Posterior Rotational and Translational Stability in Acromioclavicular Ligament Complex Reconstruction: A Comparative Biomechanical Analysis in Cadaveric Specimens

Morikawa, Daichi; Huleatt, Joel; Muench, Lukas N.; Kia, Cameron; Berthold, Daniel P.; Cote, Mark P.; Obopilwe, Elifho; Kelolli, Denis; Scheiderer, Bastian; Mazzocca, Augustus D.

doi:10.1177/0363546520939882

Cited by 19 publications

(44 citation statements)

References 21 publications

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“…Horizontal instability can occur in the anterior and posterior directions; however, the posterior direction is thought to be more relevant in the clinical setting. 8,9,21 Unfortunately, no consensus for the diagnosis, evaluation, and optimal treatment of horizontal instability exists. 1 The AC capsule, however, has been found to play a major role in both horizontal and rotational stability.…”

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confidence: 99%

Quantitative and Qualitative Surgical Anatomy of the Acromioclavicular Joint Capsule and Ligament: A Cadaveric Study

et al. 2021

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Background: The acromioclavicular (AC) capsule and ligament have been found to play a major role in maintaining horizontal stability. To reconstruct the AC capsule and ligament, precise knowledge of their anatomy is essential. Purpose/Hypothesis: The purposes of this study were (1) to determine the angle of the posterosuperior ligament in regard to the axis of the clavicle, (2) to determine the width of the attachment (footprint) of the AC capsule and ligament on the acromion and clavicle, (3) to determine the distance to the AC capsule from the cartilage border of the acromion and clavicle, and (4) to develop a clockface model of the insertion of the posterosuperior ligament on the acromion and clavicle. It was hypothesized that consistent angles, attachment areas, distances, and insertion sites would be identified. Study Design: Descriptive laboratory study. Methods: A total of 12 fresh-frozen shoulders were used (mean age, 55 years [range, 41-64 years]). All soft tissue was removed, leaving only the AC capsule and ligament intact. After a qualitative inspection, a quantitative assessment was performed. The AC joint was fixed in an anatomic position, and the attachment angle of the posterosuperior ligament was measured using a digital protractor. The capsule and ligament were removed, and a coordinate measuring device was utilized to assess the width of the AC capsule footprint and the distance from the footprint to the cartilage border of the acromion and clavicle. The AC joint was then disarticulated, and the previously marked posterosuperior ligament insertion was transferred into a clockface model. The mean values across the 12 specimens were demonstrated with 95% CIs. Results: The mean attachment angle of the posterosuperior ligament was 51.4° (95% CI, 45.2°-57.6°) in relation to the long axis of the entire clavicle and 41.5° (95% CI, 33.8°-49.1°) in relation to the long axis of the distal third of the clavicle. The mean clavicular footprint width of the AC capsule was 6.4 mm (95% CI, 5.8-6.9 mm) at the superior clavicle and 4.4 mm (95% CI, 3.9-4.8 mm) at the inferior clavicle. The mean acromial footprint width of the AC capsule was 4.6 mm (95% CI, 4.2-4.9 mm) at the superior side and 4.0 mm (95% CI, 3.6-4.4 mm) at the inferior side. The mean distance from the lateral clavicular attachment of the AC capsule to the clavicular cartilage border was 4.3 mm (95% CI, 4.0-4.6 mm), and the mean distance from the medial acromial attachment of the AC capsule to the acromial cartilage border was 3.1 mm (95% CI, 2.9-3.4 mm). On the clockface model of the right shoulder, the clavicular attachment of the posterosuperior ligament ranged from the 9:05 (range, 8:00-9:30) to 11:20 (range, 10:00-12:30) position, and the acromial attachment ranged from the 12:20 (range, 11:00-1:30) to 2:10 (range, 13:30-14:40) position. Conclusion: The finding that the posterosuperior ligament did not course perpendicular to the AC joint but rather was oriented obliquely to the long axis of the clavicle, in combination with the newly developed clockface model, may help surgeons to optimally reconstruct this ligament. Clinical Relevance: Our results of a narrow inferior footprint and a short distance from the inferior AC capsule to cartilage suggest that proposed reconstruction of the AC joint capsule should focus primarily on its superior portion.

