Acromioclavicular joint reconstruction: an additional acromioclavicular cerclage does not improve horizontal stability in double coraco-clavicular tunnel technique

Theopold, Jan; Schöbel, Tobias; Fischer, Jean-Pierre; Löffler, Sabine; Osterhoff, Georg; Schleifenbaum, Stefan; Hepp, Pierre

doi:10.1007/s00167-019-05674-1

Cited by 21 publications

(23 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…19 However, a recent systematic review including 1704 patients demonstrated a troubling complication rate of 14.2% in addition to a failure rate of 20.8% after open or arthroscopic AC joint stabilization. 12 Since Scheibel et al 33 postulated that clinical outcomes were less favorable if horizontal instability was present after AC joint stabilization, biomechanical 8,9,14,20,22,30,37 and clinical research 2,13,15,16,23,36,38 have focused on the causes of and strategies to mitigate horizontal instability. Horizontal instability can occur in the anterior and posterior directions; however, the posterior direction is thought to be more relevant in the clinical setting.…”

mentioning

confidence: 99%

Quantitative and Qualitative Surgical Anatomy of the Acromioclavicular Joint Capsule and Ligament: A Cadaveric Study

et al. 2021

View full text Add to dashboard Cite

Background: The acromioclavicular (AC) capsule and ligament have been found to play a major role in maintaining horizontal stability. To reconstruct the AC capsule and ligament, precise knowledge of their anatomy is essential. Purpose/Hypothesis: The purposes of this study were (1) to determine the angle of the posterosuperior ligament in regard to the axis of the clavicle, (2) to determine the width of the attachment (footprint) of the AC capsule and ligament on the acromion and clavicle, (3) to determine the distance to the AC capsule from the cartilage border of the acromion and clavicle, and (4) to develop a clockface model of the insertion of the posterosuperior ligament on the acromion and clavicle. It was hypothesized that consistent angles, attachment areas, distances, and insertion sites would be identified. Study Design: Descriptive laboratory study. Methods: A total of 12 fresh-frozen shoulders were used (mean age, 55 years [range, 41-64 years]). All soft tissue was removed, leaving only the AC capsule and ligament intact. After a qualitative inspection, a quantitative assessment was performed. The AC joint was fixed in an anatomic position, and the attachment angle of the posterosuperior ligament was measured using a digital protractor. The capsule and ligament were removed, and a coordinate measuring device was utilized to assess the width of the AC capsule footprint and the distance from the footprint to the cartilage border of the acromion and clavicle. The AC joint was then disarticulated, and the previously marked posterosuperior ligament insertion was transferred into a clockface model. The mean values across the 12 specimens were demonstrated with 95% CIs. Results: The mean attachment angle of the posterosuperior ligament was 51.4° (95% CI, 45.2°-57.6°) in relation to the long axis of the entire clavicle and 41.5° (95% CI, 33.8°-49.1°) in relation to the long axis of the distal third of the clavicle. The mean clavicular footprint width of the AC capsule was 6.4 mm (95% CI, 5.8-6.9 mm) at the superior clavicle and 4.4 mm (95% CI, 3.9-4.8 mm) at the inferior clavicle. The mean acromial footprint width of the AC capsule was 4.6 mm (95% CI, 4.2-4.9 mm) at the superior side and 4.0 mm (95% CI, 3.6-4.4 mm) at the inferior side. The mean distance from the lateral clavicular attachment of the AC capsule to the clavicular cartilage border was 4.3 mm (95% CI, 4.0-4.6 mm), and the mean distance from the medial acromial attachment of the AC capsule to the acromial cartilage border was 3.1 mm (95% CI, 2.9-3.4 mm). On the clockface model of the right shoulder, the clavicular attachment of the posterosuperior ligament ranged from the 9:05 (range, 8:00-9:30) to 11:20 (range, 10:00-12:30) position, and the acromial attachment ranged from the 12:20 (range, 11:00-1:30) to 2:10 (range, 13:30-14:40) position. Conclusion: The finding that the posterosuperior ligament did not course perpendicular to the AC joint but rather was oriented obliquely to the long axis of the clavicle, in combination with the newly developed clockface model, may help surgeons to optimally reconstruct this ligament. Clinical Relevance: Our results of a narrow inferior footprint and a short distance from the inferior AC capsule to cartilage suggest that proposed reconstruction of the AC joint capsule should focus primarily on its superior portion.

show abstract

mentioning

confidence: 99%

Quantitative and Qualitative Surgical Anatomy of the Acromioclavicular Joint Capsule and Ligament: A Cadaveric Study

et al. 2021

View full text Add to dashboard Cite

show abstract

“…The median CCD was 18 (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26) mm at the time of diagnosis, and it was 7.5 (6)(7)(8)(9)(10)(11)(12)(13)(14) mm after the operation 1 year later, representing a significant difference (t = −20.7 P< 0.001). The average VAS score preoperatively was 4.9 (3-7), and it improved to 0.55 (0-2), including the patient with subluxation, the difference was statistically significant (Wilcoxon test, median = −6, P < 0.001).…”

