Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut Health Center, Farmington, Connecticut, USA.
Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
Am J Sports Med. 2022 Jun;50(7):1983-1989. doi: 10.1177/03635465221092131. Epub 2022 Apr 28.
Despite the evolution of acromioclavicular joint surgery to a more anatomic coracoclavicular (CC) ligament reconstruction, no definitive guidance regarding the number and position of bone tunnels in the clavicle, as well as the ideal graft choice, is established.
PURPOSE/HYPOTHESIS: The purpose of this study was to biomechanically compare the reconstruction of the CC ligament complex between gracilis- and semitendinosus-tendon grafts in 1- and 2-tunnel techniques. It was hypothesized that the gracilis tendon graft will provide comparable primary stability in both tunnel techniques while utilizing a smaller tunnel diameter.
Controlled laboratory study.
A total of 24 cadaveric shoulders (13 men, 11 women; 66 ± 7.5 years) were randomly allocated to 4 repair groups: gracilis with 1 tunnel (GT-1), gracilis with 2 tunnels (GT-2), semitendinosus with 1 tunnel (ST-1), and semitendinosus with 2 tunnels (ST-2). First, specimens were tested for native anterior, posterior, and superior translations. Then, specimens were randomly assigned to 1 of the 4 CC reconstruction groups before undergoing the same testing, followed by cyclic loading and load to failure (LTF).
The GT-2 reconstruction demonstrated significantly less translation when compared with ST-2 in anterior ( = .024) and posterior ( = .048) directions. GT-1 and ST-2 both showed significantly less translation than ST-1 in anterior and superior directions ( < .001). All reconstructions demonstrated less superior translation compared with native testing, with GT-1 and ST-2 significantly less than ST-1 ( < .001). There were no significant differences for peak displacement and LTF between groups.
Gracilis tendon grafts using a 1- or 2-tunnel technique for CC ligament reconstruction provided comparable translation, displacement, and LTF as corresponding semitendinosus grafts. Therefore, the gracilis tendon should be considered as a biomechanical equivalent graft choice for the reconstruction of the CC ligament complex.
In a cadaveric model, the gracilis tendon demonstrated adequate fixation with minimal translation in CC ligament reconstruction while utilizing smaller diameter bone tunnels, which may help minimize the risk of complications such as loss of reduction and fracture.
尽管肩锁关节手术已经发展到更符合解剖学的喙锁韧带（CC）重建，但在锁骨的骨隧道数量和位置以及理想移植物选择方面，仍没有明确的指导。
目的/假设：本研究的目的是通过生物力学比较 1 隧道和 2 隧道技术中 gracilis-和半腱肌腱移植物重建 CC 韧带复合体的效果。假设 gracilis 肌腱移植物在两种隧道技术中都能提供相当的初始稳定性，同时使用较小的隧道直径。
对照实验室研究。
总共 24 个尸体肩（13 名男性，11 名女性；66±7.5 岁）被随机分配到 4 个修复组：1 个隧道的 gracilis（GT-1）、2 个隧道的 gracilis（GT-2）、1 个隧道的半腱肌腱（ST-1）和 2 个隧道的半腱肌腱（ST-2）。首先，对标本进行了前、后和上侧平移的测试。然后，将标本随机分配到 4 个 CC 重建组之一，然后进行相同的测试，再进行循环加载和失效负荷（LTF）。
与 ST-2 相比，GT-2 重建在前部（ =.024）和后部（ =.048）方向的平移明显减少。GT-1 和 ST-2 在前部和上部方向的平移都明显小于 ST-1（ <.001）。所有重建的上部平移都明显小于自然测试，GT-1 和 ST-2 明显小于 ST-1（ <.001）。各组之间的峰值位移和 LTF 没有显著差异。
Gracilis 肌腱移植物使用 1 或 2 隧道技术进行 CC 韧带重建，在提供类似的平移、位移和 LTF 方面与相应的半腱肌腱移植物相当。因此，Gracilis 肌腱应该被视为 CC 韧带复合体重建的一种生物力学等效移植物选择。
在尸体模型中，Gracilis 肌腱在 CC 韧带重建中表现出足够的固定，在使用较小直径骨隧道时平移最小，这可能有助于降低诸如复位丢失和骨折等并发症的风险。
