J Korean Orthop Assoc.  1996 Apr;31(2):205-210. 10.4055/jkoa.1996.31.2.205.

The Treatment of Grade 3 Acute Acromioclavicular Joint Injuries with Modified Neviaser Technique

• Park JT
• Ahn GY
• Shin YS
• Park HY

• KMID: 2423596
• DOI: http://doi.org/10.4055/jkoa.1996.31.2.205

Abstract

There has been considerable controversy in the treatment of acute grade 3 injuries of acromioclavicular joint. Neviaser reported that the possibility of a latent degenerative arthritis occurring in the acromioclavicular joint as the result of passing Kirschner wire through the joint was more theoretical than real and any changes that may take place in the acromioclavicular joint were the result of trauma. The acromioclavicular joint and the articular disc were not disturbed at the time of operation in Neviaser technique, but we excised the articular disc that were torn for the purpose of preventing acromioclavicular joint from degenerative arthritis. We had treated 26 cases of grade 3 injuries of acromioclavicular joint with modified Neviaser technique from June 1990 to May 1994 at the Pohang St. Mary's Hospital. The results were as follows. 1. The clinical results by Weitzman were consisted of 18 cases(69%) of excellent, 6 cases(23%) of good, 2 cases(8%) of fair and 0 case(0%) of poor. 2. Loss of reduction was 1.6mm by stress views of final reviews and didn't affect to functional result. 3. There were no cases of redislocation of acromioclavicular joint after removal of Kirschner wires. 4. There were no cases of degenerative arthritis of acromioclavicular joint in final review. There result suggest that excision of the articular disc that were torn may be helpful in preventing acromioclavicular joint from degenerative arthritis.

Keyword

Acromioclavicular joint; Grade 3 injury; Modified Neviaser technique

MeSH Terms

Acromioclavicular Joint*
Bone Wires
Gyeongsangbuk-do
Joints
Osteoarthritis

Figure

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  Fig. 1 Modified Neviaser technique for reconstruction of acromioclavicular ligament with coracoacromial ligament 1: Acromion 2: Coracoacromial ligament; detached from its coracoid attachment and fixed to clavicle 3: Torn articular disc of acromioclavicular joint; excised at the time of operation 4: Clavicle, 5: Trapezoid ligament, 6: Conoid ligament

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  Fig. 2-A A 32-year old male patient had a grade 3 acromioclavicular joint injury to the right shoulder in initial stress view. B. The patient was managed with modified Neviaser technique. C. Roentgenogram of last follow-up at four years after surgery showed no redislocation of acromioclavicular joint and there’s no radiolucent density at distal end of the clavicle.

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  Fig. 3-A 45-year old man patient had a grade 3 acute acromioclavicular joint injury to the left shoulder in initial stress view. B. Above; The patient was managed with modified Neviaser technique. There was intraoperative fracture of lateral end of the clavicle. Below; The functional result was good. Stress view at sixteen months after surgery showed good union of lateral end of the clavicle.

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