Quantitative and Qualitative Surgical Anatomy of the Acromioclavicular Joint Capsule and Ligament: A Cadaveric Study

2021 ◽  
pp. 036354652199550
Author(s):  
Philip-C. Nolte ◽  
Joe J. Ruzbarsky ◽  
Kaare S. Midtgaard ◽  
Kira K. Tanghe ◽  
Bryant P. Elrick ◽  
...  

Background: The acromioclavicular (AC) capsule and ligament have been found to play a major role in maintaining horizontal stability. To reconstruct the AC capsule and ligament, precise knowledge of their anatomy is essential. Purpose/Hypothesis: The purposes of this study were (1) to determine the angle of the posterosuperior ligament in regard to the axis of the clavicle, (2) to determine the width of the attachment (footprint) of the AC capsule and ligament on the acromion and clavicle, (3) to determine the distance to the AC capsule from the cartilage border of the acromion and clavicle, and (4) to develop a clockface model of the insertion of the posterosuperior ligament on the acromion and clavicle. It was hypothesized that consistent angles, attachment areas, distances, and insertion sites would be identified. Study Design: Descriptive laboratory study. Methods: A total of 12 fresh-frozen shoulders were used (mean age, 55 years [range, 41-64 years]). All soft tissue was removed, leaving only the AC capsule and ligament intact. After a qualitative inspection, a quantitative assessment was performed. The AC joint was fixed in an anatomic position, and the attachment angle of the posterosuperior ligament was measured using a digital protractor. The capsule and ligament were removed, and a coordinate measuring device was utilized to assess the width of the AC capsule footprint and the distance from the footprint to the cartilage border of the acromion and clavicle. The AC joint was then disarticulated, and the previously marked posterosuperior ligament insertion was transferred into a clockface model. The mean values across the 12 specimens were demonstrated with 95% CIs. Results: The mean attachment angle of the posterosuperior ligament was 51.4° (95% CI, 45.2°-57.6°) in relation to the long axis of the entire clavicle and 41.5° (95% CI, 33.8°-49.1°) in relation to the long axis of the distal third of the clavicle. The mean clavicular footprint width of the AC capsule was 6.4 mm (95% CI, 5.8-6.9 mm) at the superior clavicle and 4.4 mm (95% CI, 3.9-4.8 mm) at the inferior clavicle. The mean acromial footprint width of the AC capsule was 4.6 mm (95% CI, 4.2-4.9 mm) at the superior side and 4.0 mm (95% CI, 3.6-4.4 mm) at the inferior side. The mean distance from the lateral clavicular attachment of the AC capsule to the clavicular cartilage border was 4.3 mm (95% CI, 4.0-4.6 mm), and the mean distance from the medial acromial attachment of the AC capsule to the acromial cartilage border was 3.1 mm (95% CI, 2.9-3.4 mm). On the clockface model of the right shoulder, the clavicular attachment of the posterosuperior ligament ranged from the 9:05 (range, 8:00-9:30) to 11:20 (range, 10:00-12:30) position, and the acromial attachment ranged from the 12:20 (range, 11:00-1:30) to 2:10 (range, 13:30-14:40) position. Conclusion: The finding that the posterosuperior ligament did not course perpendicular to the AC joint but rather was oriented obliquely to the long axis of the clavicle, in combination with the newly developed clockface model, may help surgeons to optimally reconstruct this ligament. Clinical Relevance: Our results of a narrow inferior footprint and a short distance from the inferior AC capsule to cartilage suggest that proposed reconstruction of the AC joint capsule should focus primarily on its superior portion.

2021 ◽  
Vol 9 (2) ◽  
pp. 232596712098294
Author(s):  
Shimpei Kurata ◽  
Kazuya Inoue ◽  
Hideo Hasegawa ◽  
Takamasa Shimizu ◽  
Akio Iida ◽  
...  

