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Biomechanical evaluation and finite element analysis of coracoclavicular ligament reconstruction using a modified
Qi Zhang1, Shunlin Zhang1, Song Chen2
1Department of Orthopedics and Joint Surgery, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China.
Introduction:
Conventional point-to-point (PTP) suture-anchor fixation for coracoclavicular ligament reconstruction may lead to uneven load sharing and stress concentration. This study evaluated the biomechanical performance of a modified double-pulley (DP) technique and compared it with the conventional PTP method using synthetic bone testing and finite element analysis.
Methods:
Ten clavicle-coracoid polyurethane model pairs were randomly assigned to the modified DP group or PTP group, with five pairs in each group. All constructs underwent cyclic loading followed by load-to-failure testing. Initial displacement, final displacement, displacement change, ultimate failure load, and failure mode were recorded. Finite element models were also established to compare stress distribution and distal clavicle displacement between the two configurations under identical boundary and loading conditions.
Results:
The modified DP group showed significantly lower initial displacement, final displacement, and displacement change than the PTP group during cyclic loading. The ultimate failure load was significantly higher in the modified DP group than in the PTP group (367.07 ± 17.24 N vs. 285.70 ± 38.48 N, p < 0.01). Failure occurred through bilateral anchor pullout in the modified DP group but unilateral anchor pullout in the PTP group. Under the specified mesh and modeling conditions, the modified DP model showed lower computed peak stresses in the suture (196.01 MPa vs. 287.72 MPa), anchor (196.01 MPa vs. 274.82 MPa), and clavicle (26.54 MPa vs. 32.99 MPa), as well as lower distal clavicular displacement (0.23552 mm vs. 0.24565 mm), than the PTP model.
Conclusion:
The modified DP technique provided greater initial fixation strength and lower cyclic displacement than the conventional PTP method under the present synthetic-model testing conditions. The finite element findings provided exploratory, model-dependent mechanistic support for the observed biomechanical differences.