Section: Resultsmentioning

confidence: 95%

“…Surgical procedures focused on anatomic reconstruction of the coraco-clavicular ligaments. Biomechanical studies showed that double coraco-clavicular tunnel technique results in a significant higher stability than single coraco-clavicular tunnel technique [14]. We used optimal clavicular tunnel placements to install a double-bundle titanium cable reconstruct CC ligament (the trapezoid and conoid ligaments) in our study.…”

Section: Discussionmentioning

confidence: 99%

Acute high-grade acromioclavicular joint dislocation patients treated with titanium cable insertion under a homemade guider

et al. 2021

View full text Add to dashboard Cite

Backgrounds To describe a new technique for implanting a double-bundle titanium cable to treat acromioclavicular (AC) joint dislocation via the new guider, and evaluate clinic outcomes. Methods A retrospective study of patients treated for acute high-grade acromioclavicular joint dislocation from June 2016 to January 2020 in our trauma center, twenty patients with AC joint dislocation were managed with double-bundle titanium cable. It includes the following steps: (1) Put the guider under the coracoid close to the cortical; (2) drill proximal clavicle; (3) place the titanium cable; (4) perforate distal clavicle, (5) reset the acromioclavicular joint and lock titanium cable; and (6) suture the acromioclavicular ligament. An independent reviewer conducted functional testing of these patients, including the use of coracoclavicular distance (CCD), visual analog scale (VAS) scores, and Constant–Murley scores (CMS). Results All patients are presented following at a median duration of 15 months (12-24months) after the surgery. All patients based on X-ray evaluation and clinic evaluation. The median CCD was 7.5 (6–14) mm, the VAS score was 0.55 (0-2), the CMS score was 95.5 (92-99). One patient had subluxation again at the final follow-up based on X-ray examination. Conclusions This study demonstrates that the AC joint fixation anatomically with double-bundle titanium, acquired excellent outcomes in terms of the recovery of shoulder joint function and radiographic outcomes. It has a low complication rate and need not remove the hardware.

show abstract

“…Through computer simulation of nite element analysis combined with biomechanical research, many scholars consider that additional augmentation suture repair of acromioclavicular ligament after reconstruction of coracoclavicular ligament can signi cantly improve the postoperative posterior displacement and rotation stability of acromioclavicular joint (11)(12)(13). However, some researchers carried out biomechanical analysis of cadaveric specimens simulating surgically treated acromioclavicular joint dislocation, and found that the effect of an additional acromioclavicular cerclage on the stability of acromioclavicular joint seemed to be negligible (14). Therefore, they do not recommend to use additional acromioclavicular cerclage.…”

Section: Discussionmentioning

confidence: 99%

Reconstruction of Coracoclavicular Ligament with Endobutton and Sutures to Stabilize Acromioclavicular Joint: A Retrospective Clinical Study and Finite Element Analysis

Ding

zhang²,

Chen

et al. 2021

Preprint

View full text Add to dashboard Cite

Acromioclavicular joint dislocation is a common sports injury disease, surgical treatment to restore the acromioclavicular joint stability, including stability and vertical stability level. However, vertical stability is often neglected. So we did a retrospective study enrolled 38 patients using Endobutton reconstruction and suture repair (Group A) with those using single Endobutton (Group B). The perioperative assessments contained coracoclavicular distance (CCD), Constant-Murley shoulder joint score, University of California at Los Angeles (UCLA) shoulder joint score and the difference between bilateral CCD 12 months postoperatively. The evaluation of group A was significantly better than group B. Constant-Murley scores and UCLA shoulder scores preoperatively were significantly higher than those after operation. The postoperative CCD of the two groups was lower than that before surgery. CCD between the affected shoulder and another postoperatively was no difference in group A, but was different in group B. The difference of postoperative CCD of the two groups was different. Afterward, we evaluated the stress and deformation around the acromioclavicular joint by finite element analysis and found that the stress dispersion and displacement reduction enhanced the stability of acromioclavicular joint. Thus, reconstruction of coracoclavicular ligament with Endobutton and sutures repair can increase the stability of acromioclavicular joint.

show abstract

Acromioclavicular joint reconstruction: an additional acromioclavicular cerclage does not improve horizontal stability in double coraco-clavicular tunnel technique

Cited by 21 publications

References 28 publications

Quantitative and Qualitative Surgical Anatomy of the Acromioclavicular Joint Capsule and Ligament: A Cadaveric Study

Quantitative and Qualitative Surgical Anatomy of the Acromioclavicular Joint Capsule and Ligament: A Cadaveric Study

Acute high-grade acromioclavicular joint dislocation patients treated with titanium cable insertion under a homemade guider

Reconstruction of Coracoclavicular Ligament with Endobutton and Sutures to Stabilize Acromioclavicular Joint: A Retrospective Clinical Study and Finite Element Analysis

Contact Info

Product

Resources

About