• Clinics in Shoulder and Elbow
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• 제8권2호
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• pp.131-134
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• 2005

Distal clavicle tunnel widening was observed in coracoclavicular ligament reconstruction with semitendinous tendon autografts in a patient with acromioclavicular joint injury. Acromioclavicular joint separation, in a 44 years-old man was treated by coracoclavicular ligament reconstruction. We have performed x-ray evaluation on 2years 10months after surgery. The immediate postoperative tunnel size was measured 4.5mm in diameter. At postoperative 2years 10month the tunnel diameter was from 9.3 to 11.4mm. But the weightbearing clavicle view showed no significant acromioclavicular joint separation. Moreover the patient complained only minor intermittent shoulder discomfort.

• Clinics in Shoulder and Elbow
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• 제2권2호
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• pp.138-142
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• 1999

Coracoclavicular ligament is main restraint to superior instability of the distal clavicle. Coracoacromial ligament, extensor tendon of toe, palmaris longus tendon, and Dacron tape have been used to reconstruct coracoclavicular ligament. We used semitedinosus tendon to reconstruct coracoclavicular ligament. The semitendinosus tendon was harvested as a usual fashion. After the distal clavicle and coracoid process were exposed, a hole of six millimeter diameter was made on the center of whole thickness of the distal clavicle. A malleolar screw was fixed from distal clavicle to coracoid process to maintain the reduced position of the acromioclavicular joint. The leading suture of tendon graft was passed through the hole of the distal clavicle and looped under the coracoid process. After leading portion of ten­don graft was looped over the clavicle, sutures were made between each end of the tendon graft with nonabsorbable suture materials.

• Clinics in Shoulder and Elbow
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• 제3권1호
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• pp.44-48
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• 2000

Weaver-Dunn's operation for acromioclavicular injury yields satisfactory results in most cases. Although clavicular prominence can recur, it is not frequently symtomatic, but it can cause serious impairment of shoulder function in young and active patients. The authors performed reconstruction of coracoclavicular ligament with an autogenous hamstring tendon graft in a 31 years old electrician with recurrence of clavicular prominence accompanied by pain and limitation of overhead activity. The hamstring tendon and two coracoclavicular sutures looped under the coracoid process were passed through holes in the clavicle and around the clavicle in overreduced position. Even though clavicular prominence recurred somewhat, the modified UCLA score by Rockwood improved to 17 from 11/20 at 2 years after operation and the patient had no restriction in working as an electrician. Symptomatic patient with recurrent clavicular prominence after Weaver-Dunn's operation can benefit from reconstruction of coracoclavicular ligament with a hamstring tendon.

• 대한정형외과스포츠의학회:학술대회논문집
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• 대한정형외과스포츠의학회 2004년도 The 7th korea-japan joint meeting of orthopaedic sports medicine
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• pp.36-36
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• 2004

• Clinics in Shoulder and Elbow
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• 제24권4호
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• pp.209-214
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• 2021

Background: The treatment for acromioclavicular joint injuries (ACJI) ranges from a conservative approach to extensive surgical reconstruction, and the decision on how to manage these injuries depends on the grade of acromioclavicular (AC) joint separation, resources, and skill availability. After a thorough review of the literature, the researchers adopted a simple cost-effective technique of AC joint reconstruction for acute ACJI requiring surgery. Methods: This was a prospective single-center study conducted between April 2017 and April 2018. For patients with acute ACJI more than Rockwood grade 3, the researchers performed open coracoclavicular ligament reconstruction using synthetic sutures along with an Endobutton and a figure of 8 button plate. This was followed by AC ligament repair augmenting it with temporary percutaneous AC K-wires. Clinical outcomes were evaluated using the Constant Murley shoulder score. Results: Seventeen patients underwent surgery. The immediate postoperative radiograph showed an anatomical reduction of the AC joint dislocation in all patients. During follow-up, one patient developed subluxation but was asymptomatic. The mean follow-up period was 30 months (range, 24-35 months). The mean Constant score at 24 months was 95. No AC joint degeneration was noted in follow-up X-rays. The follow-up X-rays showed significant infra-clavicular calcification in 11 of the 17 patients, which was an evidence of a healed coracoclavicular ligament post-surgery. Conclusions: This study presents a simple cost-effective technique with a short learning curve for anatomic reconstruction of acute ACJI. The preliminary results have been very encouraging.

• Clinics in Shoulder and Elbow
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• 제11권1호
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• pp.46-52
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• 2008

목적: 본 논문은 견봉 쇄골 탈구에서 2개의 봉합 나사못과 오구 견봉 인대 이전술을 이용한 오구쇄골 인대 재건술의 소개와 임상적 결과를 알아보고자 하였다. 대상 및 방법: 40명의 환자를 대상으로 하였으며, 수술 전 방사선학적 사진에서 견봉 쇄골 탈구 환자 5명은 제3형, 4명은 제4형, 그리고 31명은 제5형이었다. 2개의 봉합 나사못을 각각 원추인대와 삼각인대의 오구 돌기 기시부에 해당하는 오구 돌기 기저부의 전외측과 후내측에 위치시켜 원위 쇄골을 오구돌기에 고정시켰으며, 오구 견봉 인대를 원위 쇄골 하면으로 이전하여 보강하였다. 결과: 평균 28개월의 추시 결과, Constant 점수는 97점으로 향상되었으며, 40명 모두 술 후 평균 3.2개월에 일상 생활로의 복귀가 가능하였다. 마지막 방사선학적 결과는 34명에서 해부학적인 정복을 보였으며, 3명은 완전 재탈구를 나타내었지만 임상적 결과는 만족할만하여 재수술을 시행하지 않았다. 또한 수상 3주 경과 후 수술한 견봉 쇄골 탈구 환자의 임상적 결과는 수상 3주 이내에 수술한 환자들과 의미 있는 차이를 보이지 않았다. 결론: 견봉 쇄골 탈구에서 2개의 봉합 나사못과 오구 견봉 인대 이전술을 이용한 오구 쇄골 인대재건술은 견봉 쇄골 관절의 물리적 안정성 얻을 수 있는 안전하고 유용한 수술 방법으로 사료된다.

