{"id":32594,"date":"2019-07-29T21:05:21","date_gmt":"2019-07-29T20:05:21","guid":{"rendered":"https:\/\/www.academiaclinicadragao.com\/uncategorized\/articulacao-acromio-clavicular\/"},"modified":"2019-07-29T21:05:21","modified_gmt":"2019-07-29T20:05:21","slug":"articulacao-acromio-clavicular","status":"publish","type":"post","link":"https:\/\/www.academiaclinicadragao.com\/en\/ombro\/articulacao-acromio-clavicular\/","title":{"rendered":"Anatomic or non-anatomic reconstruction in patients with chronic instability of the acromioclavicular joint. What is the best approach?"},"content":{"rendered":"

Reconstru\u00e7\u00e3o anat\u00f3mica ou n\u00e3o anat\u00f3mica em pacientes com instabilidade cr\u00f3nica da articula\u00e7\u00e3o acr\u00f3mio-clavicular. Qual a melhor abordagem?<\/strong><\/h2>\n

\u00a0<\/strong><\/p>\n

Anatomic and non-anatomic reconstruction improves post-operative outcomes in chronic acromio-clavicular instability: a systematic review<\/strong><\/h3>\n

Francisco Xar\u00e1-Leite, Renato Andrade, Pedro Silva Moreira, Lu\u00eds Coutinho, Olufemi R. Ayeni, Nuno Sevivas, Jo\u00e3o Espregueira-Mendes<\/strong><\/h3>\n

\u00a0<\/strong><\/p>\n

Em que consistiu o estudo?<\/strong><\/h4>\n

Revis\u00e3o sistem\u00e1tica da literatura que teve como objetivo analisar os resultados da reconstru\u00e7\u00e3o anat\u00f3mica e n\u00e3o-anat\u00f3mica da articula\u00e7\u00e3o acr\u00f3mio-clavicular (AC) em pacientes com instabilidade AC cr\u00f3nica e determinar qual t\u00e9cnica \u00e9 superior.<\/p>\n

Um total de 28 estudos envolvendo 799 participantes foram inclu\u00eddos na revis\u00e3o. As t\u00e9cnicas de reconstru\u00e7\u00e3o anat\u00f3mica inclu\u00edram a utiliza\u00e7\u00e3o de enxertos tendinosos ou sint\u00e9ticos de origem aut\u00f3loga ou alogr\u00e1fica. As reconstru\u00e7\u00f5es n\u00e3o-anat\u00f3mica inclu\u00edram maioritariamente as t\u00e9cnicas de Weaver-Dunn<\/em> ou Weaver-Dunn<\/em> modificado.<\/p>\n

\"reconstru\u00e7\u00e3o<\/p>\n

 <\/p>\n

E a que resultados se chegou?<\/strong><\/h4>\n
    \n
  • Ambas as abordagens anat\u00f3mica e n\u00e3o-anat\u00f3mica da articula\u00e7\u00e3o acr\u00f3mio-clavicular<\/strong> resultaram em melhorias significativas na dor em fun\u00e7\u00e3o do ombro dos pacientes em instabilidade cr\u00f3nica da articula\u00e7\u00e3o AC.<\/li>\n
  • A taxa de falha cir\u00fargica foi semelhante quando usado a reconstru\u00e7\u00e3o anat\u00f3mica (7.5%) ou n\u00e3o-anat\u00f3mica (8.5%).<\/li>\n
  • Apesar de ambas as abordagens anat\u00f3mica e n\u00e3o-anat\u00f3mica da articula\u00e7\u00e3o acr\u00f3mio-clavicular<\/strong> mostrarem resultados positivos, os estudos comparativos mostram uma tend\u00eancia para melhores resultados na reconstru\u00e7\u00e3o anat\u00f3mica.<\/li>\n<\/ul>\n

     <\/p>\n

    O que ficamos a saber com este trabalho?<\/strong><\/h4>\n
      \n
    • Ambas as reconstru\u00e7\u00f5es anat\u00f3mica e n\u00e3o-anat\u00f3mica da articula\u00e7\u00e3o acr\u00f3mio-clavicular<\/strong> mostram resultados positivos.<\/li>\n
    • Uma conclus\u00e3o definitiva de qual a melhor abordagem n\u00e3o foi poss\u00edvel ser obtida.<\/li>\n
    • At\u00e9 ser comprovado com base em evidencia cient\u00edfica robusta que uma abordagem \u00e9 superior \u00e0 outra, o cirurgi\u00e3o deve tomar a decis\u00e3o de qual t\u00e9cnica ir\u00e1 usar baseando-se na sua experi\u00eancia e prefer\u00eancia do paciente.<\/li>\n<\/ul>\n

