The Coracoidal Insertion of the Coracoclavicular Ligaments

Salzmann, Gian M.; Paul, Jochen; Sandmann, Gunther H.; Imhoff, Andreas B.; Schöttle, Philip B.

doi:10.1177/0363546508322887

Cited by 118 publications

(119 citation statements)

References 35 publications

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“…Only such techniques can restore the coracoclavicular anatomy, because even though both ligaments have a confluent course in the coracoclavicular interval, they end in separate footprints at the coracoid base [29]. In our study only the double MINAR repair meets this request performing four different bone tunnels.…”

Section: Discussionmentioning

confidence: 75%

Coracoclavicular ligament reconstruction: biomechanical comparison of tendon graft repairs to a synthetic double bundle augmentation

Wellmann

Kempka

Schanz

et al. 2009

Knee Surg Sports Traumatol Arthrosc

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For currently presented anatomical coracoclavicular ligament repairs issues such as autologous tendon graft versus synthetic suture augmentation and the optimum fixation strategies for both types of reconstruction are not solved. The purpose of the study was to compare the biomechanical properties of different tendon graft repairs to the characteristics of a synthetic polyester augmentation. Four anatomical coracoclavicular ligament repairs were biomechanically tested: 5 mm coracoclavicular tendon loop with suture fixation, tendon loop with flip button fixation, tendon loop with interference screw fixation versus a double 1.0-mm polyester repair with flip button fixation. The biomechanical testing included cyclic superio-inferior loading and a subsequent load to failure protocol. The ultimate failure loads were significantly higher for the double polyester/flip button repair (927 N) compared to all tendon repair techniques (maximum 640 N). In contrast the stiffness level was higher for the tendon repairs compared to the polyester/flip button repair (68.7 N/mm) but strongly dependent on the fixation technique (interference screw 97.2 N/mm, flip button 84.9 N/mm, side to side suture 60.9 N/mm). A synthetic coracoclavicular augmentation using a polyester suture provides adequate structural properties compared to a tendon repair. Therefore the decision for a tendon graft should be made by the necessity of a biologic substrate rather than by the assumption of a biomechanical advantage.

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Section: Discussionmentioning

confidence: 75%

Coracoclavicular ligament reconstruction: biomechanical comparison of tendon graft repairs to a synthetic double bundle augmentation

Wellmann

Kempka

Schanz

et al. 2009

Knee Surg Sports Traumatol Arthrosc

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“…The conoid tunnel was placed posteromedially, and the trapezoid tunnel was positioned more anterolaterally, considering the anatomic origins of both ligaments [20]. The clavicular tunnel placement remained the same as in the other groups.…”

Section: Synthetic Coracoclavicular Reconstruction Techniquementioning

confidence: 99%

Biomechanics of a new technique for minimal-invasive coracoclavicular ligament reconstruction

Schliemann

Lenschow

Schürmann

et al. 2012

Knee Surg Sports Traumatol Arthrosc

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Purpose To evaluate the biomechanical properties of a new coracoclavicular (CC) ligament reconstruction using a subcoracoidal flip button and a tendon graft compared to an augmented tendon loop and a synthetic coracoclavicular ligament reconstruction. Methods A porcine metatarsalia model was used to assess supero-inferior fixation strength of (1) a new technique using an augmented tendon graft and a subcoracoidal flip button in a lifting block fashion, (2) an augmented tendon loop around the coracoid base and (3) a synthetic coracoclavicular ligament augmentation technique. Cyclic loading from 20 to 70 N for 1,000 cycles was performed, followed by a load-to-failure protocol. Results All specimens of the three different groups survived the cyclic loading protocol. The maximum loads to failure under superior loading conditions were 760 ± 78 N for group 1, 702 ± 48 N for group 2 and 1117 ± 91 N for group 3. The synthetic coracoclavicular ligament augmentation technique revealed significantly higher maximum loads compared to the other groups (p \ 0.001). The augmented tendon graft/flip button construct had higher maximum loads than the augmented tendon loop (n.s.). No significant differences were found for stiffness and elongation behaviour among the 3 tested groups. ConclusionThe results suggest that the described technique is an alternative option to reconstruct the CC ligaments in AC joint instability in a minimal-invasive technique. Under superior loading conditions, the biomechanical properties exhibited by this novel technique were comparable to those of the tendon loop around the coracoid base.

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“…Many studies have described their footprints, both in the inferior distal third of the clavicle and in the proximal half of the coracoid process (9,22) . Harris et al (23) described the coracoid footprint of the conoid ligament as 10.6 by 4.4 mm and the trapezoid ligament as 14 by 4.8 mm.…”

Section: Discussionmentioning

confidence: 99%

Osteotomias do processo coracoide: um estudo anatômico

Terra

Figueiredo

Marczyk³

et al. 2012

Rev. bras. ortop.

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Objective: Relate the main tendinous and ligamentous structures attached in the coracoid process, correlating it to several levels of osteotomy and describing the involved structures. Methods: Thirty shoulders were dissected. The coracoid process with mainly inserted anatomic structures was dissected, and five levels of osteotomy (1.0; 1.5; 2.0; 2.5; 3.0 cm) were made from the apex of the process and the mainly involved structures were recorded. Results: In osteotomies of 1.0 cm, in 100% of the cases only the conjoint tendon (CT). In osteotomies of 1.5 cm there were 63.33% of cases involved with the CT and the Pectoralis minor (PMi), in 20% of cases only the CT, and in 16.66% the CT, PMi, and the coracohumeral ligament (CUL). In osteotomies of Rev Bras Ortop. 2012;47(3):337-43 2.0 cm, in 80% of the shoulders, the osteotomies embraced the CT, PMi and the CUL, and in 20% only the CT and the PMi were involved. In the osteotomies of 2.5cm there was involvement of the CT, PMi and CUL in 100% of cases. In the osteotomies of 3.0cm, six cases (20%) have presented an injury on the trapezoid ligament, and in 100% of these osteotomies, the osteotomized distal fragment had embraced the CT, PMi, CUL. Conclusion: The knowledge of anatomic structures inserted and involved in the osteotomies cuts of the coracoid process is very importan to lead with osteotomies performed in the treatment techniques of the coracoid process. Osteotomies of 3.0 cm can injure the trapezoid ligament.

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The Coracoidal Insertion of the Coracoclavicular Ligaments

Abstract: Coracoidal anatomic landmarks can be used intraoperatively for an anatomic reconstruction of the coracoclavicular ligaments.

Cited by 118 publications

References 35 publications

Coracoclavicular ligament reconstruction: biomechanical comparison of tendon graft repairs to a synthetic double bundle augmentation

Coracoclavicular ligament reconstruction: biomechanical comparison of tendon graft repairs to a synthetic double bundle augmentation

Biomechanics of a new technique for minimal-invasive coracoclavicular ligament reconstruction

Osteotomias do processo coracoide: um estudo anatômico

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