Manejo de la inestabilidad acromioclavicular crónica

ResumenLa articulación acromioclavicular representa el vínculo entre la clavícula y la escápula necesario para que se produzca una dinámica funcional sincronizada. La inestabilidad acromioclavicular crónica supone la producción de cambios en la orientación anatómica de la escápula, situación que condiciona alteraciones en la trayectoria cinemática de los grupos musculares que se pueden traducir finalmente en dolor crónico. Se han descrito una serie de estrategias quirúrgicas para el tratamiento de los pacientes con inestabilidad acromioclavicular crónica sintomática. El abanico de posibilidades contempla técnicas anatómicas y no anatómicas, cirugía abierta y cirugía asistida por artroscopia, injertos biológicos y plastias sintéticas. En el manejo quirúrgico de la inestabilidad acromioclavicular crónica de debe contemplar la reconstrucción de los ligamentos rotos, ya que se acepta que después de 3 semanas de producida la lesión dichas estructuras carecen de potencial de cicatrización.En el presente artículo se presenta una revisión de la literatura en cuanto al manejo de la inestabilidad acromioclavicular crónica.AbstractThe acromioclavicular joint represents the link between the clavicle and the scapula, responsible for the synchronized dynamics of the shoulder girdle. Chronic acromioclavicular joint instability involves the occurrence of changes in the anatomical orientation of the scapula, a situation that leads to changes in muscle kinematics that could result in chronic pain. Several surgical strategies for the management of patients with chronic and symptomatic acromioclavicular joint instability have been described. The range of possibilities includes anatomical and non-anatomical techniques, open and arthroscopy-assisted surgery, and biological and synthetic grafts. Surgical management of chronic acromioclavicular joint instability should involve the reconstruction of the torn ligaments, as it is accepted that after 3 weeks from the injury, these structures lack healing potential.This paper describes a review of the literature as regards to the management of chronic acromioclavicular instability

Management of chronic unstable acromioclavicular joint injuries

The acromioclavicular joint represents the link between the clavicle and the scapula, which is responsible for the synchronized dynamic of the shoulder girdle. Chronic acromioclavicular joint instability involves changes in the orientation of the scapula, which provokes cinematic alterations that might result in chronic pain. Several surgical strategies for the management of patients with chronic and symptomatic acromioclavicular joint instability have been described. The range of possibilities includes anatomical and non-anatomical techniques, open and arthroscopy-assisted procedures, and biological and synthetic grafts. Surgical management of chronic acromioclavicular joint instability should involve the reconstruction of the torn ligaments because it is accepted that from three weeks after the injury, these structures may lack healing potential. Here, we provide a review of the literature regarding the management of chronic acromioclavicular joint instability. Expert opinion, Level V

Toxicity of malathion during Senegalese sole, Solea senegalensis larval development and metamorphosis: Histopathological disorders and effects on type B esterases and CYP1A enzymatic systems

The toxicity of malathion to Solea senegalensis was studied in a static renewal bioassay during its first month of larval life (between 4 and 30 dph). Through the use of different biomarkers and biochemical, cellular and molecular approaches (inhibition of cholinesterases [ChEs], changes in cytochrome P450-1A [CYP1A] and the study of histopathological alterations), the effects of three concentrations of malathion (1.56, 3.12, and 6.25 mu g/L) have been analyzed. In subacute exposure, malathion inhibited cholinesterase activities (AChE, BChE, CbE) in a dose- and time-dependent manner, ranging the inhibition percentage from 20% to 90%. However, the expression levels of CYP1A and AChE transcripts or proteins were not modified. Additionally, exposure to malathion provoked histopathological alterations in several organ systems of Senegalese sole in a time- and dose dependent way, namely disruption of parenchymal architecture in the liver, epithelial desquamation, pyknotic nuclei and steatosis in the intestine, disorganization of supporting cartilage, and sings of hyperplasia and hypertrophy in the gills and degeneration of the epithelial cells from the renal tubules. Malathion exposure also provoked strong disorganization of cardiac fibers from the heart. The findings provide evidence that exposure to sublethal concentrations of malathion that provoked serious injury to the fish S. senegalensis, were below the expected environmental concentrations reported in many other ecosystems and different fish species,revealing a higher sensitivity for Solea senegalensis to malathion exposure, thus reinforcing its use as sentinel species for environmental pollution in coastal and estuarine environments

