Division of Sports Medicine, Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA, USA; Shiley Center for Orthopaedic Research & Education (SCORE) at Scripps Clinic, La Jolla, CA, USA.
Division of Sports Medicine, Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA, USA; Shiley Center for Orthopaedic Research & Education (SCORE) at Scripps Clinic, La Jolla, CA, USA.
J Shoulder Elbow Surg. 2020 Sep;29(9):1901-1911. doi: 10.1016/j.jse.2019.11.034. Epub 2020 Mar 17.
The variation in the anatomic relationship between the coracoid and the clavicle affects the biomechanical stability of coracoclavicular ligament reconstruction (CCLR).
Three-dimensional computed tomography reconstruction of 85 patients was analyzed. Anatomic landmarks were used to derive the coracoclavicular sagittal reconstruction angle (sRA). The lateral concave angle, which indicated the shape of the distal clavicle, and the offsets between the clavicle and coracoid were also measured. To investigate the biomechanical effects of the sRA on CCLR, 7 computed tomography scans with different sRAs were 3D printed. Two reconstructions, a single trans-coracoclavicular tunnel and a looped reconstruction technique, were performed sequentially. Models were cyclically loaded at 70 N in the anterior, posterior, and superior directions.
The mean sRA was 68° ± 9.3° (range, 47°-85°). The superoinferior offset between the clavicle and the coracoid and the lateral concave angle positively correlated with the sRA (r = 0.359 and 0.837, respectively; P ≤ .001), whereas the anteroposterior offset had a negative correlation (r = -0.925; P < .001). The sRA had a negative correlation with the anterior displacement of the clavicle (rho = -0.96; P < .001) and a positive correlation with the posterior displacement for both surgical techniques (rho = 1.0; P < .001).
The anatomic orientation of the native coracoclavicular ligaments is highly variable in the sagittal plane. Low sagittal angles can reduce anterior stability, whereas high sagittal angles can reduce posterior stability of CCLR.
喙锁间韧带重建（CCLR）中喙突与锁骨解剖关系的变化会影响生物力学稳定性。
对 85 例患者进行三维 CT 重建。使用解剖标志得出喙锁间矢状重建角（sRA）。还测量了指示锁骨远端形态的锁骨外侧凹角和锁骨与喙突之间的偏移量。为了研究 sRA 对 CCLR 的生物力学影响，3D 打印了 7 个具有不同 sRA 的 CT 扫描。依次进行了两种重建，即单一喙锁间隧道重建和环形重建技术。模型在前后和上下方向以 70N 的力进行循环加载。
平均 sRA 为 68°±9.3°（范围，47°-85°）。锁骨与喙突的上下偏移量和外侧凹角与 sRA 呈正相关（r = 0.359 和 0.837，分别；P≤.001），而前后偏移量呈负相关（r = -0.925；P<.001）。sRA 与锁骨的前向移位呈负相关（rho = -0.96；P<.001），与两种手术技术的后向移位呈正相关（rho = 1.0；P<.001）。
喙锁间韧带的固有解剖方向在矢状面有很大的变异性。低矢状角会降低前向稳定性，而高矢状角会降低 CCLR 的后向稳定性。
