Basic ScienceBiomechanical evaluation of a coracoclavicular and acromioclacicular ligament reconstruction technique utilizing a single continuous intramedullary free tendon graft
Section snippets
Specimens
Ten matched pairs of fresh frozen cadaveric shoulders (20 shoulders) were used. There were 4 males and six females with an average age of 66.7 ± 12.3 years (range, 52-87). All specimens underwent dual-emission x-ray absorptiometry (DEXA) and were thawed for 24 hours prior to testing. No specimens had any deformity. Thawed fresh-frozen human semi-tendinous allografts were utilized for ligament reconstruction. The ligament-intact potted specimens were placed in a custom shoulder testing system
Results
Age (P = .83) and bone mineral density (P = .66) were not significantly different between the groups or paired shoulders, respectively. Superior-inferior translation showed no difference at 5 N of tensioning between intact and CC-only reconstructions at 5 N (3.2 vs 2.7 mm, P = .43) or 10 N loads (5.9 vs 4.2 mm, P = .20). At 5 N of tensioning, there was no significant difference in superior-inferior translation of intact specimens versus AC/CC reconstructions at 5 N and 10 N loads (2.7 vs 2.2
Discussion
Biomechanical studies have shown that the AC ligaments are important in providing anterior-posterior stability to the AC joint. Both Urist22 and Dawson et al3 showed that when the AC ligament and capsule was sectioned, there was significantly greater A-P translation of the AC joint. Furthermore, Debski et al demonstrated that forces upon the CC ligaments increased after disrupting the AC joint via sectioning of the AC ligament and capsule when loading occurred in the A-P direction.5 In another
Conclusion
This investigation reports on the biomechanical properties of a new method of AC and CC ligament reconstruction using a single free tendon graft which passes through the intramedullary canal of the clavicle. The reconstruction demonstrated restoration of translational stability of the AC joint in both the A-P and S-I directions. Furthermore, standard CC ligament reconstruction was unable to recreate A-P translational stability back to the intact state.
Disclaimer
None of the authors, their immediate families, and any research foundation with which they are affiliated received any financial payments or other benefits from any commercial entity related to the subject of this article.
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Acromioclavicular reconstruction techniques after acromioclavicular joint injuries: A systematic review of biomechanical studies
2023, Clinical BiomechanicsCitation Excerpt :At least during unidirectional loading, but preferably also during scapular rotations, as these also belong to the physiological movements of the shoulder. In this review, two studies met four out of four criteria (Hislop et al., 2019; Weiser et al., 2017), seven studies met three out of four (Beitzel et al., 2014; Dyrna et al., 2018; Freedman et al., 2010; Garg et al., 2013; Lädermann et al., 2013; Peeters et al., 2020; Schär et al., 2019), eight met two out of four (Abrams et al., 2013; Dyrna et al., 2018; Grutter and Petersen, 2005b; Martetschläger et al., 2013; Morikawa et al., 2020b; Saier et al., 2015; Shin et al., 2014; Theopold et al., 2019) and two studies met one criterion (Gonzalez-Lomas et al., 2010; Ibrahim et al., 2020). Next, we evaluated an AC capsule/ligament reconstruction, sole or in combination with CC reconstruction after AC joint injury.
Arthroscopic Coracoclavicular Fixation Technique Using Multiple All-Suture Anchors
2019, Arthroscopy TechniquesArthroscopic Coracoclavicular Fixation Using Multiple Low-Profile Devices in Acute Acromioclavicular Joint Dislocation
2019, Arthroscopy - Journal of Arthroscopic and Related SurgeryDisorders of the Acromioclavicular Joint
2016, Rockwood and Matsen’s The ShoulderBiomechanical evaluation of coracoid tunnel size and location for coracoclavicular ligament reconstruction
2015, Arthroscopy - Journal of Arthroscopic and Related SurgeryCitation Excerpt :Before testing, the cortical button was arranged so that it rested on the inferior surface of the coracoid perpendicular to the medial-lateral line. With a preload of 5 N, the construct was cyclically loaded from 5 to 25 N for 30 cycles and was then loaded to failure by a method similar to that described previously.9,13 All testing was performed at a rate of 20 mm/min.
Percutaneous endobutton fixation of acute acromioclavicular joint injuries and lateral clavicle fractures
2019, Journal of Clinical Orthopaedics and TraumaCitation Excerpt :Perhaps a screening MRI can be performed in suspicious high grade ACJ injuries to exclude such concomitant GH pathology before employing this percutaneous technique. Another downside is that this method does not allow for repair of the ruptured delto-trapezial fascia or reconstruction of the injured ACJ ligaments, which some believe is crucial for a good clinical outcome.22–25 However, it should be noted that the popular all-arthroscopic and mini-open methods of CC-ligament reconstructions do not allow for these either and their long term clinical results are still good.1,7,26