Biomechanical Evaluation of Effect of Coracoid Tunnel Placement on Load to Failure of Fixation During Repair of Acromioclavicular Joint Dislocations

Managing and recognizing complications after treatment of acromioclavicular joint repair or reconstruction

“…Furthermore, adequate visualization of the entire base of the coracoid is essential. Accurate coracoid tunnel placement particularly in the center-center or medial-center position in the coracoid minimizes bony failure risk [28]. The combination of minimization of the tunnel diameter in the coracoid and appropriate visualization are therefore recommended to help prevent coracoid fracture or cutout in techniques using transcoracoid fixation.…”

Image-free navigated coracoclavicular drilling for the repair of acromioclavicular joint dislocation: a cadaver study

“…A correct placement of transclavicular-transcoracoidal tunnel may reduce the risk of repair failure and cortical breach, as emphasized in recent anatomic considerations of transclaviculartranscoracoid drilling for coracoclavicular ligament [10,17,19]. Our experiment sought to evaluate the feasibility and accuracy of fluoro-free navigated transclaviculartranscoracoidal tunnel placement in comparison to drill guide-based targeting as used in arthroscopically assisted procedures.…”

“…Nevertheless, complications such as persisting instability, loss of reduction, coracoid fracture, slip of the coracoid button with subsequent recurrent vertical instability and wound infection were observed [6][7][8]. One area of particular concern involves reports of coracoid process fracture and repair failure [9,10]. Taking into account the coracoid and clavicular anatomical variations and the patient's individual soft tissue proportion around the shoulder one may agree that anatomical placement of the tunnels is not always feasible with a rigid drill guide.…”

“…2). All subcoracoidal perforations within 5 mm distance from the medial and lateral coracoid border were defined as ''error in tunnel placement'' [10].…”

All-arthroscopic, Guideless Single Suture-button Fixation of Acute Acromioclavicular Joint Dislocation: A Description of the Technique and Early Treatment Results

“…We performed a cadaver study (unpublished data) prior to this study and found that the anatomical relationship of the clavicle and the coracoid process is too complex to be precisely addressed by only using a drill guide, which is a rigid tool and not sufficiently flexible to adjust for any variations in the CC anatomy. Ferreira et al 23) showed a higher peak load to failure with a center-center or medial-center coracoid tunnel orientation, which may have lessened the risk of coracoid fracture during drilling with a 6 mm cannulated drill bit. In another cadaver study, a 4.5 mm coracoid tunnel provided greater fixation strength than a 6 mm tunnel in CC ligament reconstruction, and the base of the coracoid was more forgiving than the distal coracoid regarding location.…”