Biomechanical evaluation of an independent acromioclavicular ligament repair for acromioclavicular joint reconstruction

Abstract

Background A number of surgical techniques for the treatment of acromioclavicular joint separations have been described; however, few have been able to create a strong intra-operative construct that provides minimal joint translation. A biomechanical study was conducted to examine joint translation in an independent acromioclavicular ligament repair. Methods Three variations of a novel independent acromioclavicular ligament repair technique underwent testing using a Sawbones model. The technique involves threading sutures through two acromial bone tunnels in a suture-bridge configuration and anchoring them into the distal clavicle. Three groups of eight specimens underwent reconstruction; group 1 using FiberTape, group 2 using FiberWire and group 3 using FiberTape in a modified (under-over) suture-bridge configuration. Superior, anterior and posterior translation was tested at loads of 10, 20 and 30 N. Results Group 3 repair yielded the least translation in both anterior–posterior and superior–inferior planes, with a two-fold decrease in superior translation compared to groups 1 and 2 (P < .05). Both groups 1 and 3 using FiberTape resulted in significantly less anterior and posterior translation compared to the FiberWire group (P < .05). Discussion The independent acromioclavicular ligament repair, without repair of the coracoclavicular ligament, demonstrated significant translational stability in the anterior–posterior and superior–inferior planes.

Acromioclavicular reconstruction techniques after acromioclavicular joint injuries: A systematic review of biomechanical studies

“…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 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).…”

“…The search strategy resulted in 413 studies. After screening and eligibility assessment, 19 biomechanical studies were included in this review (Abrams et al, 2013;Beitzel et al, 2014;Dyrna et al, 2018;Freedman et al, 2010;Garg et al, 2013;Gonzalez-Lomas et al, 2010;Grutter and Petersen, 2005a;Hislop et al, 2019;Ibrahim et al, 2020;Lädermann et al, 2013;Martetschläger et al, 2013;Morikawa et al, 2020a;Morikawa et al, 2020b;Peeters et al, 2020;Saier et al, 2015;Schär et al, 2019;Shin et al, 2014;Theopold et al, 2019;Weiser et al, 2017) (Table 2).…”

“…However, an optimal technique, which mimics all biomechanical characteristics of the native joint is not yet available. Three out of 5 studies concluded that a sole repair can approximates or equalize the characteristics of the native AC joint (Freedman et al, 2010;Ibrahim et al, 2020;Peeters et al, 2020). Peeters et al (Peeters et al, 2020) demonstrated that translation in three directions was adequately restored, but they did not analyze rotations.…”

“…Within the studies, different testing protocols were used. A sawbones model was used in two studies (Ibrahim et al, 2020;Schär et al, 2019), one study used Polyurethane foam blocks (Peeters et al, 2020) and the remainder utilized cadaveric models (16 studies).…”

“…Five studies evaluated the difference between several AC capsule/ ligament reconstruction techniques without CC ligament reconstruction (Dyrna et al, 2018;Freedman et al, 2010;Ibrahim et al, 2020;Morikawa et al, 2020a;Peeters et al, 2020). In 10 studies, a sole CC ligament reconstruction was compared to a CC ligament reconstruction with an additional AC capsule/ligament reconstruction (Abrams et al, 2013;Gonzalez-Lomas et al, 2010;Hislop et al, 2019;Lädermann et al, 2013;Morikawa et al, 2020b;Saier et al, 2015;Schär et al, 2019;Shin et al, 2014;Theopold et al, 2019;Weiser et al, 2017).…”