A biomechanical evaluation of an anatomical coracoclavicular ligament reconstruction.
BACKGROUND
Despite numerous surgical techniques described, there have been few studies evaluating the biomechanical performance of acromioclavicular joint reconstructions.


OBJECTIVE
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.


METHODS
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.


CONCLUSIONS
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.


CONCLUSIONS
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.
Mazzocca
Augustus D
AD
University of Connecticut Health Center, Farmington, USA. admazzocca@yahoo.com
Santangelo
Stephen A
SA
Johnson
Sean T
ST
Rios
Clifford G
CG
Dumonski
Mark L
ML
Arciero
Robert A
RA
D000173:Acromioclavicular Joint / Q000293:injuries / Q000503:physiopathology / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D001178:Arthroplasty / Q000379:methods*; D001696:Biomechanical Phenomena; D015519:Bone Density; D002102:Cadaver; D006801:Humans; D004204:Joint Dislocations / Q000503:physiopathology / Q000601:surgery*; D007593:Joint Instability / Q000503:physiopathology* / Q000601:surgery; D008023:Ligaments, Articular / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D016059:Range of Motion, Articular; D013536:Suture Techniques; D016474:Weight-Bearing