Reconstruction of the acromioclaviular joint disruption by anchor sutures: surgical technique and preliminary results

Over hundred different surgical procedures have been described for the reconstruction of acromioclavicular joint separation: however the use of anchor sutures tied over a small button plate was introduced for the reconstruction because of its biomechanical superiority. Our objective was to propose a new technique of acromioclavicular joint surgery and to evaluate the preliminary results of this technique. Fifteen patients with a mean follow up of 12 months underwent the acromioclavicular joint reconstruction using anchor sutures and a small button plate. The mean age was 31 years [range 19-48 years]. The shoulder was evaluated using the Constant-Murely Shoulder Score and radiographs. Indication for surgery included acromioclavicular joint dislocation Rockwood type IV-V. All patients returned to their work within 11.2 [range 8-18] weeks after operation. The average constant score at last follow up was 92.8. Postoperative radiographs confirmed anatomic reduction in all patients. Residual subluxation. occurred in one patient and dislocation occurred in another. All patients except one were satisfied with results and cosmetic appearance. Considering its less morbidity, no need of hardware removal and minimal complications from breakage or migration of metal implants, this new technique offers good alternative in acromioclavicular joint stabilization

Chronic dislocation of the radial head in children, open reduction and annular ligament reconstruction

Background: There is a controversy as regard treatment of chronic dislocation of the radial head in children. Treatment varies from watchful waiting, open reduction with or without annual ligament reconstructions, open reduction with or without ulnar or radial osteotomy and excision of the radial head. Purpose To evaluate our results of open reduction and annular ligament reconstruction, using triceps aponeuosis

Patients and Methods: Nine elbows [4 traumatic, 2 congenital, 2 following brachial plexus injuries, one following multiple osteochondromas] in nine children with chronic radial head dislocation were treated with open reduction and annular ligament reconstruction using triceps apponeurosis. There were six girls and three boys. Their mean age at the time of surgery was 6 years 8 months [range: 3 years 9 months to 9 years 1 month]. Radial osteotomies were needed in 3 cases. Clinical and radiological evaluations were done according to Kim's elbow scoring system

Results: Initial postoperative radiographs showed anatomic reduction of radial head in all cases however during follow up two redislocations were encountered. Mean follow up period was 3 years 4 months [range: 1 year 2 months to 4 years 5 months]. Cases were graded excellent in 5 patients, good in one, fair in one and poor in two patients

Conclusion: Open reduction and annular ligament reconstruction ensure stable radial head in cases of chronic dislocation of the radial head however congenital dislocation needs careful approach