scholarly journals The Role of the Acromioclavicular Ligament in Acromioclavicular Joint Stability: A Cadaveric Biomechanical Study

2021 ◽  
Vol 9 (2) ◽  
pp. 232596712098294
Author(s):  
Shimpei Kurata ◽  
Kazuya Inoue ◽  
Hideo Hasegawa ◽  
Takamasa Shimizu ◽  
Akio Iida ◽  
...  
Keyword(s):  
Biomechanical Study ◽  
Joint Capsule ◽  
Joint Stability ◽  
Ac Joint ◽  
Rockwood Classification ◽  
Posterior Displacement ◽  
Horizontal Stability ◽  
Fresh Frozen ◽  
Trapezoid Ligament ◽  
Stage 1

Background: Acromioclavicular (AC) joint dislocation is evaluated using the radiologically based Rockwood classification. The relationship between ligamentous injury and radiological assessment is still controversial. Purpose/Hypothesis: To investigate how the AC ligament and trapezoid ligament biomechanically contribute to the stability of the AC joint using cadaveric specimens. The hypothesis was that isolated sectioning of the AC ligament would result in increased instability in the superior direction and that displacement >50% of the AC joint would occur. Study Design: Controlled laboratory study. Methods: Six shoulders from 6 fresh-frozen cadavers were used in this study. Both the scapula and sternum were solidly fixed on a customized wooden jig with an external fixator. We simulated distal clavicular dislocation with sequential sectioning of the AC and coracoclavicular (CC) ligaments. Sectioning stages were defined as follows: stage 0, the AC ligament, CC ligament, and AC joint capsule were left intact; stage 1, the anteroinferior bundle of the AC ligament, joint capsule, and disk were sectioned; stage 2, the superoposterior bundle of the AC ligament was sectioned; and stage 3, the trapezoid ligament was sectioned. The distal clavicle was loaded with 70 N in the superior and posterior directions, and the magnitudes of displacement were measured. Results: The amounts of superior displacement averaged 3.7 mm (stage 0), 3.8 mm (stage 1), 8.3 mm (stage 2), and 9.5 mm (stage 3). Superior displacement >50% of the AC joint was observed in stage 2 (4/6; 67%) and stage 3 (6/6; 100%). The magnitudes of posterior displacement were 3.7 mm (stage 0), 3.7 mm (stage 1), 5.6 mm (stage 2), and 9.8 mm (stage 3). Posterior displacement >50% of the AC joint was observed in stage 3 (1/6; 17%). Conclusion: We found that the AC ligaments contribute significantly to AC joint stability, and superior displacement >50% of the AC joint can occur with AC ligament tears alone. Clinical Relevance: The AC ligament plays an important role not only in horizontal stability but also in vertical stability of the AC joint.

scholarly journals Acromioclavicular Joint Instability on Cross-Body Adduction View: The Biomechanical Effect of Acromioclavicular and Coracoclavicular Ligaments Sectioning

2021 ◽  
Author(s):  
Shimpei Kurata ◽  
Kazuya Inoue ◽  
Takamasa Shimizu ◽  
Mitsuyuki Nagashima ◽  
Hirakazu Murayama ◽  
...  
Keyword(s):  
Joint Instability ◽  
Joint Capsule ◽  
Distal Clavicle ◽  
Ligament Injuries ◽  
Ac Joint ◽  
Ac Joint Dislocation ◽  
Fresh Frozen ◽  
Trapezoid Ligament ◽  
Stage 1 ◽  
Conoid Ligament

