Skip to main content
SpringerLink
Log in

Value of additional acromioclavicular cerclage for horizontal stability in complete acromioclavicular separation: a biomechanical study

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

Abstract

Purpose

To evaluate whether isolated anatomical coracoclavicular (CC) ligament reconstruction with two suture-button devices provides equal horizontal acromioclavicular joint (ACJ) stability compared to additional ACJ suture tape cerclage.

Methods

A servohydraulic testing machine was used to assess horizontal ACJ translation in 12 fresh-frozen human shoulders during 5,000 cycles of dynamic anteroposterior directed loading (70 N). Horizontal ACJ stability was assessed for native specimen (n = 6) and compared to specimen with dissected AC ligaments but intact CC ligaments (n = 6). After complete AC/CC dissection, an anatomical CC reconstruction was performed with two suture-button devices (n = 6) and compared to the additional ACJ suture tape cerclage (n = 6).

Results

Native specimen showed an mean horizontal amplitude of 10.8 mm [standard deviation (SD) 3.29]. After 5,000 cycles of horizontal loading (70 N), mean amplitude increased by 1.5 mm (SD 0.75, p = 0.005). Specimen with dissected AC ligaments started at an mean amplitude of 14.1 mm (SD 4.11), which was increased by 0.9 mm (SD 0.56, n.s.) after loading. Initially, amplitude of specimen with anatomical CC reconstruction was 13.2 mm (SD 2.75), which increased by 2.9 mm (SD 1.45, p = 0.001) after loading. The specimen with additional AC cerclage initially showed an amplitude of 10.6 mm (SD 2.35). After loading, translation was increased by 3.0 mm (SD 0.97, p = 0.001). There was no failure of any surgical reconstruction in the tests.

Conclusion

The results of this study suggest that only combined AC and CC reconstruction can adequately re-establish physiological horizontal ACJ stability. Therefore, it is likely that a combined surgical procedure with double suture-button devices and AC suture tape cerclage can adequately re-establish horizontal AC joint stability in case of an acute injury (≥type Rockwood IV and may allow superior clinical outcomes for patients, especially if early functional rehabilitation is intended).

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
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. 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 

  2. Beitzel K, Obopilwe E, Chowaniec DM, Nowak MD, Hanypsiak BT, Guerra JJ, Arciero RA, Mazzocca AD (2012) Biomechanical properties of repairs for dislocated AC joints using suture button systems with integrated tendon augmentation. Knee Surg Sports Traumatol Arthrosc 20(10):1931–1938

    Article  PubMed  Google Scholar 

  3. Clevenger T, Vance RE, Bachus KN, Burks RT, Tashjian RZ (2011) Biomechanical comparison of acromioclavicular joint reconstructions using coracoclavicular tendon grafts with and without coracoacromial ligament transfer. Arthroscopy 27(1):24–30

    Article  PubMed  Google Scholar 

  4. Costic RS, Labriola JE, Rodosky MW, Debski RE (2004) Biomechanical rationale for development of anatomical reconstructions of coracoclavicular ligaments after complete acromioclavicular joint dislocations. Am J Sports Med 32(8):1929–1936

    Article  PubMed  Google Scholar 

  5. Debski RE, Parsons IM, Woo SL, Fu FH (2001) Effect of capsular injury on acromioclavicular joint mechanics. J Bone Joint Surg Am 83(9):1344–1351

    PubMed  Google Scholar 

  6. Deshmukh AV, Wilson DR, Zilberfarb JL, Perlmutter GS (2004) Stability of acromioclavicular joint reconstruction: biomechanical testing of various surgical techniques in a cadaveric model. Am J Sports Med 32(6):1492–1498

    Article  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

    CAS  PubMed  Google Scholar 

  8. Klimkiewicz JJ, Williams GR, Sher JS, Karduna A, Des Jardins J, Iannotti JP (1999) The acromioclavicular capsule as a restraint to posterior translation of the clavicle: a biomechanical analysis. J Shoulder Elb Surg 8(2):119–124

    Article  CAS  Google Scholar 

  9. 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 

  10. Lee KW, Debski RE, Chen CH, Woo SL, Fu FH (1997) Functional evaluation of the ligaments at the acromioclavicular joint during anteroposterior and superoinferior translation. Am J Sports Med 25(6):858–862

    Article  CAS  PubMed  Google Scholar 

  11. Lee SJ, Keefer EP, McHugh MP, Kremenic IJ, Orishimo KF, Ben-Avi S, Nicholas SJ (2008) Cyclical loading of coracoclavicular ligament reconstructions: a comparative biomechanical study. Am J Sports Med 36(10):1990–1997

