AC Joint dislocation open repair lennard funk
-
Upload
lennard-funk -
Category
Health & Medicine
-
view
1.155 -
download
7
description
Transcript of AC Joint dislocation open repair lennard funk
![Page 1: AC Joint dislocation open repair lennard funk](https://reader034.fdocuments.net/reader034/viewer/2022052304/557d5b7fd8b42aba3d8b4bcb/html5/thumbnails/1.jpg)
Lennard Funk
![Page 2: AC Joint dislocation open repair lennard funk](https://reader034.fdocuments.net/reader034/viewer/2022052304/557d5b7fd8b42aba3d8b4bcb/html5/thumbnails/2.jpg)
MY EXPERIENCE
2001 2008
![Page 3: AC Joint dislocation open repair lennard funk](https://reader034.fdocuments.net/reader034/viewer/2022052304/557d5b7fd8b42aba3d8b4bcb/html5/thumbnails/3.jpg)
REVISIONS !!!
![Page 4: AC Joint dislocation open repair lennard funk](https://reader034.fdocuments.net/reader034/viewer/2022052304/557d5b7fd8b42aba3d8b4bcb/html5/thumbnails/4.jpg)
5
![Page 5: AC Joint dislocation open repair lennard funk](https://reader034.fdocuments.net/reader034/viewer/2022052304/557d5b7fd8b42aba3d8b4bcb/html5/thumbnails/5.jpg)
![Page 6: AC Joint dislocation open repair lennard funk](https://reader034.fdocuments.net/reader034/viewer/2022052304/557d5b7fd8b42aba3d8b4bcb/html5/thumbnails/6.jpg)
PLAN
Indications!
Why Open?!
Why LARS?!
My Technique!
Modifications!
Results
![Page 7: AC Joint dislocation open repair lennard funk](https://reader034.fdocuments.net/reader034/viewer/2022052304/557d5b7fd8b42aba3d8b4bcb/html5/thumbnails/7.jpg)
INDICATIONS
• Symptoms • Patient Demands
–Work demands –Society demands
• Overhead Athlete
![Page 8: AC Joint dislocation open repair lennard funk](https://reader034.fdocuments.net/reader034/viewer/2022052304/557d5b7fd8b42aba3d8b4bcb/html5/thumbnails/8.jpg)
Review!3 weeks
APPROACHAcute Injury!
< 1 week
Review 3 months Surgery
Coping Not Coping
![Page 9: AC Joint dislocation open repair lennard funk](https://reader034.fdocuments.net/reader034/viewer/2022052304/557d5b7fd8b42aba3d8b4bcb/html5/thumbnails/9.jpg)
WHY OPEN?
![Page 10: AC Joint dislocation open repair lennard funk](https://reader034.fdocuments.net/reader034/viewer/2022052304/557d5b7fd8b42aba3d8b4bcb/html5/thumbnails/10.jpg)
ACJ STABILISERS
• CC Ligaments – Vertical Stability
• DeltoTrap Fascia – Vertical Stability
• AC Ligaments – Horizontal Stability
Urist, JBJSA, 1946 Debski, JBJSA, 2001
![Page 11: AC Joint dislocation open repair lennard funk](https://reader034.fdocuments.net/reader034/viewer/2022052304/557d5b7fd8b42aba3d8b4bcb/html5/thumbnails/11.jpg)
ACJ LIGAMENTS
Two thirds of the superior stability for lesser displacements!
90% the posterior stability
Fukuda et al. JBJSA. 1986
![Page 12: AC Joint dislocation open repair lennard funk](https://reader034.fdocuments.net/reader034/viewer/2022052304/557d5b7fd8b42aba3d8b4bcb/html5/thumbnails/12.jpg)
DYNAMIC STABILITY
Delto-trapezial fascia
Fukuda et al. JBJSA. 1986: Copeland & Kessel. Injury. 1980; DePalma. 1973; Urist. JBJS 1963.
“Many unsatisfactory results could be due to lack of repair of the trapezius and deltoid.”
Lizaur et al. JBJS. 1994
![Page 13: AC Joint dislocation open repair lennard funk](https://reader034.fdocuments.net/reader034/viewer/2022052304/557d5b7fd8b42aba3d8b4bcb/html5/thumbnails/13.jpg)
WHY LARS?(LIGAMENT AUGMENTATION REINFORCEMENT SYSTEM)
![Page 14: AC Joint dislocation open repair lennard funk](https://reader034.fdocuments.net/reader034/viewer/2022052304/557d5b7fd8b42aba3d8b4bcb/html5/thumbnails/14.jpg)
SURGICAL PROCEDURES
>100 PUBLISHED!!20% FAILURE RATE
![Page 15: AC Joint dislocation open repair lennard funk](https://reader034.fdocuments.net/reader034/viewer/2022052304/557d5b7fd8b42aba3d8b4bcb/html5/thumbnails/15.jpg)
HARRIS ET AL. AJSM 2000
“None of the reconstruction techniques analyzed ... were able to restore the normal mechanical function of the intact coracoclavicular ligament complex”
![Page 16: AC Joint dislocation open repair lennard funk](https://reader034.fdocuments.net/reader034/viewer/2022052304/557d5b7fd8b42aba3d8b4bcb/html5/thumbnails/16.jpg)
CORACOCLAVICULAR LIGAMENTS
Strength – 500N (+/- 134)!
