Skip to main content
SpringerLink
Log in

Acromioclavicular joint dislocations: coracoclavicular reconstruction with and without additional direct acromioclavicular repair

  • Shoulder
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To evaluate different stabilisation techniques for acromioclavicular (AC) joint separations, including direct AC repair, and to compare the properties of the stabilised and native joints.

Methods

An established in vitro testing model for the AC joint was used to analyse joint stability after surgical reconstruction [double TightRope (DTR), DTR with AC repair (DTR + AC), single TR with AC repair (TR + AC), and PDS sling with AC repair (PDS + AC)]. Twenty-four human cadaveric shoulders were randomised by age into four testing groups. Joint stiffness was measured by applying an axial load during defined physiological ranges of motion. Similar tests were performed for the native joints, after dissecting the coracoclavicular and AC ligaments, and after surgical reconstruction. Cyclic loading was performed for 1000 cycles with 20–70 N and vertical load to failure determined after cyclic testing.

Results

Axial stiffness for all TR groups was significantly higher than for the native joint (DTR 38.94 N/mm, p = 0.005; DTR + AC 37.79 N/mm, p = 0.015; TR + AC 45.61 N/mm, p < 0.001 vs. native 26.05 N/mm). The axial stiffness of the PDS + AC group was similar to that of the native joint group (21.4 N/mm, n.s.). AC repair did not significantly influence rotational stiffness. Load to failure was similar and >600 N in all groups (n.s.).

Conclusion

Reconstruction of AC dislocations with one or two TRs leads to stable results with a higher stiffness than the native joints. For the PDS + AC group, axial stiffness was similar to the native situation, although there might be a risk of elongation. Direct AC repair showed no significantly increased stability in comparison with reconstructions without direct AC repair. Thus, a direct AC repair seems to be dispensable in clinical practice, while TRs or PDS cerclages appear to provide sufficiently stable results.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Alyas F, Curtis M, Speed C, Saifuddin A, Connell D (2008) MR imaging appearances of acromioclavicular joint dislocation. Radiographics 28(2):463–479 (quiz 619)

    Article  PubMed  Google Scholar 

  2. Bannister GC, Wallace WA, Stableforth PG, Hutson MA (1989) The management of acute acromioclavicular dislocation. A randomised prospective controlled trial. J Bone Joint Surg Br 71(5):848–850

    CAS  PubMed  Google Scholar 

  3. Beitzel K, Cote MP, Apostolakos J, Solovyova O, Judson CH, Ziegler CG, Edgar CM, Imhoff AB, Arciero RA, Mazzocca AD (2013) Current concepts in the treatment of acromioclavicular joint dislocations. Arthroscopy 29(2):387–397

    Article  PubMed  Google Scholar 

  4. Beitzel K, Obopilwe E, Apostolakos J, Cote MP, Russell RP, Charette R, Singh H, Arciero RA, Imhoff AB, Mazzocca AD (2014) Rotational and translational stability of different methods for direct acromioclavicular ligament repair in anatomic acromioclavicular joint reconstruction. Am J Sports Med 42(9):2141–2148

    Article  PubMed  Google Scholar 

  5. Dragoo JL, Braun HJ, Bartlinski SE, Harris AH (2012) Acromioclavicular joint injuries in National Collegiate Athletic Association football: data from the 2004–2005 through 2008–2009 National Collegiate Athletic Association Injury Surveillance System. Am J Sports Med 40(9):2066–2071

    Article  PubMed  Google Scholar 

  6. Fremerey RW, Lobenhoffer P, Bosch U, Freudenberg E, Tscherne H (1996) Surgical treatment of acute, complete acromioclavicular joint dislocation. Indications, technique and results. Unfallchirurg 99(5):341–345

    CAS  PubMed  Google Scholar 

  7. Fukuda K, Craig EV, An KN, Cofield RH, Chao EY (1986) Biomechanical study of the ligamentous system of the acromioclavicular joint. J Bone Joint Surg Am 68(3):434–440

    Article  CAS  PubMed  Google Scholar 

  8. Greiner S, Braunsdorf J, Perka C, Herrmann S, Scheffler S (2009) Mid to long-term results of open acromioclavicular-joint reconstruction using polydioxansulfate cerclage augmentation. Arch Orthop Trauma Surg 129(6):735–740

    Article  CAS  PubMed  Google Scholar 

  9. Jensen G, Katthagen JC, Alvarado LE, Lill H, Voigt C (2014) Has the arthroscopically assisted reduction of acute AC joint separations with the double tight-rope technique advantages over the clavicular hook plate fixation? Knee Surg Sports Traumatol Arthrosc 22(2):422–430

