Evaluation of the clavicular tunnel placement on coracoclavicular ligament reconstruction for acromioclavicular dislocations: a finite element analysis
- 80 Downloads
The two-tunnel coracoclavicular ligament reconstruction (CLR) technique is one of the treatment approaches commonly used in the surgical treatment of acromioclavicular (AC) injuries. Clavicular tunnel malposition is one of the major causes of failure in coracoclavicular ligament reconstruction. The main purpose of this study was to investigate the effects of clavicular tunnel placement on tendon loading in the CLR technique with finite element analysis.
Models of clavicle and scapula were constructed using computerized tomography images. Two clavicular bone tunnel reconstruction models were created with the tendon passing through the conoid and trapezoid tunnels. Four models based on the tunnel ratio (TR) method and defined as primary, anatomic, medialized, and lateralized were constructed to evaluate the effect of tunnel placement on loading conditions during tendon graft. All models were loaded by insertion from the trapezius and sternocleidomastoid muscles. The loading on the tendon were evaluated with the finite element analysis.
The highest load value measured on the tendon was in the anatomic model (0.789 kPa), and the lowest load value (0.598 kPa) was measured in the lateralized tunnel model. The load value of the primary model was (0.657 kPa), and the medialized model’s value was (0.752 kPa).
In two-tunnel CLR technique, tendon loadings are related to tunnel placement. Medialized tunnel placement increases tendon loading. The TR method may be an appropriate option for determining tunnel placement.
KeywordsAcromioclavicular dislocation Coracoclavicular reconstruction Tunnel placement Finite element analysis Conoid ligament Trapezoid ligament
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
This manuscript does not contain any studies with animals or human participants performed by any of the authors.
- 4.Weiser L, Nüchtern JV, Sellenschloh K, Püschel K, Morlock MM, Rueger JM, Hoffmann M, Lehmann W, Großterlinden LG (2017) Acromioclavicular joint dislocations: coracoclavicular reconstruction with and without additional direct acromioclavicular repair. Knee Surg Sports Traumatol Arthrosc 25:2025–2031. https://doi.org/10.1007/s00167-015-3920-1 CrossRefPubMedGoogle Scholar
- 9.Eisenstein ED, Lanzi JT, Waterman BR, Bader JM, Pallis MP (2016) Medialized clavicular bone tunnel position predicts failure after anatomic coracoclavicular ligament reconstruction in young, active male patients. Am J Sports Med 44:2682–2689. https://doi.org/10.1177/0363546516651613 CrossRefPubMedGoogle Scholar
- 10.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 42:2141–2148. https://doi.org/10.1177/0363546514538947 CrossRefPubMedGoogle Scholar
- 14.Seo Y-J, Yoo Y-S, Noh K-C, Song S-Y, Lee Y-B, Kim H-J, Kim HY (2012) Dynamic function of coracoclavicular ligament at different shoulder abduction angles: a study using a 3-dimensional finite element model. Arthroscopy 28:778–787. https://doi.org/10.1016/j.arthro.2012.04.001 CrossRefPubMedGoogle Scholar
- 20.Wan C, Hao Z, Wen S (2011) The finite element analysis of three grafts in the anterior cruciate ligament reconstruction. In: 2011 4th International Conference on Biomedical Engineering and Informatics (BMEI). pp. 1338–1342Google Scholar