Management of chronic unstable acromioclavicular joint injuries

Abstract The acromioclavicular joint represents the link between the clavicle and the scapula, which is responsible for the synchronized dynamic of the shoulder girdle. Chronic acromioclavicular joint instability involves changes in the orientation of the scapula, which provokes cinematic alterations that might result in chronic pain. Several surgical strategies for the management of patients with chronic and symptomatic acromioclavicular joint instability have been described. The range of possibilities includes anatomical and non-anatomical techniques, open and arthroscopy-assisted procedures, and biological and synthetic grafts. Surgical management of chronic acromioclavicular joint instability should involve the reconstruction of the torn ligaments because it is accepted that from three weeks after the injury, these structures may lack healing potential. Here, we provide a review of the literature regarding the management of chronic acromioclavicular joint instability. Level of evidence Expert opinion, Level V

Arthroscopic-Assisted Management of Unstable Distal-Third Clavicle Fractures: Conoid Ligament Reconstruction and Fracture Cerclage With Sutures

Surgical treatment is usually indicated for the management of Neer type IIB fractures of the distal third of the clavicle. These unstable injuries have shown a rate of nonunion that oscillates around 30% to 45% when managed conservatively, and surgical strategies often require a second operation for implant removal. We describe an arthroscopic-assisted technique for the treatment of Neer type IIB unstable distal-third clavicle fractures that overcomes the issues related to open surgery, metal hardware, and implant irritation. This technique increases the load to failure of the construct by means of adding a synthetic conoid ligament reconstruction with a nonrigid suspension device, and it allows the diagnosis and treatment of associated glenohumeral injuries. Our technique incorporates a fracture interfragmentary fixation with sutures, thus avoiding a second operation for implant removal

Management of chronic unstable acromioclavicular joint injuries

The acromioclavicular joint represents the link between the clavicle and the scapula, which is responsible for the synchronized dynamic of the shoulder girdle. Chronic acromioclavicular joint instability involves changes in the orientation of the scapula, which provokes cinematic alterations that might result in chronic pain. Several surgical strategies for the management of patients with chronic and symptomatic acromioclavicular joint instability have been described. The range of possibilities includes anatomical and non-anatomical techniques, open and arthroscopy-assisted procedures, and biological and synthetic grafts. Surgical management of chronic acromioclavicular joint instability should involve the reconstruction of the torn ligaments because it is accepted that from three weeks after the injury, these structures may lack healing potential. Here, we provide a review of the literature regarding the management of chronic acromioclavicular joint instability. Expert opinion, Level V

Anatomic Reconstruction of Chronic Coracoclavicular Ligament Tears: Arthroscopic-Assisted Approach With Nonrigid Mechanical Fixation and Graft Augmentation

It has recently been suggested that all coracoclavicular ligament tears could be considered for surgery because nonoperative management might result in irreversible changes in the scapular position that could lead to muscle kinematic alterations that would perturb the shoulder girdle function and result in pain. In this technical note we describe an anatomic technique for the treatment of chronic coracoclavicular ligament tears that overcomes the issues related to open surgery, metal hardware, the inferior resistance to secondary displacement of only grafting and nonanatomic techniques, and the saw effect and anterior loop translation that can be seen in systems that surround the base of the coracoid. Our technique incorporates the use of a tendon graft and a nonrigid mechanical stabilizer that protects the graft from stretching during the process of healing and integration into bone, guaranteeing the maintenance of a reduced acromioclavicular joint

Horizontal and Vertical Stabilization of Acute Unstable Acromioclavicular Joint Injuries Arthroscopy-Assisted

We describe the technical aspects of an arthroscopy-assisted procedure indicated for the management of acute unstable acromioclavicular joint injuries, consisting of a synthetic augmentation of both the coracoclavicular and acromioclavicular ligaments, that anatomically reproduces the coracoclavicular biomechanics and offers fixation that keeps the torn ends of the ligaments facing one another, thus allowing healing of the native structures without the need for a second surgical procedure for metal hardware removal