    Article  PubMed  Google Scholar 

  10. Kaplan LD, Flanigan DC, Norwig J, Jost P, Bradley J (2005) Prevalence and variance of shoulder injuries in elite collegiate football players. Am J Sports Med 33(8):1142–1146

    Article  PubMed  Google Scholar 

  11. Kraus N, Haas NP, Scheibel M, Gerhardt C (2013) Arthroscopically assisted stabilization of acute high-grade acromioclavicular joint separations in a coracoclavicular Double-TightRope technique: V-shaped versus parallel drill hole orientation. Arch Orthop Trauma Surg 133(10):1431–1440

    Article  PubMed  Google Scholar 

  12. Ladermann A, Grosclaude M, Lubbeke A, Christofilopoulos P, Stern R, Rod T, Hoffmeyer P (2011) Acromioclavicular and coracoclavicular cerclage reconstruction for acute acromioclavicular joint dislocations. J Shoulder Elb Surg 20(3):401–408

    Article  Google Scholar 

  13. Ladermann A, Gueorguiev B, Stimec B, Fasel J, Rothstock S, Hoffmeyer P (2013) Acromioclavicular joint reconstruction: a comparative biomechanical study of three techniques. J Shoulder Elb Surg 22(2):171–178

    Article  Google Scholar 

  14. Leidel BA, Braunstein V, Pilotto S, Mutschler W, Kirchhoff C (2009) Mid-term outcome comparing temporary K-wire fixation versus PDS augmentation of Rockwood grade III acromioclavicular joint separations. BMC Res Notes 2:84

    Article  PubMed  PubMed Central  Google Scholar 

  15. Ludewig PM, Phadke V, Braman JP, Hassett DR, Cieminski CJ, LaPrade RF (2009) Motion of the shoulder complex during multiplanar humeral elevation. J Bone Joint Surg Am 91(2):378–389

    Article  PubMed  PubMed Central  Google Scholar 

  16. Martetschlager F, Buchholz A, Sandmann G, Siebenlist S, Dobele S, Hapfelmeier A, Stockle U, Millett PJ, Elser F, Lenich A (2013) Acromioclavicular and coracoclavicular PDS augmentation for complete AC joint dislocation showed insufficient properties in a cadaver model. Knee Surg Sports Traumatol Arthrosc 21(2):438–444

    Article  PubMed  Google Scholar 

  17. Mazzocca AD, Santangelo SA, Johnson ST, Rios CG, Dumonski ML, Arciero RA (2006) A biomechanical evaluation of an anatomical coracoclavicular ligament reconstruction. Am J Sports Med 34(2):236–246

    Article  PubMed  Google Scholar 

  18. McConnell AJ, Yoo DJ, Zdero R, Schemitsch EH, McKee MD (2007) Methods of operative fixation of the acromio-clavicular joint: a biomechanical comparison. J Orthop Trauma 21(4):248–253

    Article  PubMed  Google Scholar 

  19. Motamedi AR, Blevins FT, Willis MC, McNally TP, Shahinpoor M (2000) Biomechanics of the coracoclavicular ligament complex and augmentations used in its repair and reconstruction. Am J Sports Med 28(3):380–384

    CAS  PubMed  Google Scholar 

  20. Murena L, Vulcano E, Ratti C, Cecconello L, Rolla PR, Surace MF (2009) Arthroscopic treatment of acute acromioclavicular joint dislocation with double flip button. Knee Surg Sports Traumatol Arthrosc 17(12):1511–1515

    Article  CAS  PubMed  Google Scholar 

  21. Nüchtern JV, Sellenschloh K, Bishop N, Jauch S, Briem D, Hoffmann M, Lehmann W, Pueschel K, Morlock MM, Rueger JM, Grossterlinden LG (2013) Biomechanical evaluation of 3 stabilization methods on acromioclavicular joint dislocations. Am J Sports Med 41(6):1387–1394

    Article  PubMed  Google Scholar 

  22. Pallis M, Cameron KL, Svoboda SJ, Owens BD (2012) Epidemiology of acromioclavicular joint injury in young athletes. Am J Sports Med 40(9):2072–2077

    Article  PubMed  Google Scholar 

  23. Patzer T, Clauss C, Kuhne CA, Ziring E, Efe T, Ruchholtz S, Mann D (2013) Arthroscopically assisted reduction of acute acromioclavicular joint separations: comparison of clinical and radiological results of single versus double TightRope technique. Unfallchirurg 116(5):442–450

    Article  CAS  PubMed  Google Scholar 

  24. Saier T, Venjakob AJ, Minzlaff P, Fohr P, Lindell F, Imhoff AB, Vogt S, Braun S (2015) Value of additional acromioclavicular cerclage for horizontal stability in complete acromioclavicular separation: a biomechanical study. Knee Surg Sports Traumatol Arthrosc 23(5):1498–1505

