Anatomical acromioclavicular ligament reconstruction: a biomechanical comparison of reconstructive techniques of the acromioclavicular joint.
BACKGROUND
Current surgical treatments for acromioclavicular separations do not re-create the anatomy of the acromioclavicular joint.


OBJECTIVE
Anatomical acromioclavicular reconstruction re-creates the strength of the native acromioclavicular joint and is stronger than a modified Weaver-Dunn repair.


METHODS
Controlled laboratory study.


METHODS
The native acromioclavicular joint in 6 fresh-frozen cadaveric upper extremities was stressed to failure under uniaxial tension in the coronal plane. A modified Weaver-Dunn procedure, anatomical acromioclavicular reconstruction using a palmaris longus graft, and anatomical acromioclavicular reconstruction using a flexor carpi radialis graft were then performed sequentially. Each repair was stressed to failure. Load-displacement curves and mechanism of failure were recorded for each.


RESULTS
Loads at failure for the native acromioclavicular joint complex, modified Weaver-Dunn procedure, anatomical acromioclavicular reconstruction using a palmaris longus tendon graft, and anatomical acromioclavicular reconstruction using a flexor carpi radialis tendon graft were 815 N, 483 N, 326 N, and 774 N, respectively. The strength of the native acromioclavicular joint complex was significantly different from the modified Weaver-Dunn repair (P < .001) and the anatomical acromioclavicular reconstruction using a palmaris longus tendon graft (P < .001) but not from the anatomical acromioclavicular reconstruction using a flexor carpi radialis tendon graft (P = .607).


CONCLUSIONS
The strength of the described anatomical acromioclavicular reconstruction is limited by the tendon graft used. Anatomical acromioclavicular reconstruction with a flexor carpi radialis tendon graft re-creates the tensile strength of the native acromioclavicular joint complex and is superior to a modified Weaver-Dunn repair.
Grutter
Paul W
PW
Department of Orthpaedic Surgery, 1st Medical Group/SGOSO, United States Air Force, 45 Pine Street, Langley Air Force Base, Virginia 23665-2080, USA. grutter@excite.com
Petersen
Steve A
SA
D000173:Acromioclavicular Joint / Q000293:injuries* / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D001696:Biomechanical Phenomena; D002102:Cadaver; D006801:Humans; D007593:Joint Instability; D008022:Ligaments / Q000293:injuries / Q000601:surgery*; D018482:Muscle, Skeletal / Q000637:transplantation; D013710:Tendons / Q000637:transplantation*