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Risk of fracture of the acromion depends on size and orientation of acromial bone tunnels when performing acromioclavicular reconstruction

Knee Surgery, Sports Traumatology, Arthroscopy volume 26, pages 275–284 (2018)Cite this article

Abstract

Purpose

Current techniques for anatomic repair of the dislocated acromioclavicular (AC) joint aim on reconstruction of the AC ligaments and utilize tunnels drilled through the acromion . This improves the stability of the reconstruction but might also increase the risk of fractures at the acromion. The purpose of this study was to evaluate the fracture risk for the acromion after transacromial tunnel placement for anatomic AC joint stabilization procedure. It was hypothesized that the risk of fracture of the acromion is correlated to size and orientation of bone tunnels commonly used for anatomic AC joint reconstruction.

Methods

A finite element analysis was used to simulate multiple bone tunnels and incoming force vectors (lateral vs. superior). Different tunnels were analysed, horizontal meaning an anterior–posterior orientation versus a vertical inferior–superior orientation through the acromion. Two tunnel diameters were simulated (2.4 vs. 4.5 mm). Furthermore, the tunnel length and distance between tunnels were altered. Forty-five cadaveric specimens (median age: 64 years, range 33–71 years) were utilized for data acquisition. Out of these, 30 specimens were used to evaluate basic tunnel orientations and drill diameters using a MTS 858 servohydraulic test system.

Results

With regard to the tunnel orientation and drill hole size, the loads to failure were limited. The acromion is at higher fracture risk, with a superior to inferior directed incoming force. Position, size and direction of bone tunnels influenced the loads to failure. Horizontal tunnels with a higher diameter (4.5 mm) had the most impact on load to failure reduction. A long horizontal tunnel with a diameter of 4.5 mm reduced the load to failure with medial direction of force to 25% of the native acromion. The identical tunnel with a diameter of 2.4 mm reduced the load to failure to 61%. Both 2.4-mm horizontal tunnels with a medium and short length did not reduce the load to failure.

Conclusion

Tunnels placed at the acromion did not result in an increased risk of fracture. However, descriptive data showed a tendency for an increased fracture risk if tunnels are placed at the acromion, especially in horizontal direction with diameters of 4.5 mm. In addition, the pattern of fracture was dependent on the orientation of the bone tunnels and the size. However, the results indicate a “safe zone” for the placement of bone tunnels within the anterior half of the acromion, which does not affect the loads to failure at the acromion. Therefore, current techniques for anatomic AC joint reconstruction which utilize fixation of grafts or sutures at the acromion are safe within current ranges of tunnel placement and sizes.

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Affiliations

  1. Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA

    Felix Dyrna, Andreas Voss, Elifho Obopilwe, Leo Pauzenberger & Augustus D. Mazzocca

  2. Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany

    Felix Dyrna, Andreas Voss, Sepp Braun, Andreas B. Imhoff & Knut Beitzel

  3. Department of Civil Environmental, and Biomedical Engineering, College of Engineering and Technology and Architecture, University of Hartford, West Hartford, CT, USA

    Celso Cruz Timm de Oliveira & Michael Nowak

  4. Gelenkpunkt, Sport- und Gelenchirurgie Innsbruck, Innsbruck, Austria

    Sepp Braun

Authors
  1. Felix Dyrna
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  2. Celso Cruz Timm de Oliveira
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  3. Michael Nowak
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  4. Andreas Voss
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  5. Elifho Obopilwe
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  6. Sepp Braun
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  7. Leo Pauzenberger
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  8. Andreas B. Imhoff
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  9. Augustus D. Mazzocca
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  10. Knut Beitzel
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Corresponding author

Correspondence to Knut Beitzel.

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Conflict of interest

The authors FD, CO, MN, AV, EO, LP declare no conflict of interest. ABI is a board member of the International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine, AGA, DGOU and DGOOC. He is a consultant for Arthrex GmbH Germany, Arthrosurface, Franklin, USA and for Medi-Bayreuth Germany. He receives grants from Arthrex GmbH Germany, holds patents from Arthrex GmbH. He receives royalties from Arthrex GmbH Germany, Springer and Thieme. ADM received grants to his institution from Arthrex Inc. Naples, Fl, USA. He is a consultant for Arthrex Inc. Naples Fl, USA and Ortho x, Inc., Lewisville, TX, USA. He holds Patents from Arthrex Inc. Naples, Fl, USA. KB and SB are consultants for Arthrex GmbH, Germany.

Funding

The University of Connecticut Health Center/New England Musculoskeletal Institute has received direct funding and material support for this study from Arthrex Inc. (Naples. FL). The company had no influence on study design, data collection or interpretation of the results or the final manuscript.

Ethical approval

The above study was conducted using only deidentified cadaveric specimens and is therefore not considered human subjects research. Our institutional review board (IRB) provides a Human Research Determination Form to help investigators determine whether IRB review is needed. While we have confirmed with our IRB that projects conducted in our biomechanics laboratory that utilize deidentified specimens does not constitute human subjects research and therefore no review required.

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Dyrna, F., de Oliveira, C.C.T., Nowak, M. et al. Risk of fracture of the acromion depends on size and orientation of acromial bone tunnels when performing acromioclavicular reconstruction. Knee Surg Sports Traumatol Arthrosc 26, 275–284 (2018). https://doi.org/10.1007/s00167-017-4728-y

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  • DOI: https://doi.org/10.1007/s00167-017-4728-y

Keywords

  • Acromioclavicular joint
  • Internal brace
  • Reconstruction
  • Acromion fracture
  • FEA