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      Anatomy and Correlation of the Coracoid Process and Coracoclavicular Ligament Based on Three-Dimensional Computed Tomography Reconstruction and Magnetic Resonance Imaging

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          Abstract

          Background

          The anatomy of the coracoid process and coracoclavicular (CC) ligament have been described and the correlation between them has been assessed based on 3-dimensional computed tomography (CT) reconstruction and magnetic resonance imaging (MRI), which provide a guide for coracoclavicular ligament reconstruction.

          Material/Methods

          Data were collected from 300 patients who underwent both CT and MRI of the shoulder joint from January 2017 to January 2019 at the Jiang’an Hospital of Traditional Chinese Medicine. The coracoid process was observed and classified and parameters of the CC ligament were measured according to different corneal types. All of the statistics were collected and classified by 2 radiologists, and average values were determined.

          Measurements of segments were taken as follows: ab – In the coronal plane, the length of the CC ligament from the central point of the CC ligament at the clavicular attachment to the CC ligament at the center of the CC attachment); ac – The distance from the center point of the CC ligament at the supraclavicular attachment to the acromioclavicular joint; de – In the sagittal plane, the length of the CC ligament from the center of the clavicular attachment to the coracoid attachment point; fg – The maximum diameter of the CC ligament at the anterior and posterior margins of the clavicle attachment; hi – The largest diameter of the CC ligament at the anterior and posterior edge of the coracoid process attachment; dj – The distance of the coracoclavicular ligament from the center point of the coracoid process attachment to the coracoid process tip; kl – The distance in the supraclavicular plane from the coracoclavicular ligament to the subcoracoid process.

          Results

          The analysis showed that there are 5 types of coracoid process: gourd (31%), short rod (20%), long rod (22.3%), wedge (10.3%), and water drop (6.3%). There were statistically significant differences between the lengths of the ac and hi segments in the among the wedge and gourd-type and the short rod and water drop-type coracoid processes. There were statistically significant differences between the lengths of the ab, de, and fg segments in the short rod, gourd, and long rod-type coracoid processes. There were statistically significant differences between the lengths of the ac, fg, hi, dj, and kl segments in the water drop, gourd, and long rod-type coracoid processes.

          Conclusions

          The present study indicated that measurement of the CC ligament and the different shapes of the coracoid process provide an anatomical basis for the diagnosis and treatment of shoulder diseases and the data can be used to improve the safety of CC ligament reconstruction.

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          Most cited references20

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          Complications following arthroscopic fixation of acromioclavicular separations: a systematic review of the literature

          Purpose Over the past decade, a number of arthroscopic or arthroscopically assisted reconstruction techniques have emerged for the management of acromioclavicular (AC) separations. These techniques provide the advantage of superior visualization of the base of the coracoid, less soft tissue dissection, and smaller incisions. While these techniques have been reported to provide excellent functional results with minimal complications, discrepancies exist within the literature. This systematic review aims to assess the rate of complications following these procedures. Methods Two independent reviewers completed a search of Medline, Embase, PubMed, and the Cochrane Library entries up to December 2013. The terms “Acromioclavicular Joint (MeSH)” OR “acromioclavicular* (text)” OR “coracoclavicular* (text)” AND “Arthroscopy (MeSH)” OR “Arthroscop* (text)” were used. Pooled estimates and 95% confidence intervals were calculated assuming a random-effects model. Statistical heterogeneity was quantified using the I2 statistic. Level of evidence IV Results A total of 972 abstracts met the search criteria. After removal of duplicates and assessment of inclusion/exclusion criteria, 12 articles were selected for data extraction. The rate of superficial infection was 3.8% and residual shoulder/AC pain or hardware irritation occurred at a rate of 26.7%. The rate of coracoid/clavicle fracture was 5.3% and occurred most commonly with techniques utilizing bony tunnels. Loss of AC joint reduction occurred in 26.8% of patients. Conclusion Arthroscopic AC reconstruction techniques carry a distinct complication profile. The TightRope/Endobutton techniques, when performed acutely, provide good radiographic outcomes at the expense of hardware irritation. In contrast, graft reconstructions in patients with chronic AC separations demonstrated a high risk for loss of reduction. Fractures of the coracoid/clavicle remain a significant complication occurring predominately with techniques utilizing bony tunnels.
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            Coracoid Process: The Lighthouse of the Shoulder.

