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Related Concept Videos

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Acromioclavicular joint reconstruction implants have differing ability to restore horizontal and vertical plane

Mohamed Alkoheji1, Hadi El-Daou2, Jillian Lee1

  • 1Department of Orthopaedics, Royal London Hospital, Whitechapel Road, London, E1 1FR, UK.

Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA
|August 26, 2021
PubMed
Summary

Suture and button reconstructions effectively restore acromioclavicular joint (ACJ) stability after high-grade injuries. Tape-based implants may cause anterior clavicle displacement, unlike direct suture methods.

Keywords:
Acromioclavicular joint reconstructionArtificial implantsBiomechanicsRobotic testingVertical and horizontal plane stability

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Area of Science:

  • Orthopedic surgery
  • Biomechanics
  • Sports medicine

Background:

  • Persistent acromioclavicular joint (ACJ) instability after high-grade injuries leads to significant patient symptoms.
  • Restoring both horizontal and vertical plane stability is crucial for native ACJ function.
  • Current implant methods' efficacy in restoring complete native ACJ stability is not well-established.

Purpose of the Study:

  • To quantitatively assess the ability of three commercially available implant reconstructions to restore native ACJ stability in the vertical and horizontal planes.
  • To compare the biomechanical performance of different ACJ reconstruction techniques.

Main Methods:

  • Fresh-frozen shoulders were tested using a robotic system to measure native ACJ stability (anterior, posterior, superior, inferior).
  • ACJ ligaments were transected, and reconstructions were performed using tape loop/screw, tape loop/button, or suture/button systems.
  • Post-reconstruction stability was remeasured and compared to native ACJ stability using statistical analysis (ANOVA, t-tests with Bonferroni correction).

Main Results:

  • All three tested reconstructions successfully restored anterior-posterior (A-P) stability to native levels.
  • Tape-based reconstructions (loop/screw, loop/button) resulted in anterior displacement of the clavicle.
  • Only the suture and button reconstruction significantly matched native ligament restraint for superior-inferior (S-I) stability.

Conclusions:

  • The suture and button reconstruction, which utilizes direct tunnels through the clavicle and coracoid, effectively restored all measured stability parameters (A, P, S, I) to native values.
  • Tape implant designs that wrap around the bones led to anteriorization of the clavicle, indicating differential abilities in restoring horizontal and vertical plane stability.
  • These findings highlight the importance of implant design in achieving comprehensive ACJ stability restoration.