Orthopaedic Biomechanics Laboratory, Veterans Administration Long Beach Healthcare System, Long Beach, California, USA. ; University of California, San Francisco-Fresno, Fresno, California, USA.
Orthopaedic Biomechanics Laboratory, Veterans Administration Long Beach Healthcare System, Long Beach, California, USA. ; Congress Medical Associates, Pasadena, California, USA.
Orthop J Sports Med. 2014 Nov 5;2(11):2325967114555478. doi: 10.1177/2325967114555478. eCollection 2014 Nov.
An anatomic reconstruction of coracoclavicular (CC) ligaments typically requires drilling tunnels in the clavicle. An increase in fracture complications has been associated with graft tunnel position. A method of drilling clavicle tunnels that would better re-create anatomic function of the CC ligaments without increasing fracture risk would be an improvement.
To evaluate the feasibility of a novel single anterior-to-posterior tunnel technique and compare the biomechanical properties to the 2-tunnel technique in CC ligament reconstruction. The hypothesis was that the single tunnel will yield similar loads to failure as the 2-tunnel technique and better reproduce the native anatomy of the conoid and trapezoid ligaments.
Controlled laboratory study.
Eight fresh-frozen matched pairs of human clavicles underwent testing. In 1 specimen of the matched pair, 2 bone tunnels were created as previously described. In the other, a single tunnel was placed obliquely from anterior to posterior. The relative position of the tunnels in relation to the conoid tuberosity was recorded. Specimens were tested on a materials testing machine. The ultimate load to failure, linear stiffness, distance of the conoid tuberosity to the conoid tunnel exit point, and mode of failure were recorded.
The ultimate load to failure in the single-tunnel group and the 2-tunnel group was 457.2 ± 139.8 and 488.8 ± 170.6, respectively. There was no significant difference (P = .5). The linear stiffness in the single-tunnel group and the 2-tunnel group was 94.6 ± 31.3 and 79.8 ± 33.5, respectively. There was no significant difference (P = .2). The 2-tunnel group had a significantly longer average maximum distance from the conoid tuberosity to the conoid tunnel exit point than the single-tunnel group (6.0 ± 2.1 vs 0.8 ± 1.9 mm; P = .05). The single-tunnel group was consistently more anatomic with regard to its relationship to the conoid tuberosity than the 2-tunnel group.
The single anterior-to-posterior clavicle tunnel had similar biomechanical properties to the 2-tunnel technique. However, the single-tunnel technique better reproduced the anatomic footprint of the conoid ligament. Utilizing this single-tunnel technique may yield an anatomic advantage that may also reduce the rate of complications caused by posterior wall blowout.
Acromioclavicular joint injuries are common in collision sports. Surgical management is often indicated to reconstruct the joint. This study assesses the feasibility of a novel surgical approach.
喙锁韧带的解剖重建通常需要在锁骨上钻孔。移植物隧道位置与骨折并发症的增加有关。一种可以更好地重建喙锁韧带解剖功能而不增加骨折风险的锁骨隧道钻孔方法将是一种改进。
评估一种新的单前向后隧道技术的可行性，并比较其在喙锁韧带重建中的生物力学性能与双隧道技术。假设单隧道的失效负载与双隧道技术相似，并能更好地再现锥状韧带和梯形韧带的解剖结构。
对照实验室研究。
对 8 对新鲜冷冻的匹配锁骨进行了测试。在匹配对的 1 个标本中，按照先前的描述创建了 2 个骨隧道。在另一个标本中，从前向后斜置一个单隧道。记录隧道相对于锥状突的相对位置。标本在材料试验机上进行测试。记录失效时的最大负载、线性刚度、锥状突至锥状隧道出口点的距离以及失效模式。
单隧道组和双隧道组的失效时最大负载分别为 457.2 ± 139.8 和 488.8 ± 170.6，无显著差异（P =.5）。单隧道组和双隧道组的线性刚度分别为 94.6 ± 31.3 和 79.8 ± 33.5，无显著差异（P =.2）。双隧道组的锥状突至锥状隧道出口点的最大距离平均明显长于单隧道组（6.0 ± 2.1 与 0.8 ± 1.9 mm；P =.05）。单隧道组与锥状突的关系更符合解剖学特征，比双隧道组更符合。
单前向后锁骨隧道的生物力学特性与双隧道技术相似。然而，单隧道技术更好地再现了锥状韧带的解剖足迹。使用这种单隧道技术可能会产生解剖学优势，也可能降低因后壁爆裂引起的并发症发生率。
肩锁关节损伤在碰撞运动中很常见。手术治疗通常是重建关节的指征。本研究评估了一种新的手术方法的可行性。