Background: Acromioclavicular (AC) joint dislocation is evaluated using the radiologically based Rockwood classification. The relationship between ligamentous injury and radiological assessment is still controversial. Purpose/Hypothesis: To investigate how the AC ligament and trapezoid ligament biomechanically contribute to the stability of the AC joint using cadaveric specimens. The hypothesis was that isolated sectioning of the AC ligament would result in increased instability in the superior direction and that displacement >50% of the AC joint would occur. Study Design: Controlled laboratory study. Methods: Six shoulders from 6 fresh-frozen cadavers were used in this study. Both the scapula and sternum were solidly fixed on a customized wooden jig with an external fixator. We simulated distal clavicular dislocation with sequential sectioning of the AC and coracoclavicular (CC) ligaments. Sectioning stages were defined as follows: stage 0, the AC ligament, CC ligament, and AC joint capsule were left intact; stage 1, the anteroinferior bundle of the AC ligament, joint capsule, and disk were sectioned; stage 2, the superoposterior bundle of the AC ligament was sectioned; and stage 3, the trapezoid ligament was sectioned. The distal clavicle was loaded with 70 N in the superior and posterior directions, and the magnitudes of displacement were measured. Results: The amounts of superior displacement averaged 3.7 mm (stage 0), 3.8 mm (stage 1), 8.3 mm (stage 2), and 9.5 mm (stage 3). Superior displacement >50% of the AC joint was observed in stage 2 (4/6; 67%) and stage 3 (6/6; 100%). The magnitudes of posterior displacement were 3.7 mm (stage 0), 3.7 mm (stage 1), 5.6 mm (stage 2), and 9.8 mm (stage 3). Posterior displacement >50% of the AC joint was observed in stage 3 (1/6; 17%). Conclusion: We found that the AC ligaments contribute significantly to AC joint stability, and superior displacement >50% of the AC joint can occur with AC ligament tears alone. Clinical Relevance: The AC ligament plays an important role not only in horizontal stability but also in vertical stability of the AC joint.


2021 ◽  
Author(s):  
Shimpei Kurata ◽  
Kazuya Inoue ◽  
Takamasa Shimizu ◽  
Mitsuyuki Nagashima ◽  
Hirakazu Murayama ◽  
...  

Abstract Background The relationship between acromioclavicular (AC) joint dislocation, corresponding radiological evaluation, and ligament injuries remains controversial. We hypothesized that AC and trapezoid ligament injuries induce AC joint instability, and the clavicle can override the acromion on cross-body adduction view without conoid ligament injury. We aimed to investigate how biomechanically sectioning the AC and coracoclavicular (CC) ligaments contributes to AC joint instability in the cross-body adduction position using fresh-frozen cadaver models. Methods Six fresh-frozen cadaveric shoulders were used in this study, comprising five male and one female specimen, with a mean age of 68.7 (range, 51–87) years). The left side of the trunk and upper limb, and the cervical and thoracic vertebrae and sternum were firmly fixed with an external fixator. The displacement of the distal end of the clavicle relative to the acromion was measured using an electromagnetic tracking device. We simulated AC joint dislocation by sequential resection of AC ligament, AC joint capsule, and CC ligaments in the following order of stages. Stage 0: Intact AC and CC ligaments and acromioclavicular joint capsule; stage 1: Completely sectioned AC ligament and joint disc; stage 2: Sectioned trapezoid ligament; and stage 3: Sectioned conoid ligament. The superior clavicle displacement related to the acromion was measured in the horizontal adduction position, and clavicle overriding on the acromion was assessed radiologically at each stage. Data were analyzed using a one-way analysis of variance and post-hoc tests. Results Superior displacement was 0.3 mm at stage 1, 6.5 mm at stage 2, and 10.7 mm at stage 3. On the cross-body adduction view, there was no distal clavicle overriding at stages 0 and 1, and distal clavicle overriding was observed in five cases (5/6: 83%) at stage 2 and in six cases (6/6: 100%) at stage 3. Conclusion We found that AC and trapezoid ligament sectioning induced AC joint instability and that the clavicle could override the acromion on cross-body adduction view regardless of conoid ligament sectioning. AC and trapezoid ligament injuries may lead to significant AC joint instability, and the distal clavicle may subsequently override the acromion.


