Reconstruction of the Acromioclavicular Ligament Complex Using Dermal Allograft: A Biomechanical Analysis

Morikawa, Daichi; Mazzocca, Augustus D.; Obopilwe, Elifho; Cote, Mark P.; Kia, Cameron; Johnson, Jeremiah X.; Imhoff, Florian B.; Scheiderer, Bastian

doi:10.1016/j.arthro.2019.07.021

Cited by 23 publications

(37 citation statements)

References 33 publications

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“…98 The same working group recently published a biomechanical study using patch augmentation to reconstruct the AC capsule and ligaments in addition to reconstruction of the CC ligaments. 104 They found that the reconstruction of the AC capsule and ligaments with dermal allograft in addition to CC reconstruction restored posterior translational and rotational stability closest to normal. 104 However, to date a gold standard has not yet been established.…”

Section: Perspectivementioning

confidence: 97%

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<p>Optimal Management of Acromioclavicular Dislocation: Current Perspectives</p>

Nolte¹,

Lacheta²,

Dekker³

et al. 2020

ORR

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Injuries to the acromioclavicular (AC) joint are common and mostly involve younger, male individuals. Whereas the majority of AC joint dislocations can be treated nonoperatively with a trial of immobilization, pain medication, cryotherapy, and physiotherapy, there are patients that do not respond well to conservative management and may require surgical treatment. Identifying and treating these patients according to the type and chronicity of AC joint dislocation is paramount. To date, a myriad of surgical techniques have been proposed to address unstable AC joint dislocations and are indicative of the uncertainty that exists in optimal management of these injuries. Historically research has focused on the restoration of the coracoclavicular ligament complex. However, recently the importance of the acromioclavicular capsule and ligaments has been emphasized. This review aims to provide the reader with an overview of current treatment strategies and research, as well as future perspectives.

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Section: Perspectivementioning

confidence: 97%

“…104 They found that the reconstruction of the AC capsule and ligaments with dermal allograft in addition to CC reconstruction restored posterior translational and rotational stability closest to normal. 104 However, to date a gold standard has not yet been established.…”

Section: Perspectivementioning

confidence: 97%

<p>Optimal Management of Acromioclavicular Dislocation: Current Perspectives</p>

Nolte¹,

Lacheta²,

Dekker³

et al. 2020

ORR

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“…The construct ensured the stability of the AC joint. However, we designed the construct without any muscle tissues and AC ligaments bridging the span 4,21,[30][31][32] , which may cause large displacements.…”

Section: Load Testingmentioning

confidence: 99%

“…Spiegl et al 40 demonstrated that the size of the clavicular can impair the bone and increase the risk of fractures. The number and size of coracoid drill holes would affect stability and increase the incidence of fractures 28,32,41 . Struhl showed that the shear forces in either the axial or AP direction contributed to the risk of not only suture abrasion but also tunnel widening.…”

Section: Load Testingmentioning

confidence: 99%

Novel Double Endobutton Technique Combined with Three‐Dimensional Printing: A Biomechanical Study of Reconstruction in Acromioclavicular Joint Dislocation

Zhang

Jin³

et al. 2020

Orthopaedic Surgery

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Objective: To reconstruct the acromioclavicular (AC) joint using an adjusted closed-loop double Endobutton technique via a guiding locator that was applied using three-dimensional (3D) printing technology. At the same time, the reliability and safety of the novel double Endobutton (NDE) were tested by comparing the biomechanics of this technique with the TightRope (TR) approach. Methods: This retrospective study was conducted between January 2017 and January 2019. The Department of Anatomy at Southern Medical University obtained 18 fresh-frozen specimens (8 left and 10 right; 12 men and 6 women). First, the guiding locators were applied using 3D printing technology. After preparation of materials, specimens were divided into an NDE group, a TR group, and a normal group. In the NDE and TR groups, the navigation module was used to locate and establish the bone tunnels; after that, the NDE or TR was implanted. However, the Endobuttons were fixed while pressing the distal clavicle downwards and the length of the loop could be adjusted by changing the upper Endobutton in the NDE group while the suture button construct was tensioned and knotted after pressing down the distal clavicle in the TR. Finally, load testing in anterior-posterior (AP), superior-inferior (SI), and medial-lateral (ML) directions as well as load-to-failure testing in the SI direction were undertaken to verify whether the NDE or TR had better biomechanics. Results: In the load testing, the displacements of the NDE and TR groups in the AP, SI, and ML direction were significantly shorter than those of the normal group (P < 0.05). In the load-to-failure testing, the ultimate load of the NDE and TR groups had significantly higher increases than the normal group (722.16 ± 92.04 vs 564.63 ± 63.05, P < 0.05; 680.20 ± 110.29 vs 564.63 ± 63.05, P < 0.05). However, there was no statistically significant difference between the two techniques for these two tests (P > 0.05). In the NDE group, four of six failures were a result of tunnel fractures of the coracoid, while two of six were due to suture breakage. In the TR, three failures were due to coracoid tunnel fractures, one was a result of a clavicle tunnel fracture, and the rest were due to suture breakage. In the