Stiffness – 103N/mm (+/- 30)!
Uniaxial Tension 25mm/min
Harris et. al. Am J Sports Med. 2000
![Page 17: AC Joint dislocation open repair lennard funk](https://reader034.fdocuments.net/reader034/viewer/2022052304/557d5b7fd8b42aba3d8b4bcb/html5/thumbnails/17.jpg)
FUNCTIONAL ANATOMY
![Page 18: AC Joint dislocation open repair lennard funk](https://reader034.fdocuments.net/reader034/viewer/2022052304/557d5b7fd8b42aba3d8b4bcb/html5/thumbnails/18.jpg)
CC LIG POSITIONS
![Page 19: AC Joint dislocation open repair lennard funk](https://reader034.fdocuments.net/reader034/viewer/2022052304/557d5b7fd8b42aba3d8b4bcb/html5/thumbnails/19.jpg)
LARS LIGAMENT (CORIN)
Braided Polyethylenetraphthalate!
1500N tensile strength (30 LAC)!
No reduction in mechanical resilience after over 10 million wear cycles loaded in torsion, traction and flexion [Fialka et al. 2005; !
Vascularisation & Fibrous ingrowth - Collagen Type 1 [Trieb et al. Eur Surg Res. 2004; Yu et al. 2005; Pelletier & Durand]
![Page 20: AC Joint dislocation open repair lennard funk](https://reader034.fdocuments.net/reader034/viewer/2022052304/557d5b7fd8b42aba3d8b4bcb/html5/thumbnails/20.jpg)
![Page 21: AC Joint dislocation open repair lennard funk](https://reader034.fdocuments.net/reader034/viewer/2022052304/557d5b7fd8b42aba3d8b4bcb/html5/thumbnails/21.jpg)
DISCLAIMER:
I have not:!
Received any funding or royalties from LARS /Corin!
Been involved in the development of the LARS
![Page 22: AC Joint dislocation open repair lennard funk](https://reader034.fdocuments.net/reader034/viewer/2022052304/557d5b7fd8b42aba3d8b4bcb/html5/thumbnails/22.jpg)
TECHNIQUE
![Page 23: AC Joint dislocation open repair lennard funk](https://reader034.fdocuments.net/reader034/viewer/2022052304/557d5b7fd8b42aba3d8b4bcb/html5/thumbnails/23.jpg)
EQUIPMENT
![Page 24: AC Joint dislocation open repair lennard funk](https://reader034.fdocuments.net/reader034/viewer/2022052304/557d5b7fd8b42aba3d8b4bcb/html5/thumbnails/24.jpg)
INCISION
Shoulderdoc.co.uk
![Page 25: AC Joint dislocation open repair lennard funk](https://reader034.fdocuments.net/reader034/viewer/2022052304/557d5b7fd8b42aba3d8b4bcb/html5/thumbnails/25.jpg)
Shoulderdoc.co.uk
![Page 26: AC Joint dislocation open repair lennard funk](https://reader034.fdocuments.net/reader034/viewer/2022052304/557d5b7fd8b42aba3d8b4bcb/html5/thumbnails/26.jpg)
NOTTINGHAM APPROACH
Shoulderdoc.co.uk
![Page 27: AC Joint dislocation open repair lennard funk](https://reader034.fdocuments.net/reader034/viewer/2022052304/557d5b7fd8b42aba3d8b4bcb/html5/thumbnails/27.jpg)
Shoulderdoc.co.uk
![Page 28: AC Joint dislocation open repair lennard funk](https://reader034.fdocuments.net/reader034/viewer/2022052304/557d5b7fd8b42aba3d8b4bcb/html5/thumbnails/28.jpg)
Shoulderdoc.co.uk
![Page 29: AC Joint dislocation open repair lennard funk](https://reader034.fdocuments.net/reader034/viewer/2022052304/557d5b7fd8b42aba3d8b4bcb/html5/thumbnails/29.jpg)
STANDARD REPAIR
Shoulderdoc.co.uk
![Page 30: AC Joint dislocation open repair lennard funk](https://reader034.fdocuments.net/reader034/viewer/2022052304/557d5b7fd8b42aba3d8b4bcb/html5/thumbnails/30.jpg)
MODIFICATION 1
Shoulderdoc.co.uk
![Page 31: AC Joint dislocation open repair lennard funk](https://reader034.fdocuments.net/reader034/viewer/2022052304/557d5b7fd8b42aba3d8b4bcb/html5/thumbnails/31.jpg)
MODIFICATION 2
Shoulderdoc.co.uk
![Page 32: AC Joint dislocation open repair lennard funk](https://reader034.fdocuments.net/reader034/viewer/2022052304/557d5b7fd8b42aba3d8b4bcb/html5/thumbnails/32.jpg)
CLOSURE
Repair the Superior AC Ligaments!
