title: Lateral clavicle fracture with coracoclavicular ligament injury: a biomechanical study of 4 different repair techniques.
abstract: OBJECTIVE
  To investigate the biomechanical performance of four different methods used for coracoclavicular (CC) ligament reconstruction in a lateral clavicle fracture repair.
  
  
  METHODS
  Native displacement, translation, and rotation at the acromioclavicular joint of 24 fresh-frozen cadaveric shoulders were tested. A reproducible fracture in the lateral third of the clavicle was created by dissecting both CC ligaments. Each specimen was then repaired with plate fixation of the fracture and the following CC repair technique: (1) Cortical button. (2) Suture anchor and plate button. (3) Suture anchor no plate button, and (4) Suture around coracoid. All reconstructed specimens were then re-tested for displacement, translation, and load to failure, and compared to their native results. Groups 1 and 3 were investigated for rotational load.
  
  
  RESULTS
  There was no difference in load to failure between the repaired groups (p: ns). Group 1 showed less superior and anterior translations (p < 0.05). Group 2 showed significantly less superior translation (p = 0.003), but no significance with anterior and posterior translations to the native joint. Group 3 showed less superior and posterior translations (p = 0.005 and p = 0.039). Anterior and posterior translations were increased in group 4 (p < 0.05).
  
  
  CONCLUSIONS
  The biomechanical analyses did not show any significance in load to failure or displacement after cyclic loading among the study groups. All repairs were effective in preventing superior translation. Groups 1 and 2 demonstrated increased horizontal stability compared to the native state. All 4 methods are clinically viable options for CC ligament repair.
authors.affiliation: Department of Orthopaedic Surgery, New England Musculoskeletal Institute, University of Connecticut, Farmington, CT, 06034, USA.
authors.forename: Farhang
authors.initials: F
authors.lastname: Alaee
authors.affiliation: Department of Orthopaedic Surgery, New England Musculoskeletal Institute, University of Connecticut, Farmington, CT, 06034, USA.
authors.forename: John
authors.initials: J
authors.lastname: Apostolakos
authors.affiliation: Department of Orthopaedic Surgery, New England Musculoskeletal Institute, University of Connecticut, Farmington, CT, 06034, USA.
authors.forename: Hardeep
authors.initials: H
authors.lastname: Singh
authors.affiliation: Department of Orthopaedic Sports Medicine, Technical University, Munich, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Holwein
authors.affiliation: Department of Orthopaedic Sports Medicine, Technical University, Munich, Germany.
authors.forename: Theresa
authors.initials: T
authors.lastname: Diermeier
authors.affiliation: Department of Orthopaedic Surgery, New England Musculoskeletal Institute, University of Connecticut, Farmington, CT, 06034, USA.
authors.forename: Mark P
authors.initials: MP
authors.lastname: Cote
authors.affiliation: Department of Orthopaedic Sports Medicine, Technical University, Munich, Germany.
authors.forename: Knut
authors.initials: K
authors.lastname: Beitzel
authors.affiliation: Department of Orthopaedic Sports Medicine, Technical University, Munich, Germany.
authors.forename: Andreas B
authors.initials: AB
authors.lastname: Imhoff
authors.affiliation: Department of Orthopaedic Surgery, New England Musculoskeletal Institute, University of Connecticut, Farmington, CT, 06034, USA. mazzocca@uchc.edu.
authors.forename: Augustus D
authors.initials: AD
authors.lastname: Mazzocca
authors.affiliation: Department of Orthopaedic Surgery, New England Musculoskeletal Institute, University of Connecticut, Farmington, CT, 06034, USA.|Department of Orthopaedic Sports Medicine, Technical University, Munich, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Voss
mesh_terms: D001696:Biomechanical Phenomena; D001860:Bone Plates; D002102:Cadaver; D002968:Clavicle / Q000293:injuries* / Q000601:surgery; D005592:Fracture Fixation / Q000295:instrumentation; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D008023:Ligaments, Articular / Q000293:injuries* / Q000601:surgery; D008422:Materials Testing; D008875:Middle Aged; D009984:Orthopedic Fixation Devices; D053441:Suture Anchors
keywords: AC joint; Biomechanics; Coracoclavicular ligament injury; Lateral clavicle fracture