title: Failure of coracoclavicular artificial graft reconstructions from repetitive rotation.
abstract: OBJECTIVE
  To assess how suture type and suture construct in an augmented Weaver-Dunn reconstruction affect coracoclavicular sling failure and rotary stability.
  
  
  METHODS
  Fifteen cadaveric shoulders were tested in rotation about the long axis of the clavicle with 10 lb of simulated arm weight. The clavicle was rotated 50 degrees about its long axis, and the applied torque was recorded. Next, modified Weaver-Dunn reconstruction was conducted. Two types of coracoclavicular sling (opposed drill holes through the clavicle and complete loop around the clavicle) were tested by use of 3 different sutures (FiberWire [Arthrex, Naples, FL], Mersilene tape [Ethicon, Somerville, NJ], and braided polydioxanone [PDS] [Ethicon]). For each sling-suture combination, the joint was retested over 50 degrees of rotation and then cycled over 40 degrees of rotation for 15,000 cycles or until failure.
  
  
  RESULTS
  After modified Weaver-Dunn reconstruction with either sling construct, mean torque over 50 degrees of acromioclavicular rotation was significantly reduced in posterior (P < .0001) and anterior (P < .0001) rotation, with any suture material tested. When the coracoclavicular sling was placed through opposed drill holes, no wear to the bone or suture was observed. When the sling material was looped around the clavicle, FiberWire and PDS resulted in abrasion of soft tissue and periosteum. In all cases sawing motion between bone and suture was observed at the coracoid. The FiberWire itself failed at a mean of 8,213 cycles. Some wear was noted in the Mersilene tape. PDS suture showed no wear.
  
  
  CONCLUSIONS
  In a cadaveric model of modified Weaver-Dunn reconstruction, a coracoclavicular suture loop was used to augment coracoacromial ligament transfer. Suture loops secured around the entire clavicle were shown to contribute to increased abrasive wear. Securing suture loops through opposed drill holes in the clavicle resulted in decreased abrasive wear.
  
  
  CONCLUSIONS
  Proper selection of suture type and suture construct may affect the failure rate of augmented Weaver-Dunn reconstructions.
authors.affiliation: William Beaumont Hospital Research Institute, Royal Oak, Michigan 48067, USA.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Kippe
authors.forename: Constantine K
authors.initials: CK
authors.lastname: Demetropoulos
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Baker
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Jurist
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Guettler
mesh_terms: D001132:Arm / Q000033:anatomy & histology / Q000502:physiology; D002102:Cadaver; D002968:Clavicle / Q000293:injuries* / Q000601:surgery*; D012090:Cumulative Trauma Disorders / Q000601:surgery*; D006801:Humans; D009043:Motor Activity / Q000502:physiology; D009068:Movement; D009929:Organ Size; D019651:Plastic Surgery Procedures / Q000379:methods*; D012399:Rotation; D012785:Shoulder Joint / Q000033:anatomy & histology; D013537:Sutures; D019415:Torque