• Clinics in Shoulder and Elbow
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• 제26권2호
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• pp.140-147
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• 2023

Background: The management of acromioclavicular (AC) joint dislocation remains controversial. Recently, anatomic coracoclavicular (CC) fixation with a double clavicular tunnel and three flip-buttons has shown promising results. This study aimed to evaluate functional and radiological outcomes in patients with high-grade AC joint dislocation treated with anatomic CC fixation using double clavicular tunnels and three flip-buttons. Methods: A retrospective, unicentric study was performed. The study included patients with high-grade AC joint dislocation who underwent surgery with anatomic CC fixation using double clavicular tunnels and three flip-buttons. Demographic data were obtained from medical records. A functional evaluation using subjective shoulder value (SSV), visual analog scale (VAS), and disabilities of the arm, shoulder, and hand (DASH) questionnaires was performed, and an evaluation of preoperative and postoperative comparative Zanca view images was performed. Factors associated with functional outcomes and radiological AC reduction were analyzed. Results: A total of 83 patients completed follow-up and were included in the analysis. The mean SSV, VAS, and DASH scores were 92.8, 0.8, and 6.4, respectively. Patients who had complications experienced significantly worse functional outcomes (DASH: P=0.037). Suboptimal final AC reduction was observed in nine patients (11.1%), and significantly more frequently in patients older than 40 years (P=0.031) and in surgeries performed more than 7 days after injury (P=0.034). There were two reoperations (2.4%). Conclusions: Anatomic CC fixation with a double clavicular tunnel and three flip-buttons leads to good functional outcomes, low complication rates, and high rates of optimal AC reduction.

• 대한관절경학회지
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• 제15권1호
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• pp.58-68
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• 2011

견봉쇄골관절 손상은 내전 상태에서 견관절 외측에 직접 타격으로 발생하며 주로 활동력 있는 비교적 젊은 세대에서 흔하다. 손상력에 따라 주로 견봉쇄골인대 단독 손상 또는 오구쇄골인대와 함께 파열된다. 대부분의 경우 수술적 치료 없이 보존적 요법으로 해결되지만 수술적인 가료가 필요할 경우 표준으로 삼을 수술법을 선택하기 어렵다. 이에 의거해서 이 장에서는 견봉쇄골관절은 해부학적 특성을 살펴보고 특성에 따른 치료법을 소개하기로 하겠다.

• Clinics in Shoulder and Elbow
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• 제21권1호
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• pp.48-55
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• 2018

While non-operative treatment with structured rehabilitation tends to be the strategy of choice in the management of Rockwood type III acromioclavicular joint injury, some advocate surgical treatment to prevent persistent pain, disability, and prominence of the distal clavicle. There is no clear consensus regarding when the surgical treatment should be indicated, and successful clinical outcomes have been reported for non-operative treatment in more than 80% of type III acromioclavicular joint injuries. Furthermore, there is no gold standard procedure for operative treatment of type III acromioclavicular joint injury, and more than 60 different procedures have been used for this purpose in clinical practice. Among these surgical techniques, recently introduced arthroscopic-assisted procedures involving a coracoclavicular suspension device are minimally invasive and have been shown to achieve successful coracoclavicular reconstruction in 80% of patients with failed conservative treatment. Taken together, currently available data indicate that successful treatment can be expected with initial conservative treatment in more than 96% of type III acromioclavicular injuries, whereas minimally invasive surgical treatments can be considered for unstable type IIIB injuries, especially in young and active patients. Further studies are needed to clarify the optimal treatment approach in patients with higher functional needs, especially in high-level athletes.

• Clinics in Shoulder and Elbow
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• 제1권2호
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• pp.175-179
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• 1998

저자들은 1990년 1월부터 1997년 1월까지 을지의과대학병원 정형외과에서 급성 견봉쇄골관절 탈구로 진단 받고 Phemister 방법, Bosworth 방법, Weaver와 Dunn의 방법 등으로 수술 받은 70례의 환자에 대하여 이중 1년 이상 추시 가능하였던 60례를 대상으로 하여 임상적 및 방사선학적 분석을 시행하여 다음과 같은 결과를 얻었다. 1. 수상 후 평균 오구쇄골 간격은 건측과 비교시 평균 7.l㎜의 차이를 보였는데 수술 방법에 상관없이 수술 후에는 평균 1㎜의 과교정, 최종 추시 시에는 평균 2㎜의 차이를 보였다. 2. 임상적 평가에서는 우수 23례(38%), 양호 31례(52%), 보통이 6례(10%)를 보여 대부분 좋은 결과를 얻어 최종 추시 시의 오구쇄골 간격 증가의 정도가 임상적 결과를 좌우하지 않는다는 결론을 얻을 수 있었다(P>0.05)