Biomechanical Comparison of Coracoclavicular Reconstructive Techniques

Abstract

Background: Acromioclavicular joint dislocations are common orthopaedic injuries. Numerous operative techniques have been described, but the gold standard has yet to be defined. The goal of fixation is to create a stiff and strong reconstruction of the coracoclavicular ligaments to provide optimal stability. The modified Weaver-Dunn is the traditional surgical procedure. However, due to the high rate of recurrent instability with this technique, a shift toward a more anatomic repair has occurred.Purpose: To evaluate the biomechanical performance of multiple types of coracoclavicular ligament reconstruction.Study Design: Controlled laboratory study.Methods: Thirty fresh-frozen human cadaveric shoulders were assigned to 1 of 5 reconstruction groups or a control group: modified Weaver-Dunn, nonanatomic allograft, anatomic allograft, anatomic suture, and GraftRope. A type III acromioclavicular joint dislocation was simulated in all specimens. The 5 techniques were completed, and a cyclic preload and a load-to-failure protocol were performed.Results: The control had an average load to failure of 1330.6 ± 447.0 N. Compared with all techniques, the anatomic allograft had the highest load to failure, 948 ± 148 N. It had a significantly higher load to failure than the modified Weaver-Dunn (523.2 ± 98.6 N, P = .001), the anatomic suture (578.2 ± 195.3 N, P = .01), the nonanatomic allograft (591.2 ± 65.6 N, P = .003), and the GraftRope (646 ± 167.4, P = .016). No significant difference in load to failure was found between the remaining techniques.Conclusion: The anatomic allograft reconstruction has superior initial biomechanical properties compared with the modified Weaver-Dunn, nonanatomic allograft, anatomic suture, and GraftRope techniques.Clinical Relevance: Anatomic reconstruction of the coracoclavicular ligaments with allograft may provide a stronger biological solution for acromioclavicular joint dislocations. This reconstruction may minimize recurrent subluxation and pain and permit earlier rehabilitation when compared with current techniques.