Biomechanical Evaluation of a Single- Versus Double-Tunnel Coracoclavicular Ligament Reconstruction With Acromioclavicular Stabilization for Acromioclavicular Joint Injuries

2018 ◽  
Vol 46 (5) ◽  
pp. 1070-1076 ◽  
Author(s):  
Michael B. Banffy ◽  
Carlos Uquillas ◽  
Julie A. Neumann ◽  
Neal S. ElAttrache
Keyword(s):  
Ligament Reconstruction ◽  
Ultimate Load ◽  
Clavicle Fracture ◽  
Biomechanical Properties ◽  
Reconstruction Technique ◽  
Ac Joint ◽  
Joint Injuries ◽  
Load To Failure ◽  
Clavicle Fractures ◽  
Ac Joint Injuries

Background: An anatomic double-tunnel (DT) reconstruction technique has been widely adopted to reconstruct the ruptured coracoclavicular (CC) ligaments seen with high-grade acromioclavicular (AC) joint injuries. However, the anatomic DT reconstruction has been associated with the risk of clavicle fractures, which may be problematic, particularly for contact athletes. Purpose/Hypothesis: The purpose was to compare a single-tunnel (ST) CC ligament reconstruction for AC joint injuries with the native state as well as with the more established anatomic DT CC ligament reconstruction. The hypothesis was that ST CC ligament reconstruction would demonstrate biomechanical properties similar to those of the native state and the DT CC ligament reconstruction. Study Design: Controlled laboratory study. Methods: Eighteen fresh-frozen human cadaveric shoulders (9 matched pairs) with mean ± SD age of 55.5 ± 8.5 years underwent biomechanical testing. One specimen of each matched pair underwent a ST CC ligament reconstruction and the second, a DT CC ligament reconstruction. The ST and DT CC ligament reconstruction techniques involved a 5-mm distal clavicle excision, avoided coracoid drilling, and utilized a 3.0-mm suture anchor to fix the excess lateral limb to reconstruct the superior AC joint capsule. The ST CC ligament reconstruction technique additionally included a 1.3-mm suture tape to help avoid a sawing effect, as well as a dog-bone button over the clavicular tunnel to increase stability of the construct. All specimens were tested to 70 N in 3 directions (superior, anterior, and posterior) in the intact and reconstructed states. The ultimate load, yield load, stiffness, and mode of failure of the reconstructed specimens were tested. Results: There were no significant differences in translation at 70 N in the superior ( P = .31), anterior ( P = .56), and posterior ( P = .35) directions between the ST CC ligament reconstruction and the intact state. The ultimate load to failure, yield load, and stiffness in the ST and DT groups were also not significantly different. There were no distal clavicle fractures in load-to-failure testing in the ST or DT group. Conclusion: In this biomechanical study, ST CC ligament reconstruction demonstrates biomechanical properties comparable to the intact state. Additionally, use of the ST CC ligament reconstruction shows biomechanical properties similar to the DT CC ligament reconstruction technique while theoretically posing less risk of clavicle fracture. Clinical Relevance: This study suggests that the ST CC ligament reconstruction has biomechanical properties equivalent to the DT CC ligament reconstruction with less theoretical risk of clavicle fracture.

scholarly journals Functional and Radiographic Outcomes After Anatomic Coracoclavicular Ligament Reconstruction for Type III/V Acromioclavicular Joint Injuries

2019 ◽  
Vol 7 (11) ◽  
pp. 232596711988453 ◽  
Author(s):  
Lukas N. Muench ◽  
Cameron Kia ◽  
Aulon Jerliu ◽  
Matthew Murphy ◽  
Daniel P. Berthold ◽  
...  
Keyword(s):  
Ligament Reconstruction ◽  
Coracoclavicular Ligament ◽  
Ac Joint ◽  
Type Iii ◽  
Radiographic Outcomes ◽  
Joint Injuries ◽  
Coracoclavicular Ligament Reconstruction ◽  
Significant Difference ◽  
Ac Joint Injuries

