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Biomechanical evaluation of a new technique for acromioclavicular stabilization
Ian Peeters1, Stijn Herregodts2, Lieven De Wilde1
1Department of Orthopedic Surgery, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Gent, Belgium.
Background:
The most commonly used repair techniques to treat an acromioclavicular dislocation imply a suspension mechanism by substituting the supero-inferior oriented coracoclavicular structures with a tight rope mechanism or allograft. Recently, the importance of restoring the antero-posterior stability by addressing the acromioclavicular structures has also been demonstrated. If an in situ repair at the acromioclavicular joint itself could achieve a reposition and would be strong enough, the suspension of the CC structures might become obsolete. Possible advantages would be minimal dissection, lower risk in damaging neurovascular structures, greater stability, reduction of the surgical time and even the possibility of locoregional anesthesia.
Hypothesis:
In this biomechanical study, the feasibility of different in situ repair techniques is explored thereby testing both compression and translation characteristics. Our hypothesis is that an in situ repair technique results in an adequate repair for the AC joint.
Methods And Materials:
Polyurethane foam blocks will be used as a model for the acromioclavicular joint and the repair techniques will be done by using a combination of sutures and bone anchors or using a transosseous technique. Compression will be measured by means of a Tekscan pressure sensor and translation will be tested in three orthogonal directions using a tensile testing machine. Four different knot anchor configurations (nice knot, surgical knot in two different configurations, Nicky's knot) will be tested for compression. The strongest knot anchor configuration will then be compared side to side with a transosseous configuration for translation.
Results:
The nice knot in combination with bone anchors provides the strongest compression. In the side to side comparison of a nice knot anchor configuration versus a transosseous nice knot configuration, the transosseous technique shows more resistance to translation.
Discussion:
An in situ repair by a combination of the nice knot with an anchor or a transosseous nice knot configuration can theoretically be used as a repair technique for an acromioclavicular dislocation. In comparison with existing techniques, this model shows favorable results for translation.
Level Of Evidence:
III, controlled laboratory study.