Abstract Background The relationship between acromioclavicular (AC) joint dislocation, corresponding radiological evaluation, and ligament injuries remains controversial. We hypothesized that AC and trapezoid ligament injuries induce AC joint instability, and the clavicle can override the acromion on cross-body adduction view without conoid ligament injury. We aimed to investigate how biomechanically sectioning the AC and coracoclavicular (CC) ligaments contributes to AC joint instability in the cross-body adduction position using fresh-frozen cadaver models. Methods Six fresh-frozen cadaveric shoulders were used in this study, comprising five male and one female specimen, with a mean age of 68.7 (range, 51–87) years). The left side of the trunk and upper limb, and the cervical and thoracic vertebrae and sternum were firmly fixed with an external fixator. The displacement of the distal end of the clavicle relative to the acromion was measured using an electromagnetic tracking device. We simulated AC joint dislocation by sequential resection of AC ligament, AC joint capsule, and CC ligaments in the following order of stages. Stage 0: Intact AC and CC ligaments and acromioclavicular joint capsule; stage 1: Completely sectioned AC ligament and joint disc; stage 2: Sectioned trapezoid ligament; and stage 3: Sectioned conoid ligament. The superior clavicle displacement related to the acromion was measured in the horizontal adduction position, and clavicle overriding on the acromion was assessed radiologically at each stage. Data were analyzed using a one-way analysis of variance and post-hoc tests. Results Superior displacement was 0.3 mm at stage 1, 6.5 mm at stage 2, and 10.7 mm at stage 3. On the cross-body adduction view, there was no distal clavicle overriding at stages 0 and 1, and distal clavicle overriding was observed in five cases (5/6: 83%) at stage 2 and in six cases (6/6: 100%) at stage 3. Conclusion We found that AC and trapezoid ligament sectioning induced AC joint instability and that the clavicle could override the acromion on cross-body adduction view regardless of conoid ligament sectioning. AC and trapezoid ligament injuries may lead to significant AC joint instability, and the distal clavicle may subsequently override the acromion.

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

2021 ◽  
pp. 036354652199550
Author(s):  
Philip-C. Nolte ◽  
Joe J. Ruzbarsky ◽  
Kaare S. Midtgaard ◽  
Kira K. Tanghe ◽  
Bryant P. Elrick ◽  
...  
Keyword(s):  
Surgical Anatomy ◽  
Joint Capsule ◽  
Ac Joint ◽  
Measuring Device ◽  
Mean Values ◽  
Precise Knowledge ◽  
Horizontal Stability ◽  
Fresh Frozen ◽  
The Mean ◽  
Superior Portion

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.

Effect of decrease in radial inclination of distal radius fractures on distal radioulnar joint stability: a biomechanical study

2018 ◽  
Vol 43 (9) ◽  
pp. 967-973 ◽  
Author(s):  
Yuki Bessho ◽  
Toshiyasu Nakamura ◽  
Masao Nishiwaki ◽  
Takeo Nagura ◽  
Morio Matsumoto ◽  
...  
Keyword(s):  
Distal Radius ◽  
Joint Stiffness ◽  
Distal Radioulnar Joint ◽  
Biomechanical Study ◽  
Joint Stability ◽  
Radius Fractures ◽  
Radioulnar Joint ◽  
Radial Inclination ◽  
Fresh Frozen ◽  
The Relationship

We investigated the relationship between the radial inclination of the distal radius and distal radioulnar joint stability. Six fresh-frozen upper extremities were used. Radial inclination was decreased by 10° and 20° and increased by 10° from the original radial inclination. Distal radioulnar joint stiffness was assessed with an intact radioulnar ligament and after partial and then complete sectioning of the radioulnar ligament. Radial angulation deformities significantly increased distal radioulnar joint stiffness when the radioulnar ligament is totally or partially attached to the ulnar fovea. After complete sectioning of the radioulnar ligament, distal radioulnar joint stiffness decreased significantly; additional radial angulation deformity slightly increased distal radioulnar joint stiffness, but the distal radioulnar joint never recovered to the original stiffness. Based on the results, radial angulation deformities of the distal radius should be corrected within 10° when the radioulnar ligament is intact, to reduce the risk of symptomatic distal radioulnar joint instability.

scholarly journals Acromioclavicular Joint Stabilization: A Biomechanical Study of Bidirectional Stability and Strength

2019 ◽  
Vol 7 (4) ◽  
pp. 232596711983675 ◽  
Author(s):  
Patrick Hislop ◽  
Kentaro Sakata ◽  
David C. Ackland ◽  
Robert Gotmaker ◽  
Matthew C. Evans
Keyword(s):  
Cyclic Loading ◽  
Laboratory Study ◽  
Vertical Plane ◽  
Joint Capsule ◽  
Ac Joint ◽  
Treatment Groups ◽  
Mode Of Failure ◽  
Load To Failure ◽  
Horizontal Stability ◽  
Group A