    Article  PubMed  Google Scholar 

  12. 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 

  13. Mazzocca AD, Arciero RA, Bicos J (2007) Evaluation and treatment of acromioclavicular joint injuries. Am J Sports Med 35(2):316–329

    Article  PubMed  Google Scholar 

  14. 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 

  15. Mazzocca AD, Spang JT, Rodriguez RR, Rios CG, Shea KP, Romeo AA, Arciero RA (2008) Biomechanical and radiographic analysis of partial coracoclavicular ligament injuries. Am J Sports Med 36(7):1397–1402

    Article  PubMed  Google Scholar 

  16. Murena L, Canton G, Vulcano E, Cherubino P (2013) Scapular dyskinesis and SICK scapula syndrome following surgical treatment of type III acute acromioclavicular dislocations. Knee Surg Sports Traumatol Arthrosc 21(5):1146–1150

    Article  PubMed  Google Scholar 

  17. Rios CG, Arciero RA, Mazzocca AD (2007) Anatomy of the clavicle and coracoid process for reconstruction of the coracoclavicular ligaments. Am J Sports Med 35(5):811–817

    Article  PubMed  Google Scholar 

  18. Rios CG, Mazzocca AD (2008) Acromioclavicular joint problems in athletes and new methods of management. Clin Sports Med 27(4):763–788

    Article  PubMed  Google Scholar 

  19. Sahara W, Sugamoto K, Murai M, Tanaka H, Yoshikawa H (2006) 3D kinematic analysis of the acromioclavicular joint during arm abduction using vertically open MRI. J Orthop Res 24(9):1823–1831

    Article  PubMed  Google Scholar 

  20. 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 

  21. 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 

  22. 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 

  23. Simovitch R, Sanders B, Ozbaydar M, Lavery K, Warner JJ (2009) Acromioclavicular joint injuries: diagnosis and management. J Am Acad Orthop Surg 17(4):207–219

    PubMed  Google Scholar 

  24. Sobhy MH (2012) Midterm results of combined acromioclavicular and coracoclavicular reconstruction using nylon tape. Arthroscopy 28(8):1050–1057

    Article  PubMed  Google Scholar 

  25. Tischer T, Salzmann GM, El-Azab H, Vogt S, Imhoff AB (2009) Incidence of associated injuries with acute acromioclavicular joint dislocations types III through V. Am J Sports Med 37(1):136–139

    Article  PubMed  Google Scholar 

  26. Venjakob AJ, Salzmann GM, Gabel F, Buchmann S, Walz L, Spang JT, Vogt S, Imhoff AB (2013) Arthroscopically assisted 2-bundle anatomic reduction of acute acromioclavicular joint separations: 58-month findings. Am J Sports Med 41(3):615–621

    Article  PubMed  Google Scholar 

  27. 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 

  28. Wellmann M, Habermeyer P (2010) Update on shoulder surgery 2010: current treatment strategies for traumatic lesions of the shoulder. Der Unfallchirurg 113(6):481–490

    Article  CAS  PubMed  Google Scholar 

  29. Yoo YS, Tsai AG, Ranawat AS, Bansal M, Fu FH, Rodosky MW, Smolinski P (2010) A biomechanical analysis of the native coracoclavicular ligaments and their influence on a new reconstruction using a coracoid tunnel and free tendon graft. Arthroscopy 26(9):1153–1161

    Article  PubMed  Google Scholar 

  30. Zooker CC, Parks BG, White KL, Hinton RY (2010) TightRope versus fiber mesh tape augmentation of acromioclavicular joint reconstruction: a biomechanical study. Am J Sports Med 38(6):1204–1208

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department for Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany

    Tim Saier, Arne J. Venjakob, Philipp Minzlaff, Andreas B. Imhoff, Stephan Vogt & Sepp Braun

  2. Berufsgenossenschaftliche Unfallklinik Murnau, Prof.-Küntscher-Str. 8, 82418, Murnau, Germany

    Tim Saier

  3. Department of Biomechanics, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany

    Peter Föhr & Filip Lindell

Authors
  1. Tim Saier
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Arne J. Venjakob
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Philipp Minzlaff
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Peter Föhr
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Filip Lindell
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Andreas B. Imhoff
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Stephan Vogt
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Sepp Braun
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Andreas B. Imhoff.

Additional information

Sepp Braun and Stephan Vogt have contributed equally for senior authorship.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Saier, T., Venjakob, A.J., Minzlaff, P. et al. Value of additional acromioclavicular cerclage for horizontal stability in complete acromioclavicular separation: a biomechanical study. Knee Surg Sports Traumatol Arthrosc 23, 1498–1505 (2015). https://doi.org/10.1007/s00167-014-2895-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-014-2895-7

Keywords

Search

Navigation