Background: Acromioclavicular (AC) joint separation is a common injury. The anatomic coracoclavicular ligament reconstruction (ACCR) technique is a viable treatment option, designed to restore the native joint anatomy. Purpose: To evaluate the clinical and radiographic outcomes of patients undergoing ACCR for the treatment of type III and V AC joint injuries with a minimum 2-year follow-up. Study Design: Case series; Level of evidence, 4. Methods: A retrospective chart review was performed on prospectively collected data. Patients who underwent ACCR for type III or V AC joint injuries between January 2003 and December 2015 were analyzed. Clinical outcome measures included the American Shoulder and Elbow Surgeons (ASES) score, Rowe score, Simple Shoulder Test (SST), and Constant-Murley (CM) score. To determine the clinical relevance of the ASES score, the minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) were used. The pre- and postoperative coracoclavicular distance (CCD) and side-to-side difference in the CCD were measured for radiographic analysis. Results: A total of 43 patients (22 acute, 21 chronic) were included in the study. The mean patient age was 43.4 ± 11.4 years, with a mean follow-up of 3.4 years (range, 2.0-7.5 years). With regard to the ASES score, 92% of patients achieved the MCID, 81% achieved the SCB, and 49% reached or exceeded the PASS. There was no significant difference when stratifying by type (III vs V) or chronicity (acute vs chronic) of injury (both P > .05). The Rowe score improved from 66.6 ± 15.9 preoperatively to 88.6 ± 12.3 postoperatively, the CM score from 61.6 ± 18.8 to 87.4 ± 15.1, and the SST score from 6.2 ± 3.6 to 9.4 ± 3.7 (all P < .001). The postoperative side-to-side difference in the CCD was 3.1 ± 2.7 mm, with type III injuries (2.4 ± 1.9 mm) showing significantly lower measurements compared with type V (4.2 ± 3.4 mm) ( P = .02). No significant trend was found between joint reduction and the improvement in clinical outcomes ( P > .05). Conclusion: Patients undergoing ACCR for acute and chronic type III and V AC joint injuries maintained significant improvement in clinical and radiographic outcomes at a minimum 2-year follow-up. Additionally, 81% of patients reached the SCB after surgical reconstruction.

scholarly journals Minimum 10-Year Outcomes After Revision Anatomic Coracoclavicular Ligament Reconstruction for Acromioclavicular Joint Instability

2020 ◽  
Vol 8 (9) ◽  
pp. 232596712094703
Author(s):  
Daniel P. Berthold ◽  
Lukas N. Muench ◽  
Knut Beitzel ◽  
Simon Archambault ◽  
Aulon Jerliu ◽  
...  
Keyword(s):  
Operative Treatment ◽  
Revision Surgery ◽  
Ligament Reconstruction ◽  
Coracoclavicular Ligament ◽  
Ac Joint ◽  
Type Iii ◽  
Joint Injuries ◽  
Coracoclavicular Ligament Reconstruction ◽  
Ac Joint Injuries

Background: Revision surgery in cases of previously failed primary acromioclavicular (AC) joint stabilization remains challenging mainly because of anatomic alterations or technical difficulties. However, anatomic coracoclavicular ligament reconstruction (ACCR) has been shown to achieve encouraging biomechanical, clinical, and radiographic short-term to midterm results. Purpose: To evaluate the clinical and radiographic long-term outcomes of patients undergoing revision ACCR after failed operative treatment for type III through V AC joint injuries with a minimum 10-year follow-up. Study Design: Case series; Level of evidence, 4. Methods: A retrospective chart review was performed on prospectively collected data within an institutional shoulder registry. Patients who underwent revision ACCR for type III through V AC joint injuries between January 2003 and December 2009 were analyzed. Clinical outcome measures included the American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test (SST), and Single Assessment Numeric Evaluation (SANE). The coracoclavicular distance (CCD) was measured for radiographic analysis immediately postoperatively and at last postoperative follow-up. Results: A total of 8 patients with a mean age at the time of surgery of 44.6 ± 10.6 years and a mean follow-up of 135.0 ± 17.4 months (range, 120-167 months) were eligible for inclusion in the study. The time from initial AC joint stabilization until revision surgery was 10.2 ± 12.4 months (range, 0.5-36 months); 62.5% of the patients had undergone more than 2 previous AC joint surgical procedures. The ASES score improved from 43.9 ± 22.4 preoperatively to 80.6 ± 28.8 postoperatively ( P = .012), the SST score improved from 4.4 ± 3.6 preoperatively to 11.0 ± 2.2 postoperatively ( P = .017), and the SANE score improved from 31.4 ± 27.3 preoperatively to 86.9 ± 24.1 postoperatively ( P = .018) at final follow-up. There was no significant difference in the CCD ( P = .08) between the first (7.6 ± 3.0 mm) and final (10.6 ± 2.8 mm) radiographic follow-up (mean, 50.5 ± 32.7 months [range, 18-98 months]). Conclusion: Patients undergoing revision ACCR after failed operative treatment for type III through V AC joint injuries maintained significant improvement in clinical outcomes at a minimum 10-year follow-up.

