الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
T
he Acromio-clavicular joint is one of four joints that comprise the shoulder complex, formed by the junction of the lateral clavicle and the acromion process of the scapula. AC joint injuries account for about 12 % of all shoulder injuries in clinical practice and nearly 50 % in athletes participating in contact sports [10]
The most important ligaments are Coraco-clavicular ligaments which are composed of the Conoid (posteromedial) and Trapezoid (anterolateral) ligaments. The Coraco-clavicular ligaments run from the coracoid process to the conoid tubercle and trapezoid line of the clavicle, near the AC joint. These ligaments contribute to vertical stability, making them crucial for preventing superior dislocation of the AC joint.
AC joint dislocation classified according to Rock wood classification to 5 grades. First and second grades is treated nonoperatively, While grades III, IV and V treated surgically. Numerous surgical techniques developed but there is no “gold standard” for surgical reconstruction of acute high grade AC-joint dislocations. Surgical treatment includes methods of CC ligaments reconstruction as ORIF by Bosworth screw or reconstruction by double button. Other methods for AC reconstruction as ORIF by hooked plate, k-wires and cerclage.
Several studies have shown significant association of horizontal instability with inferior clinical outcome following arthroscopically-assisted and open acute ACJ reconstruction. Thus, insufficient AC Ligament complex healing causing persistent horizontal ACJ instability represents a clinically relevant issue. Biomechanical studies demonstrated that only combined, non-rigid coraco- and acromioclavicular stabilization may restore physiological AC joint stability. Final horizontal AC joint stability will be determined by biomechanical quality of biologic AC ligament cpmplex healing due to the likelihood of time-dependent loosening or failure of synthetic stabilization material. Optimal biomechanical AC ligament complex healing requires both anatomical AC joint and AC ligament reduction and physiological AC joint stabilization[25].
We conducted a systematic review of literature comparing between results of Combined AC & CC ligaments reconstruction by high strength suture cerclage with isolated CC ligaments reconstruction by high strength suture cerclage for surgical treatment of acute AC dislocation type III, IV and V. The search conducted by using the databases: MEDLINE, Cochrane library, JBJS {Journal of bone and joint Surgery} and PubMed for published studies from2000-2017. Only studies on human subjects with acute AC dislocation type III, IV and V are included.
After meeting of inclusion and exclusion criteria our systematic review includes seven studies with total number of 176 patients. Four studies with total number of 121 patients underwent combined AC and CC ligaments reconstruction. Three studies with total number of 55 patients underwent isolated CC ligaments reconstruction only. We compared between studies in: Different shoulder function scoring systems, recurrence rate, CC distance and CC distance difference over postoperative period of two years.
According to our results and data extracted we found that isolated CC ligaments reconstruction only show statistically highly significant improvement in different shoulder functioning scores, CC distance & CC distance difference in comparison to combined AC and CC ligaments reconstruction by high strength suture cerclage for acute AC dislocation grade III, IV and V.
According to recurrence rate of AC joint dislocation isolated CC ligaments reconstruction show statistically non significant better results in comparison to combined AC and CC ligaments reconstruction by high strength suture cerclage for acute AC dislocation grade III, IV and V.