BACKGROUND: Despite reports of excellent results with the Weaver-Dunn coracoacromial ligament transfer, many authors recommend augmenting the transfer with supplemental fixation. The authors of this study sought to determine whether there is a biomechanical basis for this assertion and which augmentative method, if any, most closely restored acromioclavicular motion to normal. HYPOTHESIS: Augmentative coracoclavicular fixation provides better restoration of normal acromioclavicular joint laxity and an increased failure load when compared with the Weaver-Dunn reconstruction alone. STUDY DESIGN: Controlled laboratory cadaveric study. METHODS: Native acromioclavicular joint motion was measured using an infrared optical measurement system. Acromioclavicular and coracoclavicular ligaments were then cut, and 1 of 6 reconstructions was performed: Weaver-Dunn, suture cerclage, and 4 different suture anchors. Acromioclavicular joint motion was reassessed, a cyclic loading test was performed, and the failure load was recorded. RESULTS: After Weaver-Dunn reconstruction, mean anteroposterior laxity increased from 8.8 +/- 2.9 mm in the native state to 41.9 +/- 7.6 mm (P < or = .01), and mean superior laxity increased from 3.1 +/- 1.5 mm to 13.6 +/- 4.4 mm (P < or = .01). Weaver-Dunn reconstructions failed at a lower load (177 +/- 9 N) than all other reconstructions (range, 278-369 N) (P < or = .05). Reconstruction using augmentative fixation allowed less acromioclavicular motion than Weaver-Dunn reconstruction (P < or = .05) but more motion than the native ligaments (P < or = .05). Specifically, mean superior laxity after reconstruction ranged between 6.5 and 9.0 mm compared with the native ligaments (3.1 +/- 1.5 mm) and the Weaver-Dunn reconstructions (13.6 +/- 4.4 mm). Mean anteroposterior laxity after the reconstructions tested ranged between 21.8 and 33.2 mm, compared with the native ligaments (8.8 +/- 2.9 mm) and the Weaver-Dunn reconstructions (41.9 +/- 7.6 mm). CONCLUSION: Although none of the augmentative methods tested restored acromioclavicular stability to normal, all proved superior to the Weaver-Dunn reconstruction alone. CLINICAL RELEVANCE: This study suggests that when performing acromioclavicular reconstruction, supplemental fixation should be used because it provides more stability and pull-out strength than the Weaver-Dunn reconstruction alone.
BACKGROUND: Despite reports of excellent results with the Weaver-Dunn coracoacromial ligament transfer, many authors recommend augmenting the transfer with supplemental fixation. The authors of this study sought to determine whether there is a biomechanical basis for this assertion and which augmentative method, if any, most closely restored acromioclavicular motion to normal. HYPOTHESIS: Augmentative coracoclavicular fixation provides better restoration of normal acromioclavicular joint laxity and an increased failure load when compared with the Weaver-Dunn reconstruction alone. STUDY DESIGN: Controlled laboratory cadaveric study. METHODS: Native acromioclavicular joint motion was measured using an infrared optical measurement system. Acromioclavicular and coracoclavicular ligaments were then cut, and 1 of 6 reconstructions was performed: Weaver-Dunn, suture cerclage, and 4 different suture anchors. Acromioclavicular joint motion was reassessed, a cyclic loading test was performed, and the failure load was recorded. RESULTS: After Weaver-Dunn reconstruction, mean anteroposterior laxity increased from 8.8 +/- 2.9 mm in the native state to 41.9 +/- 7.6 mm (P < or = .01), and mean superior laxity increased from 3.1 +/- 1.5 mm to 13.6 +/- 4.4 mm (P < or = .01). Weaver-Dunn reconstructions failed at a lower load (177 +/- 9 N) than all other reconstructions (range, 278-369 N) (P < or = .05). Reconstruction using augmentative fixation allowed less acromioclavicular motion than Weaver-Dunn reconstruction (P < or = .05) but more motion than the native ligaments (P < or = .05). Specifically, mean superior laxity after reconstruction ranged between 6.5 and 9.0 mm compared with the native ligaments (3.1 +/- 1.5 mm) and the Weaver-Dunn reconstructions (13.6 +/- 4.4 mm). Mean anteroposterior laxity after the reconstructions tested ranged between 21.8 and 33.2 mm, compared with the native ligaments (8.8 +/- 2.9 mm) and the Weaver-Dunn reconstructions (41.9 +/- 7.6 mm). CONCLUSION: Although none of the augmentative methods tested restored acromioclavicular stability to normal, all proved superior to the Weaver-Dunn reconstruction alone. CLINICAL RELEVANCE: This study suggests that when performing acromioclavicular reconstruction, supplemental fixation should be used because it provides more stability and pull-out strength than the Weaver-Dunn reconstruction alone.
Authors: Frank Martetschläger; Arne Buchholz; Gunther Sandmann; Sebastian Siebenlist; Stefan Döbele; Alexander Hapfelmeier; Ulrich Stöckle; Peter J Millett; Florian Elser; Andreas Lenich Journal: Knee Surg Sports Traumatol Arthrosc Date: 2012-05-31 Impact factor: 4.342
Authors: Tim Saier; Arne J Venjakob; Philipp Minzlaff; Peter Föhr; Filip Lindell; Andreas B Imhoff; Stephan Vogt; Sepp Braun Journal: Knee Surg Sports Traumatol Arthrosc Date: 2014-02-21 Impact factor: 4.342
Authors: Michael Hoffmann; Maximilian Hartel; Malte Schroeder; Oliver Reinsch; Alexander S Spiro; Andreas H Ruecker; Lars Grossterlinden; Daniel Briem; Johannes M Rueger; Jan Phillip Petersen Journal: Knee Surg Sports Traumatol Arthrosc Date: 2013-07-17 Impact factor: 4.342
Authors: Cori Grantham; Nathanael Heckmann; Lawrence Wang; James E Tibone; Steven Struhl; Thay Q Lee Journal: Knee Surg Sports Traumatol Arthrosc Date: 2014-07-30 Impact factor: 4.342
Authors: L Murena; Ettore Vulcano; C Ratti; L Cecconello; P R Rolla; M F Surace Journal: Knee Surg Sports Traumatol Arthrosc Date: 2009-06-25 Impact factor: 4.342