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Surgery of the Shoulder
Published in Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou, Operative Orthopaedics, 2020
Nick Aresti, Omar Haddo, Mark Falworth
ACJ disruptions are being increasingly treated non-operatively in line with recent literature, with Rockwood grade III and IV disruptions not necessarily requiring acute surgery. If the disruption becomes symptomatic at a later date, the ACJ can be reconstructed. There are several options for reconstruction, using either allograft, autograft or synthetic materials. These can be used in the modified Weaver-Dunn (described later), a LARS ligament, Tightrope or a Lockdown procedure. Using autografts or allografts should be avoided where the donor tendon has the potential towards hyperlaxity. Describing all procedures is outside the remit of this chapter. Instead we discuss the modified Weaver-Dunn procedure, as it is popular with the authors.
Acromioclavicular Joint Injury
Published in Raymond Anakwe, Scott Middleton, Trauma Vivas for the FRCS (Tr & Orth), 2017
Raymond Anakwe , Scott Middleton
There is demonstrable widening of the acromioclavicular joint space with the distal clavicle shown to lie superior to the superior border of the acromion and a marked increase in the coraco-clavicular distance. In the Rockwood system of classification this is a type V injury and I would offer surgery. Options include surgical coracoclavicular ligament repair, LARS reconstruction, clavicle hook plate fixation or a modified Weaver–Dunn procedure. My preference would be to perform a modified Weaver–Dunn procedure through a bra-strap incision. The distal end of the clavicle is excised before reducing the clavicle into position and transferring the coracoacromial ligament to the lateral end of the clavicle. The reconstruction is augmented with three double strands of number 2 PDS sutures placed around the clavicle and under the coracoid and tied off anteriorly. I would advise the use of a sling postoperatively for 3 weeks but allow pendulum exercises. I would allow the patient to progress their therapy 3 weeks after reconstruction.
Injuries of the shoulder and upper arm
Published in Ashley W. Blom, David Warwick, Michael R. Whitehouse, Apley and Solomon’s System of Orthopaedics and Trauma, 2017
In the modified Weaver–Dunn procedure the lateral end of the clavicle is excised and the coracoacromial ligament is transferred to the outer end of the clavicle and attached by transosseous sutures. Tension on the repair can be reduced either by anchoring the clavicle to the coracoid with various techniques such as anchors or slings around the coracoid and clavicle. Great care is needed to avoid entrapment or damage to a nerve or vessel. Elbow and forearm exercises are begun on the day after operation and active-assisted shoulder movements 2 weeks later, increasing gradually to active movements at 4–6 weeks. Strenuous lifting movements are avoided for 4–6 months. An alternative procedure is to use a synthetic graft which wraps around the coracoid and is secured around the clavicle by various techniques.
Comparison of the Tight Rope Technique and Clavicular Hook Plate for the Treatment of Rockwood Type III Acromioclavicular Joint Dislocation
Published in Journal of Investigative Surgery, 2018
Leyi Cai, Te Wang, Di Lu, Wei Hu, Jianjun Hong, Hua Chen
When surgical treatment of type III is indicated, the most popular techniques are the Hook plate method, Bosworth screw method, K-wire pinning and tension banding, TightRope method, PDS-sling and Weaver–Dunn procedure [13–16]. The TightRope technique (Arthrex, USA) is a minimally invasive method used to stabilize the AC joint and augment the coracoclavicular (CC) complex with a high-strength suture. Another open procedure is a method using the clavicular hook plate (AO), in which the plate is fixated with screws on the upper surface of the clavicle and the hook is fixated transarticularly at the lower surfaceFIGURE 1 of the acromion.