Biomechanical Comparison of Anatomic and Extra-Anatomic Reconstruction Techniques Using Local Grafts for Chronic Instability of the Acromioclavicular Joint
| Autor: | Bassem T. Elhassan, Thibault Lafosse, Philippe Hardy, Jean-David Werthel, Malo Le Hanneur, Andrew R. Thoreson, Damien Delgrande |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Joint Instability Male Coracoacromial ligament Physical Therapy Sports Therapy and Rehabilitation Biceps Transplantation Autologous Arthroplasty Tendons 03 medical and health sciences 0302 clinical medicine Surgical site medicine Cadaver Acromioclavicular joint Humans Orthopedics and Sports Medicine Joint (geology) Early Ambulation Aged Orthodontics Aged 80 and over 030222 orthopedics business.industry 030229 sport sciences Middle Aged Clavicle Biomechanical Phenomena medicine.anatomical_structure Acromioclavicular Joint Conjoint tendon Ligaments Articular Female business |
| Zdroj: | The American journal of sports medicine. 46(8) |
| ISSN: | 1552-3365 |
| Popis: | Background:Anatomic reconstruction techniques are increasingly used to address cases of acromioclavicular (AC) joint chronic instability. These usually involve an additional surgical site for autograft harvesting or an allograft.Purpose:To describe a triple-bundle (TB) anatomic reconstruction using on-site autografts, the semiconjoint tendon (SCT) and the coracoacromial ligament (CAL), and compare its primary stability to the native AC joint ligamentous complex and to a modified Weaver-Dunn (WD) reconstruction.Study Design:Controlled laboratory study.Methods:Intact AC joints of 12 paired cadaveric shoulders were tested for anterior, posterior, and superior translations under cyclic loading with a servo-hydraulic testing system. One shoulder from each pair was randomly assigned to the TB group, where 2 SCT strips were used to reconstruct the coracoclavicular ligaments while the distal end of the CAL was transferred to the distal extremity of the clavicle to reconstruct the AC ligaments; the other shoulder received a modified WD reconstruction. After reconstruction, the same translational testing was performed, with an additional load-to-failure test in the superior direction.Results:In both the TB and the WD groups, no significant differences were found before and after reconstruction in terms of joint displacements after cyclic loading, in all 3 directions. Compared with the WD reconstruction, the TB repair resulted in significantly lower displacements in both the anterior (ie, 2.59 ± 1.08 mm, P = .011) and posterior (ie, 10.17 ± 6.24 mm, P = .014) directions, but not in the superior direction. No significant differences were observed between the 2 reconstructions during the load-to-failure testing, except for the displacement to failure, which was significantly smaller (ie, 5.34 ± 2.97 mm) in the WD group ( P = .037).Conclusion:Anterior, posterior, and superior displacements after an anatomic reconstruction of the AC joint complex using the SCT and CAL as graft material were similar to those of native AC joints and significantly smaller in the axial plane than those of AC joints after a WD repair.Clinical Relevance:An anatomic reconstruction is achievable using the CAL and the SCT as on-site graft materials, providing satisfactory initial stability and thereby allowing earlier mobilization. |
| Databáze: | OpenAIRE |
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