Biomechanical Comparison of Arthroscopic Repairs for Acromioclavicular Joint Instability

Beitzel, Knut; Obopilwe, Elifho; Chowaniec, David M.; Niver, Genghis E.; Nowak, Michael; Hanypsiak, Bryan T.; Guerra, James J.; Arciero, Robert A.; Mazzocca, Augustus D.

doi:10.1177/0363546511416784

Cited by 106 publications

(124 citation statements)

References 21 publications

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“…Interestingly, the modified technique using two tunnels at the clavicle (GR-DT) showed no superiority compared to the GR-ST in terms of horizontal or vertical translation. A previous study comparing a modified cortical button device with two tunnels at the clavicle showed a tendency of improvement although there have also been no significant advantages seen [1]. The modified Weaver-Dunn was chosen as the ''positive control'' in accordance with previously published studies because it is a widely used technique that serves as a reference for subsequent development of current procedures [2,10,15,23].…”

Section: Discussionmentioning

confidence: 99%

Biomechanical properties of repairs for dislocated AC joints using suture button systems with integrated tendon augmentation

Beitzel

Obopilwe

Chowaniec

et al. 2011

Knee Surg Sports Traumatol Arthrosc

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Section: Discussionmentioning

confidence: 99%

Biomechanical properties of repairs for dislocated AC joints using suture button systems with integrated tendon augmentation

Beitzel

Obopilwe

Chowaniec

et al. 2011

Knee Surg Sports Traumatol Arthrosc

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“…1 Previous studies showed the biomechanical properties and satisfactory clinical outcomes of suture button devices for the treatment of acute AC joint dislocations. [2][3][4] With treatment performed in an early stage after the initial injury, the clavicle and acromion are approached in a physiological way to promote healing of the AC and CC ligaments. The further development of fixation devices consisting of 2 "dog-bone" buttons in combination with 2 FiberTapes (Arthrex, Naples, FL) required a tunnel diameter of only 2.4 mm and therefore advanced the safety of previous arthroscopic techniques.…”

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confidence: 99%

Arthroscopically Assisted Treatment of Acute Dislocations of the Acromioclavicular Joint

Braun

Beitzel

Buchmann

2015

Arthroscopy Techniques

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Arthroscopically assisted treatments for dislocations of the acromioclavicular joint combine the advantages of exact and visually controlled coracoid tunnel placement with the possibility of simultaneous treatment of concomitant injuries. The clinical results of previous arthroscopically assisted techniques have been favorable at midterm and long-term follow-up. The presented surgical technique combines the advantages of arthroscopically positioned coracoclavicular stabilization with an additional suture cord cerclage of the acromioclavicular joint capsule for improved horizontal stability.

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“…1,3,4,7,[10][11][12][13]16,19,21 Recently, the use of tendon grafts (TGs), both autografts and allografts, has gained increased popularity for reconstructing CC ligaments to treat chronic symptomatic AC joint separation. [1][2][3]7,12 The TG technique is commonly performed with the 2 limbs of a single graft passed through the two 6.0-mm tunnels in the clavicle and fixed with tenodesis screws. 12,13 More recently, the TG technique was reported to be performed with smaller tunnel diameters of 5.0 mm.…”

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Biomechanical Consequences of Coracoclavicular Reconstruction Techniques on Clavicle Strength

et al. 2014

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Objectives: Lateral clavicle fractures have been reported following coracoclavicular (CC) ligament reconstruction with bone tunnels through the clavicle. Several techniques for CC reconstruction with different drill-hole measurements have been described. Our objective was to evaluate clavicle weakening related to tunnel diameters for common CC-reconstruction techniques. Methods: Testing was performed on 2 groups of 18 matched pair clavicles, which were randomly distributed between groups. There were no significant differences between the groups regarding bone mess density (BMD), clavicle width, age, and gender. One clavicle from each pair was prepared according to one of two reconstruction techniques; the contralateral clavicle was left intact. Both techniques placed 2 tunnels through the medial clavicle, 30 mm and 45 mm from the lateral border. Group 1 (mean age: 53, range: 44-63; mean BMD: 0.48, range: 0.39-0.59) was prepared with 2.4 mm tunnels and augmentation devices. Group 2 (mean age: 56, range: 45-63; mean BMD: 0.47, range 0.35-0.61) was prepared with 6.0 mm tunnels with hamstring grafts and tenodesis screws. A 3-point bending load was applied to the distal clavicles at 15 mm/min until failure. Ultimate failure load and anteriorposterior width 45 mm medial from the lateral border were recorded for each specimen. Strength reduction was determined as the percent reduction in ultimate failure load between paired intact and surgically prepared clavicles. Relative tunnel size was determined as the quotient of tunnel diameter and clavicle width. An independent observer performed all clavicle width measurements. Non-parametric statistics were used (MWU, Kendall's Tau). Results: The 6.0 mm technique significantly reduced clavicle strength relative to intact (p = 0.02) and caused significantly more strength reduction than the 2.4 mm technique (p = 0.02) (Figure). The 2.4 mm technique was not significantly different from intact. All but one fractures occurred at the medial tunnel. Clavicle width at the medial hole varied highly (mean: 18.1 mm, range: 12.3 -27.1 mm). There was a significant approximately linear correlation between clavicle width and strength reduction (p = 0.04, tau = -0.36) and between relative tunnel size and strength reduction (p < 0.01, tau = 0.51). Therefore, clavicle strength reductions of 30% and 50% relative to the intact state can be expected with relative tunnel diameters of 34.5% and 49.8% of the clavicle width, respectively. The intraobserver correlation coefficient of the width measurement was excellent (0.99; 95% CI: 0.98 -0.99). Conclusion: Coracoclavicular ligamentous reconstruction with 6.0 mm tunnels, graft, and tenodesis screws caused significantly greater decreases in the strength of the clavicle when compared to 2.4 mm tunnels with augementation devices and undrilled controls. Additionally, strength reductions correlated highly with the ratio of tunnel width relative to overall clavicle width. This information can help optimize techniques for reconstructing unstable distal clav...

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Biomechanical Comparison of Arthroscopic Repairs for Acromioclavicular Joint Instability

Abstract: Single clavicular tunnel arthroscopic reconstructions of the coracoacromial ligaments show good biomechanical results.

Cited by 106 publications

References 21 publications

Biomechanical properties of repairs for dislocated AC joints using suture button systems with integrated tendon augmentation

Biomechanical properties of repairs for dislocated AC joints using suture button systems with integrated tendon augmentation

Arthroscopically Assisted Treatment of Acute Dislocations of the Acromioclavicular Joint

Biomechanical Consequences of Coracoclavicular Reconstruction Techniques on Clavicle Strength

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