Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

εξελίξεις στην αρθροσκοπική χειρουργική της ακρωμιοκλειδικής


Published on


Published in: Health & Medicine
  • Be the first to comment

εξελίξεις στην αρθροσκοπική χειρουργική της ακρωμιοκλειδικής

  1. 1. Advances inAdvances in Acromioclavicular JointAcromioclavicular Joint ArthroscopyArthroscopy Manos AntonogiannakisManos Antonogiannakis DirectorDirector Center for Arthroscopy &Center for Arthroscopy & Shoulder SurgeryShoulder Surgery IASO General HospitalIASO General Hospital
  2. 2. The Shoulder GirdleThe Shoulder Girdle Three joints:Three joints:  glenohumeralglenohumeral  AcromioclavicularAcromioclavicular  ScapulothoracicScapulothoracic
  3. 3. Acromioclavicular JointAcromioclavicular Joint AC joint is situated between theAC joint is situated between the clavicleclavicle andand acromionacromion motion in three planes:motion in three planes: - AP gliding of acromion during protraction & retraction of- AP gliding of acromion during protraction & retraction of scapulascapula - tilting of acromion during abduction & adduction of armtilting of acromion during abduction & adduction of arm - rotation of the claviclerotation of the clavicle whichwhich occurs during abduction &occurs during abduction & adduction of shoulder.adduction of shoulder.
  4. 4. AnatomyAnatomy Consists of two sets ofConsists of two sets of ligaments:ligaments: - AC ligamentAC ligament superiorsuperior - posterior- posterior AC lig isAC lig is most important ligament inmost important ligament in stabilizing AC joint for normalstabilizing AC joint for normal daily activitiesdaily activities - CoracoclavicularCoracoclavicular ligaments:ligaments: ConoidConoid TrapezoidTrapezoid
  5. 5. AC pathology that can beAC pathology that can be treated by arthroscopytreated by arthroscopy  Osteolysis of the clavicleOsteolysis of the clavicle  AC arthritisAC arthritis  AC infection/cystsAC infection/cysts  AC dislocationAC dislocation
  6. 6. Osteolysis of the clavicleOsteolysis of the clavicle  Unclear PathogeneticUnclear Pathogenetic mechanismmechanism  Acute injury (type I/IIAcute injury (type I/II AC sprains)AC sprains)  Repetitive microtraumaRepetitive microtrauma  Usually in male athletesUsually in male athletes (weight-lifters)(weight-lifters)
  7. 7. Osteolysis of the clavicleOsteolysis of the clavicle Unclear Pathogenetic mechanismUnclear Pathogenetic mechanism  autonomic neurovascular originautonomic neurovascular origin  synovial invasion of the subchondral bonesynovial invasion of the subchondral bone  Cahill proposed that repetitiveCahill proposed that repetitive microtrauma caused subchondral stressmicrotrauma caused subchondral stress fractures and remodelingfractures and remodeling JBJS(Am)1982JBJS(Am)1982
  8. 8. Osteolysis of the clavicleOsteolysis of the clavicle TreatmentTreatment  Consernative (Rest, NSAIDs,Consernative (Rest, NSAIDs, Corticosteroid injections)Corticosteroid injections)  Surgical (Open or Arthroscopic distalSurgical (Open or Arthroscopic distal clavicle excision)clavicle excision)
  9. 9. AC ArthritisAC Arthritis  Post – TraumaticPost – Traumatic  DegenerativeDegenerative ConcommitantConcommitant lesion to RClesion to RC tearstears
  10. 10. AC cystAC cyst O. Levy Arthroscopy 2007
  11. 11. Surgical TreatmentSurgical Treatment Open distal clavicle excisionOpen distal clavicle excision Described by Mumford and Gurd in 1941Described by Mumford and Gurd in 1941
  12. 12. Arthroscopic Distal Clavicle ExcisionArthroscopic Distal Clavicle Excision SnyderSnyder Arthroscopy 1995Arthroscopy 1995 BiglianiBigliani Arthroscopy 1992/2000Arthroscopy 1992/2000 FlatowFlatow JSES 1995JSES 1995 AugeAuge AJSM 1998AJSM 1998 Surgical TreatmentSurgical Treatment
