Meta-analysis of coracoclavicular ligament reconstruction with autologous or allogeneic tendon and clavicular hook plate in the treatment of acromioclavicular joint dislocation

doi:10.12307/2021.076

Abstract

Abstract: OBJECTIVE: At present, tendon reconstruction of coracoclavicular ligament is still in the initial stage. In each study, the number of cases involving tendon reconstruction of coracoclavicular ligament versus clavicular hook plate is less. For this, the clinical effect comparison of the two treatment schemes is still uncertain. This paper compared the efficacy of coracoclavicular ligament reconstruction with autologous or allogeneic tendon and clavicular hook plate in the treatment of acromioclavicular joint dislocation.
METHODS: A computer was used to retrieve the PubMed, Embase, Cochrane Library, CNKI, Wanfang, and Weipu database. The retrieval time was from the inception of the database to July 2020. Domestic and foreign literature on comparative study of coracoclavicular ligament reconstruction with autologous or allogeneic tendon and clavicular hook plate in the treatment of acromioclavicular joint dislocation was retrieved. Two researchers independently screened the literature according to the inclusion and exclusion criteria, extracted data, and evaluated the risk of bias in the literature. The operation time, intraoperative blood loss, hospital stay, function score, and complications were meta-analyzed with RevMan 5.3 software. According to the treatment, the patients were divided into two groups: autogenous or allogeneic tendon reconstruction coracoclavicular ligament group and clavicular hook plate group.
RESULTS: Finally, eight articles met the inclusion criteria, including three randomized controlled studies, five retrospective cohort studies and eight articles with high quality, with 382 patients. There were 189 cases of autogenous or allogeneic tendon reconstruction coracoclavicular ligament group and 193 cases of clavicular hook plate group. The longest postoperative follow-up period was about 2.5 years and the shortest was about 6 months. Meta-analysis showed that postoperative Constant-Murley score (MD=3.44, 95%CI: 2.23-4.66), effective rate (OR=9.92, 95%CI: 2.74-35.84), and total postoperative complications (OR=0.11, 95%CI:0.04-0.32) were significantly better in the autogenous or allogeneic tendon reconstruction coracoclavicular ligament group than those in the clavicular hook plate group(P < 0.05). However, operation time (MD=-2.01, 95%CI: -15.96-11.95), intraoperative blood loss (MD=-7.37, 95%CI:-20.00-5.27), and hospital stay (MD=-1.54,
95%CI: -4.22-1.13) and the visual analogue scale score (MD=0.10, 95%CI:-0.02-0.23) had no significant difference between the two groups (P > 0.05).
CONCLUSION: According to the comparison of limited literature, the effect of coracoclavicular ligament reconstruction with autologous or allogeneic tendon in the treatment of acromioclavicular joint dislocation was better than that of clavicular hook plate group in short-term follow-up, and the success rate of acromioclavicular joint dislocation was improved. The occurrence of postoperative complications was reduced, and it was more conducive to promote the recovery of acromioclavicular joint function.

Key words: bone, joint, shoulder, ligament, clavicle, tendon, dislocation, meta-analysis

CLC Number:

Yang Kun, Fei Chen, Wang Pengfei, Zhang Binfei, Yang Na, Tian Ding, Zhuang Yan, Zhang Kun. Meta-analysis of coracoclavicular ligament reconstruction with autologous or allogeneic tendon and clavicular hook plate in the treatment of acromioclavicular joint dislocation[J]. Chinese Journal of Tissue Engineering Research, 2021, 25(28): 4580-4586.