Background: It is important to restore horizontal and vertical stability to the acromioclavicular (AC) joint when treating dislocations of this joint. Most surgical stabilization techniques of the AC joint have primarily addressed the coracoclavicular ligament complex; however, these techniques may not satisfactorily restore horizontal stability to the AC joint. Purpose: To evaluate the strength and bidirectional stability of 3 AC joint stabilizing techniques in a cadaveric model. Study Design: Controlled laboratory study. Methods: A total of 24 cadaveric shoulders were randomly allocated to 3 treatment groups. For each group, a standardized AC joint stabilizing procedure was performed, and the specimens were potted for mechanical testing. The following reconstruction techniques were used: a single clavicular tunnel for group A, a double clavicular tunnel for group B, and a double clavicular tunnel plus suture fixation across the AC joint for group C. The specimens underwent cyclic loading in the horizontal and vertical planes and then load to failure. Eight control specimens also underwent cyclic loading in both planes. Construct stiffness during cyclic loading, change in displacement after cyclic loading in both planes, load to failure in the vertical plane, and mode of failure were evaluated, and stiffness was compared among the treatment groups as well as with a control group. Results: There was a decrease in joint stiffness for all groups, including controls, during the cyclic loading. Compared with controls, all 3 treatment groups demonstrated equivalent stiffness and displacement in the vertical plane. In the horizontal plane, all 3 treatment groups demonstrated decreased stiffness, increased displacement, or both when compared with controls. When groups were compared, no treatment arm proved superior regarding stiffness or displacement in either plane. Load-to-failure testing of the 3 treatment groups in the vertical plane demonstrated construct strength and stiffness comparable with reports for the native AC joint. The mode of failure was predominantly fracture at the point of fixation to the testing apparatus. Conclusion: There was no difference in bidirectional strength and stability between the single– and double–clavicular tunnel techniques of coracoclavicular reconstruction. The addition of a stabilizing suture across the AC joint does not improve horizontal stability in the absence of repair of the AC joint capsule and deltotrapezial fascia. Clinical Relevance: This laboratory study provides further evidence of the importance of the AC joint capsule and associated soft tissues in affording horizontal stability to that joint. Information from this and subsequent studies utilizing a bidirectional model can influence the choice of surgical procedure in the clinical treatment of AC joint dislocations.

The Peroneal Groove Deepening Procedure: A Biomechanical Study of Pressure Reduction

2005 ◽  
Vol 26 (6) ◽  
pp. 442-448 ◽  
Author(s):  
Craig I. Title ◽  
Hung-Geun Jung ◽  
Brent G. Parks ◽  
Lew C. Schon
Keyword(s):  
Biomechanical Study ◽  
Posterior Tibial Tendon ◽  
Peroneal Tendon ◽  
Foot And Ankle ◽  
Calcaneofibular Ligament ◽  
Significant Difference ◽  
Mean Pressure ◽  
Fresh Frozen ◽  
The Mean ◽  
Pressure Changes

Background: The goal of this study was to identify pressure changes throughout the peroneal groove after a groove deepening procedure. We hypothesized that pressures would decrease. Methods: Twelve fresh-frozen foot and ankle specimens were used. A thin pressure strip containing four sensor pads was secured within the peroneal groove with pads 1 through 4 positioned at the calcaneofibular ligament (CFL) and at the distal, middle, and proximal groove, respectively. The midstance phase of gait was simulated with loads applied to the plantar foot and posterior tibial tendon and to the peroneus longus and brevis tendons. Pressures were recorded with the ankle in neutral, plantarflexion, dorsiflexion, inversion, and eversion. Groove deepening was done by osteotomizing the posterior fibular wall. Pressure readings were then recorded. Average pressures for each of the four sensor pads after the procedure were compared to those obtained before the procedure. Results: The mean pressure overlying the CFL increased at all five ankle positions; however, these changes were not significant. Significant decreases in pressure were noted within the distal and middle groove at all ankle positions after the peroneal groove deepening procedure. Pressure within the proximal groove increased at all but one position, with a significant difference noted in neutral and plantarflexion. Conclusion: Pressures within the middle and distal peroneal groove significantly decreased after a groove deepening procedure. Combining this technique with peroneal tendon debridement may be advantageous for treatment of partial peroneal tendon tears or recalcitrant peroneal tendinitis.

