Coracoclavicular Ligament Injury Research Articles

Arthroscopically Assisted Coracoclavicular (CC) Stabilization Using a Suture Button Device for Lateral Clavicle Fractures with CC Ligament Injury.

Background: Lateral clavicle fractures represent approximately 10-15% of all clavicle fractures. However, controversy exists regarding the optimal surgical treatment because of instability associated with the coracoclavicular (CC) ligament injury and a small lateral fragment. The purpose of this study was to evaluate the radiological and clinical outcomes of arthroscopically assisted CC stabilization using a suture button device for lateral clavicle fractures accompanied by CC ligament injury. Methods: A retrospective observational study involved six patients with modified Neer type IIB fractures, which were treated with the technique and followed for 12 months. Postoperative range of motion (ROM) and X-rays were evaluated every 3 months. Shoulder functional scores (University of California Los Angeles score, Japanese Orthopedics Association score) and visual analog scale (VAS) scores for pain (at rest, at night, and during motion) and for satisfaction were analyzed 12 months after surgery. Results: Early phase ROM recovery and excellent outcomes were achieved. All patients achieved bone union. Slight superior clavicle displacement and bone hole dilation occurred with no critical complications. Conclusions: Arthroscopically assisted CC stabilization with a suture button device for unstable lateral clavicle fractures can produce satisfactory radiological and clinical results.

Arthroscopically Assisted Coracoclavicular (CC) Stabilization Using a Suture Button Device for Lateral Clavicle Fracture with CC Ligament Injury

Arthroscopically Assisted Coracoclavicular (CC) Stabilization Using a Suture Button Device for Lateral Clavicle Fracture with CC Ligament Injury

Arthroscopic-assisted stabilization of distal clavicle fractures with coracoclavicular ligament injury: does it restore anatomy and function?

Abstract Background Fractures of the lateral-third clavicle are less common than the mid-shaft. However, these lateral thirds are associated with disruption of coracoclavicular (CC) ligaments requiring surgical management for optimal fracture healing and functional outcome. Many surgical techniques have been developed to manage these fractures; however, high failure rates and implant-related complications were reported. This study aims to assess the radiological and functional outcomes of arthroscopic-assisted stabilization of the distal end clavicle in terms of union rate, complications, and shoulder function. Patients and methods A prospective study of 32 patients with distal displaced clavicle fracture combined with CC ligament injury (Neer type IIB, V) who underwent surgery within the first 2 weeks of injury between January 2017 and February 2020. Clinical evaluation was employed postoperatively using the Constant–Murley score. The stability of the acromioclavicular joint in the horizontal and vertical planes was evaluated by the cross-arm test and manual dislocation. Radiological assessment was reviewed by an independent observer who was not a surgical team member at 1 and 2 months postoperatively. Results A series of 32 patients (24 men and eight women) were included. Their mean age was 36 years. Based on the radiological imaging, 20 patients had Neer type-IIB fractures, while 12 showed type-V fractures. Their average union time was 6.12 ± 1.26 weeks (ranged 5–9 weeks), with a mean Constant–Murley score that was 96.1 ± 3.76 (range, 89–100). An average of 6.62 ± 1.82 weeks was needed before returning to prior activities. There were no complications reported. Conclusions Arthroscopic-assisted fixation of the distal end clavicle provides excellent fixation results and restores the native anatomy by reconstructing the torn CC ligament without complications or the need for removal of the implant.

Effectiveness analysis of Endobutton plate combined with high-strength suture Nice knot fixation in the treatment of distal clavicle fractures

