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Acromioclavicular Joint Stabilization: A Biomechanical Study of Bidirectional Stability and Strength

BACKGROUND: It is important to restore horizontal and vertical stability to the acromioclavicular (AC) joint when treating dislocations of this joint. Most surgical stabilization techniques of the AC joint have primarily addressed the coracoclavicular ligament complex; however, these techniques may...

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Autores principales: Hislop, Patrick, Sakata, Kentaro, Ackland, David C., Gotmaker, Robert, Evans, Matthew C.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6472172/
https://www.ncbi.nlm.nih.gov/pubmed/31024965
http://dx.doi.org/10.1177/2325967119836751
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author Hislop, Patrick
Sakata, Kentaro
Ackland, David C.
Gotmaker, Robert
Evans, Matthew C.
author_facet Hislop, Patrick
Sakata, Kentaro
Ackland, David C.
Gotmaker, Robert
Evans, Matthew C.
author_sort Hislop, Patrick
collection PubMed
description BACKGROUND: It is important to restore horizontal and vertical stability to the acromioclavicular (AC) joint when treating dislocations of this joint. Most surgical stabilization techniques of the AC joint have primarily addressed the coracoclavicular ligament complex; however, these techniques may not satisfactorily restore horizontal stability to the AC joint. PURPOSE: To evaluate the strength and bidirectional stability of 3 AC joint stabilizing techniques in a cadaveric model. STUDY DESIGN: Controlled laboratory study. METHODS: A total of 24 cadaveric shoulders were randomly allocated to 3 treatment groups. For each group, a standardized AC joint stabilizing procedure was performed, and the specimens were potted for mechanical testing. The following reconstruction techniques were used: a single clavicular tunnel for group A, a double clavicular tunnel for group B, and a double clavicular tunnel plus suture fixation across the AC joint for group C. The specimens underwent cyclic loading in the horizontal and vertical planes and then load to failure. Eight control specimens also underwent cyclic loading in both planes. Construct stiffness during cyclic loading, change in displacement after cyclic loading in both planes, load to failure in the vertical plane, and mode of failure were evaluated, and stiffness was compared among the treatment groups as well as with a control group. RESULTS: There was a decrease in joint stiffness for all groups, including controls, during the cyclic loading. Compared with controls, all 3 treatment groups demonstrated equivalent stiffness and displacement in the vertical plane. In the horizontal plane, all 3 treatment groups demonstrated decreased stiffness, increased displacement, or both when compared with controls. When groups were compared, no treatment arm proved superior regarding stiffness or displacement in either plane. Load-to-failure testing of the 3 treatment groups in the vertical plane demonstrated construct strength and stiffness comparable with reports for the native AC joint. The mode of failure was predominantly fracture at the point of fixation to the testing apparatus. CONCLUSION: There was no difference in bidirectional strength and stability between the single– and double–clavicular tunnel techniques of coracoclavicular reconstruction. The addition of a stabilizing suture across the AC joint does not improve horizontal stability in the absence of repair of the AC joint capsule and deltotrapezial fascia. CLINICAL RELEVANCE: This laboratory study provides further evidence of the importance of the AC joint capsule and associated soft tissues in affording horizontal stability to that joint. Information from this and subsequent studies utilizing a bidirectional model can influence the choice of surgical procedure in the clinical treatment of AC joint dislocations.
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spelling pubmed-64721722019-04-25 Acromioclavicular Joint Stabilization: A Biomechanical Study of Bidirectional Stability and Strength Hislop, Patrick Sakata, Kentaro Ackland, David C. Gotmaker, Robert Evans, Matthew C. Orthop J Sports Med Article BACKGROUND: It is important to restore horizontal and vertical stability to the acromioclavicular (AC) joint when treating dislocations of this joint. Most surgical stabilization techniques of the AC joint have primarily addressed the coracoclavicular ligament complex; however, these techniques may not satisfactorily restore horizontal stability to the AC joint. PURPOSE: To evaluate the strength and bidirectional stability of 3 AC joint stabilizing techniques in a cadaveric model. STUDY DESIGN: Controlled laboratory study. METHODS: A total of 24 cadaveric shoulders were randomly allocated to 3 treatment groups. For each group, a standardized AC joint stabilizing procedure was performed, and the specimens were potted for mechanical testing. The following reconstruction techniques were used: a single clavicular tunnel for group A, a double clavicular tunnel for group B, and a double clavicular tunnel plus suture fixation across the AC joint for group C. The specimens underwent cyclic loading in the horizontal and vertical planes and then load to failure. Eight control specimens also underwent cyclic loading in both planes. Construct stiffness during cyclic loading, change in displacement after cyclic loading in both planes, load to failure in the vertical plane, and mode of failure were evaluated, and stiffness was compared among the treatment groups as well as with a control group. RESULTS: There was a decrease in joint stiffness for all groups, including controls, during the cyclic loading. Compared with controls, all 3 treatment groups demonstrated equivalent stiffness and displacement in the vertical plane. In the horizontal plane, all 3 treatment groups demonstrated decreased stiffness, increased displacement, or both when compared with controls. When groups were compared, no treatment arm proved superior regarding stiffness or displacement in either plane. Load-to-failure testing of the 3 treatment groups in the vertical plane demonstrated construct strength and stiffness comparable with reports for the native AC joint. The mode of failure was predominantly fracture at the point of fixation to the testing apparatus. CONCLUSION: There was no difference in bidirectional strength and stability between the single– and double–clavicular tunnel techniques of coracoclavicular reconstruction. The addition of a stabilizing suture across the AC joint does not improve horizontal stability in the absence of repair of the AC joint capsule and deltotrapezial fascia. CLINICAL RELEVANCE: This laboratory study provides further evidence of the importance of the AC joint capsule and associated soft tissues in affording horizontal stability to that joint. Information from this and subsequent studies utilizing a bidirectional model can influence the choice of surgical procedure in the clinical treatment of AC joint dislocations. SAGE Publications 2019-04-17 /pmc/articles/PMC6472172/ /pubmed/31024965 http://dx.doi.org/10.1177/2325967119836751 Text en © The Author(s) 2019 http://creativecommons.org/licenses/by-nc-nd/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License (http://www.creativecommons.org/licenses/by-nc-nd/4.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Article
Hislop, Patrick
Sakata, Kentaro
Ackland, David C.
Gotmaker, Robert
Evans, Matthew C.
Acromioclavicular Joint Stabilization: A Biomechanical Study of Bidirectional Stability and Strength
title Acromioclavicular Joint Stabilization: A Biomechanical Study of Bidirectional Stability and Strength
title_full Acromioclavicular Joint Stabilization: A Biomechanical Study of Bidirectional Stability and Strength
title_fullStr Acromioclavicular Joint Stabilization: A Biomechanical Study of Bidirectional Stability and Strength
title_full_unstemmed Acromioclavicular Joint Stabilization: A Biomechanical Study of Bidirectional Stability and Strength
title_short Acromioclavicular Joint Stabilization: A Biomechanical Study of Bidirectional Stability and Strength
title_sort acromioclavicular joint stabilization: a biomechanical study of bidirectional stability and strength
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6472172/
https://www.ncbi.nlm.nih.gov/pubmed/31024965
http://dx.doi.org/10.1177/2325967119836751
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