RESUMO
Objective To conduct a comparative study of the biomechanical characteristics of anatomical and vertical reconstruction for the coracoclavicular ligament. Methods Thirty fresh adult cadaveric specimens of the shoulder joint were dissected, whereas other soft tissues of the shoulder joint were resected, and only the clavicle-coracoclavicular ligament-scapula structures were retained. All the specimens were randomly divided into three groups, with ten specimens in each group. In Group 1, the coracoclavicular ligament was retained; in Group 2, the cone ligament was reconstructed vertically based on the classical Steven technique; and in Group 3, the conical ligament was reconstructed anatomically based on the central site of the original ligament. Biomechanical tests under vertical tensile resistances were conducted separately on the three groups, and the tensile forces that caused the rupture of the coracoclavicular ligament or reconstruction failure were recorded. Results In Group 1, clavicle and coracoid fractures were not found, and the tensile force that caused the coracoclavicular ligament rupture was (650.41 + 35.88) N. In Group 2, clavicle fracture (two cases), endobutton pull-out from the clavicle (two cases) or coracoid (five cases), and coracoid fracture (one case) occurred, and the tensile force that caused the failure of the coracoclavicular reconstruction was (725.68 + 35.37) N. In Group 3, clavicle fracture (three cases ), endobutton pull-out from the clavicle (one case) or coracoid (five cases), and coracoid fracture (one case) occurred, and the tensile force that caused the failure of the coracoclavicular reconstruction was (765.15+13.68) N. Conclusions The tensile forces in the anatomical and vertical reconstruction of the coracoclavicular ligament were both superior to those of the primary ligament, with the anatomical reconstruction being superior to vertical reconstruction under a tensile effect.
RESUMO
Objective To evaluate the effects of SLAP repair and biceps tendon tenotomy and fixation in treating type Ⅱ superior labrum from anterior to posterior in shoulder arthroscopy.Methods PubMed,CNKI,VIP,and Wanfang database were searched electronically to screen randomized controlled trials and non randomized controlled trials that comparing two surgical methods for type Ⅱ SLAP lesions.In addition,we also retrieved the domestic orthopedic magazine and searches references that we had included in the present study.According to the criterion,screening literatures,data extraction and quality assessment were conducted by two reviewers independently.Meta-analysis was performed by using RevMan 5.3 software to evaluate UCLA scores,ASES scores,VAS scores and SST scores.Results A total of 7 articles were included in the present study,including 3 literatures in Chinese and 4 in English.There were 2 randomized controlled trials and 5 non randomized controlled trials.Two hundred and fifty-six patients were enrolled in the present study,including one hundred and twenty-five patients with SLAP repair and one hundred and thirty-one patients with biceps tendon tenotomy and fixation.Meta-analysis showed that there was significant difference in total score of UCLA [MD=2.55,95％CI(0.57,4.53),P=0.01] and shoulder function in the UCLA scoring system [MD=0.62,95％ CI(0.21,1.02),P=0.003] compared with SLAP repair.There was no difference in the UCLA scoring system,including pain [MD=0.99,95％CI(-0.15,2.14),P=0.09],flexion [MD=0.16,95％CI(0.01,0.32),P=0.06],strength [MD=0.03,95％CI(-0.15,0.22),P=0.74],satisfaction [SMD=0.18,95％ CI(-0.57,0.93),P=0.64] compared with SLAP repair.There was significant difference in ASES scores [MD=6.32,95％CI(2.55,10.08),P=0.001] between two groups.There was no difference in VAS scores [MD=0.54,95％CI (-0.64,1.72),P=0.37] and SST scores [MD=0.81,95％CI(-0.23,1.86),P=0.13] between two groups.Conclusion The UCLA scores,ASES scores and surgical results of biceps tendon tenotomy and fixation are superior to SLAP repair in treating type Ⅱ SLAP lesions.However,there is no significant advantage in pain,flexion,strength and satisfaction between the two groups.