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A biomechanical evaluation of an anatomical coracoclavicular ligament reconstruction
Augustus D Mazzocca1, Stephen A Santangelo, Sean T Johnson
1University of Connecticut Health Center, Farmington, USA. admazzocca@yahoo.com
Background:
Despite numerous surgical techniques described, there have been few studies evaluating the biomechanical performance of acromioclavicular joint reconstructions.
Purpose:
To compare a newly developed anatomical coracoclavicular ligament reconstruction with a modified Weaver-Dunn procedure and a recently described arthroscopic method using ultrastrong nonabsorbable suture material.
Study Design:
Controlled laboratory study.
Methods:
Forty-two fresh-frozen cadaveric shoulders (72.8 +/- 13.4 years) were randomly assigned to 3 groups: arthroscopic reconstruction, anatomical coracoclavicular reconstruction, and a modified Weaver-Dunn procedure. Bone mineral density was obtained on all specimens. Specimens were tested to 70 N in 3 directions, anterior, posterior, and superior, comparing the intact to the reconstructed states. Superior cyclic loading at 70 N for 3000 cycles was then performed at a rate of 1 Hz, followed by a load to failure test (120 mm/min) to simulate physiologic states at the acromioclavicular joint.
Results:
In comparison to the intact state, the modified Weaver-Dunn procedure had significantly (P < .05) greater laxity than the anatomical coracoclavicular reconstruction or the arthroscopic reconstruction. There were no significant differences in bone mineral density (g/cm(2)), load to failure, superior migration over 3000 cycles, or superior displacement. The anatomical coracoclavicular reconstruction had significantly less (P < .05) anterior and posterior translation than the modified Weaver-Dunn procedure. The arthroscopic reconstruction yielded significantly less anterior displacement (P < .05) than the modified Weaver-Dunn procedure.
Conclusion:
The anatomical coracoclavicular reconstruction has less anterior and posterior translation and more closely approximates the intact state, restoring function of the acromioclavicular and coracoclavicular ligaments.
Clinical Relevance:
A more anatomical reconstruction using a free tendon graft of both the trapezoid and conoid ligaments may provide a stronger, permanent biologic solution for dislocation of the acromioclavicular joint. This reconstruction may minimize recurrent subluxation and residual pain and permit earlier rehabilitation.