Voss Andreas, Beitzel Knut, Alaee Farhang, Dukas Alex, Herbst Elmar, Obopilwe Elifho, Apostolakos John, DiVenere Jessica, Singh Hardeep, Cote Mark P, Mazzocca Augustus D
Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A..
Department of Orthopaedic Sportsmedicine, Technical University, Munich, Germany.
Arthroscopy. 2016 Aug;32(8):1551-7. doi: 10.1016/j.arthro.2016.01.050. Epub 2016 May 12.
To evaluate the biomechanical stability of a tendon-to-clavicle bone interface fixation of a graft in revision acromioclavicular reconstruction.
Fifteen fresh-frozen cadaveric shoulders were used. All specimens underwent bone density evaluation. For the primary reconstruction, a 5-mm semitendinosus allograft was inserted into a 5-mm bone tunnel at 25 and 45 mm from the lateral end of the clavicle using a 5.5 × 8-mm PEEK (polyether ether ketone) tenodesis screw. Each single graft was fixed in a cryo-clamp and cyclically loaded from 5 to 70 N for 3,000 cycles, followed by load-to-failure testing at a rate of 120 mm/min to simulate the revision case. To simulate tunnel widening, the tunnels of the revision series were over-drilled with an 8-mm drill, and a 5-mm semitendinosus graft with an 8 × 12-mm PEEK tenodesis screw was inserted. Biomechanical testing was then repeated.
The bone mineral density analysis showed a significantly higher density at the 45-mm hole compared with the 25-mm hole (P = .001). The ultimate load to failure increased from the 5.5-mm screw to the 8-mm screw at the 45-mm hole position (P = .001). There was no statistically significant difference at the 25-mm hole position (P = .934). No statistical significance for graft elongation comparing the 5.5-mm screw and the 8-mm screw at the 25-mm (P = .156) and 45-mm (P = .334) positions could be found.
Comparable biomechanical stability for the tendon-to-bone interface fixation in different clavicular tunnel diameters simulating primary and revision reconstruction was achieved.
There is a lack of literature regarding revision acromioclavicular joint reconstruction, but our biomechanical results show comparable stability to primary reconstruction. These data provide support for the use of anatomic acromioclavicular ligament reconstruction in revision cases.
评估翻修肩锁关节重建术中移植物肌腱与锁骨骨界面固定的生物力学稳定性。
使用15个新鲜冷冻的尸体肩部标本。所有标本均进行骨密度评估。对于初次重建，将5毫米的半腱肌同种异体移植物通过一根5.5×8毫米的聚醚醚酮（PEEK）腱固定螺钉插入锁骨外侧端25毫米和45毫米处的5毫米骨隧道中。每个单一移植物固定在低温夹具中，以5至70牛的力进行3000次循环的周期性加载，然后以120毫米/分钟的速率进行破坏载荷测试以模拟翻修情况。为模拟隧道扩大，翻修组的隧道用8毫米钻头扩钻，然后插入一根带有8×12毫米PEEK腱固定螺钉的5毫米半腱肌移植物。然后重复生物力学测试。
骨矿物质密度分析显示，45毫米孔处的密度显著高于25毫米孔处（P = 0.001）。在45毫米孔位置，破坏的极限载荷从5.5毫米螺钉增加到8毫米螺钉（P = 0.001）。在25毫米孔位置没有统计学上的显著差异（P = 0.934）。在25毫米（P = 0.156）和45毫米（P = 0.334）位置比较5.5毫米螺钉和8毫米螺钉时，移植物伸长没有统计学意义。
在模拟初次和翻修重建的不同锁骨隧道直径中，实现了肌腱与骨界面固定的可比生物力学稳定性。
关于翻修肩锁关节重建的文献较少，但我们的生物力学结果显示与初次重建具有可比的稳定性。这些数据为在翻修病例中使用解剖学肩锁韧带重建提供了支持。