Repair the Delto-Trapezial Fascia
![Page 33: AC Joint dislocation open repair lennard funk](https://reader034.fdocuments.net/reader034/viewer/2022052304/557d5b7fd8b42aba3d8b4bcb/html5/thumbnails/33.jpg)
X-RAYS - DAY 1, 3 WEEKS, 3 MONTHS, 1YR, 2YRS
Shoulderdoc.co.uk Shoulderdoc.co.uk
![Page 34: AC Joint dislocation open repair lennard funk](https://reader034.fdocuments.net/reader034/viewer/2022052304/557d5b7fd8b42aba3d8b4bcb/html5/thumbnails/34.jpg)
![Page 35: AC Joint dislocation open repair lennard funk](https://reader034.fdocuments.net/reader034/viewer/2022052304/557d5b7fd8b42aba3d8b4bcb/html5/thumbnails/35.jpg)
Phase 1: (Level 1-2 Exercises)
Core stability & Scapula control!
Proprioceptive exercises (minimal weightbearing below 90 degrees)!
Active ROM as comfortable!
Do not force or stretch
No resistance exercises
Phase 2: (Level 2-3 Exercises)
Progress to light resistance exercises as tolerated!
Sports-specific rehabilitation - Plyometrics and pertubation training!
Phase 3: (Level 3+ Exercises)
Regain scapula & glenohumeral stability working for shoulder joint control rather than range!
Gradually Strengthen
POST-OP
![Page 36: AC Joint dislocation open repair lennard funk](https://reader034.fdocuments.net/reader034/viewer/2022052304/557d5b7fd8b42aba3d8b4bcb/html5/thumbnails/36.jpg)
3 WEEKS POST-OP
![Page 37: AC Joint dislocation open repair lennard funk](https://reader034.fdocuments.net/reader034/viewer/2022052304/557d5b7fd8b42aba3d8b4bcb/html5/thumbnails/37.jpg)
RESULTS
Three year period !
55 patients !
12 Acute; 43 Chronic!
Mean age of 29 yrs
Nicoletti, Quin & Funk. Presented at SECEC 2008
FU = Minimum 2yrs!
X-Rays at 3 & 24 months!
29 Type III; 5 Type IV; 19 Type V!
12 Revisions
![Page 38: AC Joint dislocation open repair lennard funk](https://reader034.fdocuments.net/reader034/viewer/2022052304/557d5b7fd8b42aba3d8b4bcb/html5/thumbnails/38.jpg)
RESULTS
SATISFACTION!
85% Pts Satisfied !
!
PAIN:!
PREOP-OP = 10.43(5-15)!
POST-OP = 1.27(0-6)
![Page 39: AC Joint dislocation open repair lennard funk](https://reader034.fdocuments.net/reader034/viewer/2022052304/557d5b7fd8b42aba3d8b4bcb/html5/thumbnails/39.jpg)
RESULTS
![Page 40: AC Joint dislocation open repair lennard funk](https://reader034.fdocuments.net/reader034/viewer/2022052304/557d5b7fd8b42aba3d8b4bcb/html5/thumbnails/40.jpg)
REDUCTION
Mean post-op displacement =15%
BA
Displacement = A/B x 100
![Page 41: AC Joint dislocation open repair lennard funk](https://reader034.fdocuments.net/reader034/viewer/2022052304/557d5b7fd8b42aba3d8b4bcb/html5/thumbnails/41.jpg)
1 FAILURE:
![Page 42: AC Joint dislocation open repair lennard funk](https://reader034.fdocuments.net/reader034/viewer/2022052304/557d5b7fd8b42aba3d8b4bcb/html5/thumbnails/42.jpg)
3 WEEKS POST OP:
![Page 43: AC Joint dislocation open repair lennard funk](https://reader034.fdocuments.net/reader034/viewer/2022052304/557d5b7fd8b42aba3d8b4bcb/html5/thumbnails/43.jpg)
Shoulderdoc.co.uk
![Page 44: AC Joint dislocation open repair lennard funk](https://reader034.fdocuments.net/reader034/viewer/2022052304/557d5b7fd8b42aba3d8b4bcb/html5/thumbnails/44.jpg)
2012 UPDATE
114 Cases over 6 years!
Constant score = 86 (67-100)!
92% returned to previous level sport !
Mean displacement at 28 months = 17%!
Early failures = 2 cases post-trauma!
Late failures = 2 cases post-trauma!
Revisions = 4 cases
![Page 45: AC Joint dislocation open repair lennard funk](https://reader034.fdocuments.net/reader034/viewer/2022052304/557d5b7fd8b42aba3d8b4bcb/html5/thumbnails/45.jpg)
SUMMARY
Open - Repair all structures!
LARS - Strongest, Anatomical, Biological!
My Technique - Modified to Patient!
Results