Reconstruction of the Coracoclavicular Ligaments with Tendon Grafts

Abstract

Background Numerous surgical techniques have been described to address injuries to the coracoclavicular ligaments. Purpose To compare the biomechanical properties of tendon graft reconstructions with those of the native coracoclavicular ligaments and various other repair methods. Study Design Controlled laboratory study. Methods Eleven fresh-frozen human cadaveric shoulders were tensile tested to failure to compare the biomechanical properties of the native coracoclavicular ligaments, coracoacromial ligament transfer, No. 5 Mersilene suture repair, 5-mm Mersilene tape repair, and tendon graft reconstructions with gracilis, semitendinosus, and long toe extensor tendons. Results Reconstructions with semitendinosus, gracilis, or long toe extensor tendon grafts were found to have superior initial biomechanical properties compared with coracoacromial ligament transfer; failure strengths were as strong as those of the native coracoclavicular ligaments. Failure of the tendon grafts occurred through the midsubstance of the tendon graft, not at the fixation site. Conclusions Tendon graft reconstruction may be an alternative to coracoacromial ligament transfer and may provide a permanent biologic reconstruction with superior initial biomechanical properties, including that of tensile strength. Clinical Relevance Use of tendon graft reconstruction may limit the need for postoperative immobilization and lead to an accelerated rehabilitation program.