2019 ◽  
Vol 7 (4) ◽  
pp. 232596711983675 ◽  
Author(s):  
Patrick Hislop ◽  
Kentaro Sakata ◽  
David C. Ackland ◽  
Robert Gotmaker ◽  
Matthew C. Evans

Background: It is important to restore horizontal and vertical stability to the acromioclavicular (AC) joint when treating dislocations of this joint. Most surgical stabilization techniques of the AC joint have primarily addressed the coracoclavicular ligament complex; however, these techniques may not satisfactorily restore horizontal stability to the AC joint. Purpose: To evaluate the strength and bidirectional stability of 3 AC joint stabilizing techniques in a cadaveric model. Study Design: Controlled laboratory study. Methods: A total of 24 cadaveric shoulders were randomly allocated to 3 treatment groups. For each group, a standardized AC joint stabilizing procedure was performed, and the specimens were potted for mechanical testing. The following reconstruction techniques were used: a single clavicular tunnel for group A, a double clavicular tunnel for group B, and a double clavicular tunnel plus suture fixation across the AC joint for group C. The specimens underwent cyclic loading in the horizontal and vertical planes and then load to failure. Eight control specimens also underwent cyclic loading in both planes. Construct stiffness during cyclic loading, change in displacement after cyclic loading in both planes, load to failure in the vertical plane, and mode of failure were evaluated, and stiffness was compared among the treatment groups as well as with a control group. Results: There was a decrease in joint stiffness for all groups, including controls, during the cyclic loading. Compared with controls, all 3 treatment groups demonstrated equivalent stiffness and displacement in the vertical plane. In the horizontal plane, all 3 treatment groups demonstrated decreased stiffness, increased displacement, or both when compared with controls. When groups were compared, no treatment arm proved superior regarding stiffness or displacement in either plane. Load-to-failure testing of the 3 treatment groups in the vertical plane demonstrated construct strength and stiffness comparable with reports for the native AC joint. The mode of failure was predominantly fracture at the point of fixation to the testing apparatus. Conclusion: There was no difference in bidirectional strength and stability between the single– and double–clavicular tunnel techniques of coracoclavicular reconstruction. The addition of a stabilizing suture across the AC joint does not improve horizontal stability in the absence of repair of the AC joint capsule and deltotrapezial fascia. Clinical Relevance: This laboratory study provides further evidence of the importance of the AC joint capsule and associated soft tissues in affording horizontal stability to that joint. Information from this and subsequent studies utilizing a bidirectional model can influence the choice of surgical procedure in the clinical treatment of AC joint dislocations.


2009 ◽  
Vol 35 (4) ◽  
pp. 196-200 ◽  
Author(s):  
Mansour Rismanchian ◽  
Farshad Bajoghli ◽  
Zahra Mostajeran ◽  
Akbar Fazel ◽  
Psadr Eshkevari

Abstract One of the main goals of prosthetic dentistry is to reconstruct the masticatory system. Replacing missing teeth by complete or partial denture is associated with decreased bite force and patient satisfaction. The aim of the present study was to measure the maximum bite force (MBF) and to evaluate patients' satisfaction from their conventional complete dentures and their mandibular implant-supported overdentures opposed by complete denture. In this cross sectional analytical descriptive study, seventy-five 45- to 65-year-old patients were divided into 3 groups wearing: (1) conventional complete dentures for up to 6 months; (2) conventional complete dentures for 10 years or more; and (3) complete maxillary dentures opposing mandibular implant-supported overdentures. Bite force was measured by means of electronic bite force measuring device with strain gauges. Three measurements were made on each side on the first molar region and the mean values were recorded. Patient satisfaction was also recorded using questionnaires. Results were analyzed by analysis of variance (ANOVA), t test, chi-square, and Pearson correlation test. The mean MBF for the first, the second, and the third group was, respectively, 5.65 ± 1.46 kgf, 7.01 ± 2.1 kgf, and 12.22 ± 27 kgf. The difference between MBF in patients with overdentures and in patients with conventional complete dentures was statistically significant (P  =  .001). Patient satisfaction with mandibular implant-supported overdentures was recorded as “great.” Results indicated MBF in the patients with mandibular implant-supported overdentures was significantly higher than that of patients with conventional complete dentures. This difference may indicate the important role of dental implants in the improvement of bite force and chewing efficiency and therefore patients' satisfaction.


1980 ◽  
Vol 23 (3) ◽  
pp. 630-645 ◽  
Author(s):  
Gerald Zimmermann ◽  
J.A. Scott Kelso ◽  
Larry Lander

High speed cinefluorography was used to track articulatory movements preceding and following full-mouth tooth extraction and alveoloplasty in two subjects. Films also were made of a control subject on two separate days. The purpose of the study was to determine the effects of dramatically altering the structural dimensions of the oral cavity on the kinematic parameters of speech. The results showed that the experimental subjects performed differently pre and postoperatively though the changes were in different directions for the two subjects. Differences in both means and variabilities of kinematic parameters were larger between days for the experimental (operated) subjects than for the control subject. The results for the Control subject also showed significant differences in the mean values of kinematic variables between days though these day-to-day differences could not account for the effects found pre- and postoperatively. The results of the kinematic analysis, particularly the finding that transition time was most stable over the experimental conditions for the operated subjects, are used to speculate about the coordination of normal speech.


