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Variability in attachment of the coracoacromial ligament in relation with its morphology

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Abstract

Purpose

The coracoacromial ligament (CAL) presents with variable morphology and plays a significant role in the development of subacromial impingement syndrome. Sectioning the CAL has been suggested to relieve impingement of the rotator cuff. The aim of the current study was to investigate the CAL attachment in relation with ligament morphology.

Materials and methods

The CAL was investigated in 220 cadaveric shoulders from 58 males and 59 females, with a median age of 82 years (range 53–102 years). CALs were classified according to three factors: (1) number of bands present; (2) shape; and (3) attachment to the acromial and coracoid processes.

Results

35 (16%) CALs had a single band, 84 (38%) two bands, and 101 (46%) three or more bands. CAL shape was either broadband (14: 6%), quadrangular (21: 10%), Y-shaped (84: 38%), or multiple-banded (101: 46%). More ligaments were attached to the medial aspect of the acromion (60%) and medial end of the coracoid (75%) than those restricted to the anterior edge of the acromion (40%) and posterior aspect of the coracoid (25%). Multiple-banded ligaments attached significantly more medially at the acromion and coracoid processes, while single band ligament attachments were restricted to the anterior edge of the acromion and posterior aspect of the coracoid process.

Conclusion

The CAL has variable morphology and attachments with interconnections to different structures around the shoulder. CALs with a medial acromial attachment may narrow the subacromial space leading to further shoulder impingement.

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References

  1. Anderson K, Bowen MK (1999) Spur reformation after arthroscopic acromioplasty. Arthroscopy 15(7):788–791

    Article  CAS  PubMed  Google Scholar 

  2. Birnbaum K, Prescher A, Heller KD (1998) Anatomic and functional aspects of the kinetics of the shoulder joint capsule and the subacromial bursa. Surg Radiol Anat 20(1):41–45. doi:10.1007/BF01628114

    Article  CAS  PubMed  Google Scholar 

  3. Blanchard TK, Bearcroft PW (1997) Magnetic resonance imaging of the coraco-acromial ligament. Clin Anat 10(2):88–91

    Article  CAS  PubMed  Google Scholar 

  4. Brodie CG (1914) Note on the transverse-humeral, coracoacromial and coracohumeral ligaments of the shoulder. J Anat Physiol 24:247–252

    Google Scholar 

  5. Chen J, Luo CF, Luo ZP (2009) Initiatory biomechanical study on humeral head migration after coracoacromial ligament cut. Arch Orthop Trauma Surg 129(1):133–137

    Article  PubMed  Google Scholar 

  6. Ciochon RL, Corruccini RS (1977) The coracoacromial ligament and projection index in man and other anthropoid primates. J Anat 124:627–632

    CAS  PubMed  PubMed Central  Google Scholar 

  7. Delforge S, Lecoq B, Hulet C, Marcelli C (2014) Coracoacromial ligament section under ultrasonographic control: a cadaveric study on 20 cases. Orthop Traumatol Surg Res 100(2):167–170

    Article  Google Scholar 

  8. Edelson JG, Luchs J (1995) Aspects of coracoacromial ligament anatomy of interest to the arthroscopic surgeon. Arthrosc J Arthrosc Rel Surg 11:715–719. doi:10.1016/0749-8063(95)90115-9

    Article  CAS  Google Scholar 

  9. Fagelman M, Sartori M, Freedman KB, Patwardhan AG, Carandang G, Marra G (2007) Biomechanics of coracoacromial arch modification. J Shoulder Elb Surg 16:101–106. doi:10.1016/j.jse.2005.02.006

    Article  Google Scholar 

  10. Fealy S, April EW, Khazzam M, Armengol-Barallat J, Bigliani LU (2005) The coracoacromial ligament: morphology and study of acromial enthesopathy. J Shoulder Elb Surg 14:542–548. doi:10.1016/j.jse.2005.02.006