What to Do About AC Joint Injuries

2001 ◽  
Vol 29 (11) ◽  
pp. 57-58
Author(s):  
Robert J. Johnson ◽  
Kim Harmon ◽  
Aaron Rubin
Keyword(s):  
Ac Joint ◽  
Joint Injuries ◽  
Ac Joint Injuries

scholarly journals Epidemiology of Acromioclavicular Joint Injuries in Professional Baseball

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0041
Author(s):  
Prem Ramkumar ◽  
Salvatore Frangiamore ◽  
Grant Jones ◽  
Lonnie Soloff ◽  
Keshia Pollack ◽  
...  
Keyword(s):  
Acromioclavicular Joint ◽  
Return To Play ◽  
Professional Baseball ◽  
Shoulder Injuries ◽  
Ac Joint ◽  
Joint Injuries ◽  
Acute Injuries ◽  
Chronic Injuries ◽  
The Impact ◽  
Ac Joint Injuries

Objectives: Shoulder injuries account for a large portion of all recorded injures in professional baseball. Much is known about other shoulder pathologies in the overhead athlete, but the incidence and impact of acromioclavicular (AC) joint injuries in this population is unknown. The purpose of this study was to examine the incidence, rates, and characteristics of AC joint injuries in professional baseball, and determine the impact on time missed. Methods: The Major League Baseball Health and Injury Tracking System (HITS) was used to compile records of all major and minor league player from 2011-2017 with documented AC joint injuries. These injuries were classified as acute (sprain or separation) or chronic (AC joint arthritis or distal clavicular osteolysis), and associated data included laterality, date of injury, player position, activity, mechanism of injury, length of return to play (RTP), and need for surgical intervention. Results: A total of 312 AC joint injuries (183 MiLB, 129 MLB; range 39-60 per year) were recorded (acute n=201, 64.4%; chronic n=111, 35.6%). A total of 81% of acute injuries resulted in time missed with an average RTP of 22.8 days whereas 59% of chronic injuries resulted in days missed with an average RTP of 32.2 days (p<0.001). Acute injuries occurred most commonly in outfielders (42.7%), followed by infielders (27.3%). Chronic injuries were seen in higher proportions among pitchers and catchers (45.5-56.4% chronic injuries). Acute AC injuries occurred most often while playing defense (n=100; 49.8%) in the infield or outfield (n=138; 68.7%), with 63.2% the result of a contact injury. Chronic AC joint injuries were most commonly with throwing or pitching (n=48; 43.2%) and non-contact injuries (n=79; 71.2%). Conclusion: Acute AC joint injuries are contact injuries occurring most commonly among infielders and outfielders that result in more than 3 weeks missed before return to play whereas chronic AC joint injuries occur more commonly in pitchers and catchers from repetitive overhead activity. Knowledge of these data can better guide expectation management in this elite population to better elucidate the prevalence of two common injury patterns in the acromioclavicular joint.

Horizontal Instability of the Acromioclavicular Joint: A Systematic Review

2019 ◽  
Vol 48 (2) ◽  
pp. 504-510 ◽  
Author(s):  
Gianna M. Aliberti ◽  
Matthew J. Kraeutler ◽  
Jeffrey D. Trojan ◽  
Mary K. Mulcahey
Keyword(s):  
Systematic Review ◽  
Patient Outcomes ◽  
Operative Management ◽  
Complication Rates ◽  
Ac Joint ◽  
Horizontal Instability ◽  
Joint Injuries ◽  
Meta Analyses ◽  
Joint Separation ◽  
Ac Joint Injuries