1986 ◽  
Vol 55 (01) ◽  
pp. 108-111 ◽  
Author(s):  
M Köhler ◽  
P Hellstern ◽  
C Miyashita ◽  
G von Blohn ◽  
E Wenzel

SummaryThis study was performed to evaluate the influence of different routes of administration on the efficacy of DDAVP treatment. Ten healthy volunteers received DDAVP intranasally (i.n.), subcutaneously (s.c.) and intravenously (i.v.) in a randomized cross-over trial. Factor XII and high molecular weight (HMW)-kininogen levels increased only slightly after DDAVP administration. The mean increase of factor VIII: C was 3.1 (i. v.), 2.3 (s. c.), and 1.3 (i.n.) - fold over baseline. Ristocetin cofactor (von Willebrand factor antigen) increased 3.1 (2.5), 2.0 (2.3) and 1.2 (1.2) - fold over baseline mean values after i.v., s.c. and i.n. DDAVP, respectively. The half-disappearance time of factor VIII and von Willebrand factor (vWF) after DDAVP ranged from five (factor VIII: C) to eight hours (vWF). The mean increase of fibrinolytic activity was more pronounced after i.v. DDAVP. The antidiuretic effect was moderate with no apparent differences between the routes of application. This study provides further evidence that both i.v. and s.c. DDAVP administration result in an appropriate and reliable stimulation of haemostasis. An additional advantage of s. c. administration is its suitability for home treatment.


2018 ◽  
Vol 4 (4) ◽  
pp. 519-522
Author(s):  
Jeyakumar S ◽  
Jagatheesan Alagesan ◽  
T.S. Muthukumar

Background: Frozen shoulder is disorder of the connective tissue that limits the normal Range of motion of the shoulder in diabetes, frozen shoulder is thought to be caused by changes to the collagen in the shoulder joint as a result of long term Hypoglycemia. Mobilization is a therapeutic movement of the joint. The goal is to restore normal joint motion and rhythm. The use of mobilization with movement for peripheral joints was developed by mulligan. This technique combines a sustained application of manual technique “gliding” force to the joint with concurrent physiologic motion of joint, either actively or passively. This study aims to find out the effects of mobilization with movement and end range mobilization in frozen shoulder in Type I diabetics. Materials and Methods: 30 subjects both male and female, suffering with shoulder pain and clinically diagnosed with frozen shoulder was recruited for the study and divided into two groups with 15 patients each based on convenient sampling method. Group A patients received mobilization with movement and Group B patients received end range mobilization for three weeks. The outcome measurements were SPADI, Functional hand to back scale, abduction range of motion using goniometer and VAS. Results: The mean values of all parameters showed significant differences in group A as compared to group B in terms of decreased pain, increased abduction range and other outcome measures. Conclusion: Based on the results it has been concluded that treating the type 1 diabetic patient with frozen shoulder, mobilization with movement exercise shows better results than end range mobilization in reducing pain and increase functional activities and mobility in frozen shoulder.


1966 ◽  
Vol 53 (2) ◽  
pp. 177-188 ◽  
Author(s):  
P. Lund-Johansen ◽  
T. Thorsen ◽  
K. F. Støa

ABSTRACT A comparison has been made between (A), a relatively simple method for the measurement of aldosterone secretion rate, based on paper chromatography and direct densitometry of the aldosterone spot and (B) a more elaborate isotope derivative method. The mean secretion rate in 9 normal subjects was 112 ± 26 μg per 24 hours (method A) and 135 ± 35 μg per 24 hours (method B). The »secretion rate« in one adrenalectomized subject after the intravenous injection of 250 μg of aldosterone was 230 μg per 24 hours (method A) and 294 μg per 24 hours (method B). There was no significant difference in the mean values, and correlation between the two methods was good (r = 0.80). It is concluded that the densitometric method is suitable for clinical purposes as well as research, being more rapid and less expensive than the isotope derivative method. Method A also measures the urinary excretion of the aldosterone 3-oxo-conjugate, which is of interest in many pathological conditions. The densitometric method is obviously the less sensitive and a prerequisite for its use is an aldosterone secretion of 20—30 μg per 24 hours. Lower values are, however, rare in adults.