      Radiological and clinical outcomes.<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
      REFERENCE<\/strong><\/td>\nSub-groups<\/strong><\/td>\nPain (VAS)<\/strong><\/td>\nReturn to same level work<\/strong><\/td>\nPost-op RX C-C distance<\/strong><\/td>\nROM (\u00ba)<\/strong><\/td>\n<\/tr>\n
      Pre<\/strong><\/td>\nPost<\/strong><\/td>\n%<\/strong><\/td>\nAvg time (mo)<\/strong><\/td>\n(mm)<\/strong><\/td>\nDifference to uninjured side (mm)<\/strong><\/td>\n<\/td>\n<\/tr>\n
      w\/out stress<\/strong><\/td>\nw\/ stress (10kg)<\/strong><\/td>\nw\/out stress<\/strong><\/td>\nw\/ stress (10kg)<\/strong><\/td>\n<\/tr>\n
      Lopez-Alameda, 2018 [28]<\/td>\n1) ModWD<\/td>\n6.9<\/td>\n1.8<\/td>\n96<\/td>\nNR<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\n<\/tr>\n
      Kocaoglu, 2017 [20]<\/td>\n1) ModWD<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\nNR<\/td>\n15.6<\/td>\nNR<\/td>\n3.3<\/td>\nNA<\/td>\n<\/tr>\n
      2) AUTOgraft (PL)<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\nNR<\/td>\n13.9<\/td>\nNR<\/td>\n1.1<\/td>\nNA<\/td>\n<\/tr>\n
      Mucciolli 2016 [30]<\/td>\n1) LARS<\/td>\nNA<\/td>\nNA<\/td>\nNR<\/td>\n5<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\n<\/tr>\n
      Spencer 2016 [42]<\/td>\n1) ModWD<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\n<\/tr>\n
      2) ALLOgraft tunnel<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\n<\/tr>\n
      3) ALLOgraft loop<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\n<\/tr>\n
      4) Synthetic + ALLO loop<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\n<\/tr>\n
      Tauber 2016 [47]<\/td>\n1) AUTOgraft (Gr, SB)<\/td>\nNR<\/td>\n2.13<\/td>\nNA<\/td>\nNA<\/td>\nNR<\/td>\n13.1 \u00b1 5.4<\/td>\nNR<\/td>\n6 \u00b1 4.6<\/td>\nNA<\/td>\n<\/tr>\n
      2) AUTOgraft (ST, TB)<\/td>\nNR<\/td>\n0.93<\/td>\nNA<\/td>\nNA<\/td>\nNR<\/td>\n10.7 \u00b1 5<\/td>\nNR<\/td>\n3.1 \u00b1 3.3<\/td>\nNA<\/td>\n<\/tr>\n
      Hegazy 2016 [14]<\/td>\n1) ModWD<\/td>\n4.8 \u00b1 1<\/td>\n1 \u00b1 0.3<\/td>\nNA<\/td>\nNA<\/td>\n13.3 \u00b1 3<\/td>\n15.9 \u00b1 4<\/td>\nNR<\/td>\nNR<\/td>\nAbd 174 \u00b1 4, Flex 171 \u00b1 7, ER 56 \u00b1 9<\/td>\n<\/tr>\n
      2) AUTOgraft (ST)<\/td>\n4.9 \u00b1 0.3<\/td>\n0.4 \u00b1 0.2<\/td>\nNA<\/td>\nNA<\/td>\n11.7 \u00b1 3<\/td>\n12.1 \u00b1 3<\/td>\nNR<\/td>\nNR<\/td>\nAbd 178 \u00b1 2, Flex 179 \u00b1 3, ER 66 \u00b1 6<\/td>\n<\/tr>\n
      Lee 2015 [24]<\/td>\n1) ModWD<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\nNR<\/td>\n11.9<\/td>\nNR<\/td>\n1.7<\/td>\nAbd 163.5, Flex 165.7, ER 50.7, IR 73.3<\/td>\n<\/tr>\n
      Parnes 2015 [32]<\/td>\n1) ALLOgraft (ST)<\/td>\n8.1 \u00b1 1.3<\/td>\n0.58 \u00b1 0.79<\/td>\n100<\/td>\n6<\/td>\nNR<\/td>\nNR<\/td>\nNR<\/td>\n1.0<\/td>\nNA<\/td>\n<\/tr>\n
      Vitali 2015 [55]<\/td>\n1) Vascular<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\n<\/tr>\n
      Saccomanno 2014 [38]<\/td>\n1) AUTOgraft (ST)<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\n<\/tr>\n
      Kumar 2014 [22]<\/td>\n1) ModWD<\/td>\nNA<\/td>\nNA<\/td>\n100<\/td>\n3.5<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\n<\/tr>\n
      2) Surgilig<\/td>\nNA<\/td>\nNA<\/td>\n100<\/td>\n1.5<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\n<\/tr>\n
      Struhl 2014 [44]<\/td>\n1) Double endobutton w\/ continuous loop<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\n8.5 \u00b1 2.4<\/td>\nNR<\/td>\n1.1 \u00b1 1.2<\/td>\nNR<\/td>\nNA<\/td>\n<\/tr>\n
      Virtanen 2014 [54]<\/td>\n1) AUTOgraft (ST & Gr)<\/td>\nNR<\/td>\n1 \u00b1 2 (rest)<\/p>\n

