Purpose
The purposes were to determine the bone density at specific bone tunnel locations
in the clavicle and to determine ultimate load to failure of a graft fixed with an
interference screw at specific areas.
Methods
Bone mass densitometry was tested at 5-mm intervals from the lateral to the medial
end of 11 clavicles (mean age, 70.0 ± 17.7 years). Tunnels were drilled in 10-mm increments
from the lateral edge, and tenodesis screws were used to fix semitendinosus grafts
in the tunnel. Grafts were cyclically loaded, followed by load to failure.
Results
The bone mineral density (BMD) of the cadaveric clavicles increased from lateral (0.304
± 0.078 g/cm2 at 10 mm) to medial (0.760 ± 0.103 g/cm2 at 50 mm). Load to failure increased from lateral to medial, and most specimens failed
by tendon pullout. The load was 125.3 ± 42.5 N at the most lateral tunnel and 349.3
± 120.3 N at the most medial tunnel. The Pearson correlation coefficient was 0.653
between tunnel position and load to failure, 0.659 between bone density and load to
failure, and 0.803 between tunnel position and bone density. These all showed strong
correlation.
Conclusions
BMD shows that optimal bone density is found in the anatomic insertion area of the
coracoclavicular ligaments between 20 mm and 50 mm from the lateral end of the clavicle.
Low BMD correlated with decreased load to failure.
Clinical Relevance
Failure at the lateral bone tunnel in coracoclavicular ligament reconstruction may
be a result of poor bone quality. When one is drilling bone tunnels for this surgery,
consideration should be given to both anatomic position and bone quality.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ArthroscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Treatment of complete acromioclavicular dislocation.J Bone Joint Surg Am. 1962; 44: 1008-1011
- Complete dislocations of the acromioclavicular joint; the nature of the traumatic lesion and effective methods of treatment with an analysis of forty-one cases.J Bone Joint Surg. 1946; 28: 813-837
- The treatment of dislocation of the acromioclavicular joint by open reduction and threaded wire fixation.J Bone Joint Surg. 1942; 24: 166-168
- Complete dislocation of the acromio-clavicular joint.J Bone Joint Surg Br. 1954; 36: 202-208
- Biomechanical rationale for development of anatomical reconstructions of coracoclavicular ligaments after complete acromioclavicular joint dislocations.Am J Sports Med. 2004; 32 (1929-1936)
- The anatomic coracoclavicular reconstruction.Oper Tech Sports Med. 2004; 12: 56-61
- Biomechanical comparison of coracoclavicular reconstructive techniques.Am J Sports Med. 2011; 39: 804-810
- Foreign-body reactions to fracture fixation implants of biodegradable synthetic polymers.J Bone Joint Surg Br. 1990; 72: 592-596
- Reconstruction of the coracoclavicular ligaments with tendon grafts: A comparative biomechanical study.Am J Sports Med. 2003; 31: 648-655
- Treatment of acromioclavicular joint separation: Suture or suture anchors?.J Shoulder Elbow Surg. 2002; 11: 225-229
- A biomechanical evaluation of an anatomical coracoclavicular ligament reconstruction.Am J Sports Med. 2006; 34: 236-246
- Anatomical acromioclavicular ligament reconstruction: A biomechanical comparison of reconstructive techniques of the acromioclavicular joint.Am J Sports Med. 2005; 33: 1723-1728
- Arthroscopic reconstruction of the acromioclavicular joint disruption: Surgical technique and preliminary results.Arch Orthop Trauma Surg. 2006; 126: 575-581
- Stability of acromioclavicular joint reconstruction: Biomechanical testing of various surgical techniques in a cadaveric model.Am J Sports Med. 2004; 32: 1492-1498
- Anatomy of the clavicle and coracoid process for reconstruction of the coracoclavicular ligaments.Am J Sports Med. 2007; 35: 811-817
- Management of the failed AC joint reconstruction: Causation and treatment.Sports Med Arthrosc. 2010; 18: 167-172
- Effect of cortical thickness and cancellous bone density on the holding strength of internal fixator screws.J Orthop Res. 2004; 22: 1237-1242
- Proximal humeral fractures: Regional differences in bone mineral density of the humeral head affect the fixation strength of cancellous screws.J Shoulder Elbow Surg. 2006; 15: 620-624
- Material properties and composition of soft-tissue fixation.Arthroscopy. 2010; 26: 821-831
- Foreign-body reaction and the course of osteolysis after polyglycolide implants for fracture fixation: Experimental study in sheep.J Bone Joint Surg Br. 1996; 78: 369-376
- Tensile properties, tension-tension fatigue and biological response of polyetheretherketone-hydroxyapatite composites for load-bearing orthopedic implants.Biomaterials. 2003; 24: 2245-2250
- Polyetheretherketone as a biomaterial for spinal applications.Biomaterials. 2006; 27: 324-334
Article info
Publication history
Published online: January 16, 2013
Accepted:
October 7,
2012
Received:
February 13,
2012
Footnotes
The authors report the following potential conflict of interest or source of funding in relation to this article: Arthrex. Research grant to support salary and equipment.
Identification
Copyright
© 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