            The coracoid process is a hook-shaped bone structure projecting anterolaterally from the superior aspect of the scapular neck. Surgeons often refer to the coracoid process as the "lighthouse of the shoulder" given its proximity to major neurovascular structures such as the brachial plexus and the axillary artery and vein, its role in guiding surgical approaches, and its utility as a landmark for other important structures in the shoulder. The coracoid also serves as a critical anchor for many tendinous and ligamentous attachments. These include the tendons of the pectoralis minor, coracobrachialis, and short head of the biceps brachii muscles, and the coracoclavicular, coracohumeral, coracoacromial, and transverse scapular ligaments. Consequently, the coracoid and its associated structures are linked to numerous shoulder pathologic conditions. This article will detail the anatomy of the coracoid and its associated structures and review the clinical and radiologic findings of corresponding pathologic conditions in this region with original illustrations and multimodality imaging examples. Highlighted in this article are the coracoclavicular joint, the classification and management of coracoid fractures, subcoracoid impingement, the coracoacromial arch and subacromial impingement, the coracohumeral ligament and the biceps pulley, the coracoclavicular ligament and its surgical reconstruction, adhesive capsulitis, the suprascapular notch and suprascapular notch impingement, subcoracoid bursitis, coracoid transfer procedures, and coracoid tumors. A brief summary of the pathophysiology, potential causes, and management options for each of the pathologic entities will also be discussed. ©RSNA, 2016.
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              Quantitative Assessment of the Coracoacromial and the Coracoclavicular Ligaments With 3-Dimensional Mapping of the Coracoid Process Anatomy: A Cadaveric Study of Surgically Relevant Structures

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                Author and article information

                Journal
                Med Sci Monit
                Med Sci Monit
                Medical Science Monitor
                Medical Science Monitor : International Medical Journal of Experimental and Clinical Research
                International Scientific Literature, Inc.
                1234-1010
                1643-3750
                2021
                24 April 2021
                16 February 2021
                : 27
                : e930435-1-e930435-7
                Affiliations
                [1 ]Department of Orthopedics, Jiang’an Hospital of Traditional Chinese Medicine, Yibin, Sichuan, P.R. China
                [2 ]Department of Medicine, Jiang’an Hospital of Traditional Chinese Medicine, Yibin, Sichuan, P.R. China
                [3 ]Department of Internal Medicine, Jiang’an Hospital of Traditional Chinese Medicine, Yibin, Sichuan, P.R. China
                [4 ]Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, P.R. China
                [5 ]Center for Orthopedic Diseases Research, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, P.R. China
                [6 ]Expert Workstation in Luzhou, Luzhou, Sichuan, P.R. China
                [7 ]Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Clinical Base of Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Guangdong, Guangzhou, P.R. China
                Author notes
                Corresponding Author: Lei Zhang, e-mail: zhanglei870722@ 123456126.com
                [A]

                Study Design

                [B]

                Data Collection

                [C]

                Statistical Analysis

                [D]

                Data Interpretation

                [E]

                Manuscript Preparation

                [F]

                Literature Search

                [G]

                Funds Collection

                [*]

                Lan Xin, Jin Luo, Mingying Chen, Bing He and Bi Tang contributed equally to this work

                Article
                930435
                10.12659/MSM.930435
                8080654
                33947821
                fc82b7ae-46b0-49d0-9d2c-2f0f27e89ad8
                © Med Sci Monit, 2021

                This work is licensed under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International ( CC BY-NC-ND 4.0)

                History
                : 11 December 2020
                : 27 January 2021
                Categories
                Clinical Research

                ligaments, articular,magnetic resonance imaging, cine,pathological conditions, anatomical

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