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confidence: 99%

Quantitative and Qualitative Surgical Anatomy of the Acromioclavicular Joint Capsule and Ligament: A Cadaveric Study

et al. 2021

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“…The potted clavicle was then centered into the cylindrical mount, which allowed for a consistent set up for each specimen. 18,19…”

Section: Specimen Preparationmentioning

confidence: 99%

“…6,7 There are a plethora of studies that have investigated the biomechanics and function of the AC ligaments, in addition to innumerable repair studies. 5,[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] There are very few studies, however, on the mechanism of failure at the level of the AC ligaments. The AC capsule comprises four ligaments (anterior, posterior, superior, and inferior).…”

Section: Introductionmentioning

confidence: 99%

“…26 Previous biomechanical studies have used a fixedscapula model to simulate acromioclavicular joint movement and evaluate postreconstruction joint stability. 5,[8][9][10][18][19][20][21][22] However, in vivo, the scapula moves while the clavicle remains relatively rigidly attached at the sternoclavicular joint. Debski et al used a robotic universal force-moment sensor system to evaluate the effects of transecting the AC ligament, while allowing the scapula to translate across its three axes.…”

Section: Introductionmentioning

confidence: 99%

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Clavicular-Sided Tears Were the Most Frequent Mode of Failure During Biomechanical Analysis of Acromioclavicular Ligament Complex Failure During Adduction of the Scapula

DiCosmo

Rumpf

Mancini

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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The purpose of this study was to describe the force and failure pattern of the acromioclavicular ligament complex (ACLC) in an adducted scapula, potentially simulating an indirect force injury of the AC joint. By using a biomechanical simulation in which the scapula is moved and the clavicle is fixed, we are able to better replicate the in vivo motion of the joint. Methods: Ten cadaveric shoulders (mean age of 62.0 AE 8.6) with a bone mineral density of .51 AE .18 g/cm 2 were used. A standard reproducible anatomic mounting system was used to secure the clavicle and move the scapula. Displacement control was used to adduct the scapula (inferior angle of the scapula moving toward the clavicle) with the clavicle fixed until specimen failure, producing torque and angle of rotation. The failure mode of the ACLC during this simulated adduction was analyzed with slow motion video analysis. Tears of the ACLC were characterized as clavicular, midline, or acromion-sided tears. Results: The mean torque required for load to failure was found to be 27.75 ). The mean rotary angle at failure was 30 (95% CI [25 , 35 ]). The mean stiffness (resistance provided by the ACLC) was 1.64 N-m/ (95% CI [1.28 N-m/ , 2.01 N-m/ ]. Mode of failure analysis showed there were 6 clavicle-sided tears, 1 acromion-sided tear, 2 acromion fractures, and 1 clavicle fracture. Conclusion: Clavicular side tears were the most frequent mode of failure compared to midline and acromion side tears. The first segment of the ACLC to fail most frequently during adduction was the posterosuperior ligament.

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“…Study #5: Posterior rotational and translational stability in acromioclavicular ligament complex reconstruction: A comparative biomechanical analysis in cadaveric specimens 10) The purpose of study #5 was to evaluate the posterior translational and rotational stability of an ACLC reconstruction with a dermal allograft (ACLC patch) compared with three internal suture brace augmentation techniques (Figure -6: ACLC patch, oblique brace, anterior brace, and x-frame brace). A total of 28 cadaveric shoulders were…”

Section: Study #3: Repair Of the Entire Superior Acromioclavicular Ligament Complex Best Restores Posterior Translation And Rotational Stmentioning

confidence: 99%

Basic Science Research into New Treatments for Shoulder Joint Disease - My Experience at the University of Connecticut -

Morikawa

Mazzocca

2021

Juntendo Medical Journal

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I worked in the Human Soft Tissue Research Laboratory, which is part of the Department of Orthopedic Surgery at the University of Connecticut. I performed basic research to develop new treatments for shoulder joint disease with Prof. Augustus D. Mazzocca, who has done extensive work in biological and biomechanical orthopedics, especially for shoulder disease. I was fortunate to be able to work alongside seven highly motivated German orthopedic surgeons from the

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Posterior Rotational and Translational Stability in Acromioclavicular Ligament Complex Reconstruction: A Comparative Biomechanical Analysis in Cadaveric Specimens

Cited by 19 publications

References 21 publications

Quantitative and Qualitative Surgical Anatomy of the Acromioclavicular Joint Capsule and Ligament: A Cadaveric Study

Quantitative and Qualitative Surgical Anatomy of the Acromioclavicular Joint Capsule and Ligament: A Cadaveric Study

Clavicular-Sided Tears Were the Most Frequent Mode of Failure During Biomechanical Analysis of Acromioclavicular Ligament Complex Failure During Adduction of the Scapula

Basic Science Research into New Treatments for Shoulder Joint Disease - My Experience at the University of Connecticut -

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