Biomechanical Consequences of Coracoclavicular Reconstruction Techniques on Clavicle Strength

The treatment of acromioclavicular (AC) joint injuries that entail disruption of the coracoclavicular (CC) ligaments remains a question of debate. Several different anatomic reconstruction techniques of the CC ligaments have been described in the literature. Recently, the use of tendon grafts (TGs), both autografts and allografts, has gained increased popularity for reconstructing CC ligaments to treat chronic symptomatic AC joint separation. The TG technique is commonly performed with the 2 limbs of a single graft passed through the two 6.0-mm tunnels in the clavicle and fixed with tenodesis screws. More recently, the TG technique was reported to be performed with smaller tunnel diameters of 5.0 mm. Alternatively, AC reconstruction has been performed by use of cortical fixation buttons (CFBs), for which tunnel sizes were most commonly reduced to 4.0 mm. The tunnel diameter can be reduced to as small as 2.4 mm if the inferior coracoid button is introduced arthroscopically through an anterolateral portal. The CFB technique can be combined with a nonanatomic graft reconstruction by looping the graft around the clavicle and does not require additional tunnels.

Several studies have reported lateral clavicle fractures after CC ligament reconstruction with bone tunnels through the clavicle. Martetschlager recently reported a 4.3% incidence rate of lateral clavicle fractures after CC reconstruction using the TG technique with 6.0-mm tunnels and 5.5-mm tenodesis screws. The fractures in this series all occurred at the medial screw hole. The authors reportedly changed to the CFB technique due to the increased risk of clavicle fractures associated with the TG technique. However, little is known of the biomechanical differences between TG (6.0-mm tunnels) and CFB (2.4-mm tunnels) reconstruction techniques on clavicle strength. Furthermore, no data exist about the potential risk factors for an increased onset of clavicle fractures after CC ligament reconstruction, such as small clavicle diameter.

Therefore, the purpose of this study was to compare the strength of matched-pair cadaveric clavicles after surgical treatment with a TG technique that used 6.0-mm tunnels and a CFB technique that used 2.4-mm tunnels, relative to the intact contralateral side, in response to a 3-point bending force. We hypothesized that the TG technique would significantly weaken the clavicle relative to intact and would cause significantly more reduction in clavicle strength than the CFB technique.

Full Article: Biomechanical Consequences of Coracoclavicular Reconstruction Techniques on Clavicle Strength

Peter Millett, MD

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39 reviews

Alexandra Thompson

Mar 23, 2024

by Alexandra Thompson on Peter Millett, MD

110%

Dr. Millett and his team did a SLAP tear repair and bicep tenodesis on my left shoulder. I use my arms as an artist, and love to swim in the ocean, surf, paddle, and telemark ski. So regaining full use of my shoulder and keeping my bicep attached was very important to me. Now, over two years later, my shoulder has the equivalent range of motion as my other arm and as before the injury, and no pain. After the first three months it felt so good and was so strong that - to my horror - I completely forgot my six-month follow-up.

Not only did Dr. Millett and his team make my arm as good as new, but having had the experience of such kindness and expertise throughout the process of surgery and recovery is like an added shoulder superpower.

Thank you Rita, Brooke, Jason, Sarah, Camille, Olivia, Dr. Millett and everyone! And see you soon when my husband comes in for his knee...

Jeff Chandler

Jan 31, 2022

by Jeff Chandler on Peter Millett, MD

Flawless procedure, Easy recovery

Dr. Millet's repaired my knee and tibia, following a botched operation by a different surgeon. That procedure was virtually pain free and I was weight bearing within a few days. That was 18 years ago and the knee is still strong. A few years after the knee incident, Dr Millet repaired my shoulder. My insurance company approved me for 3 months of disability following that surgery. I was off pain medication in 2 days and had 90% range of motion within a week. I withdrew my disability claim and returned to work within two weeks of surgery. I’m not a famous athlete—just a regular guy. Nonetheless, I was treated like an NFL at the Steadman clinic. Most notable was the time for recovery. Other surgeons perform their hour-long task in the OR and don’t involve themselves in the other functions. Peter and his team manages the entire process from diagnosis, anesthesia, nursing care, and therapy. He takes a holistic approach to patient care and doesn’t skip any steps.

Jenn West

Jul 2, 2021

by Jenn West on Peter Millett, MD

Saved My Life

I went to Dr. Millett after 7 knee surgeries (6 on my right and 1 on my left) and had seen 11 different surgeons who all refused to remove femur metal from my right leg. I am highly allergic to metal and the chronic pain was leaving me bedridden for 3.5wks out of a month. He personally wrote me back on my inquiry, listened to my concerns, scheduled my surgery within a week (due to insurance issues) and personally followed up with my recovery. The level of patient care from Dr. Millett and his ENTIRE team is above any care I have ever received in my 20 years of dealing with orthopedic surgeons. There are not enough words to describe the level of care, dedication and professionalism you receive from Dr. Millett and his staff.
My only disappointment is that I did not find him sooner!!!

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