Use of the pectoralis minor and coracoacromial ligament for a biplanar coracoclavicular and acromioclavicular reconstruction: A cadaveric feasibility study

Abstract

Purpose

The aim of this study was to evaluate the feasibility of a novel technique that focuses on vertical and horizontal stabilization of the acromioclavicular joint using two local autologous grafts, the pectoralis minor (Pm) and the coracoacromial ligament (CAL).

Methods

Ten fresh-frozen shoulder cadaveric pieces were dissected. Length and width of the Pm and CAL were measured in their anatomical position and anatomical variants were noted. The Pm tendon was harvested at the myothendinous junction keeping the insertion at the coracoid process. The CAL was detached from the coracoid process keeping the acromial insertion. The free limbs of both grafts were prepared with the Krackow technique and the Arthrex SpeedWhip technique, respectively. The primary coracoclavicular reduction and fixation were with the button system or with two subcoracoid ultrahigh-strength suture cerclage through and around the clavicle. The Pm graft was fixed inside a clavicular tunnel by a cortical button and the CAL was transferred and fixed to the lateral clavicle using a knotless anchor or intramedullary when lateral clavicle resection was performed.

Results

The median length of the Pm was 50 mm (interquartile range [IQR]: 50–54), and the median length of the CAL was 36.5 mm (IQR 34–40) which decreased by 15% and 23% once were prepared with the Krackow and Arthrex SpeedWhip techniques to 44.5 mm (IQR: 30–65) and 30 mm (IQR: 22–32), respectively. The diameter of the prepared Pm graft was 5 mm (IQR: 4.5–6) and the CAL graft 5.5 mm (5–6). All grafts were able to reach the fixation points. The procedure was feasible in 100% of the cases.

Conclusion

A biplanar reconstruction using autologous Pm and CAL appears feasible in restoring the acromioclavicular joint stability.

Level of Evidence

Level IV. Basic science, anatomy, cadaveric dissection