To investigate the effectiveness of Endobutton plate coracoclavicular fixation combined with fracture site high-strength suture Nice knot cerclage fixation in the treatment of distal clavicle fracture with coracoclavicular ligament injury. The clinical data of 33 cases of distal clavicular fracture with coracoclavicular ligament injury treated by Endobutton coracoclavicular plate fixation between January 2017 and December 2020 were analyzed retrospectively. According to the fixation methods of fracture site, they were divided into two groups: the high-strength suture Nice knot fixation group (study group, 16 cases) and the transacromial Kirschner wire fixation group (control group, 17 cases). There was no significant difference between the two groups in common data such as age, gender, injury side, cause of injury, Craig type, combined injury, time from injury to operation, and preoperative visual analogue scale (VAS) score and Constant-Murley score ( P>0.05). Postoperative fracture healing and complications were observed, and the increase rate of coracoclavicular space on the affected side was calculated at last follow-up. VAS score was used to evaluate shoulder pain before operation, at 1 week, 1 month, 3 months after operation, and at last follow-up. The shoulder function was evaluated according to Constant-Murley shoulder score before operation, at 1 month, 3 months after operation, and at last follow-up. The operations were successfully completed in both groups without severe complications such as vascular nerve injury and coracoid fracture. In the control group, 1 case (5.9%) had slight pin tract infection and 1 case (5.9%) had Kirschner wire displacement; there was no obvious complication in the study group. The patients in both groups were followed up 9-36 months (mean, 22.9 months). The fracture healing time of the study group and the control group were (12.56±0.73) weeks and (13.59±0.87) weeks, respectively, and the difference was significant ( t=-3.661, P=0.001). At last follow-up, the increase rates of coracoclavicular space on the affected side of the study group and the control group were 8.88%±1.19% and 8.55%±1.07%, respectively, showing no significant difference ( t=0.837, P=0.409). The postoperative VAS score and Constant-Murley score of the two groups significantly improved when compared with those before operation, and the two scores gradually improved with the extension of time after operation ( P<0.05). Except that the VAS score at 1 week and 1 month after operation and the Constant-Murley score at 1 month after operation in the study group were significantly better than those in the control group ( P<0.05), there was no significant difference between the two groups at other time points after operation ( P>0.05). For oblique fracture or combined with butterfly fracture in the distal clavicle fracture with coracoclavicular ligament injury, the fracture site high-strength suture Nice knot fixation is a good supplement to the Endobutton plate coracoclavicular fixation. It can stabilize the fracture end, reduce the complications of Kirschner wire fixation, and is more conducive to fracture healing. The effectiveness is satisfactory.

Is osteosynthesis using coracoclavicular ligament reconstruction useful for distal clavicular fractures with coracoclavicular ligament injury?

Is osteosynthesis using coracoclavicular ligament reconstruction useful for distal clavicular fractures with coracoclavicular ligament injury?

Reconstruction of coracoclavicular ligament combined with hook plate technique for treatment of distal clavicle fractures involving avulsion of coracoclavicular ligament

Objective To explore the operative strategy of distal clavicle fracture involving coracoclavicular ligament. Methods Data of 17 cases of distal clavicle fracture involving coracoclavicular ligament in our hospital from January 2013 to December 2018 were analyzed retrospectively. According to whether the coracoclavicular ligament was reconstructed or not, the patients were divided into two groups: non reconstruction group (10 cases), male (7 cases), female (3 cases), 19-60 years old (37.9±11.9). In the reconstruction group, 7 cases were male 5, female 2, 25-62 years old (44.9±13.0). Three dimensional CT was used to judge the ligament injury and X-ray was used to evaluate the fracture reduction and healing after operation. The time of fracture healing was compared between the two groups. The function of shoulder joint was evaluated by visual analog scale (VAS) and Constant score of shoulder joint. Results The patients in both groups were followed up for (18.7±6.7) months (range, 9-27 months). At the latest follow-up, the time of fracture healing in the reconstruction group was 12.6±0.7 weeks (range, 12-14 weeks); VAS score was 3.0±1.3 and Constant-Murley score was 85±11. While those in the non reconstruction group were 23.7±7.9 (range, 16- 48 weeks), 3.1±1.8 and 77±10 respectively. The time of fracture healing was statistically significant (t=3.361, P=0.004). There was no significant difference in VAS score and Constant score (P> 0.05). In the non reconstruction group, there were 1 case of delayed union of fracture (healed 48 weeks after operation), 1 case of loosening of clavicular hook plate, 5 cases of acromioclavicular joint dislocation (Rockwood type II) after removal of internal fixation, and the overall complication rate was 70% (7/10). Reconstruction group: 1 case of acromial fracture, the overall complication rate was 14.3% (1/7). There was significant difference between the two groups (χ2=5.13, P=0.024). Conclusion Reconstruction of clavicular insertion of coracoclavicular ligament can effectively reduce the postoperative complications of distal clavicular fracture involving the coracoclavicular insertion. Attention should be paid to the repair and reconstruction of coracoclavicular ligament injury during fracture treatment. Key words: Clavicle; Fractures, bone; Ligaments

Predictors of safety margin for coracoid transfer: a cadaveric morphometric analysis

BackgroundThe purpose of this study was to investigate the relationship between the bone length available for coracoid transfer without coracoclavicular ligament injury and the distance from the coracoid tip to the attachments of the coracoacromial ligament or pectoralis minor. We hypothesized that cadaver height and the soft tissue attachments on the coracoid process were predictive factors for sufficient bone length for coracoid transfer.MethodsThis study included 28 shoulders from Japanese cadavers: 19 male and 9 female. The distance from the coracoid tip to the distal attachment of the coracoclavicular ligament and the anterior and posterior margins of the coracoacromial ligament or pectoralis minor on the coracoid process were measured.ResultsThe mean available length for coracoid transfer was 24.8 ± 3.4 mm. There was a significant difference in length between male and female subjects, being 26.0 ± 2.9 mm and 22.2 ± 3.0 mm, respectively (p = 0.004). High positive correlations were found between the length of the coracoid transfer and cadaver’s height (r = 0.48, p = 0.009) and the distance from the coracoid tip to the anterior coracoacromial ligament attachment (r = 0.63, p < 0.001). The receiver operating characteristic curve area under the curve for cadaver height was 0.72 while that for distance from coracoid tip to anterior coracoacromial ligament was 0.88 when predicted for a sufficient length for coracoid transfer > 25 mm.ConclusionsOur findings will aid surgeons in preoperative planning and performing of osteotomy of the coracoid safely by predicting the available length of coracoid bone graft.