  13. 13. Arthroscopic vs Open DistalArthroscopic vs Open Distal Clavicle ExcisionClavicle Excision  Better cosmesisBetter cosmesis  Less PainLess Pain  Avoids Muscle WeaknessAvoids Muscle Weakness  Residual AC instabilityResidual AC instability  Comparable outcome resultsComparable outcome results JP Warner Arthroscopy 2009JP Warner Arthroscopy 2009
  14. 14. TechniqueTechnique  Patient positioning exactly the same asPatient positioning exactly the same as shoulder arthroscopyshoulder arthroscopy
  15. 15. Skin Marking & PortalsSkin Marking & Portals
  16. 16. Subacromial DebridementSubacromial Debridement
  17. 17. AcromioplastyAcromioplasty
  18. 18. Starting distal clavicle excisionStarting distal clavicle excision
  19. 19. External depression of theExternal depression of the clavicleclavicle
  20. 20. Establishing Anterior AC portalEstablishing Anterior AC portal
  21. 21. Check Lateral PortalCheck Lateral Portal
  22. 22. Scope in AC portalScope in AC portal
  23. 23. Use 70˚ scope to completeUse 70˚ scope to complete excisionexcision
  24. 24. Final AC space 5-8mmFinal AC space 5-8mm Zhang et al.Arthroscopy 2007
  25. 25. Check distance in abductionCheck distance in abduction and external rotationand external rotation
  26. 26. AC dislocationAC dislocation Rockwood ClassificationRockwood Classification
  27. 27. AC dislocationAC dislocation  Conservative treatment for types I – IIConservative treatment for types I – II  Surgical treatment for types IV – VISurgical treatment for types IV – VI  What about type III ?What about type III ?
  28. 28. AC dislocationAC dislocation  Treatment of acute Type III dislocationsTreatment of acute Type III dislocations remains controversialremains controversial “More prospective randomized studies using validated outcome measures are needed to identify the suitable operation techniques for the acute injuries”
  29. 29. Arthroscopic AC reconstructionArthroscopic AC reconstruction Several techniques have been publishedSeveral techniques have been published either full arthroscopic or arthroscopicallyeither full arthroscopic or arthroscopically assisted by Wolf, Boileau, Lafosseassisted by Wolf, Boileau, Lafosse
  30. 30. AC reconstruction usingAC reconstruction using synthetic graftsynthetic graft E. WOLF – W. PENINGTON ARTHROSCOPY 2001 First publication of all arthroscopic AC reconstruction
  31. 31. Arthroscopic CA ligamentArthroscopic CA ligament transfertransfer LAFOSSE et al. ARTHROSCOPY 2005
  32. 32. Arthroscopic Weaver DunnArthroscopic Weaver Dunn P. BOILEAU et al. ARTHROSCOPY 2010
  33. 33. Our Experience in ACOur Experience in AC dislocationsdislocations We prefer open reduction – fixation of theWe prefer open reduction – fixation of the AC because ofAC because of  Small incisionSmall incision  Precise reductionPrecise reduction  Residual scaring seems to have effect onResidual scaring seems to have effect on stabilitystability
  34. 34. Methods of FixationMethods of Fixation  For Acute dislocations use of syntheticFor Acute dislocations use of synthetic ligaments (Tightrope – Arthrex, Surgilig –ligaments (Tightrope – Arthrex, Surgilig – Surgicraft) along with ligament suturingSurgicraft) along with ligament suturing  For Chronic dislocations use of syntheticFor Chronic dislocations use of synthetic ligaments along with hamstrings autograftligaments along with hamstrings autograft
  35. 35. Interesting CaseInteresting Case Patient has his 3Patient has his 3rdrd revision for ACrevision for AC dislocation (Surgilig along with hamstringsdislocation (Surgilig along with hamstrings autograft)autograft)
  36. 36. Pre - op Post - op
  37. 37. 6 months later after a fall from6 months later after a fall from his bikehis bike Note that the ac remains intact!!!
  38. 38. Final Outcome (4Final Outcome (4thth operation)operation)
  39. 39. Thank you!!!Thank you!!!