Acromioclavicular joint reconstruction: an additional acromioclavicular cerclage does not improve horizontal stability in double coraco-clavicular tunnel technique
- 160 Downloads
Horizontal instability—especially in the posterior plane—is a common problem after acromioclavicular joint injuries. The purpose was to compare the stability of a single coraco-clavicular tunnel technique and a double coraco-clavicular tunnel technique for coraco-clavicular ligament reconstruction and to examine the influence of an additional acromioclavicular cerclage on the horizontal stability in the acromioclavicular joint.
21 acromioclavicular joints of human cadaveric shoulders were randomly assigned to the following groups: single coraco-clavicular tunnel technique with horizontal augmented acromioclavicular cerclage (SCT + AC); double coraco-clavicular tunnel technique (DCT); double coraco-clavicular tunnel technique and acromioclavicular cerclage (DCT + AC). The specimens underwent cyclic horizontal testing and were recorded using a 3D optical measuring system.
The displacement and the increase in displacement in relation to the displacement after precondition for SCT + AC were significantly higher after every measured amount of cycles than for DCT (p10 = 0.0023; p5000 = 0.0012) and DCT + AC (p10 = 0.0006; p5000 = 0.0012). There was no significant difference in the total displacement, or in the increase in total displacement between double coraco-clavicular tunnel reconstructed groups with and without additional acromioclavicular cerclage.
Double coraco-clavicular tunnel technique with and without additional acromioclavicular cerclage results in a significant higher stability regarding the horizontal plane in comparison to single coraco-clavicular tunnel technique with acromioclavicular cerclage. Based on the results of this biomechanical in vitro study, the use of an additional acromioclavicular cerclage with single coraco-clavicular tunnel technique may not be indicated in most cases. The effect of an additional acromioclavicular cerclage seems to be negligible, at least in presence of a double-coraco-clavicular tunnel technique reconstruction. Techniques of AC joint reconstruction should focus on the use of double coraco-clavicular tunnel devices.
KeywordsAcromioclavicular joint/injuries/surgery Arthroscopy/methods Cadaver Joint instability/surgery Ligaments Articular/surgery Humans Joint dislocation
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
We acknowledge support from the “Deutsche Arthrose Hilfe e.V.”.
Institutional approval for the use of the post-mortem tissues of 126 the donors was obtained. For this reason there is no specific number from the ethics committee.
- 11.Gerhardt C, Kraus N, Pauly S et al (2013) Arthroskopisch assistierte stabilisierung akuter schultereckgelenkverletzungen in Doppel-TightRope-Technik: einjahresergebnisse (Arthroscopically assisted stabilization of acute injury to the acromioclavicular joint with the double TightRope technique: one-year results). Unfallchirurg 116(2):125–130CrossRefGoogle Scholar
- 15.Jensen G, Ellwein A, Voigt C et al (2015) Doppel-button-fixierung mit minimalinvasiver akromioklavikularer cerclage: arthroskopisch-assistierte Versorgung der akuten Schultereckgelenkinstabilitat (Double button Fixation with minimally invasive acromioclavicular cerclage: arthroscopically-assisted treatment of acute acromioclavicular joint instability). Unfallchirurg 118(12):1056–1061CrossRefGoogle Scholar
- 17.Kraus N, Haas NP, Scheibel M et al (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):1431–1440CrossRefGoogle Scholar