On the other hand, the isometric approach seeks to restore the anatomy of the conoid and trapezoid ligaments by using a single anchoring stitch in the coracoid at the midway point of the insertion of both ligaments. This technique allows the conoid and trapezoid ligaments to be emulated, and has shown biomechanical advantages, but there is also an increased risk of fracture of the clavicle during the construction of two tunnels and an increase in technical difficulty. Among the options for repairs with synthetic devices is anatomic reconstruction with a double tunnel in the clavicle as well as in the coracoid. Synthetic CC suspension devices placed arthroscopically permit the reduction of AC dislocations during the biological healing of the CC ligaments. To replace CC ligaments, some authors advocate using tendons (autograft or allograft), while others perform repairs with synthetic devices which allow for the reduction of the AC joint, with the expectation that these devices might act as scaffolding while the injured ligaments heal. It is currently popular to perform these repairs in an anatomic way. There are many techniques that can be applied to the repair of the AC and CC ligaments in the literature. įrom a biomechanical point of view, the importance of the acromioclavicular and coracoclavicular ligaments for maintaining the vertical and horizontal stability of the acromioclavicular joint has been shown. Despite their clinical impact, there is still no consensus for the surgical treatment of Rockwood high-grade lesions. However, surgical treatment is recommended for high-grade lesions IV–VI. The treatment of grade III injuries is controversial. Grade I–II injuries are treated conservatively, without surgery, leading to satisfactory results and a return to sporting activity in most cases. Rockwood classified them into grades I–VI depending on the severity of the injury and the degree of displacement. It brings about a variable separation of the acromioclavicular joint depending on the degree of damage to the capsule, the acromioclavicular ligaments, as well as the coracoclavicular (CC) ligaments. Acromioclavicular repair in a “V” configuration does not seem to be biomechanically sufficient.Īcromioclavicular (AC) dislocations usually present as the result of a fall that produces trauma to the lateral aspect of the shoulder. ConclusionĪnatomic repair of coracoclavicular ligaments with a double system (double tunnel in the clavicle and in the coracoid) permits vertical translation that is more like that of the acromioclavicular joint. A comparison of the three groups did not find any significant difference despite the loss of resistance presented by group III. The corresponding force was 939.37 N (mean 495.6 N) for group II and 533.11 N (mean 343.9 N) for group III. Group I reached a maximum force to failure of 635.59 N (mean 444.0 N). The force required for acromioclavicular reconstruction system failure was analyzed for each cadaveric piece. The biomechanical study was performed with a universal testing machine (Electro Puls 3000, Instron, Boulder, MA, USA), with the clamping jaws set in a vertical position. Three groups were formed group I ( n = 6): control group II ( n = 6): repair with a double tunnel in the clavicle and in the coracoid (with two CC suspension devices) group III ( n = 6): repair in a “V” configuration with two tunnels in the clavicle and one in the coracoid (with one CC suspension device). Materials and methodsĮighteen human cadaveric shoulders in which repair using a coracoclavicular suspension device was initiated after injury to the acromioclavicular joint were included in the study. For this reason, the aim of this study was to evaluate the vertical biomechanical behavior of two techniques for the anatomic repair of coracoclavicular (CC) ligaments after an AC injury. The best treatment option for some acromioclavicular (AC) joint dislocations is controversial.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |