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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 single anterior-to-posterior drill hole demonstrating the ratio and direction of tunnel placement.
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fig4-2325967114555478: Clavicle with single anterior-to-posterior drill hole demonstrating the ratio and direction of tunnel placement.

Mentions: In the other specimen of the pair, a single tunnel was placed in the anterior to posterior direction angled medially following a predrawn line. The line was drawn between 2 positions marked on the superior surface of the clavicle. A position on the posterior cortex, simulating the conoid origin, was marked using a distance 25% of the clavicular length from the lateral border. Another position was marked on the anterior cortex, simulating the trapezoid origin, using 17% of the clavicular length from the lateral border. A straight line was then drawn between the 2 marks, and a guide pin was placed aiming from anterior to posterior and from slightly superior to inferior attempting to exit on the posterior inferior surface of the clavicle (Figures 3 and 4). No attempt was made to specifically exit on the conoid tuberosity but rather on the predrawn lines. A tunnel was drilled over the guide pin using a 5-mm reamer.


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 single anterior-to-posterior drill hole demonstrating the ratio and direction of tunnel placement.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

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

fig4-2325967114555478: Clavicle with single anterior-to-posterior drill hole demonstrating the ratio and direction of tunnel placement.
Mentions: In the other specimen of the pair, a single tunnel was placed in the anterior to posterior direction angled medially following a predrawn line. The line was drawn between 2 positions marked on the superior surface of the clavicle. A position on the posterior cortex, simulating the conoid origin, was marked using a distance 25% of the clavicular length from the lateral border. Another position was marked on the anterior cortex, simulating the trapezoid origin, using 17% of the clavicular length from the lateral border. A straight line was then drawn between the 2 marks, and a guide pin was placed aiming from anterior to posterior and from slightly superior to inferior attempting to exit on the posterior inferior surface of the clavicle (Figures 3 and 4). No attempt was made to specifically exit on the conoid tuberosity but rather on the predrawn lines. A tunnel was drilled over the guide pin using a 5-mm reamer.

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