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Biomechanical Evaluation of Minimally Invasive Repairs for Complete Acromioclavicular Joint Dislocation

From the Department of Traumatology, Hand, and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany

^* Address correspondence to Mathias Wellmann, MD, Department of Traumatology, Hand, and Reconstructive Surgery, University Hospital Muenster, Waldeyerstr. 1, 48149 Muenster, Germany (e-mail: Mathias.Wellmann{at}ukmuenster.de).

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.

Key Words: acromioclavicular separation • coracoclavicular ligament reconstruction • suture anchor • polydioxanone (PDS) augmentation • flip button

This article has been cited by other articles:

				J. A. Fraser-Moodie, N. L. Shortt, and C. M. Robinson Injuries to the acromioclavicular joint J Bone Joint Surg Br, June 1, 2008; 90-B(6): 697 - 707. [Abstract] [Full Text] [PDF]