Triple-bundle anatomical reconstruction using the coracoacromial ligament and the short head of biceps tendon to stabilize chronic acromioclavicular joint dislocations: A cadaver feasibility study

Hanneur, Malo Le; Delgrande, Damien; Lafosse, Thibault; Werthel, Jean‐David; Hardy, P.; Elhassan, Bassem T.

doi:10.1016/j.otsr.2017.11.003

Cited by 6 publications

(6 citation statements)

References 24 publications

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“…In a preliminary anatomic study that we conducted in 12 paired cadaveric shoulders, the SCT graft was found to be long enough in all specimens to reconstruct both CC ligaments in such a fashion, with a mean excess length of 39.9 6 5.7 mm (range, 32.2-47 mm) medially and 37.6 6 5 mm (range, 31-45.1 mm) laterally. 22 These findings were confirmed during the present study, since the reconstruction could be performed in all cases. In addition, with the SCT restoring the CC complex, the CAL may be used to reconstruct the AC ligamentous complex, with its proximal end detached from the coracoid tip to be transferred posteriorly to the distal clavicle.…”

Section: Discussionsupporting

confidence: 86%

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Biomechanical Comparison of Anatomic and Extra-Anatomic Reconstruction Techniques Using Local Grafts for Chronic Instability of the Acromioclavicular Joint

et al. 2018

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Background: Anatomic reconstruction techniques are increasingly used to address cases of acromioclavicular (AC) joint chronic instability. These usually involve an additional surgical site for autograft harvesting or an allograft. Purpose: To describe a triple-bundle (TB) anatomic reconstruction using on-site autografts, the semiconjoint tendon (SCT) and the coracoacromial ligament (CAL), and compare its primary stability to the native AC joint ligamentous complex and to a modified Weaver-Dunn (WD) reconstruction. Study Design: Controlled laboratory study. Methods: Intact AC joints of 12 paired cadaveric shoulders were tested for anterior, posterior, and superior translations under cyclic loading with a servo-hydraulic testing system. One shoulder from each pair was randomly assigned to the TB group, where 2 SCT strips were used to reconstruct the coracoclavicular ligaments while the distal end of the CAL was transferred to the distal extremity of the clavicle to reconstruct the AC ligaments; the other shoulder received a modified WD reconstruction. After reconstruction, the same translational testing was performed, with an additional load-to-failure test in the superior direction. Results: In both the TB and the WD groups, no significant differences were found before and after reconstruction in terms of joint displacements after cyclic loading, in all 3 directions. Compared with the WD reconstruction, the TB repair resulted in significantly lower displacements in both the anterior (ie, 2.59 6 1.08 mm, P = .011) and posterior (ie, 10.17 6 6.24 mm, P = .014) directions, but not in the superior direction. No significant differences were observed between the 2 reconstructions during the load-to-failure testing, except for the displacement to failure, which was significantly smaller (ie, 5.34 6 2.97 mm) in the WD group (P = .037). Conclusion: Anterior, posterior, and superior displacements after an anatomic reconstruction of the AC joint complex using the SCT and CAL as graft material were similar to those of native AC joints and significantly smaller in the axial plane than those of AC joints after a WD repair. Clinical Relevance: An anatomic reconstruction is achievable using the CAL and the SCT as on-site graft materials, providing satisfactory initial stability and thereby allowing earlier mobilization.

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Section: Discussionsupporting

confidence: 86%

“…35 In a preliminary anatomic study, these dimensions were determined to be sufficient for the reconstruction. 22 This lateral SCT band was then divided longitudinally into two 6 mm–wide strips, and each of them was prepared with a No. 2 suture (FiberWire; Arthrex) in a Krackow fashion.…”

Section: Methodsmentioning

confidence: 99%

Biomechanical Comparison of Anatomic and Extra-Anatomic Reconstruction Techniques Using Local Grafts for Chronic Instability of the Acromioclavicular Joint

et al. 2018

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“…Although the use of CA ligament autograft has not previously been described in the setting of RCR, it has a successful track record when used for stabilizing procedures for acromioclavicular separation, such as the modified Weaver-Dunn procedure. 5 Previous anatomic dissections of the CA ligament have approximated the length at nearly 46 mm, with a width of 30 mm at the coracoid and 15 mm at the acromion. 6 Whereas the use of the CA ligament has been assessed in biomechanical studies of the Weaver-Dunn procedure, no previous biomechanical studies have been performed on the use of the CA ligament in RCR.…”

Section: Discussionmentioning

confidence: 99%

Rotator Cuff Repair Using Coracoacromial Ligament Autograft for Supraspinatus Footprint Augmentation

Vaudreuil

Powers²,

Limpisvasti

2022

Arthroscopy Techniques

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Failure of rotator cuff repair can be a disastrous clinical outcome. Although failure is a multifactorial issue, recent interest has piqued in understanding the biology of the insertional components of the supraspinatus and infraspinatus at the footprint. When the torn tendon is of poor quality, especially if it is diminutive or thin, rotator cuff repair augmentation should be considered to aid in long-term healing. Various allograft options have been described in the past, and more recently, xenografts and synthetics have become more commonly used. The use of autografts in the treatment of insertional footprint deficiency has great potential; however, few grafts have been described. This study describes the surgical technique for footprint augmentation in arthroscopic supraspinatus repair using harvested autologous coracoacromial ligament tissue.

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“…Le Hanneur et al described a technique using a split short head of the biceps tendon in addition to a CA ligament transfer. 75 The split tendon was fixed to the clavicle in an anatomic position to account for the individual position of the conoid and trapezoid ligaments. A biomechanical comparison utilizing the above mentioned technique showed significantly lower displacements after cyclic loading in the axial plane compared to a modified Weaver-Dunn procedure.…”

Section: Dynamic Fixation With Conjoined Tendonsmentioning

confidence: 99%

<p>Optimal Management of Acromioclavicular Dislocation: Current Perspectives</p>

Nolte¹,

Lacheta²,

Dekker³

et al. 2020

ORR

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Injuries to the acromioclavicular (AC) joint are common and mostly involve younger, male individuals. Whereas the majority of AC joint dislocations can be treated nonoperatively with a trial of immobilization, pain medication, cryotherapy, and physiotherapy, there are patients that do not respond well to conservative management and may require surgical treatment. Identifying and treating these patients according to the type and chronicity of AC joint dislocation is paramount. To date, a myriad of surgical techniques have been proposed to address unstable AC joint dislocations and are indicative of the uncertainty that exists in optimal management of these injuries. Historically research has focused on the restoration of the coracoclavicular ligament complex. However, recently the importance of the acromioclavicular capsule and ligaments has been emphasized. This review aims to provide the reader with an overview of current treatment strategies and research, as well as future perspectives.

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Triple-bundle anatomical reconstruction using the coracoacromial ligament and the short head of biceps tendon to stabilize chronic acromioclavicular joint dislocations: A cadaver feasibility study

Abstract: Not applicable - cadaver study.

Cited by 6 publications

References 24 publications

Biomechanical Comparison of Anatomic and Extra-Anatomic Reconstruction Techniques Using Local Grafts for Chronic Instability of the Acromioclavicular Joint

Biomechanical Comparison of Anatomic and Extra-Anatomic Reconstruction Techniques Using Local Grafts for Chronic Instability of the Acromioclavicular Joint

Rotator Cuff Repair Using Coracoacromial Ligament Autograft for Supraspinatus Footprint Augmentation

<p>Optimal Management of Acromioclavicular Dislocation: Current Perspectives</p>

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