Ability of Medial Patellofemoral Ligament Reconstruction to Overcome Lateral Patellar Motion in the Presence of Trochlear Flattening: A Cadaveric Biomechanical Study

2021 ◽  
pp. 036354652110410
Author(s):  
Amrit V. Vinod ◽  
Alex M. Hollenberg ◽  
Melissa A. Kluczynski ◽  
John M. Marzo
Keyword(s):  
Repeated Measures ◽  
Knee Flexion ◽  
Medial Patellofemoral Ligament ◽  
Operative Procedure ◽  
Biomechanical Study ◽  
Mpfl Reconstruction ◽  
Trochlear Groove ◽  
Sulcus Angle ◽  
Fresh Frozen ◽  
Patellar Stability

Background: Medial patellofemoral ligament (MPFL) reconstruction is an established operative procedure to restore medial restraining force in patients with patellar instability. In the setting of a shallow sulcus, it is unclear whether an isolated MPFL reconstruction is sufficient to restore patellofemoral stability. Hypothesis: Progressively increasing the sulcus angle would have an adverse effect on the ability of an MPFL reconstruction to restrain lateral patellar motion. Study Design: Controlled laboratory study. Methods: Seven fresh-frozen human cadaveric knees were harvested and prepared for experimentation. Each specimen was run through the following test conditions: native, lateral retinacular release, lateral retinacular repair, MPFL release, MPFL reconstruction, and MPFL reconstruction with trochlear flattening. Four 3-dimensional printed wedges (10°, 20°, 30°, and 40°) were created to insert beneath the native trochlea to raise the sulcus angle incrementally and simulate progressive trochlear flattening. For each test condition, the knee was positioned at 0°, 15°, 30°, and 45° of flexion, and the force required to displace the patella 1 cm laterally at 10 mm/s was measured. Group comparisons were made with repeated measures analysis of variance. Results: In the setting of an MPFL reconstruction, as the trochlear groove was incrementally flattened, the force required to laterally displace the patella progressively decreased. A 10° increase in the sulcus angle significantly reduced the force at 15° ( P = .01) and 30° ( P = .03) of knee flexion. The force required to laterally displace the patella was also significantly lower at all knee flexion angles after the addition of the 20°, 30°, and 40° wedges ( P≤ .05). Specifically, a 20° increase in the sulcus angle reduced the force by 29% to 36%; a 30° increase, by 35% to 43%; and a 40° increase, by 40% to 47%. Conclusion: Despite an MPFL reconstruction, the force required to laterally displace the patella decreased as the sulcus angle was increased in our cadaveric model. Clinical Relevance: An isolated MPFL reconstruction may not be sufficient to restore patellar stability in the setting of a shallow or flat trochlea. Patients with an abnormal sulcus angle may have recurrent instability postoperatively if treated with an isolated MPFL reconstruction.

Effect of biceps rerouting technique to restore glenohumeral joint stability for large irreparable rotator cuff tears: a cadaveric biomechanical study

2020 ◽  
Vol 29 (7) ◽  
pp. 1425-1434 ◽  
Author(s):  
Sang-Yup Han ◽  
Thay Q. Lee ◽  
David J. Wright ◽  
Il-Jung Park ◽  
Maniglio Mauro ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Glenohumeral Joint ◽  
Biomechanical Study ◽  
Rotator Cuff Tears ◽  
Joint Stability

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

2020 ◽  
Vol 48 (10) ◽  
pp. 2525-2533
Author(s):  
Daichi Morikawa ◽  
Joel B. Huleatt ◽  
Lukas N. Muench ◽  
Cameron Kia ◽  
Daniel P. Berthold ◽  
...  
Keyword(s):  
Surgical Techniques ◽  
Biomechanical Analysis ◽  
Rotational Stability ◽  
Posterior Instability ◽  
Ligament Repair ◽  
Ac Joint ◽  
Improved Stability ◽  
Horizontal Stability ◽  
Posterior Translation ◽  
Joint Biomechanics

