Biomechanical comparison of coracoclavicular reconstructive techniques.
BACKGROUND
Acromioclavicular joint dislocations are common orthopaedic injuries. Numerous operative techniques have been described, but the gold standard has yet to be defined. The goal of fixation is to create a stiff and strong reconstruction of the coracoclavicular ligaments to provide optimal stability. The modified Weaver-Dunn is the traditional surgical procedure. However, due to the high rate of recurrent instability with this technique, a shift toward a more anatomic repair has occurred.


OBJECTIVE
To evaluate the biomechanical performance of multiple types of coracoclavicular ligament reconstruction.


METHODS
Controlled laboratory study.


METHODS
Thirty fresh-frozen human cadaveric shoulders were assigned to 1 of 5 reconstruction groups or a control group: modified Weaver-Dunn, nonanatomic allograft, anatomic allograft, anatomic suture, and GraftRope. A type III acromioclavicular joint dislocation was simulated in all specimens. The 5 techniques were completed, and a cyclic preload and a load-to-failure protocol were performed.


RESULTS
The control had an average load to failure of 1330.6 ± 447.0 N. Compared with all techniques, the anatomic allograft had the highest load to failure, 948 ± 148 N. It had a significantly higher load to failure than the modified Weaver-Dunn (523.2 ± 98.6 N, P = .001), the anatomic suture (578.2 ± 195.3 N, P = .01), the nonanatomic allograft (591.2 ± 65.6 N, P = .003), and the GraftRope (646 ± 167.4, P = .016). No significant difference in load to failure was found between the remaining techniques.


CONCLUSIONS
The anatomic allograft reconstruction has superior initial biomechanical properties compared with the modified Weaver-Dunn, nonanatomic allograft, anatomic suture, and GraftRope techniques.


CONCLUSIONS
Anatomic reconstruction of the coracoclavicular ligaments with allograft may provide a stronger biological solution for acromioclavicular joint dislocations. This reconstruction may minimize recurrent subluxation and pain and permit earlier rehabilitation when compared with current techniques.
Beth Israel Medical Center, New York, New York, USA.
Kristen
K
Thomas
Alan
A
Litsky
Grant
G
Jones
Julie Y
JY
Bishop
D000173:Acromioclavicular Joint / Q000293:injuries / Q000601:surgery*; D001696:Biomechanical Phenomena; D002102:Cadaver; D006801:Humans; D004204:Joint Dislocations / Q000601:surgery*; D008023:Ligaments, Articular / Q000601:surgery* / Q000637:transplantation; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods*; D013536:Suture Techniques; D014184:Transplantation, Homologous; D016896:Treatment Outcome