Coracoacromial Ligament Transfer Research Articles

Bone-ligament transfer of coracoacromial ligament for acromioclavicular dislocation. A new fixation method used in 6 cases.

We treated 6 grade III acromioclavicular injuries with a new fixation method using a bone-ligament transfer of the coracoacromial ligament into a clavicular tunnel. After an average of 16 months, function and cosmesis were excellent in all patients.

Ｌｏｏｓｅ Ｓｈｏｕｌｄｅｒに対するＩｎｆｅｒｉｏｒ Ｃａｐｓｕｌａｒ Ｓｈｉｆｔ及びＣｏｒａｃｏ‐Ａｃｒｏｍｉａｌ Ｌｉｇ．Ｔｒａｎｓｆｅｒの経験

Two cases of loose shoulder were treated with inferior capsular shift and coracoacromial ligament transfer. Case 1 was a 19-year-old woman with 46.9% inferior instability of her left shoulder on the 3kg stress test. Case 2 was an 18-year-old woman with 88% inferior instability of her left shoulder on the 3kg stress test. Both cases had multi-directional instability in the drawer test and had a positive sulcus sign. Postoperatively they had stable shoulders with a remarkable improvement in range of motion. We suggest that inferior capsular shift combined with c-a ligament transfer is a useful method for producing multidirectional stability.

The treatment of acromiclavicular ligament injury using coracoacrom ial ligament transfer with acromial bone block report of fourcases

The treatment of acromiclavicular ligament injury using coracoacrom ial ligament transfer with acromial bone block report of fourcases

肩鎖関節脱臼に対するＷｅａｖｅｒ変法の検討

It is not easy to maintain anatomical restoration conservatively for acromioclavicular separation. We have reported previously that reconstruction of acromioclavicular or coracoclavicular ligament offers superior result to the simple transfixation of acromioclavicular joint by the Kirschner wires.Nine patients treated by modified Weaver procedure were reviewed and were compared to the five patients by modified Dewar procedure and a patient by modified Neviaser procedure. At review, a functional result of the shoulder including pain, range of motion, muscle weakness and activity of daily living was evaluated . A radiographic result was also evaluated. The displacement less than 50% of the width of clavicle was rated as good restoration.Seven patients were satisfactory in the functional assessment, but the good restoration was maintained only in four patients. The fact that the poor restoration doesn't always lead to poor function, encourages conservative treatments.The fifteen patients who had been treated operatively, were assigned into good restoration group (8) and poor restoration group (7). Functional assesment was significantly (p<0.05) higher in good restoration group. We concluded the operative procedure which can maintain good restoration to be the better treatment. On that standpoint of view, the transfer of coracoacromial ligament as a substitute for coracoclavicular ligament seems to be insufficient for the acromioclavicular separation.

Complete Acromioclavicular Separations

A retrospective study of the surgical treatment methods for complete acromioclavicular (AC) dislocations was initiated to investigate the efficacy of each. During the years 1972-1985, a total of 95 surgical procedures were performed for complete AC dislocations. The medical records of 90 cases were available for review. The operative methods compared coracoclavicular (CC) with AC fixation methods. Excision of the distal clavicle was performed for chronic dislocations. AC fixation methods included Kirschner wires alone, Kirschner-wire fixation with coracoacromial ligament transfer, and Kirschner-wire fixation with tension wiring. Results were graded using evaluation of pain, range of motion, and residual deformity. AC fixation methods proved to be more successful than CC fixation methods. Excellent results were obtained in more than 89% of both AC and CC methods. AC methods had more minor complications including infections and implant breakage, but no failure or recurrences of the dislocation. CC methods resulted in 9% failure or recurrences. Of the AC fixation methods, the Kirschner wire with tension wiring gave the best results but required a more extensive operation for removal of implants. Excision of the distal end of the clavicle is an adequate form of treatment for the chronic complete painful AC dislocation.

Acromioclavicular dislocations treated by coracoacromial ligament transfer.

Forty-seven patients with acute Allman type-III acromioclavicular dislocations were treated with open reduction and coracoacromial ligament transfer. At follow-up 1.6-10 years (mean 6) post-operatively 44 patients (94%) had excellent or good functional results. Two of the three patients with unsatisfactory results had degenerative joint changes. No late dislocation was found but there were three subluxations (3-5 mm). Two of the three patients with subluxation in the acromioclavicular joint at follow-up had unsatisfactory results. Complications were infrequent and cosmetic results satisfactory.

Bone Block Transfer of Coracoacromial Ligament in Acromioclavicular Injury

A bone block transfer of coracoacromial ligament into the medullary canal of the clavicle for Grade III acromioclavicular injury was developed in an attempt to prevent occasional pullout of the ligament in the procedure described by Weaver and Dunn. Fifteen consecutive cases (12 acute, three chronic) with Grade III acromioclavicular injury were treated by this method. All but one patient regained painless full range of shoulder motion. All patients returned to previous activity. Failure of coracoclavicular reconstruction occurred in one case. Asymptomatic focal myositis ossificans developed in four cases with no functional deficit.

Treatment of Complete Acromioclavicular Separation by Coracoacromial Ligament Transfer

There is still discussion concerning the methods for treating Type 3 dislocations of the acromioclavicular joints. Since 1969 the authors have treated 41 patients with Type 3 dislocations by transfer of the coracoacromial ligament, with favorable results. The advantages of the method are as follows: (1) The replaced coracocromial ligaments substitute for the strong coracoclavicular ligaments, reproducing a construction that closely resembles a physiologically and anatomically normal state. (2) There is no fear of rupture if transplanted tendon or wire is used. A concentrated force will not occur in this system because of dispersion in the tendon, and no injury is produced in the clavicle. (3) The operation can be performed under the same visual field, and the technique is relatively simple.