Three-Dimensional Footprint Mapping of the Deltoid and Trapezius: Anatomic Pearls for Acromioclavicular Joint Reconstruction

LeVasseur, Matthew R.; Mancini, Michael R.; Kakazu, Rafael; Cusano, Antonio; Spencer, Mark; Pina, Matthew; Cote, Mark P.; Mazzocca, Augustus D.

doi:10.1016/j.arthro.2021.07.016

Cited by 7 publications

(9 citation statements)

References 19 publications

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“…This is because of the deltotrapezial fascia acting as a static and dynamic stabilizer of the ACJ via transmission from the trapezius and deltoid muscles. 19 The current study supports that trapezial injury at the ACJ may specifically contribute to increased ACJ instability. However, it should be acknowledged that in vivo deltotrapezial fascial injuries may differ from the transection featured in this biomechanical study.…”

Section: Discussionsupporting

confidence: 80%

“…Currently, ACJ reconstruction surgical techniques do not feature reconstitution of the trapezial insertion on the clavicle. A recent study by LeVasseur et al 19 trapezial insertion on the ACJ. This consideration may also be similarly applied to reconstitution of the anterior deltoid to the distal clavicle during ACJ reconstruction in an effort to obtain increased ACJ stabilization.…”

Section: Discussionmentioning

confidence: 99%

“… 13 Additionally, it has been accepted that these transverse fibers secondarily provide dynamic stabilization to the ACJ. 8 , 19 In this study, angle-controlled rotation of the scapula (internal and external) with a static clavicle was used to reproducibly mimic protraction and retraction as it occurs in vivo. This approach allows for the most functional analysis of dynamic trapezial support.…”

Section: Discussionmentioning

confidence: 99%

“…Currently, ACJ reconstruction surgical techniques do not feature reconstitution of the trapezial insertion on the clavicle. A recent study by LeVasseur et al 19 highlighted the possible importance of either maintaining or repairing trapezial insertion to the ACJ during reconstructions to enhance stability. Considering that this current study demonstrated the increased instability of the ACJ in internal rotation with trapezial injury, future advancements in ACJ reconstruction may benefit from repairing the trapezial insertion on the ACJ.…”

Section: Discussionmentioning

confidence: 99%

“…The trapezius is of particular interest because of its attachments to the clavicle, ACLC, and scapula. 8 , 19 However, underlying mechanisms of trapezial dynamic stabilization of the ACJ are largely unknown. 10 , 17 , 18 , 22 , 26 Sahara et al 25 demonstrated in a 3-dimensional kinematic analysis of the ACJ using magnetic resonance imaging that during abduction, the trapezius played a critical role through attachment to the distal end of the clavicle and providing posterior translation.…”

mentioning

confidence: 99%

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The Role of the Trapezius in Stabilization of the Acromioclavicular Joint: A Biomechanical Evaluation

Trudeau

Peters

Hawthorne

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: Acromioclavicular joint (ACJ) injuries are common, and many are adequately treated nonoperatively. Biomechanical studies have mainly focused on static ligamentous stabilizers. Few studies have quantified ACJ stabilization provided by the trapezius. Purpose/Hypothesis: To elucidate the stabilization provided by the trapezius to the ACJ during scapular internal and external rotation (protraction and retraction). It was hypothesized that sequential trapezial resection would result in increasing ACJ instability. Study Design: Controlled laboratory study. Methods: A biomechanical approach was pursued, with 10 cadaveric shoulders with the trapezius anatomically force loaded to normal. The trapezius was then serially transected over 8 trials, which alternated between clavicular defects (CD) and scapular defects (SD); each sequential defect consisted of 25% of the clavicular or scapular trapezial attachment. After each defect, specimens were tested with angle-controlled scapular internal and external rotation (12°) with rotary torque measurements to evaluate ACJ stability. Results: The mean resistance in rotary torque for 12° of scapular internal rotation (protraction) with native specimens was 7.0 ± 2.0 N·m. Overall, internal rotation demonstrated a significant decrease in ACJ stability with trapezial injury ( P < .001). Eight sequential defects resulted in the following significant percentage decreases in rotary torque from native internal rotation: 1.5% (25% CD; 0% SD), 5.6% (25% CD; 25% SD), 5.1% (50% CD; 25% SD), 6.5% (50% CD; 50% SD), 3.8% (75% CD; 50% SD), 7.1% (75% CD; 75% SD), 6.7% (100% CD; 75% SD), and 12.3% (100% CD 100% SD) ( P < .001). The mean resistance in rotary torque for 12° of scapular external rotation (retraction) with native specimens was 7.1 ± 1.7 N·m. External rotation did not demonstrate a significant decrease in ACJ stability with trapezial injury ( P = .596). The 8 sequential defects resulted in decreases in rotary torque from native external rotation of 0%, 3.8%, 4.0%, 3.2%, 3.5%, 3.4%, 4.2%, and 0.7%. Conclusion: Trapezial injury resulted in increased instability in the setting of scapular internal rotation (protraction) of the ACJ. Clinical Relevance: These findings validate the inclusion of deltotrapezial fascial injury consideration in the modified Rockwood classification system. Repair of the trapezial insertion on the ACJ may provide improved outcomes in the setting of ACJ reconstruction.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%