    Article  Google Scholar 

  11. Flatwo EL, Fealy S, April EW, O’Flynn HM, Barallat JB, Bigiliani LU (1996) The coracoacromial ligament: anatomy, morphology and a study of acromial enthesopathy. J Shoulder Elb Surg 60:177. doi:10.1016/S1058-2746(96)80286-2

    Google Scholar 

  12. Fremery R, Bastian L, Siebert WE (2000) The coracoacromial ligament: anatomical and biomechanical properties with respect to age and rotator cuff disease. Knee Surg Sport Traumatol Arthrosc 8:309–313. doi:10.1007/s001670000135

    Article  Google Scholar 

  13. Gagey N, Ravaud E, Lassau JP (1993) Anatomy of the acromial arch: correlation of anatomy and magnetic resonance imaging. Surg Radiol Anat 15:63–70. doi:10.1007/BF01629865

    Article  CAS  PubMed  Google Scholar 

  14. Gallino M, Battiston B, Annaratone G, Terragnoli F (1995) Coracoacromial ligament: a comparative arthroscopic and anatomic study. J Arthrosc Relat Surg 11:564–567. doi:10.1016/0749-8063(95)90133-7

    Article  CAS  Google Scholar 

  15. Hansen U, Levy O, Even T, Copeland SA (2004) Mechanical properties of regenerated coracoacromial ligament after subacromial decompression. J Shoulder Elb Surg 13(1):51–56

    Article  Google Scholar 

  16. Holt EM, Allibone RO (1995) Anatomic variants of the coracoacromial ligament. J Shoulder Elb Surg 4:370–375. doi:10.1016/S1058-2746(95)80021-2

    Article  CAS  Google Scholar 

  17. Hu X, Huang F, Zhong G, Cen S, Xiang Z, Li J (2009) Biomechanical study on proximally based conjoined tendon transfer for coracoacromial ligament reconstruction as anterosuperior restraint of shoulder. Chin J Rep Reconstr Surg 23:1469–1473

    Google Scholar 

  18. Hunt JL, Moore RJ, Krishnan J (2000) The fate of the coracoacromial ligament in arthroscopic acromioplasty: an anatomical study. J Shoulder Elb Surg 9:491–492. doi:10.1067/mse.2000.109319

    Article  CAS  Google Scholar 

  19. Kesmezacar H, Akgun I, Ogut T, Gokay S, Uzun I (2008) The coracoacromial ligament: the morphology and relation to rotator cuff pathology. J Shoulder Elb Surg 17:182–188. doi:10.1016/j.jse.2007.05.015

    Article  Google Scholar 

  20. Kopuz C, Baris S, Yildirim M, Gülman B (2002) Anatomic variations of the coracoacromial ligament in neonatal cadavers: a neonatal cadaver study. J Ped Orthop Br 11:350–354. doi:10.1097/01202412-200210000-00015

    Google Scholar 

  21. Le Reun O, Lebhar J, Mateos F, Voisin JL, Thomazeau H, Ropars M (2016) Anatomical and morphological study of the subcoracoacromial canal. Orthop Traumatol Surg Res 102(8):S295–S299

    Article  PubMed  Google Scholar 

  22. Michener LA, McClure PW, Karduna AR (2003) Anatomical and biomechanical mechanisms of subacromial impingement syndrome. Clin Biomech 18(5):369–379

    Article  Google Scholar 

  23. Moorman CT, Hussain SS, Warren RF, Deng XH, Wickiewicz TL, Torzilli PA (2008) Anatomy of the coracoacromial veil. J Surg Orthop Adv 17(2):69–73

    PubMed  Google Scholar 

  24. Neer CS (1972) Anterior acromioplasty for the chronic impingement syndrome in the shoulder. J Bone Jt Surg Am 54(1):41–50

    Article  Google Scholar 

  25. Pieper HG, Radas CB, Krahl H, Blank M (1997) Anatomic variation of the coracoacromial ligament: a macroscopic and microscopic cadaveric study. J Shoulder Elb Surg 6:291–296. doi:10.1016/S1058-2746(97)90019-7

