Clin Orthop Surg.  2013 Dec;5(4):298-305. 10.4055/cios.2013.5.4.298.

Biomechanical Comparison of an Intramedullary and Extramedullary Free-Tissue Graft Reconstruction of the Acromioclavicular Joint Complex

• Garg R
• Adamson GJ
• Javidan P
• Lee TQ

• KMID: 1787033
• DOI: http://doi.org/10.4055/cios.2013.5.4.298

Abstract

BACKGROUND
Several different surgical techniques have been described to address the coracoclavicular (CC) ligaments in acromioclavicular (AC) joint injuries. However, very few techniques focus on reconstructing the AC ligaments, despite its importance in providing stability. The purpose of our study was to compare the biomechanical properties of two free-tissue graft techniques that reconstruct both the AC and CC ligaments in cadaveric shoulders, one with an extramedullary AC reconstruction and the other with an intramedullary AC reconstruction. We hypothesized intramedullary AC reconstruction will provide greater anteroposterior translational stability and improved load to failure characteristics than an extramedullary technique.
METHODS
Six matched cadaveric shoulders underwent translational testing at 10 N and 15 N in the anteroposterior and superoinferior directions, under AC joint compression loads of 10 N, 20 N, and 30 N. After the AC and CC ligaments were transected, one of the specimens was randomly assigned the intramedullary free-tissue graft reconstruction while its matched pair received the extramedullary graft reconstruction. Both reconstructed specimens then underwent repeat translational testing, followed by load to failure testing, via superior clavicle distraction, at a rate of 50 mm/min.
RESULTS
Intramedullary reconstruction provided significantly greater translational stability in the anteroposterior direction than the extramedullary technique for four of six loading conditions (p < 0.05). There were no significant differences in translational stability in the superoinferior direction for any loading condition. The intramedullary reconstructed specimens demonstrated improved load to failure characteristics with the intramedullary reconstruction having a lower deformation at yield and a higher ultimate load than the extramedullary reconstruction (p < 0.05).
CONCLUSIONS
Intramedullary reconstruction of the AC joint provides greater stability in the anteroposterior direction and improved load to failure characteristics than an extramedullary technique. Reconstruction of the injured AC joint with an intramedullary free tissue graft may provide greater strength and stability than other currently used techniques, allowing patients to have improved clinical outcomes.

Keyword

Shoulder; Acromioclavicular joint; Biomechanics; Graft reconstruction

MeSH Terms

Acromioclavicular Joint/physiology/*surgery
Aged
Biomechanical Phenomena
Humans
Male
Middle Aged
Orthopedic Procedures/*methods
Reconstructive Surgical Procedures/*methods
Transplants/*physiology

Figure

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  Fig. 1 Custom translational testing apparatus.

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  Fig. 2 The intramedullary acromioclavicular reconstruction technique.

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  Fig. 3 The extramedullary acromioclavicular reconstruction technique.

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  Fig. 4 Percent change of anteroposterior translation compared to intact for both reconstruction techniques for each translational load of 10 N and 15 N and compressive load of 10 N, 20 N, and 30 N. I: intramedullary, E: extramendullary.

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  Fig. 5 Percent change of superoinferior translation compared to intact for both reconstruction techniques for each translational load of 10 N and 15 N and compressive load of 10 N, 20 N, and 30 N. I: intramedullary, E: extramendullary.

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  Fig. 6 Representative load-displacement curve for each reconstruction.

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