Purpose
The purpose of this study was to analyze the capsular and ligamentous insertions about
the acromioclavicular (AC) joint to determine the amount of bone that can be removed
without destabilizing the joint.
Methods
We dissected 28 cadaveric shoulders. The AC ligament insertions were measured under
loupe magnification with a digital caliper on the acromial and clavicular sides on
the anterior, posterior, superior, and inferior edges. We measured the distance to
the coracoacromial (CA) and coracoclavicular ligaments. In addition, the axial and
coronal angle of the AC joint was measured.
Results
The AC joint capsular insertion on the acromion begins, on average, 2.8 mm (range,
2.3 to 3.3 mm) from the medial acromion and begins on the lateral clavicle a mean
of 3.5 mm (range, 2.9 to 3.9 mm) from the distal clavicle. The mean capsular width
ranged from 1.6 to 2.9 mm. The mean distance from the medial acromion to the CA ligament
insertion was 3.5 mm. The mean axial angle of the AC joint was 51°, with a 12° coronal
angle. The mean distance from the lateral clavicle to the start of the trapezoid ligament
was 14.7 mm, and that to the conoid ligament was 32.1 mm.
Conclusions
An anatomic-based recommendation for safe AC joint resection is that 2 to 3 mm of
the medial acromion and 3 to 4 mm of the distal clavicle can be resected without removing
the AC capsular insertions. The trapezial and CA attachments are in close proximity
to the AC capsular insertions. Medial resections greater that 15 mm will begin to
take down the trapezoid ligament. Arthroscopic bone resection should be directed into
the AC joint at approximately 50° in the axial plane and 12° in the coronal plane
for safe symmetric resection.
Clinical Relevance
These anatomic measurements suggest that AC joint resections (5 to 7 mm) with 2 to
3 mm from the acromial side and 3 to 4 mm from the clavicular side will not disrupt
the stabilizing ligaments of the AC joint after distal clavicle resection.
Key Words
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Article info
Publication history
Accepted:
April 17,
2009
Received:
March 11,
2008
Footnotes
The authors report no conflict of interest.
Identification
Copyright
© 2009 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
