Anterior and coracoid base tunnel location combined with single -or double clavicular tunnel techniques using double-button fixation for coracoclavicular ligament reconstruction both restore horizontal stability. A biomechanical cadaver study

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY Accounts of Chemical Research Pub Date : 2024-10-12 DOI:10.1016/j.clinbiomech.2024.106363

Maketo Molepo , Natalie Keough , Abrie Oberholster , Erik Hohmann

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Abstract

Background

The placement of clavicle tunnels in coracoclavicular ligament reconstruction is well established, but the optimal position of the coracoid tunnel remains unclear. This study aimed to investigate how the coracoid tunnel's position affects horizontal stability during coracoclavicular ligament reconstruction using a double-button technique.

Methods

Fifteen fresh frozen shoulder cadaver specimens were tested under various conditions: intact coracoclavicular ligaments, disrupted ligaments, and reconstructions with a single coracoid and clavicle tunnel or double clavicle tunnels. The coracoid tunnel was positioned at the coracoid base 1/9, and 1/5 anterior to the base. Specimens underwent displacement-controlled loading, with 2D motion analysis conducted on captured digital images using TEMA motion analysis.

Findings

Mean displacement for intact coracoclavicular ligaments was 1.61 ± 0.92 mm, and 3.69 ± 1.09 mm for disrupted ligaments. For reconstructed conditions, displacements were as follows: Single-Tunnel Base (1.87 ± 0.64 mm), Single-Tunnel 1/9 (2.54 ± 1.13 mm), Single-Tunnel 1/5 (2.62 ± 1.17 mm), Double-Tunnel Base (1.25 ± 0.73 mm), Double-Tunnel 1/9 (2.03 ± 1.22 mm), and Double-Tunnel 1/5 (1.88 ± 1.20 mm). Differences among intact, reconstructed, and disrupted states were statistically significant (p = 0.01–0.0001), with all reconstruction techniques restoring horizontal displacement near the intact state.

Interpretation

At point zero both single coracoid tunnel and single- and double-clavicle tunnel restored horizontal displacement to its intact state. Coracoid tunnel placement anterior to the base of the coracoid did not influence horizontal displacement but single coracoid at the coracoid base and single clavicle tunnel resulted in the most anatomic reconstruction. Single coracoid tunnel at the base and double-clavicle resulted in the most stable reconstruction.

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前方和冠状基底隧道位置结合使用双扣固定的单锁骨或双锁骨隧道技术进行锁骨韧带重建，都能恢复水平稳定性。一项尸体生物力学研究

背景锁骨隧道在锁骨韧带重建中的位置已得到公认，但冠状带隧道的最佳位置仍不明确。本研究旨在探讨在使用双扣技术进行角锁关节韧带重建时，锁骨隧道的位置如何影响水平稳定性。方法在不同条件下对 15 个新鲜冰冻肩部尸体标本进行了测试：完整的角锁关节韧带、中断的韧带、单锁骨和锁骨隧道或双锁骨隧道重建。肩胛骨隧道位于肩胛骨基部的 1/9，以及基部前方的 1/5。研究结果完整的锁骨韧带的平均位移为 1.61 ± 0.92 毫米，断裂的韧带的平均位移为 3.69 ± 1.09 毫米。重建条件下的位移如下：单隧道基底（1.87 ± 0.64 毫米）、单隧道 1/9（2.54 ± 1.13 毫米）、单隧道 1/5（2.62 ± 1.17 毫米）、双隧道基底（1.25 ± 0.73 毫米）、双隧道 1/9（2.03 ± 1.22 毫米）和双隧道 1/5（1.88 ± 1.20 毫米）。完整状态、重建状态和中断状态之间的差异具有统计学意义（p = 0.01-0.0001），所有重建技术都能将水平位移恢复到接近完整状态。将肩胛骨隧道放置在肩胛骨基部前方不会影响水平位移，但在肩胛骨基部放置单肩胛骨隧道和单锁骨隧道可实现最符合解剖学的重建。位于基部的单冠状突隧道和双锁骨重建最为稳定。

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.