肩鎖関節完全脱臼に対するCadenat変法の治療成績

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Background: Many procedures have been described for treatment of complete acromioclavicular dislocations. However, the best primary treatment still remains unclear. The purpose of this study was to evaluate the clinical outcomes for patients with Rockwood type III /V acromioclavicular joint dislocation by modified Cadenat's procedure. Methods: After reduction, the acromioclavicular joint was temporarily fixed using an acromiocavicular plate. Ligamentoplasty, using the corcoacromial ligament detached from the acromion process as a new ligament between the coracoid and the clavicle, was also performed. We retrospectively analyzed 25 consecutive patients (all men; mean age 43.9 years) according to the criteria of Japanese Orthopaedic Association score (JOA score) and the Japan Shoulder Society score for acromioclavicular dislocation score (JSS-ACj score). The acromioclavicular dislocation ratio and the coracoclavicular distance ratio were evaluated to assess AC separations radiographically. Results: The postoperative JOA score and JSS-ACj score were 94.9 and 92.1, respectively. Acromioclavicular dislocation rates at injury, after the removal of the plate, and at follow-up were 151.5%, 11.5%, 34.4%, respectively. Coracoclavicular distances ratio at injury, after the removal of the plate, and at follow-up were 222.8%, 105.1%, 123.1%, respectively. Discussion: Recently, an anatomical reconstruction of both the conoid and the trapezoid coracoclavicular ligament using of free tendon grafts has been described. However, the fractures associated with the clavicular bone tunnels were reported. The modified Cadenat's procedure is a simple procedure compared with an anatomical reconstruction, and could provide excellent results in both clinical and X-rays evaluation.
日本肩関節学会の論文

肩鎖関節完全脱臼に対するCadenat変法の治療成績

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