Purpose
To assess how suture type and suture construct in an augmented Weaver-Dunn reconstruction
affect coracoclavicular sling failure and rotary stability.
Methods
Fifteen cadaveric shoulders were tested in rotation about the long axis of the clavicle
with 10 lb of simulated arm weight. The clavicle was rotated 50° about its long axis,
and the applied torque was recorded. Next, modified Weaver-Dunn reconstruction was
conducted. Two types of coracoclavicular sling (opposed drill holes through the clavicle
and complete loop around the clavicle) were tested by use of 3 different sutures (FiberWire
[Arthrex, Naples, FL], Mersilene tape [Ethicon, Somerville, NJ], and braided polydioxanone
[PDS] [Ethicon]). For each sling-suture combination, the joint was retested over 50°
of rotation and then cycled over 40° of rotation for 15,000 cycles or until failure.
Results
After modified Weaver-Dunn reconstruction with either sling construct, mean torque
over 50° of acromioclavicular rotation was significantly reduced in posterior (P < .0001) and anterior (P < .0001) rotation, with any suture material tested. When the coracoclavicular sling
was placed through opposed drill holes, no wear to the bone or suture was observed.
When the sling material was looped around the clavicle, FiberWire and PDS resulted
in abrasion of soft tissue and periosteum. In all cases sawing motion between bone
and suture was observed at the coracoid. The FiberWire itself failed at a mean of
8,213 cycles. Some wear was noted in the Mersilene tape. PDS suture showed no wear.
Conclusions
In a cadaveric model of modified Weaver-Dunn reconstruction, a coracoclavicular suture
loop was used to augment coracoacromial ligament transfer. Suture loops secured around
the entire clavicle were shown to contribute to increased abrasive wear. Securing
suture loops through opposed drill holes in the clavicle resulted in decreased abrasive
wear.
Clinical Relevance
Proper selection of suture type and suture construct may affect the failure rate of
augmented Weaver-Dunn reconstructions.
Key Words
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Article info
Publication history
Accepted:
March 16,
2009
Received:
August 13,
2008
Footnotes
Supported by Stryker Endoscopy, San Jose, CA. The authors report no conflict of interest.
Identification
Copyright
© 2009 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