Background: Injuries to the acromioclavicular (AC) joint are common and should be suspected in patients who have shoulder pain in the region of the acromion and clavicle. Injuries to the AC ligament can cause horizontal instability and are often neglected or underdiagnosed, which can lead to poor patient outcomes. Purpose: To perform a systematic review of the literature on the diagnosis and treatment of horizontal instability of the AC joint. Study Design: Systematic review. Methods: The authors performed a systematic review using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed and EMBASE were searched for studies that investigated diagnosis, treatment, and failure of operative management of acute and chronic AC separations. Studies that did not specifically evaluate AC joint injuries, were not written in English, or were specific only to vertical instability of the AC joint were excluded. Results: Overall, 23 articles met the inclusion criteria and were therefore included in this systematic review. Diagnosing horizontal AC instability is difficult using plain radiographs; dynamic views were shown in some cases to better detect horizontal instability than with static views. More than 60 procedures for treating AC joint injuries have been published, but many focus on vertical rather than horizontal instability. Modifications to current surgical procedures to incorporate reconstruction of the horizontal component showed improved patient outcomes. Such modifications included additional AC joint suture cord cerclage, combined AC and coracoclavicular ligament reconstruction, and the Twin Tail TightRope triple button technique. Failure after surgical stabilization of AC joint separation has been reported to occur in 15% to 80% of cases. Conclusion: No consensus is available regarding the best practices for diagnosis, evaluation, and treatment of acute or chronic horizontal instability of the AC joint. Moreover, horizontal instability injuries are often neglected or poorly understood, making diagnosis difficult, which may lead to high complication rates and failure after surgical stabilization.

scholarly journals Is suture cut-out damage reduced by the use of tape instead of thread in transtibial posterior root repair? Influence on the biomechanical properties of the meniscus-suture complex in a porcine model

2018 ◽  
Vol 6 (6_suppl3) ◽  
pp. 2325967118S0005
Author(s):  
A Espejo-Reina ◽  
M Lombardo Torre ◽  
A Pérez de la Blanca ◽  
F Ezquerro-Juanco ◽  
M Prado-Novoa ◽  
...  
Keyword(s):  
Contact Area ◽  
Ultimate Load ◽  
Porcine Model ◽  
Biomechanical Properties ◽  
Early Postoperative Period ◽  
Meniscal Root ◽  
Meniscus Suture ◽  
Rehabilitation Protocols ◽  
Load To Failure ◽  
Ultimate Failure

Objectives: To assess the influence of suture shape, tape or thread, in the development of suture cut-out damage by modifying the contact area at the tissue-suture interface in transtibial repair of the posterior meniscal root, and to analyze its relation with the initial biomechanical properties of the meniscus-suture complex. Methods: Twenty medial porcine menisci were randomized in two groups depending on the suture shape: thread or tape. The sutured menisci were first subjected to 1000 cycles of [10,30]N load at 0.5 Hz; stiffness, residual displacement and displacement at 30 N were computed. Following this, load-to-failure testing was conducted at 0.5mm/s and stiffness, ultimate failure load and displacement were determined. During tests, the tissue-suture interface was recorded using a high-resolution camera. Results: In cyclic tests, cut-out progression at suture insertion points was not observed for any specimen of either group and no differences were found between groups for any parameter. In load-to-failure test, all specimens failed by suture cut-out and suture tape had a greater ultimate load (221.61(sd=43.77)N vs 291.58(sd=78.98)N, p=0.03) with no other differences. Conclusions: In a porcine model simulating a repaired posterior meniscal root, there is no evidence of suture cut-out progression using thread or tape of the same material until high loading levels close to the ultimate load. Accordingly, the larger meniscus-suture contact area of tape compared to thread does not reduce displacements under cyclic loads representative of current rehabilitation protocols in the early postoperative period but increases resistance to tissue cut-through during load-to-failure, producing a higher ultimate load.

scholarly journals Anatomical and Biomechanical properties of MPFL reconstruction technique using Adductor Magnus tendon graft

2020 ◽  
Vol 8 (5_suppl4) ◽  
pp. 2325967120S0031
Author(s):  
Danko Dan Milinkovic ◽  
Christian Fink ◽  
Petri Sillanpää ◽  
Michael J. Raschke ◽  
Christoph Kittl ◽  
...  
Keyword(s):  
Insertion Site ◽  
Biomechanical Properties ◽  
Tendon Graft ◽  
Mpfl Reconstruction ◽  
Reconstruction Technique ◽  
Maximum Elongation ◽  
Load To Failure ◽  
Application Potential ◽  
Length Changes ◽  
The Mean