Application of the method of anatomic coracoclavicular ligament reconstruction for distal clavicle fractures

Objective: To assess the clinical results of the method of anatomic coracoclavicular ligament reconstruction for distal clavicle fractures. Methods: From August 2013 to January 2015, the super image system was used to measure the CT data of 16 patients suffering distal clavicle fractures before operation in Department of Orthopaedics , the First Affiliated Hospital of Nanjing Medical Univerisity. The fractures' morphological features and acromioclavicular dislocation degree were assessed. By referring to the data collected by the my research group on Chinese people's coracoclavicular ligament, the injuries of the coracoclavicular ligament were estimated, which was then to verify the actual injuries detected during operation. Coracoclavicular ligament reconstruction was performed on patients and screws or suture anchors fixing small bone blocks was used as an adjuvant therapy. Clinical and radiological follow-up was at 1, 3, 6 and 12 months after the procedure. The clinical outcomes were assessed pre- and postoperatively with Constant Scores. Anteroposterior radiographs for the bilateral acromioclavicular joints were obtained immediately after surgery and every follow-up.To compare the reduction maintenance, coracoclavicular distances of the injured shoulders were measured in preoperative and postoperative standard radiographs. Results: All patients received satisfactory fracture and acromioclavicular joint reduction. The average follow-up period was (12.6±3.9) months (ranging from 6 to 22 months). Fractures healed six months after the operation. The coracoclavicular distances increased from (7.8±1.4)mm at one month follow-up to (7.9±1.2)mm at the final follow-up (P>0.05), which could be considered as no difference statistically. The constant score significantly increased from (49.1±4.4) at one month follow-up to (93.8±2.1) at the final evaluation (P<0.001). Obvious loss of acromioclavicular joint reduction was not observed after the operation. Coracoid process and calvicle fractures did not appear. Fractures healed well and shoulder joints also functioned well. Patients' lives and work went back to normal. Conclusion: Accompanied by ligament injuries, distal clavicle fractures is different from middle fractures. Coracoclavicular ligament injury is a major cause of the acromioclavicular joint instability, and the focus of the surgery. Therefore, the application of the double-bundle coracoclavicular ligament reconstruction is a feasible method to treat distal clavicle fractures, displaying satisfying clinical results.

Lateral clavicle fracture with coracoclavicular ligament injury: a biomechanical study of 4 different repair techniques.

To investigate the biomechanical performance of four different methods used for coracoclavicular (CC) ligament reconstruction in a lateral clavicle fracture repair. Native displacement, translation, and rotation at the acromioclavicular joint of 24 fresh-frozen cadaveric shoulders were tested. A reproducible fracture in the lateral third of the clavicle was created by dissecting both CC ligaments. Each specimen was then repaired with plate fixation of the fracture and the following CC repair technique: (1) Cortical button. (2) Suture anchor and plate button. (3) Suture anchor no plate button, and (4) Suture around coracoid. All reconstructed specimens were then re-tested for displacement, translation, and load to failure, and compared to their native results. Groups 1 and 3 were investigated for rotational load. There was no difference in load to failure between the repaired groups (p: ns). Group 1 showed less superior and anterior translations (p < 0.05). Group 2 showed significantly less superior translation (p = 0.003), but no significance with anterior and posterior translations to the native joint. Group 3 showed less superior and posterior translations (p = 0.005 and p = 0.039). Anterior and posterior translations were increased in group 4 (p < 0.05). The biomechanical analyses did not show any significance in load to failure or displacement after cyclic loading among the study groups. All repairs were effective in preventing superior translation. Groups 1 and 2 demonstrated increased horizontal stability compared to the native state. All 4 methods are clinically viable options for CC ligament repair.

