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![@thearmclinic
LARS Ligament (Corin)
• Braided Polyethylenetraphthalate
• 1500N tensile strength (30 LAC)
• No reduction in mechanical resilience after
over 10 million wear cycles loaded in torsion,
traction and flexion [Fialka et al. 2005;
• Vascularisation & Fibrous ingrowth - Collagen
Type 1 [Trieb et al. Eur Surg Res. 2004; Yu et al. 2005; Pelletier & Durand]](https://image.slidesharecdn.com/acjrevisionsurgery2017-170126170151/85/ACJ-revision-surgery-2017-14-320.jpg)
Uploaded byLennard Funk
ACJ revision surgery 2017
The document discusses the complexities of acromioclavicular joint (ACJ) revision surgery, highlighting common causes of surgical failure and presenting outcomes of various techniques used between 2008 and 2015. It emphasizes the need for anatomical reconstruction to restore function and details the results of surgeries performed, including improvement in patient scores and complications encountered. Overall, it stresses the importance of tailored management approaches for each unique case of ACJ instability.
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ACJ revision surgery 2017
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- 3. @thearmclinic AC Ligaments • SuperiorAC Lig = 56% Posterior Translation • Posterior AC Lig = 25% Posterior Translation – Klimkiewikcz • Superior AC Lig = Rotational Stability – Branch et al. Urist, JBJSA. 1946
- 4. @thearmclinic Note: • Post-op paincorrelates with Translation, but not amount of bone resected – Blazar et al. CORR. 1998 • Superior & Posterior not capable of stabilising clavicle - 32% incr. of posterior translation after Ant & Inf capsular resection – Corteen & Teitge – No difference if superior or inferior AC lig. cut (horizontal, vertical & rotatory instability) – Branch et al. AJSM 1996
- 5. @thearmclinic Failed ACJ Excision(Basmania, 1995) 1. Diagnostic Error 2. Inadequate resection 3. Joint Instability 4. Weakness 5. Miscellaneous
- 6. @thearmclinic Failed ACJ Excision(Strauss et al. 2010) Common Causes Less Common Causes Instability Distal Clavicle Fracture Under Resection Suprascapular neuropathy Over Resection Other Cause - Neck pain, SLAP, etc. Stiffness (29%) Bony regrowth Untreated Concomitant Pathology Infection
- 7. @thearmclinic Failed ACJ Excision(Robinson, Phandis, Torrance, Funk - in press 2016) Common Causes Less Common Causes Instability - 22% Distal Clavicle Fracture Under Resection - 3% Suprascapular neuropathy Over Resection - 8% Other Cause - Neck pain, SLAP, etc. Stiffness - 12% Bony regrowth Untreated Concomitant Pathology - 4% Infection - 0.8%
- 8. @thearmclinic Unstable ACJ • Excesstranslation ‘with pain’ in any direction, compared to the opposite side • Clinical • USS
- 9. @thearmclinic Granville-Chapman, Robinson, Phandis,Funk In press, 2016 • 23 revisions betw. 2008 - 2015 • Mean Age = 32yrs (20-57) • M:F = 18:5
- 10. @thearmclinic Original Procedure N/23 Tightropeor equivalent 6 Lockdown / Surgilig 6 LARS 4 Weaver-Dunn 3 Hook Plate 3 Bosworth Screw 1 Granville-Chapman, Robinson, Phandis, Funk In press, 2016
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- 12. @thearmclinic Harris et al.AJSM 2000 “None of the reconstruction techniques were able to restore the normal mechanical function of the intact coracoclavicular ligament complex”
- 13. @thearmclinic Revision Technique • AnatomicalReconstruction • Very strong, but flexible • Allows early Rehab. • Biological • Avoid donor site • Allows variable options
- 14. @thearmclinic LARS Ligament (Corin) •Braided Polyethylenetraphthalate • 1500N tensile strength (30 LAC) • No reduction in mechanical resilience after over 10 million wear cycles loaded in torsion, traction and flexion [Fialka et al. 2005; • Vascularisation & Fibrous ingrowth - Collagen Type 1 [Trieb et al. Eur Surg Res. 2004; Yu et al. 2005; Pelletier & Durand]
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- 16. @thearmclinic Procedure(s) 1. Remove allprevious fix & Scar tissue 2. Micro samples 3. CC Ligs - LARS anatomical + ‘Biceps Flip’ 4. AC Ligs - LARS + Reverse CAL Transfer 5. Delto-trapezial Reefing
- 17. @thearmclinic • 23 casesover 7 years • Follow-up = 37 months (24-48) • Constant Score = 51.8 pre to 85.2 post • 10% re-displaced radiologically • 13% superficial infections • No further revisions Results (failed Recons) Robinson, Phandis, Torrance, Funk - in press 2016
- 18. @thearmclinic Results (failed Excisions) Baxter,Robinson, Phandis, Torrance, Funk - in press 2016 • 13 cases over 5 years • Follow-up = 34 months (24-48) • Constant Score = 26 pre to 73 post • 1 re-displaced radiologically • 1 chronic pain • No further revisions
- 19. @thearmclinic Management • Each caseis unique • May be multiple problems • Retained bone & unstable • Excess excision & scar neuroma • Blame • Medicolegal • Multiple Opinions • Diagnostic Injection
- 20. @thearmclinic Summary • Awareness • Testfor Horizontal & Vertical Instability • Ultrasound • CT Scan • Revise if Symptomatic • Strong • Anatomical • Biological
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