Limits...
Biomechanical Comparison of Fracture Risk Created by 2 Different Clavicle Tunnel Preparations for Coracoclavicular Ligament Reconstruction.

Nuzzo MS, Adamson GJ, Lee TQ, McGarry MH, Husak L - Orthop J Sports Med (2014)

Bottom Line: There was no significant difference (P = .5).There was no significant difference (P = .2).Utilizing this single-tunnel technique may yield an anatomic advantage that may also reduce the rate of complications caused by posterior wall blowout.

View Article: PubMed Central - PubMed

Affiliation: Orthopaedic Biomechanics Laboratory, Veterans Administration Long Beach Healthcare System, Long Beach, California, USA. ; University of California, San Francisco-Fresno, Fresno, California, USA.

ABSTRACT

Background: An anatomic reconstruction of coracoclavicular (CC) ligaments typically requires drilling tunnels in the clavicle. An increase in fracture complications has been associated with graft tunnel position. A method of drilling clavicle tunnels that would better re-create anatomic function of the CC ligaments without increasing fracture risk would be an improvement.

Purpose: To evaluate the feasibility of a novel single anterior-to-posterior tunnel technique and compare the biomechanical properties to the 2-tunnel technique in CC ligament reconstruction. The hypothesis was that the single tunnel will yield similar loads to failure as the 2-tunnel technique and better reproduce the native anatomy of the conoid and trapezoid ligaments.

Study design: Controlled laboratory study.

Methods: Eight fresh-frozen matched pairs of human clavicles underwent testing. In 1 specimen of the matched pair, 2 bone tunnels were created as previously described. In the other, a single tunnel was placed obliquely from anterior to posterior. The relative position of the tunnels in relation to the conoid tuberosity was recorded. Specimens were tested on a materials testing machine. The ultimate load to failure, linear stiffness, distance of the conoid tuberosity to the conoid tunnel exit point, and mode of failure were recorded.

Results: The ultimate load to failure in the single-tunnel group and the 2-tunnel group was 457.2 ± 139.8 and 488.8 ± 170.6, respectively. There was no significant difference (P = .5). The linear stiffness in the single-tunnel group and the 2-tunnel group was 94.6 ± 31.3 and 79.8 ± 33.5, respectively. There was no significant difference (P = .2). The 2-tunnel group had a significantly longer average maximum distance from the conoid tuberosity to the conoid tunnel exit point than the single-tunnel group (6.0 ± 2.1 vs 0.8 ± 1.9 mm; P = .05). The single-tunnel group was consistently more anatomic with regard to its relationship to the conoid tuberosity than the 2-tunnel group.

Conclusion: The single anterior-to-posterior clavicle tunnel had similar biomechanical properties to the 2-tunnel technique. However, the single-tunnel technique better reproduced the anatomic footprint of the conoid ligament. Utilizing this single-tunnel technique may yield an anatomic advantage that may also reduce the rate of complications caused by posterior wall blowout.

Clinical relevance: Acromioclavicular joint injuries are common in collision sports. Surgical management is often indicated to reconstruct the joint. This study assesses the feasibility of a novel surgical approach.

No MeSH data available.


Related in: MedlinePlus

Clavicle with double superior-inferior tunnel potted and affixed to the Instron device.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License 1 - License 2 - License 3
getmorefigures.php?uid=PMC4555557&req=5

fig1-2325967114555478: Clavicle with double superior-inferior tunnel potted and affixed to the Instron device.

Mentions: Eight fresh-frozen matched pairs of human cadaveric clavicles (4 male, 4 female specimens; mean age, 50.4 years; range, 38-62 years) were obtained. In 1 specimen of each matched pair, 2 bone tunnels were created. Tunnel positions were chosen to simulate the anatomic position of the conoid and trapezoid ligaments, as determined by Rios et al,11 and a ratio of the total length of the clavicle was utilized to account for variable lengths between pairs. The trapezoid ligament tunnel was placed at 17% per Rios et al,11 and the conoid tunnel position was modified to 25% based on recent anatomic and clinical studies that suggested better outcomes when the conoid tunnel is placed at a distance of 25% of the clavicular length from the lateral border in the posterior half of the clavicle.2,13,16 The lateral trapezoid tunnel was placed at 17% of the length of the clavicle from the lateral border in the center of the clavicle (Figures 1 and 2). Tunnels were drilled with a 5 mm–diameter reamer using a cannulated drill and guide pin.