Aims and Objectives: The main goal of the presented study was to evaluate the anatomical and biomechanical properties of the proposed surgical technique for anatomical Medial Patellofemoral ligament (MPFL) reconstruction using the flat Adductor tendon (AT) graft in order to primarily determine its overall plausibility and application potential, as well as to reveal the main risks and pitfalls of the technique. Materials and Methods: Anatomical descriptive evaluation, followed by biomechanical testing of the proposed AT- MPFL reconstruction was conducted on 12 fresh frozen human cadaveric knees. The morphological and topographical features of the AT and native MPFL were reported. The biomechanical tests were performed in order to determine the strength and resistance to maximum loading force of the reconstruction. The construct was placed in an uniaxial testing machine and cyclically loaded 500 times between 5 and 50N, followed by load to failure, measuring the maximum elongation, stiffness and maximum load respectively. Results: Regarding the anatomical evaluation of the structures in focus, several findings have been reported. The mean length of the tendon was found to be 12,59±1,54cm, the mean distance between the insertion on the Adductor tubercule and Hiatus was measured at 10,83±1,27cm, exceeding the mean desired length of the graft, found at 7,54±0,45cm by 2,43±0,56cm. The desired length of the graft was based on the measured length of the native MPFL with additional ±25-30mm of the tendon that allows for intraoperative length changes and different means of patellar fixation depending on the surgeons preference. The insertion of the Adductor tendon on the Adductor tubercule was found to be superior and posterior to the insertion of the native MPFL. The distal portion of AT was found to be consisted of two distinct parts with varying fiber orientation, the tendinous and the membranous part. After cyclic load, the maximum elongation was reported at 1,9 ± 0,4mm. The mean stiffness and load to failure of the construct were measured at 26,2±7,6N/mm and 148,74±22,01N. The graft failed at the patellar insertion site in two of the tested specimens and at the femoral insertion site in the remaining 10. Conclusion: Due to its advantageous anatomical and topographical aspects, as well as adequate biomechanical properties, the Adductor tendon graft caries a high utilization potential for MPFL reconstruction. Application that allows for primarily soft tissue fixation on the patella, in addition to absence of femoral drill holes with consequently no risk of injury to the physis, makes the AT graft choice a preferable option when considering MPFL reconstruction in patients with open growth plates. Even though it includes graft and methods of fixation alternative to the traditionally used techniques, this reconstruction is not exclusively predetermined for the skeletally immature patients and has a high application potential for the older patient population as well.

Reliability of the Traditional Classification Systems for Acromioclavicular Joint Injuries by Radiography

2012 ◽  
Vol 4 (4) ◽  
pp. 266-269 ◽  
Author(s):  
Chye Yew Ng ◽  
Emma Kate Smith ◽  
Lennard Funk
Keyword(s):  
Weighted Kappa ◽  
Classification Systems ◽  
Observer Agreement ◽  
Ac Joint ◽  
Joint Injuries ◽  
Common Technique ◽  
The Mean ◽  
Single Standard ◽  
Ac Joint Injuries

Background The present study aimed to examine the reliability of the radiographic classification systems for acromioclavicular (AC) joint injuries. Methods We initially polled 47 orthopaedic surgeons regarding what common technique they used for applying the Rockwood and the Tossy and Allman classification systems. All used a single standard AC joint view (Zanca view). We then presented 24 Zanca view radiographs of patients who had sustained AC joint injuries to 19 specialist shoulder surgeons and asked each of them to classify the injuries using the Rockwood and the Tossy and Allman classification systems. We then altered the order of radiographs and repeated the survey with the same group of surgeons 1 month later. Results The mean inter-observer agreement and the corresponding weighted kappa for the Rockwood and the Tossy and Allman classification system were 64.6% and 0.258; and 68.1% and 0.309, respectively. The mean intra-observer agreement and the corresponding weighted kappa for the systems were 59.4% and 0.150; and 67.4% and 0.113, respectively. Conclusions We conclude that the classification of AC joint injuries using a radiograph alone has limited reliability and consistency in clinical practice.

scholarly journals Navigated versus conventional transfixation of AC joint injuries: Feasibility and accuracy

2013 ◽  
Vol 18 (3-4) ◽  
pp. 68-75
Author(s):  
Timo Stübig ◽  
Torsten Jähnisch ◽  
Maximilian Petri ◽  
Nael Hawi ◽  
Christian Zeckey ◽  
...  
Keyword(s):  
Ac Joint ◽  
Joint Injuries ◽  
Ac Joint Injuries
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