Figures/Tables 13

References

[1] MCCREESH KM, RILEY SJ, CROTTY JM, et al. Acromio-clavicular joint cyst associated with a complete rotator cuff tear-A case report. Man Ther. 2014;19(5):490-493.
[2] SHAW MBK, MCINERNEY JJ, DIAS JJ, et al. Acromioclavicular joint sprains: the post-injury recovery interval. Injury. 2003;34(6): 438-442.
[3] 许福生,李桓毅,刘方刚,等.三重带袢纽扣钢板与锁骨钩钢板治疗急性肩锁关节脱位的疗效比较[J].中国矫形外科杂志,2012, 20(8):700-703.
[4] FRANCESCO AD, ZOCCALI C, COLAFARINA O, et al. The use of hook plate in type III and V acromio-clavicular Rockwood dislocations: Clinical and radiological midterm results and MRI evaluation in 42 patients. Injury. 2012; 43(2):147-152.
[5] 朱义用,汪建良,许科峰,等.锁骨钩钢板治疗肩锁关节脱位和锁骨远端骨折的肩痛原因分析[J].中华创伤骨科杂志,2007,9(7):692-693.
[6] 傅青松,张豪,王立志,等.自体掌长肌腱与半腱肌腱重建喙锁韧带的疗效对比观察[J].实用骨科杂志,2017,23(10):930-933.
[7] 赵沛,张华,张健,等.自体半腱肌肌腱重建喙锁韧带治疗肩锁关节脱位[J].中华手外科杂志,2015,31(6):427-429.
[8] 王古衡,李双,陈亚兰,等.同种异体肌腱重建韧带技术与Endobutton技术治疗肩锁关节脱位的疗效比较[J].中华手外科杂志, 2020,36(2):99-102.
[9] 孙伟,薛骋,李翔,等.喙锁韧带解剖重建治疗肩锁关节脱位的初步研究[J].中国矫形外科杂志,2016,24(24):2252-2256.
[10] MICHLITSCH MG, ADAMSON GJ, PINK M, et al. Biomechanical comparison of a modified weaver-dunn and a free-tissue graft reconstruction of the acromioclavicular joint complex. Am J Sports Med. 2010;38(6):1196-1203.
[11] 黄健林,刘文涛.掌长肌腱重建韧带与钩钢板治疗肩锁关节脱位的比较[J].实用骨科杂志,2020,26(5):447-451.
[12] 何建平,朱泽兴,马东印,等.锁骨钩钢板固定与单纯同种异体肌腱重建喙锁韧带治疗肩锁关节脱位效果对比[J].实用手外科杂志,2019,33(2):199-201.
[13] 施利华,李恒,郭攀,等.斜方韧带和锥状韧带走行方向对肩锁关节脱位治疗的价值[J].中国临床保健杂志,2019,22(5):660-663.
[14] 谢亮,张彦祥,高博,等.自体腓骨长肌腱前侧半重建喙锁韧带与钩钢板固定治疗RockwoodⅢ-Ⅴ型肩锁关节脱位疗效观察[J].海南医学,2019,30(20):2654-2657.
[15] WANG GH, XIE R, TIAN M, et al. Treatment of AC dislocation by reconstructing CC and AC ligaments with allogenic tendons compared with hook plates. J Orthop Surg Res. 2018;13(1):175.
[16] 梁程亮,陈志刚,吴文健.全关节镜下自体掌长肌腱重建喙锁韧带治疗肩锁关节脱位的临床研究[J].山西医药杂志,2015,44(16): 1867-1870.
[17] 汪志芳,施海伟,张黎明,等.两种不同术式治疗肩锁关节脱位的临床疗效对比研究[J].医药前沿,2014(30):18-19.
[18] 扶世杰,关钛元,杨本伍,等.关节镜下自体肌腱重建与锁骨钩钢板治疗Rockwood Ⅲ型肩锁关节脱位的疗效比较[J].中华创伤骨科杂志,2013,15(10):912-914.
[19] 张建华,聂宇,周永焕,等.锁骨钩钢板置入治疗Rockwood Ⅲ型肩锁关节脱位[J].中国组织工程研究,2012,16(30):5686-5690.
[20] TOBY OS, RACHEL C, EYIYEMI OP, et al. Operative versus non-operative management following Rockwood grade III acromioclavicular separation: a meta-analysis of the current evidence base. J Orthop Traumatol. 2011;12(1): 19-27.
[21] BALKE M, SCHNEIDER MM, AKOTO R, et al. Acute acromioclavicular joint injuries: changes in diagnosis and therapy over the last 10 years. Der Unfallchirurg. 2014;118(10):851.
[22] THOMAS K, LITSKY A, JONES G, et al. Biomechanical comparison of coracoclavicular reconstructive techniques. Am J Sports Med. 2011;39(4):804.
[23] COSTIC RS, LABRIOLA JE, RODOSKY MW, et al. Biomechanical rationale for development of anatomical reconstructions of coracoclavicular ligaments after complete acromioclavicular joint dislocations. Am J Sports Med. 2004; 32(8):1929.
[24] JARI R, COSTIC RS, RODOSKY MW, et al. Biomechanical function of surgical procedures for acromioclavicular joint dislocations. Arthroscopy. 2004;20(3):237-245.
[25] LAWHORN KW, HOWELL SM. Scientific justification and technique for anterior cruciate ligament reconstruction using autogenous and allogeneic soft-tissue grafts. Orthop Clin North Am. 2003;34(1):19-30.
[26] 常青,陈兴,关长勇,等.应用异体肌腱重建喙锁韧带治疗肩锁关节完全脱位[J].中国矫形外科杂志,2003,11(1):21-23.
[27] 印飞,孙振中,韦旭明,等.自体及同种异体肌腱重建喙锁韧带结合钩钢板固定治疗肩锁关节脱位的疗效比较[J].中国修复重建外科杂志,2016,30(5):532-536.
[28] 李传和,沈锐,秦春跃,等.改良可调式Rigidloop双钢板解剖重建喙锁韧带治疗肩锁关节脱位[J].临床骨科杂志,2019,22(4): 498-500.
[29] 刘瀚忠,隋文渊,翟丽芹,等.锁骨钩钢板与Endobutton带袢钢板治疗肩锁关节脱位的疗效比较[J].中华创伤骨科杂志,2019, 21(8):710-713.
[30] MILEWSKI MD, TOMPKINS M, GIUGALE JM, et al.Complications related to anatomic reconstruction of the coracoclavicular ligaments. Am J Sports Med. 2012;40(7):1628-1634.
[31] CAROFINO BC, MAZZOCCA AD. The anatomic coracoclavicular ligament reconstruction: surgical technique and indications. J Shoulder Elbow Surg. 2010;19:37-46.
[32] BEITZEL K, OBOPILWE E, APOSTOLAKOS J, et al. Rotational and translational stability of different methods for direct acromioclavicular ligament repair in anatomic acromioclavicular joint reconstruction. Am J Sports Med. 2014; 42(9):2141-2148.
[33] MAZZOCCA AD, SANTANGELO SA, Johnson ST, et al. A biomechanical evaluation of an anatomical coracoclavicular ligament reconstruction. Am J Sports Med. 2006;34(2): 236-246.
[34] KOCADAL O, YüKSEL K, GüVEN M. Evaluation of the clavicular tunnel placement on coracoclavicular ligament reconstruction for acromioclavicular dislocations: a finite element analysis. Int Orthop. 2018;42(6):1891-1896.