer for CAL reconstruction increased over intact CAL, though no significance was found (P gt; 0.05); when they were compared with subperiosteal CAL release, the migration decreased significantly (P lt; 0.05). The translation of lateral half of the proximally conjoined tendon transfer for CAL reconstruction increased over CAL anatomic reattachment, but no significance was evident (P gt; 0.05). Conclusion The CAL should be preserved or reconstructed as far as possible during subacromial decompression, rotator cuff tears repair, and hemiarthroplasty for patients with massive rotator cuff deficiency. If preservation or the insertion reattachment after subperiosteal release from acromion of the CAL of the CAL is impossible, or CAL is entirely resected becauseof previous operation, the use of the lateral half of the proximally based conjoined tendon transfer for CAL reconstruction isfeasible.
Objective To investigate the clinicalvalue of modified Weaver-Dunn technique in repair of acute acromioclavicular dislocation. Methods From January 1993 to December 1998, 18 cases of acromioclavicular dislocation were treated bymodified Weaver-Dunn technique, and other 17 cases of the same suffering were treated by tension band fixation of the acromioclavicular joints. All of the patients were followed up for 12-36 months before clinical evaluation of the functionof shoulder joints, according to University of Pennsylvanian Shoulder Score System. Results In short term, the shoulder joints recovered much more rapidly in the cases repaired by modified Weaver-Dunn technique; 12, 24 and 36 months after operation, the scores of the cases repaired by modified Weaver-Dunn technique were (1897±67), (193.7±3.6) and (194.7±3.4) respectively according to the Shoulder Score System, while those of the cases treated by tension band fixation were (167.3±7.8), (170.2±6.3) and (165.6±5.9) respectively. The above data indicated that there was significant difference between two groups (P＜0.05). Conclusion The modified Weaver-Dunn technique was a better surgical approach than tension band fixation for repair of acute acromioclavicular dislocation.
目的 探讨锁骨钩钢板并改良Weaver-Dunn技术治疗Tossy Ⅲ型陈旧性肩锁关节脱位的疗效。 方法 2007年１月－2011年１月，对12例Tossy Ⅲ型陈旧性肩锁关节脱位采用锁骨钩钢板并改良Weaver-Dunn技术治疗。其中3例为肩锁关节脱位手术后再次发生脱位，2例合并锁骨远端骨折采用保守治疗无效，余7例单纯性陈旧性肩锁关节脱位未经任何检查治疗。 结果 术后患者切口均Ⅰ期愈合，无神经血管损伤、无切口感染等并发症。12例均获随访，随访时间12～30个月。X线片示锁骨复位情况良好，去除内固定后未见肩锁关节脱位复发。肩锁关节功能好，局部畸形消失，无肩周肌肉萎缩及肩周炎出现，锁骨位置良好。手术疗效评价：获优10例，良2例，优良率100%。 结论 锁骨钩钢板并改良Weaver-Dunn技术治疗Tossy Ⅲ型陈旧性肩锁关节脱位，复位固定满意，韧带重建易成功，肩关节功能恢复好，是一种治疗陈旧性肩锁关节脱位较理想的方法。
Objective To evaluate the early-term effectiveness of Latarjet procedure with double EndoButtons fixation for recurrent anterior shoulder dislocation by coracoid osteotomy with preserving coracoacromial ligament. Methods Between January 2021 and June 2023, 19 patients with recurrent anterior shoulder dislocations were treated by arthroscopic Latarjet procedure with double EndoButtons fixation, all of which underwent coracoid osteotomy with preserving the coracoacromial ligament. There were 11 males and 8 females, with an average age of 23.3 years (range, 17-32 years). Shoulder dislocations ranged from 3 to 11 times, with an average of 6.4 times. The disease duration ranged from 3 to 35 months, with an average of 12.9 months. All apprehension tests were positive. Imaging examination showed that the defect width of the ipsilateral glenoid bone was 13%-26%, with an average of 19.8%. After operation, the shoulder range of motion was examined, including flexion lift, lateral external rotation, extension 90° external rotation, and internal rotation. Shoulder joint function was evaluated by Walch-Duplay score, American Association for Shoulder and Elbow Surgery (ASES) score, and Rowe score. Imaging examinations were taken to observe the position and shaping of coracoid. Results All incisions healed by first intention and no nerve or vessel injury occurred. All patients were followed up 9-24 months (mean, 14.5 months). There was no recurrence of shoulder dislocation and the apprehension tests were negative during follow-up. There was no significant difference in the shoulder range of motion (flexion lift, lateral external rotation, extension 90° external rotation, and internal rotation) between preoperation and at last follow-up (P>0.05). The Walch-Duplay score, ASES score, and Rowe score significantly improved when compared with those before operation (P<0.05). Postoperative imaging showed that coracoid graft was at the same level with the glenoid in all cases; the center of coracoid graft was located between 3 to 5 o’clock. During follow-up, there was no glenohumeral joint degeneration, the acromiaohumeral distance was not reduced when compared with preoperation, and the coracoid bone gradually formed concentric circles with the humeral head. Conclusion The Latarjet procedure with double EndoButtons fixation can effectively treat recurrent anterior shoulder dislocation by coracoid osteotomy with preserving coracoacromial ligament, and the early-term effectiveness is satisfactory.
ObjectiveTo investigate the morphological characteristics of the glenohumeral joint (including the glenoid and coracoid) in the Chinese population and determine the feasibility of designing coracoid osteotomy based on the preoperative glenoid defect arc length by constructing glenoid defect models and simulating suture button fixation Latarjet procedure. MethodsTwelve shoulder joint specimens from 6 adult cadavers donated voluntarily were harvested. First, whether the coracoacromial ligament and conjoint tendon connected was anatomically observed and their intersection point was identified. The vertical distance from the intersection point to the coracoid, the maximum allowable osteotomy length starting from the intersection point, and the maximum osteotomy angle were measured. Next, the anteroinferior glenoid defect models of different degrees were randomly constructed. The arc length and area of the glenoid defect were measured. Based on the arc length of the glenoid defect of the model, the size of coracoid oblique osteotomy was designed and the actual length and angle of the coracoid osteotomy were measured. A limited osteotomy suture button fixation Latarjet procedure with the coracoacromial ligament and pectoralis minor preservation was performed and the position of coracoid block was observed. ResultsAll shoulder joint specimens exhibited crossing fibers between the coracoacromial ligament and the conjoint tendon. The vertical distance from the tip of the coracoid to the coracoid return point was 24.8-32.2 mm (mean, 28.5 mm). The maximum allowable osteotomy length starting from the intersection point was 26.7-36.9 mm (mean, 32.0 mm). The maximum osteotomy angle was 58.8°-71.9° (mean, 63.5°). Based on the anteroinferior glenoid defect model, the arc length of the glenoid defect was 22.6-29.4 mm (mean, 26.0 mm); the ratio of glenoid defect was 20.8%-26.2% (mean, 23.7%). Based on the coracoid block, the length of the coracoid osteotomy was 23.5-31.4 mm (mean, 26.4 mm); the osteotomy angle was 51.3°-69.2° (mean, 57.1°). There was no significant difference between the arc length of the glenoid defect and the length of the coracoid osteotomy (P>0.05). After simulating the suture button fixation Latarjet procedure, the highest points of the coracoid block (suture loop fixation position) in all models located below the optimal center point, with the bone block concentrated in the anteroinferior glenoid defect position. ConclusionThe size of the coracoid is generally sufficient to meet the needs of repairing larger glenoid defects. The oblique osteotomy with preserving the coracoacromial ligament may potentially replace the traditional Latarjet osteotomy method.