options
1. conservative. the results of conservative equal surgical
In type 3. 4 , 5 ,6 surgical might have better results
Patient was advised surgery elsewhere and had a relative with symptomatic ?acjt subluxation with symptoms and was pushing for surgery. Not sure the indication that pt wants surgery as an indication is acecptable. Was given independant literature and time to rethink. Came back saying surgery is what he wants.
So plan was for stabilisation with implants (dog bone) and semitendinosis graft for Conoid, Trapezoid and anterior and superior acjt lig reconstruction. 5 mm excision of lateral end of clavicle was done to avoid acjt symptoms lateral. there are reports of leaving the joint alone and also removing only the acjt disc. only the conoid was drilled thru clvicle as was worried about 3 drill holes in clavice and fracture seen in another pt. A small superior subscap flap tear was seen on scopy which was missed on MRI
The 2 red circles are where the graft was knotted and reinforced with fibre wire sutures
Few questions remain if surgical tt is planned
Do we tighten the dog bone first or the graft
Excision of acjt- was it necessary
Weaver and Dunn procedure is abandoned
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