Acromioclavicular hook plate versus anatomical reconstruction of coracoclavicular ligaments using hamstring autograft in acromioclavicular joint dislocation
Notice bibliographique
Résumé
Introduction Acromioclavicular joint (ACJ) injuries can result from a multitude of causes. Most injuries occur during activities with high-impact risks such as contact sports, football, ice hockey, and wrestling, with male athletes at greater risk than female athletes. The stability of AC joint depends on the joint capsule, the acromioclavicular (AC) and coracoclavicular (CC) ligaments, and the intraarticular fibrocartilaginous disc. The choice of the required surgical technique for the management of AC disruption is a controversial issue owing to the abundance of the surgical options described for treatment. However, the clinical superiority of these procedures remains debatable, and various complications have been reported. Hypothesis This hypothesis is that the anatomical reconstruction of the CC ligaments may render better long-term functional and radiological results compared with the use of a hook plate in ACJ dislocations. Patients and methods This is a prospective nonrandomized comparative study that was held between August 2011 and January 2017 at Cairo University Hospitals. It included 64 patients with acute AC dislocation type III–VI and divided into two groups: group A, which underwent anatomic reconstruction of CC and AC ligaments, and group B, which underwent ACJ dislocation using the hook plate. The mean age of group A patients was 43.22±11.46 years, whereas it was 41.56±8.70 years in group B. There were 22 male and 10 female patients in group A compared with 21 male and 11 female patients in group B. The mean time from injury was 8.41±3.41 weeks in group A compared with 9.91±1.59 weeks in group B. The average follow-up was 64.06±4.24 months in group A versus 63.94±3.79 months in group B. The clinical outcome was assessed preoperatively and postoperatively at 1, 2, and 5 years using the visual analog scale, Constant score, and American shoulder and elbow surgeon score. Radiological assessment included the measurement of the CC distance (vertical displacement) and the anteroposterior (horizontal) displacement preoperatively and postoperatively at 1 year and at the final follow-up. Results Regarding the clinical outcome, the visual analog scale score improved from 7.06±1.22 preoperatively to 1.06±1.07 at 5-year follow-up in group A, whereas it improved from 7.5±0.92 preoperatively to 2.97±0.59 at 5-year follow-up in group B, with P=0.000. Similarly, the American shoulder and elbow surgeon score improved from 26.64±8.15 preoperatively to 92.06±5.37 postoperatively in group A, whereas in group B, it improved from 19.87±7.56 preoperatively to 77.1±5.40 postoperatively (P=0.000). The constant score in group A improved from 20.44±2.66 preoperatively to 92.91±3.64 postoperatively, and in group B, it improved from 20.13±2.29 preoperatively to 80.53±4.76 postoperatively (P=0.000). The radiological assessment at the final follow-up showed that the anteroposterior (horizontal) displacement in group A was 4.31±2.62 preoperatively and became 1.06±1.01 postoperatively, whereas in group B, it was 5.56±2.12 preoperatively and became 3.41±1.29 postoperatively, with a statistically significant difference (P=0.000). The superior displacement in group A was 21.57±5.09 mm preoperatively and decreased to 10.61±1.02 postoperatively compared with 23.99±5.92 preoperatively, which decreased to 13.36±3.67 postoperatively in group B, with statistically significant difference (P=0.001). Conclusion The concomitant anatomical reconstruction of the CC and AC ligaments using autograft provides long-term functional outcome and mechanical stability in both the vertical and horizontal translation compared with the hook plate fixation in acute unstable ACJ dislocation.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».