In vivo analysis of acromioclavicular joint motion after hook plate fixation using three-dimensional computed tomography

The clavicle hook plate can be used to treat acromioclavicular and coracoclavicular ligament injury or distal clavicular fracture with comminution. However, the hook plate can induce subacromial impingement, resulting in discomfort from the hardware. Our inclusion criteria were (1) men and women aged older than 20 years and (2) the presence of comminuted distal clavicular fractures (Neer type IIB) fixed with a hook plate (Synthes, Oberdorf, Switzerland). Three-dimensional computed tomography was obtained before removal of the hook plate. Seven patients were enrolled prospectively. The mean age was 42 years (range, 24-60 years). Zero degree images and abduction images were obtained. The sagittal cut surface was obtained 5 mm medial from the distal clavicle. The equator of the cut surface of the clavicle was compared with the full abduction model to analyze rotation. The center of the cut surface of the clavicle was compared with the full abduction model to analyze translation. The average difference in rotation of the distal clavicle between both shoulders was 16° (range, 3°-22°; P = .001). The mean difference in anterior translation of the distal clavicle was 2.2 mm (range, -0.7 to 5.6 mm; P = .030). Hook plate fixation at the acromioclavicular joint causes decreased internal rotation and increased anterior translation of the distal clavicle with respect to the medial acromion, indicating that the scapula relative to the thorax has decreased posterior tilting and increased external rotation in shoulders fixed using a hook plate.

Coracoclavicular Ligament Suture Augmentation with Anatomical Locking Plate Fixation for Distal Clavicle Fracture

Background: For Neer type IIB fracture of distal clavicle with coracoclavicular ligament injury, various surgical treatments have been used in literatures. However, there was no consensus on the optimal treatment. The aim of this study is to report the clinical and radiological results of open reduction and internal fixation of unstable distal clavicle fracture and suture augmentation of disrupted coracoclavicular ligament. Methods: A prospective study was performed in 23 patients with Neer type IIB distal clavicle fracture in Seoul Medical Center, Eulji Hospital, and National Medical Center. Firstly, suture anchors are inserted in the base of coracoid process and preliminary reduction was achieved by tie-off of three suture limbs around the clavicle. Then, the final fixation was completed with anatomical locking plate. Bony union and the distance between coracoclavicular ligaments were evaluated. Clinical results and complications including stiffness and secondary procedures were evaluated. Results: Bony union was achieved in all cases except one (22 of 23). At mean 14.9 months, no significant difference in the mean coracoclavicular distance was observed compared to uninjured shoulder (8.2 ± 7.9 mm versus 7.3 ± 3.4 mm, p=0.14). Pain visual analogue scale, American Shoulder and Elbow Surgeons score, Constant score, and Disabilities of the Arm, Shoulder and Hand score were 0.5, 83.4, 78.5, and 6.2, respectively. Revision surgery was performed in one case of nonunion. Four patients who complained of skin irritation underwent implant removal. Conclusions: In cases of an unstable distal clavicle fracture with coracoclavicular ligament disruption, satisfactory clinical results were obtained by locking plate fixation and coracoclavicular ligament suture augmentation concurrently.

肩鎖関節損傷におけるMR 画像による烏口鎖骨靱帯損傷の検討 （第2報）

肩鎖関節損傷におけるMR 画像による烏口鎖骨靱帯損傷の検討 （第2報）

MRI evaluation of coracoclavicular ligament injury in acromioclavicular joint separation

Acromioclavicular joint separation is divided into three types according to Tossy and six types according to Rockwood. However, the trapezoid and conoid ligaments that constitute the coracoclavicular ligaments are not detailed in these classifications. In this study, we investigated the location and degree of ligament injury in acromioclavicular joint separation by means of magnetic resonance (MR) images. Cross-sectional study. The study subjects were 25 patients (21 men and 4 women) ranging in age from 19 to 58 years (mean: 31.1 years). According to Rockwood’s classification criteria, these patients consisted of one case in type 1, seven cases in type 2, seven cases in type 3, and ten cases in type 5. All patients were also performed the procedure for MR images and enhanced MR images with intravenous gadolinium injection within 3 days after the occurrence of injury. Both the trapezoid and conoid ligaments had ruptured in fifteen cases of the seventeen cases in types 3 and 5. Both ligaments had ruptured at the same locations in eleven of the fifteen cases. However, there were four cases in which the ligaments had ruptured at different locations. On the other hand, the conoid ligaments did not clearly demonstrate abnormal findings, but the trapezoid ligaments had ruptured in all cases of type 2. The coracoclavicular ligament injuries evaluated by MR images and enhanced MR images were not always coincident with Rockwood’s classification criteria from plain X-ray films, especially in types 2 and 3 of acromioclavicular joint separation.

Treatment of Distal Clavicle Fractures with Coracoclavicular ligament Injury

Treatment of Distal Clavicle Fractures with Coracoclavicular ligament Injury

Clinical analysis of Acromioclavicular and Coracoclavicular Ligament Injury

Clinical analysis of Acromioclavicular and Coracoclavicular Ligament Injury