      3 \u00b1 3 (activity)<\/td>\n

      		NR<\/td>\n3.6<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\n<\/tr>\n
      Wang 2014 [57]<\/td>\n1) Conjoined Transfer<\/td>\n4.7<\/td>\n1.2<\/td>\n100<\/td>\n3.7<\/td>\n11.4<\/td>\nNR<\/td>\nNA<\/td>\nAbd 172, Flex 170, ER 56<\/td>\n<\/tr>\n
      Fauci 2013 [11]<\/td>\n1) AUTOgraft (ST)<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\n<\/tr>\n
      2) LARS<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\n<\/tr>\n
      Jensen 2013 [17]<\/td>\n1) AUTOgraft (PL)<\/td>\nNR<\/td>\n4.1 \u00b1 2<\/td>\nNA<\/td>\nNA<\/td>\nNR<\/td>\n24.8<\/td>\n3 \u00b1 2.3*<\/td>\nNR<\/td>\nNA<\/td>\n<\/tr>\n
      Kim 2012 [19]<\/td>\n1) ModWD<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\nNR<\/td>\n8.9 \u00b1 1.6<\/td>\nNR<\/td>\nNR<\/td>\nNA<\/td>\n<\/tr>\n
      Windhamre 2010 [60]<\/td>\n1) WD w\/ PDS braid<\/td>\nNR<\/td>\n0.7 (rest)<\/p>\n

      1 (activity)<\/td>\n

      		NA<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\n<\/tr>\n
      2) WD w\/ hook plate<\/td>\nNR<\/td>\n2.4 (rest)<\/p>\n

