title: Axial-Plane Biomechanical Evaluation of 2 Suspensory Cortical Button Fixation Constructs for Acromioclavicular Joint Reconstruction.
abstract: BACKGROUND
  Although numerous suture-button fixation techniques for acromioclavicular (AC) joint reconstruction have been validated with biomechanical testing in the superior direction, clinical reports continue to demonstrate high rates of construct slippage and breakage.
  
  
  OBJECTIVE
  To compare the stability of a novel closed-loop double Endobutton construct with a commercially available cortical button system in both the axial and superior directions.
  
  
  METHODS
  Controlled laboratory study.
  
  
  METHODS
  Six matched pairs of fresh-frozen cadaveric upper extremities were anatomically dissected and prepared to simulate a complete AC joint dislocation. One side of each pair was reconstructed with the double Endobutton (DE) construct and other side with the dog bone button (DB) construct. The specimens were then tested using a materials testing machine, determining initial superior and axial displacements with a preload, and then cyclically loaded in the axial direction with 70 N for 5000 cycles. Displacement was again measured with the same preloads at fixed cycle intervals. The specimens were then loaded superiorly to failure.
  
  
  RESULTS
  At 5000 cycles, the mean axial displacement was 1.7 mm for the DB group and 1.2 mm for the DE group (P= .19), and the mean superior displacement was 1.1 mm for the DB group and 0.7 mm for the DE group (P= .32). Load at failure was similar (558 N for DE, 552 N for DB;P= .96). There was no statistically significant difference in the modes of failure.
  
  
  CONCLUSIONS
  Biomechanical testing of both constructs showed similar fixation stability after cyclical axial loading and similar loads to failure.
  
  
  CONCLUSIONS
  The strength of both constructs after cyclical loading in the axial plane and load-to-failure testing in the superior plane validate their continued clinical use for achieving stability in AC joint reconstruction procedures.
authors.affiliation: Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, New York, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Struhl
authors.affiliation: Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, New York, USA.
authors.forename: Theodore S
authors.initials: TS
authors.lastname: Wolfson
authors.affiliation: Musculoskeletal Research Center, New York University Hospital for Joint Diseases, New York, New York, USA.
authors.forename: Frederick
authors.initials: F
authors.lastname: Kummer
keywords: Endobutton; acromioclavicular joint; anatomic reconstruction; biomechanics; coracoclavicular ligament