Morphological Variations Of The Coraco-acromial Ligament: A Cadaveric Study

Introduction: The coraco-acromial ligament forms coraco-acromial arch along with acromion and coracoidprocess of scapula which prevent the superior humeral head displacement. It plays a key role in the pathoetiology of sub-acromial impingement syndrome when there are no significant bony abnormalities.Material and Methods: In the present study we have studied 120 formalin preserved upper limbs (right: 60; left:60) of unknown age and sex. Each shoulder was dissected carefully to see coraco-acromial ligament. The CALwas identified with careful blunt dissection to prevent overlooking any thinner bands. We observed the numberof bands present and shape of the ligament. Photographs were taken.Results: Different morphological subtypes of coraco-acromial ligament were observed and classified accordingto Kesmezacar et al. Type II (28.33 %) was the most common then type I (25 %), type IV (17.5 %), type V (15 %), typeIII (11.66%). Anterolateral band of ligament extended antero-laterally to form coracoacromial falx in 51%.Discussion: Coraco-acromial ligament shows different morphological variations in Indian population. Knowledgeof morphological variations of coraco-acromial ligament will be helpful for orthopedic surgeon for clinical andintraoperative decision while dealing with sub-acromial impingement syndrome.

Acromio-Clavicular Joint Dislocation Types IV to VI: Does the Outcome with the modified Weaver-Dunn Procedure Justify the Treatment?

@#clavicular joint (ACJ) injuries remains controversial. Themodified Weaver-Dunn (WD) procedure is one of thefrequently used techniques. Recently when it was comparedwith anatomical autogenous tendon graft reconstructionprocedures, the results were inferior. However, theseanatomical procedures are technically more demanding withsmall margin of error and they have tendency forpostoperative pain because of extra donor site incision.Materials and Methods: Forty patients with type IV to VIACJ dislocations were treated by modified WD procedureusing non-absorbable synthetic suture passed through thebase of coracoid process for augmentation of transferredcoraco-acromial (CA) ligament. Functional outcome wasassessed using the Oxford Shoulder Score, NottinghamClavicular Score and Visual Analog Score (VAS) at the finalfollow-up after surgery.Results: The mean pre-operative Oxford Shoulder Scoreimproved from 25.22±2.64 (range 20 to 30) to 44.75±1.99(range 40 to 48) and mean pre-operative NottinghamShoulder Score improved from 49.25±4.91 (range 39 to 58)to 87.27±4.39 (range 79 to 96) at last follow-up after surgerywith p-value <0.001. Thirty-five (87.5%) patients hadexcellent outcomes, four (10%) patients had good outcomesand one (2.5%) patient had fair outcome. Thirty-eight (95%)patients had no pain while two (5%) had moderate painbased on VAS score.Conclusion: Modified Weaver-Dunn is a simple wellestablished technique for grade IV to VI ACJ dislocation.We cannot consider this procedure as old and outdated on theargument that the long term functional outcomes are notsubopti