Background: Persistent posterior instability of the acromioclavicular (AC) joint is a reported complication after isolated coracoclavicular (CC) reconstruction. Thus, multiple techniques have been proposed attempting to restore biomechanics of the AC ligament complex (ACLC). Purpose/Hypothesis: The purpose was to evaluate the posterior translational and rotational stability of an ACLC reconstruction with a dermal allograft (ACLC patch) as compared with 3 suture brace constructs. It was hypothesized that the ACLC patch would better restore AC joint posterior stability. Study Design: Controlled laboratory study. Methods: A total of 28 cadaveric shoulders (mean ± SD age, 57.6 ± 8.3 years) were randomly assigned to 1 of 4 surgical techniques: ACLC patch, oblique brace, anterior brace, and x-frame brace. The force and torque to achieve 10 mm of posterior translation and 20° of posterior rotation of the AC joint were recorded in the following conditions: intact, transected ACLC, ACLC patch/brace repair, ACLC patch/brace repair with dissected CC ligaments, and ACLC patch/brace repair with CC ligament repair. Results: For posterior translation, transection of the ACLC reduced resistance to 16.7% of the native. With the native CC ligaments intact, the ACLC patch (59.1%), oblique brace (54.1%), and anterior brace (60.7%) provided significantly greater stability than the x-frame brace (33.2%; P < .001, P = .008, P < .001, respectively). ACLC patch, oblique brace, and anterior brace continued to have significantly higher posterior translational resistance than the x-frame (35.1%; P < .001, P = .003, P < .001) after transection and subsequent CC ligament repair. For posterior rotation, transection of the ACLC decreased the resistance to 5.4% of the intact state. With the CC ligaments intact, the ACLC patch (77.1%) better restored posterior rotational stability than the oblique (35.3%), anterior (48.5%), and x-frame (23.0%) brace repairs ( P < .001, P = .002, P < .001). CC ligament transection and subsequent repair demonstrated the ACLC patch (41.0%) to have improved stability when compared with the oblique (16.0%), anterior (14.0%), and x-frame (12.7%) repairs ( P = .006, P = .003, P = .002). Conclusion: ACLC reconstruction with a dermal allograft better restored native posterior rotational stability than other brace constructs, with translational stability similar to the oblique and anterior brace technique at the time of surgery. Clinical Relevance: Horizontal stability of the AC joint is primarily controlled by the ACLC. Inability to restore AC joint biomechanics can result in persistent posterior instability and lead to functional impairment.

Comparison of Two Fixation Methods of Oblique Lesser Metatarsal Osteotomies: A Biomechanical Study

1995 ◽  
Vol 16 (7) ◽  
pp. 437-439 ◽  
Author(s):  
Mark P. Slovenkai ◽  
Daniel Linehan ◽  
Linda McGrady ◽  
Tae-Hong Lim ◽  
Gerald F. Harris ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Screw Fixation ◽  
Material Testing ◽  
Biomechanical Study ◽  
Testing System ◽  
Human Cadaver ◽  
Kirschner Wires ◽  
Fixation Methods ◽  
Single Screw ◽  
Fresh Frozen

Two methods of internal fixation of oblique lesser metatarsal osteotomies were compared biomechanically using fresh-frozen human cadaver bones. Osteotomies were made obliquely through the metatarsal shafts and fixed with either crossed Kirschner wires or a single AO screw using the lag technique. The specimens were then fixed at their proximal end and loaded to failure using an axial torsion material testing system (MTS, Minneapolis, MN). Load displacement curves were obtained and the stiffness of the constructs was determined. Single-screw fixation was found to be significantly stiffer than the crossed wire configuration ( P < .01). Single-screw fixation resulted in a stiffness of 211.2 ± 111.7 N/cm (mean ± SD), while stiffness of the crossed wire configuration averaged 56.9 ± 25.1 N/cm.

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