BACKGROUND: The conventional coracoclavicular ligament augmentation with a single polydioxanone loop has been shown to have some pivotal disadvantages. HYPOTHESIS: A minimally invasive flip button/polydioxanone repair provides similar biomechanical properties to the conventional polydioxanone cerclage around the coracoid. However, the authors expected a difference in linear stiffness, ultimate load, and permanent elongation between suture anchor repairs and polydioxanone repairs. STUDY DESIGN: Controlled laboratory study. METHODS: The tensile fixation strength of 4 different minimally invasive repairs was tested in a porcine metatarsal model: (1) 1.3-mm single polydioxanone cerclage with a subcoracoidal flip button fixation, (2) 1.3-mm single polydioxanone cerclage, (3) Twinfix Ti 3.5-mm/Ultrabraid 2-suture anchor, and (4) Twinfix Ti 5.0-mm/Ultrabraid 2-suture anchor. The testing protocol included cyclic superoinferior loading and a subsequent load to failure trial. RESULTS: The flip button repair (646 N) and the conventional polydioxanone banding (663 N) revealed significant higher ultimate loads than did the suture anchor repairs (295 and 331 N, respectively; P < .001), whereas no significant differences were found for the elongation behavior under cyclic loading. CONCLUSION: There was no significant difference between the 2 polydioxanone repairs. The ultimate load of the flip button procedure reaches the level of the native coracoclavicular ligament complex as it has been quantified in the literature. CLINICAL RELEVANCE: Although the biomechanical results comparing a minimally invasive flip button procedure versus a conventional polydioxanone cerclage are similar, the authors recommend the flip button procedure because of its minimally invasive approach and the secure subcoracoidal fixation technique with a minimized risk of anterior loop dislocation and neurovascular damage.
BACKGROUND: The conventional coracoclavicular ligament augmentation with a single polydioxanone loop has been shown to have some pivotal disadvantages. HYPOTHESIS: A minimally invasive flip button/polydioxanone repair provides similar biomechanical properties to the conventional polydioxanone cerclage around the coracoid. However, the authors expected a difference in linear stiffness, ultimate load, and permanent elongation between suture anchor repairs and polydioxanone repairs. STUDY DESIGN: Controlled laboratory study. METHODS: The tensile fixation strength of 4 different minimally invasive repairs was tested in a porcine metatarsal model: (1) 1.3-mm single polydioxanone cerclage with a subcoracoidal flip button fixation, (2) 1.3-mm single polydioxanone cerclage, (3) Twinfix Ti 3.5-mm/Ultrabraid 2-suture anchor, and (4) Twinfix Ti 5.0-mm/Ultrabraid 2-suture anchor. The testing protocol included cyclic superoinferior loading and a subsequent load to failure trial. RESULTS: The flip button repair (646 N) and the conventional polydioxanone banding (663 N) revealed significant higher ultimate loads than did the suture anchor repairs (295 and 331 N, respectively; P < .001), whereas no significant differences were found for the elongation behavior under cyclic loading. CONCLUSION: There was no significant difference between the 2 polydioxanone repairs. The ultimate load of the flip button procedure reaches the level of the native coracoclavicular ligament complex as it has been quantified in the literature. CLINICAL RELEVANCE: Although the biomechanical results comparing a minimally invasive flip button procedure versus a conventional polydioxanone cerclage are similar, the authors recommend the flip button procedure because of its minimally invasive approach and the secure subcoracoidal fixation technique with a minimized risk of anterior loop dislocation and neurovascular damage.
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: Lukas Weiser; Jakob V Nüchtern; Kay Sellenschloh; Klaus Püschel; Michael M Morlock; Johannes M Rueger; Michael Hoffmann; Wolfgang Lehmann; Lars G Großterlinden Journal: Knee Surg Sports Traumatol Arthrosc Date: 2015-12-19 Impact factor: 4.342