Structural Properties of the Intact and the Reconstructed Coracoclavicular Ligament Complex

Abstract

Numerous procedures have been described for the operative management of acromioclavicular joint injuries, but surprisingly little information is available on the ultimate mechanical behavior of the native coracoclavicular ligament complex or on the various methods of reconstruction. We tested 19 fresh-frozen cadaveric bone-ligament-bone preparations of the coracoclavicular ligament in uniaxial tension at 25 mm/min until failure. Seven specimens were left intact, six had the trapezoid ligament sectioned, and six had the conoid ligament sectioned. Reconstruction of the coracoclavicular ligament was achieved using coracoacromial ligament transfers, woven polyester slings, suture anchors, and Bosworth screws; all reconstructions were also tested to failure. The intact coracoclavicular ligament failed by avulsion or midsubstance tear at 500 (+/-134) N, with a stiffness of 103 (+/-30) N/mm and elongation to failure of 7.7 (+/-1.9) mm. There was no significant difference between the contributions of the conoid or trapezoid ligaments in this loading configuration. Coracoclavicular slings and suture anchors provided strength similar to that of the coracoclavicular ligament, but with significantly greater deformations (14 to 26 mm). Screw fixation resulted in comparable stiffness and superior strength to the coracoclavicular ligament, but only if bicortical purchase was obtained. Coracoacromial ligament transfers were the weakest and least stiff, and augmentation with another form of coracoclavicular fixation is recommended. These results provide a useful baseline for comparison of the initial performance of reconstructive techniques with the performance of the native coracoclavicular ligament.

3D kinematic analysis of the acromioclavicular joint during arm abduction using vertically open MRI

“…[36][37][38] However, their results do not strictly apply to the postoperative condition, since they did not reproduce the physiologic AC joint motions that were shown in the present study. If the structural properties of intact or reconstructed ligaments could be certified in AC joint motion according to the present result, the optimal procedure for surgical treatment of the AC dislocation could be established.…”

Triple endobuttton technique for the treatment of acute complete acromioclavicular joint dislocations: preliminary results

“…Native coracoacromial ligaments can withstand tensile forces of up to 500 Newtons [11]. The metallic buttons can withstand forces in excess of 1,150 Newtons [9].…”

Tratamento artroscópico da luxação acromio-clavicular pelo método "tight rope" (arthrex®)

“…Nas luxações agudas da articulação acrômio-clavicular, a reconstrução dos ligamentos coracoclaviculares, também, tem sido empregado (16)(17)(18) . As opções cirúrgicas são inúmeras podendo o cirurgião escolher entre dezenas de técnicas (11) .…”

“…Veado et al chamam a atenção para a não realização da cirurgia na fase aguda quando houver escoriação/ abrasão no local ou presença de flictenas ou infecção cutânea na região da cintura escapular (16) . Conduta esta também por nós defendida que mesmo aplicando um procedimento minimamente invasivo, entendemos que é um risco desnecessário comprometer a cirurgia sem corrigir antes tais problemas.…”