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“…9 This led to the development of a surgical technique that utilized a dermal allograft to reconstruct the superior half of the ACLC in an attempt to better restore the posterior translational and rotational stability. 17 While this construct may be costly and more technically demanding—mainly because several drill holes are required in close proximity, which may act as stress risers and increase the likelihood of fractures or other complications—this might be outweighed clinically by the added stability provided to the AC joint.…”

mentioning

confidence: 99%

Posterior Rotational and Translational Stability in Acromioclavicular Ligament Complex Reconstruction: A Comparative Biomechanical Analysis in Cadaveric Specimens

et al. 2020

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Background: Persistent posterior instability of the acromioclavicular (AC) joint is a reported complication after isolated coracoclavicular (CC) reconstruction. Thus, multiple techniques have been proposed attempting to restore biomechanics of the AC ligament complex (ACLC). Purpose/Hypothesis: The purpose was to evaluate the posterior translational and rotational stability of an ACLC reconstruction with a dermal allograft (ACLC patch) as compared with 3 suture brace constructs. It was hypothesized that the ACLC patch would better restore AC joint posterior stability. Study Design: Controlled laboratory study. Methods: A total of 28 cadaveric shoulders (mean ± SD age, 57.6 ± 8.3 years) were randomly assigned to 1 of 4 surgical techniques: ACLC patch, oblique brace, anterior brace, and x-frame brace. The force and torque to achieve 10 mm of posterior translation and 20° of posterior rotation of the AC joint were recorded in the following conditions: intact, transected ACLC, ACLC patch/brace repair, ACLC patch/brace repair with dissected CC ligaments, and ACLC patch/brace repair with CC ligament repair. Results: For posterior translation, transection of the ACLC reduced resistance to 16.7% of the native. With the native CC ligaments intact, the ACLC patch (59.1%), oblique brace (54.1%), and anterior brace (60.7%) provided significantly greater stability than the x-frame brace (33.2%; P < .001, P = .008, P < .001, respectively). ACLC patch, oblique brace, and anterior brace continued to have significantly higher posterior translational resistance than the x-frame (35.1%; P < .001, P = .003, P < .001) after transection and subsequent CC ligament repair. For posterior rotation, transection of the ACLC decreased the resistance to 5.4% of the intact state. With the CC ligaments intact, the ACLC patch (77.1%) better restored posterior rotational stability than the oblique (35.3%), anterior (48.5%), and x-frame (23.0%) brace repairs ( P < .001, P = .002, P < .001). CC ligament transection and subsequent repair demonstrated the ACLC patch (41.0%) to have improved stability when compared with the oblique (16.0%), anterior (14.0%), and x-frame (12.7%) repairs ( P = .006, P = .003, P = .002). Conclusion: ACLC reconstruction with a dermal allograft better restored native posterior rotational stability than other brace constructs, with translational stability similar to the oblique and anterior brace technique at the time of surgery. Clinical Relevance: Horizontal stability of the AC joint is primarily controlled by the ACLC. Inability to restore AC joint biomechanics can result in persistent posterior instability and lead to functional impairment.

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Reconstruction of the Acromioclavicular Ligament Complex Using Dermal Allograft: A Biomechanical Analysis

Cited by 23 publications

References 33 publications

<p>Optimal Management of Acromioclavicular Dislocation: Current Perspectives</p>

<p>Optimal Management of Acromioclavicular Dislocation: Current Perspectives</p>

Novel Double Endobutton Technique Combined with Three‐Dimensional Printing: A Biomechanical Study of Reconstruction in Acromioclavicular Joint Dislocation

Posterior Rotational and Translational Stability in Acromioclavicular Ligament Complex Reconstruction: A Comparative Biomechanical Analysis in Cadaveric Specimens

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