In Vivo Analysis of Coracoclavicular Ligament Kinematics During Shoulder Abduction

Izadpanah, Kaywan; Weitzel, E.; Honal, Matthias; Winterer, Jan Thorsten; Vicari, Marco; Maier, Dirk; Jaeger, Martin; Kotter, Elmar; Hennig, Jürgen; Weigel, Matthias; Südkamp, Norbert P.

doi:10.1177/0363546511423015

Cited by 24 publications

(16 citation statements)

References 33 publications

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“…These relatively strict limitations of range of motion were established based on clinical experience and in vivo studies of ACJ kinematics showing significant lengthening of the conoid ligament and horizontal clavicular translation with greater than 60 of abduction. 8,9 Thereby, early failure of synthetic coracoclavicular and acromioclavicular stabilization should be prevented until biological ligament healing has occurred.…”

Section: Rehabilitationmentioning

confidence: 99%

Arthroscopically Assisted Reconstruction of Acute Acromioclavicular Joint Dislocations: Anatomic AC Ligament Reconstruction With Protective Internal Bracing—The “AC-RecoBridge” Technique

Izadpanah¹,

Jaeger²,

Ogon³

et al. 2015

Arthroscopy Techniques

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An arthroscopically assisted technique for the treatment of acute acromioclavicular joint dislocations is presented. This pathology-based procedure aims to achieve anatomic healing of both the acromioclavicular ligament complex (ACLC) and the coracoclavicular ligaments. First, the acromioclavicular joint is reduced anatomically under macroscopic and radiologic control and temporarily transfixed with a K-wire. A single-channel technique using 2 suture tapes provides secure coracoclavicular stabilization. The key step of the procedure consists of the anatomic repair of the ACLC ("ACReco"). Basically, we have observed 4 patterns of injury: clavicular-sided, acromial-sided, oblique, and midportion tears. Direct and/or transosseous ACLC repair is performed accordingly. Then, an X-configured acromioclavicular suture tape cerclage ("AC-Bridge") is applied under arthroscopic assistance to limit horizontal clavicular translation to a physiological extent. The AC-Bridge follows the principle of internal bracing and protects healing of the ACLC repair. The AC-Bridge is tightened on top of the repair, creating an additional suture-bridge effect and promoting anatomic ACLC healing. We refer to this combined technique of anatomic ACLC repair and protective internal bracing as the "AC-RecoBridge." A detailed stepwise description of the surgical technique, including indications, technical pearls and pitfalls, and potential complications, is given.

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Section: Rehabilitationmentioning

confidence: 99%

Arthroscopically Assisted Reconstruction of Acute Acromioclavicular Joint Dislocations: Anatomic AC Ligament Reconstruction With Protective Internal Bracing—The “AC-RecoBridge” Technique

Izadpanah¹,

Jaeger²,

Ogon³

et al. 2015

Arthroscopy Techniques

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“…According to open-MRI (Izadpanah et al, 2012) and CT (Seo et al, 2012) studies, the conoid ligament is not a fixed length during arm abduction. The conoid ligament׳s length and attachments vary by up to 25% between subjects (Harris et al, 2001; Takase, 2010), and may scale with clavicle length (Rios et al, 2007).…”

Section: Introductionmentioning

confidence: 99%

Scaling and kinematics optimisation of the scapula and thorax in upper limb musculoskeletal models

Prinold

Bull

2014

Journal of Biomechanics

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Accurate representation of individual scapula kinematics and subject geometries is vital in musculoskeletal models applied to upper limb pathology and performance. In applying individual kinematics to a model׳s cadaveric geometry, model constraints are commonly prescriptive. These rely on thorax scaling to effectively define the scapula׳s path but do not consider the area underneath the scapula in scaling, and assume a fixed conoid ligament length. These constraints may not allow continuous solutions or close agreement with directly measured kinematics.A novel method is presented to scale the thorax based on palpated scapula landmarks. The scapula and clavicle kinematics are optimised with the constraint that the scapula medial border does not penetrate the thorax. Conoid ligament length is not used as a constraint. This method is simulated in the UK National Shoulder Model and compared to four other methods, including the standard technique, during three pull-up techniques (n=11). These are high-performance activities covering a large range of motion.Model solutions without substantial jumps in the joint kinematics data were improved from 23% of trials with the standard method, to 100% of trials with the new method. Agreement with measured kinematics was significantly improved (more than 10° closer at p<0.001) when compared to standard methods. The removal of the conoid ligament constraint and the novel thorax scaling correction factor were shown to be key. Separation of the medial border of the scapula from the thorax was large, although this may be physiologically correct due to the high loads and high arm elevation angles.

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“…This is due to the fact that a conventional MRI is performed in a lying position with relaxed CC ligaments. They become tensioned under traction as they function as suspension of the entire scapulohumeral complex (11, 12). Since established and accepted x‐ray stress measurements evoked similar changes within the CC distance, the particular weight application in the supine position during MRI could be accepted as a feasible means for the functional MRI assessment.…”

Section: Discussionmentioning

confidence: 99%

A stress MRI of the shoulder for evaluation of ligamentous stabilizers in acute and chronic acromioclavicular joint instabilities

Izadpanah

Winterer

Vicari

et al. 2012

Magnetic Resonance Imaging

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In Vivo Analysis of Coracoclavicular Ligament Kinematics During Shoulder Abduction

Cited by 24 publications

References 33 publications

Arthroscopically Assisted Reconstruction of Acute Acromioclavicular Joint Dislocations: Anatomic AC Ligament Reconstruction With Protective Internal Bracing—The “AC-RecoBridge” Technique

Arthroscopically Assisted Reconstruction of Acute Acromioclavicular Joint Dislocations: Anatomic AC Ligament Reconstruction With Protective Internal Bracing—The “AC-RecoBridge” Technique

Scaling and kinematics optimisation of the scapula and thorax in upper limb musculoskeletal models

A stress MRI of the shoulder for evaluation of ligamentous stabilizers in acute and chronic acromioclavicular joint instabilities

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