[Comparative study on the treatment of acromioclavicular joint dislocation: coracoclavicular ligament reconstruction using lateral half of conjoined tendon or tractusiliotibialis with hook plate fixation]

Weijun An, Shaodong Qiu, Tao Zhu, Zewen Qiao, Teng Ma
Zhonghua Yi Xue za Zhi [Chinese medical journal] 2015 February 3, 95 (5): 363-7

OBJECTIVE: To explore the clinical outcomes of acromioclavicular joint (ACJ) dislocation treated with coracoclavicular ligament (CCL) reconstruction using lateral half of conjoined tendon and tractusiliotibialis with hook plate fixation. Comparative study on their advantages and disadvantages in order to provide the materials for the clinic.

METHODS: From June 2005 to June 2012, the patients with Rockwood type III or severer ACJ dislocation were randomly divided into 2 groups. They underwent CCL reconstruction using lateral half of conjoined tendon (conjoined tendon reconstruction group, n = 36) and tractusiliotibialis (tractusiliotibialis reconstruction group, n = 38) with subsequent fixation of hook plates. During the follow-up, the AC and CC distances were measured on postoperative plain films after a removal of hook plates. And the outcomes were assessed according to Karlsson criteria and Constant-Murley shoulder score. Ranked data were analyzed with the use of χ2 test and measurement date with two-sample t test. Results A total of 74 patients were followed up for an average of 20 (12 - 24) months. No significant inter-group differences existed in age, gender, injured side or classification. And there was no statistical difference in ACor CC distance between two groups within 6 months (P > 0. 05) after a removal of hook plates. The AC and CC distances of conjoined tendon reconstruction group were larger than those of tractusiliotibialis reconstruction group (t = 2. 313, P = 0. 026; t = 2. 114, P = 0. 041) within 12 months. The AC and CC distances of 12 months were both larger than those of 6 months (t =2. 631, P =0. 017; t = 2. 297, P = 0. 032). According to the Constant-Murley shoulder score, conjoined tendon reconstruction group was less than tractusiliotibialis reconstruction group (85. 2 ± 10. 2 vs 93. 1 ± 6. 9, t = 2. 965, P = 0. 006). According to the Karlsson Criteria, the excellent and good rate of functional recovery was 75. 00% in conjoined tendon reconstruction group versus 94. 74% in tractusiliotibialis reconstruction group (χ2 = 8. 111, P = 0. 044).

CONCLUSION: The efficacy of Rockwood type III acromioclavicular joint dislocation for reconstructing coracoclavicular ligament using tractusiliotibialis is better than conjoined tendon. The AC and CC distances increase after a removal of hook plates while it is more obvious for conjoined tendon tractusiliotibialis reconstruction.

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