The reverse coracoacromial ligament transfer for “horizontal” acromioclavicular joint instability

Background: Acromioclavicular (AC) horizontal instability is a problem affecting not only young athletic patients after a trauma to the AC joint but also older patients who have undergone distal clavicle resection. It may cause pain and poor functional outcomes unless the reconstruction technique sp...

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Autores principales:	Jessica L. Mowbray, MBCHB, Gabriela Moreno, MD, Christiaan G.M. Albers, MD, Peter Poon, FRACS
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	Clavicle Horizontal Instability Coracoacromial ligament Surgery RD1-811
Acceso en línea:	https://doaj.org/article/22e4d9e8eb864353ab18358acf487c18
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spelling	oai:doaj.org-article:22e4d9e8eb864353ab18358acf487c182021-11-22T04:31:34ZThe reverse coracoacromial ligament transfer for “horizontal” acromioclavicular joint instability2666-639110.1016/j.xrrt.2021.05.003https://doaj.org/article/22e4d9e8eb864353ab18358acf487c182021-11-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2666639121000511https://doaj.org/toc/2666-6391Background: Acromioclavicular (AC) horizontal instability is a problem affecting not only young athletic patients after a trauma to the AC joint but also older patients who have undergone distal clavicle resection. It may cause pain and poor functional outcomes unless the reconstruction technique specifically addresses the horizontal instability of the clavicle, in addition to the well-known superior instability. Methods: Three cadaveric specimens underwent dissection of the AC joint capsule to determine the superior attachments of the AC joint capsule. These shoulders subsequently underwent distal clavicle resection and were loaded to a 7-kg weight in the horizontal plane. The horizontal displacement of the clavicle was measured and resection continued to the point of horizontal instability of the clavicle. Thereafter, the reverse coracoacromial ligament reconstruction technique was performed and recreation of horizontal stability assessed. Utilization of the reverse coracoacromial ligament transfer in two clinical cases will also be presented. Results: The AC joint capsule is continuous with trapezius and deltoid insertions. The average distance between the articular surface and insertion of the capsule on the clavicle is 10 mm and on the acromion is 14.8 mm. Horizontal clavicular translation increased from 2.3 mm when intact to 3.3 mm with capsular transection, 8.7 mm with 5 mm clavicle resection, and finally 15 mm with a 10-mm clavicle resection. Horizontal instability of the clavicle was demonstrated with a 10-mm clavicle resection. Conclusion: Horizontal instability of the clavicle is evident with distal clavicle resection of greater than 10 mm. A reverse coracoacromial ligament transfer may be a reasonable technique to address horizontal stability of the clavicle during AC joint reconstruction in the context of painful instability.Jessica L. Mowbray, MBCHBGabriela Moreno, MDChristiaan G.M. Albers, MDPeter Poon, FRACSElsevierarticleClavicleHorizontalInstabilityCoracoacromial ligamentSurgeryRD1-811ENJSES Reviews, Reports, and Techniques, Vol 1, Iss 4, Pp 381-388 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Clavicle Horizontal Instability Coracoacromial ligament Surgery RD1-811
spellingShingle	Clavicle Horizontal Instability Coracoacromial ligament Surgery RD1-811 Jessica L. Mowbray, MBCHB Gabriela Moreno, MD Christiaan G.M. Albers, MD Peter Poon, FRACS The reverse coracoacromial ligament transfer for “horizontal” acromioclavicular joint instability
description	Background: Acromioclavicular (AC) horizontal instability is a problem affecting not only young athletic patients after a trauma to the AC joint but also older patients who have undergone distal clavicle resection. It may cause pain and poor functional outcomes unless the reconstruction technique specifically addresses the horizontal instability of the clavicle, in addition to the well-known superior instability. Methods: Three cadaveric specimens underwent dissection of the AC joint capsule to determine the superior attachments of the AC joint capsule. These shoulders subsequently underwent distal clavicle resection and were loaded to a 7-kg weight in the horizontal plane. The horizontal displacement of the clavicle was measured and resection continued to the point of horizontal instability of the clavicle. Thereafter, the reverse coracoacromial ligament reconstruction technique was performed and recreation of horizontal stability assessed. Utilization of the reverse coracoacromial ligament transfer in two clinical cases will also be presented. Results: The AC joint capsule is continuous with trapezius and deltoid insertions. The average distance between the articular surface and insertion of the capsule on the clavicle is 10 mm and on the acromion is 14.8 mm. Horizontal clavicular translation increased from 2.3 mm when intact to 3.3 mm with capsular transection, 8.7 mm with 5 mm clavicle resection, and finally 15 mm with a 10-mm clavicle resection. Horizontal instability of the clavicle was demonstrated with a 10-mm clavicle resection. Conclusion: Horizontal instability of the clavicle is evident with distal clavicle resection of greater than 10 mm. A reverse coracoacromial ligament transfer may be a reasonable technique to address horizontal stability of the clavicle during AC joint reconstruction in the context of painful instability.
format	article
author	Jessica L. Mowbray, MBCHB Gabriela Moreno, MD Christiaan G.M. Albers, MD Peter Poon, FRACS
author_facet	Jessica L. Mowbray, MBCHB Gabriela Moreno, MD Christiaan G.M. Albers, MD Peter Poon, FRACS
author_sort	Jessica L. Mowbray, MBCHB
title	The reverse coracoacromial ligament transfer for “horizontal” acromioclavicular joint instability
title_short	The reverse coracoacromial ligament transfer for “horizontal” acromioclavicular joint instability
title_full	The reverse coracoacromial ligament transfer for “horizontal” acromioclavicular joint instability
title_fullStr	The reverse coracoacromial ligament transfer for “horizontal” acromioclavicular joint instability
title_full_unstemmed	The reverse coracoacromial ligament transfer for “horizontal” acromioclavicular joint instability
title_sort	reverse coracoacromial ligament transfer for “horizontal” acromioclavicular joint instability
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/22e4d9e8eb864353ab18358acf487c18
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The reverse coracoacromial ligament transfer for “horizontal” acromioclavicular joint instability

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