Anatomic variation of the coracoacromial ligament: A macroscopic and microscopic cadaveric study

The coracoacromial ligament: Morphology and study of acromial enthesopathy

“…In a previously reported study, no significant relationship was found between the morphology of the CAL being either Y-shaped, quadrangular, or 3-banded and the incidence of degenerative changes/spur formation. 21 Whether this ligamentous morphology causes impingement or is a function of impingement is unclear. The preferential location of spurs in the ALB suggests that it is a major load-bearing structure.…”

“…The ligament thus completes the coracoacromial arch, which has been described and implicated in shoulder pathology. 6,9,12,13,21,25,30,32 Brodie 2 first described the CAL differentiating into two distinct bands or ligaments that attach at different points on the coracoid process and noted that these two bands are separated by a diaphanous membrane. These distinguishable bands of the CAL were described as medial and lateral, the lateral band being stronger and thicker than the medial band.…”

“…1,3,4,8,9,14,17,20,21,25,27,28,30,31 The CAL may form a small ridge at the inferolateral margin of the acromion that contributes toward rotator cuff pathology. Acromion enthesopathy (spur formation within the CAL at the anterior margin of the acromion) has been attributed to forces transmitted through the CAL via traction.…”

Biomechanics of coracoacromial arch modification

“…11,13,18,19,21,24,25 Holt and Allibone 11 classified the CAL into quadrangular, Y-shaped, and broad band ligaments. In addition, a new variant of the CAL was described, a multiple-banded ligament composed of 3 bands and 2 diaphanous regions.…”

“…3,7 Previous studies have investigated the morphologic characteristics of the CAL. 11,13,19 Usually, the CAL will have 2 distinct bands, medial and lateral, with a variable diaphanous region in between. A cadaveric study proved that anatomic reattachment of the CAL after anterior acromioplasty was impossible.…”