    Article  PubMed  Google Scholar 

  25. Salzmann GM, Paul J, Sandmann GH, Imhoff AB, Schottle PB (2008) The coracoidal insertion of the coracoclavicular ligaments: an anatomic study. Am J Sports Med 36(12):2392–2397

    Article  PubMed  Google Scholar 

  26. Salzmann GM, Walz L, Buchmann S, Glabgly P, Venjakob A, Imhoff AB (2010) Arthroscopically assisted 2-bundle anatomical reduction of acute acromioclavicular joint separations. Am J Sports Med 38(6):1179–1187

    Article  PubMed  Google Scholar 

  27. Sandmann GH, Martetschlager F, Mey L, Kraus TM, Buchholz A, Ahrens P, Stockle U, Freude T, Siebenlist S (2012) Reconstruction of displaced acromio-clavicular joint dislocations using a triple suture-cerclage: description of a safe and efficient surgical technique. Patient Saf Surg 6(1):25

    Article  PubMed  PubMed Central  Google Scholar 

  28. Scheibel M, Droschel S, Gerhardt C, Kraus N (2011) Arthroscopically assisted stabilization of acute high-grade acromioclavicular joint separations. Am J Sports Med 39(7):1507–1516

    Article  PubMed  Google Scholar 

  29. Schliemann B, Lenschow S, Schurmann P, Schroeglmann M, Herbort M, Kosters C, Raschke MJ (2013) Biomechanics of a new technique for minimal-invasive coracoclavicular ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 21(5):1176–1182

    Article  PubMed  Google Scholar 

  30. Stucken C, Cohen SB (2015) Management of acromioclavicular joint injuries. Orthop Clin North Am 46(1):57–66

    Article  PubMed  Google Scholar 

  31. Walz L, Salzmann GM, Fabbro T, Eichhorn S, Imhoff AB (2008) The anatomic reconstruction of acromioclavicular joint dislocations using 2 TightRope devices: a biomechanical study. Am J Sports Med 36(12):2398–2406

    Article  PubMed  Google Scholar 

  32. Wellmann M, Kempka JP, Schanz S, Zantop T, Waizy H, Raschke MJ, Petersen W (2009) Coracoclavicular ligament reconstruction: biomechanical comparison of tendon graft repairs to a synthetic double bundle augmentation. Knee Surg Sports Traumatol Arthrosc 17(5):521–528

    Article  PubMed  Google Scholar 

  33. Wellmann M, Zantop T, Weimann A, Raschke MJ, Petersen W (2007) Biomechanical evaluation of minimally invasive repairs for complete acromioclavicular joint dislocation. Am J Sports Med 35(6):955–961

    Article  PubMed  Google Scholar 

Download references

Author information

Author notes

    Authors and Affiliations

    1. Department of Trauma, Hand and Reconstructive Surgery, Hamburg-Eppendorf University Medical Center, Martinistrasse 52, 20246, Hamburg, Germany

      Lukas Weiser, Jakob V. Nüchtern, Johannes M. Rueger, Michael Hoffmann, Wolfgang Lehmann & Lars G. Großterlinden

    2. Institute of Biomechanics, TUHH Hamburg University of Technology, Hamburg, Germany

      Kay Sellenschloh & Michael M. Morlock

    3. Institute of Forensic Medicine, Hamburg-Eppendorf University Medical Center, Hamburg, Germany

      Klaus Püschel

    Authors
    1. Lukas Weiser
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Jakob V. Nüchtern
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Kay Sellenschloh
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Klaus Püschel
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Michael M. Morlock
      View author publications

      You can also search for this author in PubMed Google Scholar

    6. Johannes M. Rueger
      View author publications

      You can also search for this author in PubMed Google Scholar

    7. Michael Hoffmann
      View author publications

      You can also search for this author in PubMed Google Scholar

    8. Wolfgang Lehmann
      View author publications

      You can also search for this author in PubMed Google Scholar

    9. Lars G. Großterlinden
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding author

    Correspondence to Lukas Weiser.

    Additional information

    Lukas Weiser and Jakob V. Nüchtern have contributed equally and therefore share first authorship.

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Weiser, L., Nüchtern, J.V., Sellenschloh, K. et al. Acromioclavicular joint dislocations: coracoclavicular reconstruction with and without additional direct acromioclavicular repair. Knee Surg Sports Traumatol Arthrosc 25, 2025–2031 (2017). https://doi.org/10.1007/s00167-015-3920-1

    Download citation

    • Received:

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s00167-015-3920-1

    Keywords

    Search

    Navigation