1970 ◽  
Vol 64 (2) ◽  
pp. 265-272 ◽  
Author(s):  
A. A. van der Gugten ◽  
M. Sala ◽  
H. G. Kwa

ABSTRACT Eight female and eight male rats were castrated at the age of 8 to 10 weeks. Four spayed and four orchidectomized rats received one oestrone/cholesterol pellet (200 μg oestrone) on the day of operation (day 0), a second pellet on day 11 and a third on day 23. The remaining animals received four oestrone/cholesterol pellets at these times. The fluctuations in the prolactin levels in the circulation induced by the oestrogen challenges in these animals were followed during 31 days by radioimmunoassays performed on days 3, 7, 9, 14, 15, 17, 23, 24, 25, 28 and 31. The results suggested that the homoeostatic mechanism regulating plasma levels of prolactin was capable of withstanding the three time-spaced oestrogen challenges only in the spayed animals receiving the lower doses of oestrogen, since it allowed the mean values of the prolactin levels to remain fairly constant during the first 4 weeks. The levels in this group rose to much higher levels only on day 31. The higher doses of oestrone in the spayed rats and both dose levels of oestrone in the orchidectomized animals apparently resulted in a primary break-down of the homoeostatic mechanism, since the prolactin levels in the animals of these groups rose to much higher levels either on day 7 or on day 9. This was followed by a period during which the prolactin levels appeared to be more or less under control, until a second and probably definitive failure of the homoeostatic mechanism allowed the mean levels to rise sharply again.


2017 ◽  
Vol 13 (1) ◽  
Author(s):  
Izabel Aparecida Soares ◽  
Mauro Sérgio Téo ◽  
Carlise DEBASTIANI ◽  
Suzymeire BARONI ◽  
Vanessa Silva RETUCI

O trabalho teve por objetivo verificar diferenças entre rendimento do concentrado proteico e proteína bruta da folha da mandioca (Manihot esculenta Crantz), obtidos a partir de três variedades comerciais: branca, cascuda e vermelha. As manivas foram plantadas seguindo o delineamento experimental inteiramente casualizado com três repetições. Nas comparações entre as variedades, considerou coletas escalonadas pós-plantio, realizadas aos 12, 14 e 16 meses. O concentrado proteico foi obtido a partir da farinha das folhas inteiras e submetido ao método de termo - coagulação ácido e a proteína bruta pelo método padrão AOAC. Os dados foram submetidos a análise de variância e comparados pelo teste de Tukey - 5% de probabilidade. Os resultados não indicaram diferença significativa entre as médias obtidas para rendimento de concentrado proteico. Para a variável porcentagem de proteína bruta a variedade Branca foi a que apresentou maior valor, com média de 46,25%, seguida pela Cascuda e Vermelha, 44,52% e 37,30%, sucessivamente. Conclui-se que outros estudos devem avaliar condições que possam influenciar no teor de proteína foliar, como clima e solo, e, avaliar os níveis de ácido cianídrico de cada variedade, indicando qual das três é a melhor para a extração do concentrado proteico das folhas. Palavras chaves: Manihot esculenta Crantz, variedades comerciais, concentrado proteico, proteína bruta. ABSTRACT: The study aimed to assess the differences between income protein concentrate, crude protein of cassava leaf (Manihot esculenta Crantz), obtained from three commercial varieties: white, red and cascuda. The cuttings were planted following the completely randomized design with three replications. Comparisons between the varieties considered after planting staggered collections, held on 12, 14 and 16 months. The protein concentrate was obtained from flour of whole sheets and subjected to the term method - acid coagulation and crude protein by AOAC standard method. The data were submitted to ANOVA and Tukey test - 5% probability. The results indicated no significant difference between the mean values obtained for protein concentrate income. For the variable percentage of crude protein White variety showed the highest, with an average of 46.25%, followed by cascuda and Red, 44.52% and 37.30%, successively. We conclude that further studies should evaluate conditions that may affect the leaf protein content, such as climate and soil, and evaluate the hydrocyanic acid levels of each variety, indicating which of the three is the best for the extraction of protein concentrate from leaves Key words: Manihot esculenta Crantz, commercial varieties, protein concentrate, crude protein.


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