      3.7 (activity)<\/td>\n

      		NA<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\n<\/tr>\n
      Fraschini 2010 [12]<\/td>\n1) Vascular<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\n<\/tr>\n
      2) LARS<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\n<\/tr>\n
      Boileau 2010 [5]<\/td>\n1) ModWD<\/td>\nNA<\/td>\nNA<\/td>\n90<\/td>\n3<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\n<\/tr>\n
      Bezer 2009 [4]<\/td>\n1) ModWD<\/td>\nNA<\/td>\nNA<\/td>\n100<\/td>\nNR<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
      Tauber 2009 [46]<\/td>\n1) ModWD<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\n12.3 \u00b1 4<\/td>\n14.9 \u00b1 6<\/td>\nNR<\/td>\nNR<\/td>\nAbd 171 \u00b1 7, Flex 172.5 \u00b1 6, ER 57 \u00b1 7<\/td>\n<\/tr>\n
      2) AUTOgraft (ST)<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\n11.4 \u00b1 3<\/td>\n11.8 \u00b1 3<\/td>\nNR<\/td>\nNR<\/td>\nAbd 176 \u00b1 4, Flex 177 \u00b1 5, ER 63 \u00b1 8<\/td>\n<\/tr>\n
      Ejam 2008 [10]<\/td>\n1) Hook Plate<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\n<\/tr>\n
      Jeon 2007 [18]<\/td>\n1) Surgilig<\/td>\nNA<\/td>\nNA<\/td>\n91<\/td>\n1.25<\/td>\nNR<\/td>\n7<\/td>\nNA<\/td>\nNA<\/td>\n<\/tr>\n
      Adam 2004 [1]<\/td>\n1) ModWD<\/td>\nNA<\/td>\n<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\nnormal\/improved (n=11, 92%), decreased (n=1, 8%)<\/td>\n<\/tr>\n
      Pavlik 2001 [33]<\/td>\n1) ModWD<\/td>\nNA<\/td>\nNA<\/td>\n94<\/td>\nNR<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\n<\/tr>\n
      Dumontier 1995 [8]<\/td>\n1) ModWD<\/td>\nNA<\/td>\nNA<\/td>\n88<\/td>\nNR<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\n<\/tr>\n
      Weinstein 1995 [59]<\/td>\n1) ModWD<\/td>\nNA<\/td>\nNA<\/td>\n78<\/td>\nNR<\/td>\nNA<\/td>\nNA<\/td>\nNA<\/td>\n<\/tr>\n
      <\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

       <\/p>\n

      Legend: \u00a0Abd \u2013 <\/strong>Abduction; A-C<\/strong> \u2013 Acromio-Clavicular; Avg<\/strong> \u2013 Average; C-C<\/strong> \u2013 Coraco-clavicular; ER<\/strong> \u2013 External Rotation; Flex<\/strong> \u2013 Anterior Flexion; Gr<\/strong> – Gracillis; LARS<\/strong> – Ligament Advanced Reinforcement System; Lig<\/strong> \u2013 Ligament; mo<\/strong> \u2013 Months; ModWD<\/strong> \u2013 Modified Weaver-Dunn procedure; PL<\/strong> \u2013 Palmaris Longus; ROM<\/strong> \u2013 Range Of Motion; RX<\/strong> \u2013 Radiological; SB<\/strong> \u2013 Single Bundle; ST<\/strong> \u2013 Semitendinous; TB<\/strong> \u2013 Triple Bundle; VAS<\/strong> \u2013 Visual Analog Scale; WD<\/strong> \u2013 Weaver-Dunn procedure.<\/p>\n

      Este artigo poder\u00e1 ser consultado a revista KSSTA no link abaixo indicado.<\/p>\n

      Xar\u00e1-Leite, F., Andrade, R., Moreira, P.S. et al. Knee Surg Sports Traumatol Arthrosc (2019). <\/a><\/p>\n

      https:\/\/doi.org\/10.1007\/s00167-019-05408-3<\/p>\n

      Sabia que exite uma nova t\u00e9cnica cir\u00fargica para o tratamento da artrose do joelho? Saiba mais no Link<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

      Anatomic or non-anatomic reconstruction in patients with chronic instability of the acromio-clavicular joint. What is the best approach? Anatomic and<\/p>","protected":false},"author":1,"featured_media":32596,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[67,40],"tags":[66,68,69],"_links":{"self":[{"href":"https:\/\/www.academiaclinicadragao.com\/en\/wp-json\/wp\/v2\/posts\/32594"}],"collection":[{"href":"https:\/\/www.academiaclinicadragao.com\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.academiaclinicadragao.com\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.academiaclinicadragao.com\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.academiaclinicadragao.com\/en\/wp-json\/wp\/v2\/comments?post=32594"}],"version-history":[{"count":0,"href":"https:\/\/www.academiaclinicadragao.com\/en\/wp-json\/wp\/v2\/posts\/32594\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.academiaclinicadragao.com\/en\/wp-json\/wp\/v2\/media\/32596"}],"wp:attachment":[{"href":"https:\/\/www.academiaclinicadragao.com\/en\/wp-json\/wp\/v2\/media?parent=32594"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.academiaclinicadragao.com\/en\/wp-json\/wp\/v2\/categories?post=32594"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.academiaclinicadragao.com\/en\/wp-json\/wp\/v2\/tags?post=32594"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}