TightRope Versus Fiber Mesh Tape Augmentation of Acromioclavicular Joint Reconstruction

Abstract

TightRope augmentation of a Weaver-Dunn procedure could provide increased protection for AC joint reconstruction, allowing for earlier mobilization and more aggressive early rehabilitation. The potential clinical effect of additional tightening in the superoinferior direction beyond that of the native joint remains an issue for further study.

Arthroscopic-Assisted Acromioclavicular Joint Reconstruction Using the TightRope Device With Allograft Augmentation: Surgical Technique

“…Many of the described repair options offer biomechanically robust reconstructions; however, they often require multiple drill holes through the clavicle, which can create stress risers or result in suture cutout (or both). The TightRope device has been described both biomechanically [2][3][4][5] and clinically 6-8 as a viable reconstruction option requiring only a single drill hole through the clavicle; however, concerns over suture failure through bony cutout remain. Allograft augmentation of this fixation construct helps to eliminate the stress risers potentially created by the device while increasing overall repair construct stability.…”

“…9 Several authors have evaluated the biomechanical properties of the TightRope system for AC joint reconstruction. [2][3][4][5] Most often, these studies have reported high vertical stiffness loads with the TightRope construct but more physiological axial stiffness with other techniques such as hook plates, bone anchors, and cerclage wires. 2,4 Similarly, clinical investigations have examined the clinical application of the TightRope device for AC joint reconstruction, with encouraging outcomes.…”

“…Recently, Motta et al 10 reported on 20 patients undergoing arthroscopic AC joint reconstruction with the TightRope device, with loss of joint reduction due to rupture of the sutures across the buttons in 4 patients (20%). In addition, supraphysiological stiffness of the repair construct has been shown biomechanically 3 ; however, the clinical relevance of this is as yet undetermined. Furthermore, the use of allograft has inherent limitations not related to the AC joint, including cost, availability, and risk of disease transmission and infection.…”

Biomechanik aktueller Rekonstruktionstechniken bei Schultereckgelenksprengungen

“…Diese reduzieren aufgrund der transklavikulären und -korakoidalen Fixation die Gefahr eines Sägeeffektes des Nahtmaterials und eines anterioren "slippage" der Cerclage entlang der Korakoid-Krümmung [9,24]. Die maximale Belastbarkeit solcher Augmentationen erreicht dabei das Niveau des intakten AC-Gelenkes und die verbleibende horizontale Instabilität ist gegenüber der konventionellen CC-Cerclage reduziert [26], allerdings nicht auf das Niveau des intakten AC-Gelenkes. Als implantatspezifisches Problem stellte sich zudem die Lastkonzentration bei kleinflächigen Fixations-Buttons heraus, was in einem gewissen Prozentsatz der Patienten zum Einsinken der Buttons vor allem in den klavikulären Knochen führte.…”

“…Die biomechanischen Ergebnisse dieser Techniken sind wahrscheinlich bedingt durch die unterschiedlichen Formen der CC-Augmentation inkonsistent. Letztendlich bildet aber auch für diese Techniken die posteriore AC-Gelenkstabilisierung eine nachgewiesene Schwachstelle [13,23,26].…”