    Article  CAS  Google Scholar 

  26. Rothenberg A, Gasbarro G, Chlebeck J, Lin A (2017) The coracoacromial ligament: anatomy, function, and clinical significance. Orthop J Sports Med 5(4):2325967117703398. doi:10.1177/2325967117703398

    Article  PubMed  PubMed Central  Google Scholar 

  27. Salter GE, Nasca RJ, Shelly BS (1987) Anatomical observations in the acromioclavicular joint and supporting ligaments. Am J Sports Med 15:199–206. doi:10.1177/036354658701500301

    Article  PubMed  Google Scholar 

  28. Sarkar K, Taine W, Uhthoff HK (1990) The ultrastructure of the coracoacromial ligament in patients with chronic impingement syndrome. Clin Orthop 254:49–54. doi:10.1097/00003086-199005000-00007

    Google Scholar 

  29. Shaffer B, Evans B, Ferrero G (1997) Release and reattachment of the coracoacromial ligament: a cadaveric study. J Shoulder Elb Surg 6:297–305. doi:10.1016/S1058-2746(97)90020-3

    Article  CAS  Google Scholar 

  30. Sood A, Wallwork N, Bain GI (2008) Clinical results of coracoacromial ligament transfer in acromioclavicular dislocations: a review of published literature. Int J Shoulder Surg 2(1):13. doi:10.4103/0973-6042.39582

    Article  PubMed  PubMed Central  Google Scholar 

  31. Soslowsky L, Johnston S, Carpenter J (1994) Geometric and mechanical properties of the coracoacromial ligament and relationship to rotator cuff disease. Clin Orthop Relat Res 304:7–10

    Google Scholar 

  32. Uhthoff HK, Hammond DI, Sarkar K, Hooper GJ, Papoff WJ (1988) The role of the coracoacromial ligament in the impingement syndrome: a clinical, radiological and histological study. Int Orthop 12:97–104. doi:10.1007/BF00266972

    Article  CAS  PubMed  Google Scholar 

  33. Zuckerman JD, Kummer JF, Cuomo JF, Simon J, Rosenblum S, Katz N (1992) The influence of coracoacromial arch anatomy on rotator cuff tears. J Shoulder Elb Surg 1(1):4–14

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Centre for Anatomy and Human Identification, School of Science and Engineering, University of Dundee, Dundee, UK

    Abdulrahman Alraddadi, Abduelmenem Alashkham, Clare Lamb & Roger Soames

  2. Department of Basic Medical Sciences, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia

    Abdulrahman Alraddadi

  3. Department of Anatomy, College of Medicine, University of Zawia, Zawia, Libya

    Abduelmenem Alashkham

  4. Centre for Anatomy, School of Biomedical Sciences, University of Edinburgh, Edinburgh, UK

    Abduelmenem Alashkham

  5. King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Mail Code 3127, P.O. Box. 3660, Riyadh, 11481, Kingdom of Saudi Arabia

    Abdulrahman Alraddadi

Authors
  1. Abdulrahman Alraddadi
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  3. Clare Lamb
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Correspondence to Abdulrahman Alraddadi.

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Ethical approval

As the study was conducted on cadaveric material, relevant consent had been obtained at the time of body donation in accordance with the Human Anatomy (Scotland) Act 2006.

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Obtained prior to and at the time of body donation.

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None of the authors have any conflict of interest with the content of this manuscript.

Funding

A. Alraddadi received funding from King Saud bin Abdulaziz University for Health Sciences.

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Alraddadi, A., Alashkham, A., Lamb, C. et al. Variability in attachment of the coracoacromial ligament in relation with its morphology. Surg Radiol Anat 39, 1323–1330 (2017). https://doi.org/10.1007/s00276-017-1900-5

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  • DOI: https://doi.org/10.1007/s00276-017-1900-5

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