Biomechanical Comparison of Fracture Risk Created by 2 Different Clavicle Tunnel Preparations for Coracoclavicular Ligament Reconstruction.

Nuzzo MS, Adamson GJ, Lee TQ, McGarry MH, Husak L - Orthop J Sports Med (2014)

Clavicle with double superior-inferior tunnel potted and affixed to the Instron device.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License 1 - License 2 - License 3
Show All Figures
getmorefigures.php?uid=PMC4555557&req=5

fig1-2325967114555478: Clavicle with double superior-inferior tunnel potted and affixed to the Instron device.
Mentions: Eight fresh-frozen matched pairs of human cadaveric clavicles (4 male, 4 female specimens; mean age, 50.4 years; range, 38-62 years) were obtained. In 1 specimen of each matched pair, 2 bone tunnels were created. Tunnel positions were chosen to simulate the anatomic position of the conoid and trapezoid ligaments, as determined by Rios et al,11 and a ratio of the total length of the clavicle was utilized to account for variable lengths between pairs. The trapezoid ligament tunnel was placed at 17% per Rios et al,11 and the conoid tunnel position was modified to 25% based on recent anatomic and clinical studies that suggested better outcomes when the conoid tunnel is placed at a distance of 25% of the clavicular length from the lateral border in the posterior half of the clavicle.2,13,16 The lateral trapezoid tunnel was placed at 17% of the length of the clavicle from the lateral border in the center of the clavicle (Figures 1 and 2). Tunnels were drilled with a 5 mm–diameter reamer using a cannulated drill and guide pin.

Bottom Line: There was no significant difference (P = .5).There was no significant difference (P = .2).Utilizing this single-tunnel technique may yield an anatomic advantage that may also reduce the rate of complications caused by posterior wall blowout.

View Article: PubMed Central - PubMed

Affiliation: Orthopaedic Biomechanics Laboratory, Veterans Administration Long Beach Healthcare System, Long Beach, California, USA. ; University of California, San Francisco-Fresno, Fresno, California, USA.

ABSTRACT

Background: An anatomic reconstruction of coracoclavicular (CC) ligaments typically requires drilling tunnels in the clavicle. An increase in fracture complications has been associated with graft tunnel position. A method of drilling clavicle tunnels that would better re-create anatomic function of the CC ligaments without increasing fracture risk would be an improvement.

Purpose: To evaluate the feasibility of a novel single anterior-to-posterior tunnel technique and compare the biomechanical properties to the 2-tunnel technique in CC ligament reconstruction. The hypothesis was that the single tunnel will yield similar loads to failure as the 2-tunnel technique and better reproduce the native anatomy of the conoid and trapezoid ligaments.

Study design: Controlled laboratory study.

Methods: Eight fresh-frozen matched pairs of human clavicles underwent testing. In 1 specimen of the matched pair, 2 bone tunnels were created as previously described. In the other, a single tunnel was placed obliquely from anterior to posterior. The relative position of the tunnels in relation to the conoid tuberosity was recorded. Specimens were tested on a materials testing machine. The ultimate load to failure, linear stiffness, distance of the conoid tuberosity to the conoid tunnel exit point, and mode of failure were recorded.

Results: The ultimate load to failure in the single-tunnel group and the 2-tunnel group was 457.2 ± 139.8 and 488.8 ± 170.6, respectively. There was no significant difference (P = .5). The linear stiffness in the single-tunnel group and the 2-tunnel group was 94.6 ± 31.3 and 79.8 ± 33.5, respectively. There was no significant difference (P = .2). The 2-tunnel group had a significantly longer average maximum distance from the conoid tuberosity to the conoid tunnel exit point than the single-tunnel group (6.0 ± 2.1 vs 0.8 ± 1.9 mm; P = .05). The single-tunnel group was consistently more anatomic with regard to its relationship to the conoid tuberosity than the 2-tunnel group.

Conclusion: The single anterior-to-posterior clavicle tunnel had similar biomechanical properties to the 2-tunnel technique. However, the single-tunnel technique better reproduced the anatomic footprint of the conoid ligament. Utilizing this single-tunnel technique may yield an anatomic advantage that may also reduce the rate of complications caused by posterior wall blowout.

Clinical relevance: Acromioclavicular joint injuries are common in collision sports. Surgical management is often indicated to reconstruct the joint. This study assesses the feasibility of a novel surgical approach.

No MeSH data available.


Related in: MedlinePlus