Purpose
To measure the multiaxial stability of the acromioclavicular joint before and after
transection of the acromioclavicular capsule and coracoclavicular ligaments and after
sequential repair of acromioclavicular and coracoclavicular ligaments.
Methods
Biomechanical testing was performed on fresh-frozen human cadaveric shoulders (N =
6). Translational and rotational stability in the vertical and horizontal planes was
measured in intact specimens, after transecting the acromioclavicular and coracoclavicular
ligaments, and after sequentially performing the following procedures: single-bundle
coracoclavicular repair (CCR), modified Weaver–Dunn procedure (WD), and acromioclavicular
stabilization (ACS).
Results
Resecting the acromioclavicular and coracoclavicular significantly reduced translational
stiffness in the inferior and anteroposterior directions, as well as rotational stiffness
about the vertical and anteroposterior axes. All 3 surgical procedures increased inferior
translational stiffness relative to the intact condition (Intact: 38 ± 9 N/mm, CCR:
54 ± 23 N/mm (P = .03), CCR+WD 52 ± 20 N/mm (P = .07), CCR ± WD+ACS 50 ± 21 N/mm (P = .17)). However, the combination of CCR, modified WD, and ACS resulted in the greatest
increase in stiffness in internal rotation (Intact: 12.5 ± 7.4 cNm/deg, CCR: 1.2 ±
1.1 cNm/deg, CCR+WD 7.2 ± 3.0 N∗m/deg [P = .023], CCR+WD+ACS 11.6 ± 4.9 cNm/deg [P = .055]).
Conclusions
The cumulative stability of CCR, WD reconstruction, and ACS appears to be additive.
Our findings provide a biomechanical justification for combining all three techniques.
Biomechanical studies assessing the performance of various acromioclavicular repairs
and reconstructions should therefore incorporate multiaxial testing in their protocols.
Clinical Relevance
Multiple points of fixation that provide multidirectional stability have the potential
to improve clinical outcomes and reduce failure rates of acromioclavicular joint repair
or stabilization.
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Article Info
Publication History
Published online: December 14, 2021
Accepted:
November 30,
2021
Received:
June 16,
2021
Footnotes
The authors report the following potential conflicts of interest or sources of funding: Funding for this study was provided by Shaffer Family Foundation. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2021 by the Arthroscopy Association of North America
