Top

Archives of Orthopaedic and Trauma Surgery

Published in:

01-08-2015 | Trauma Surgery

Image-free navigated coracoclavicular drilling for the repair of acromioclavicular joint dislocation: a cadaver study

Authors: Jan Theopold, Kevin Weihs, Sabine Löffler, Bastian Marquass, Nikolaus von Dercks, Christoph Josten, Pierre Hepp

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 8/2015

Abstract

Background

Reconstruction of the coracoclavicular ligament functions to restore anatomic alignment of the clavicle and may improve biomechanical function and clinical outcomes. Improper placement of the coracoclavicular tunnel may inherently weaken the coracoid. The purpose of this study was to evaluate the feasibility and accuracy of navigated image-free placement of K-wires for coracoclavicular tunnel position in comparison to conventional drill guide-based placement.

Materials and methods

Eight human shoulder specimens were assigned for conventional technique with a coracoclavicular guide device (group CP) and the paired contralateral side for the navigated procedure (group NP) with an optoelectronic system with a fluoro-free software module. First-pass accuracy (%) and the K-wire trajectory (lateral–center orientation (LC), center–center (CC) orientation and medial–center orientation (MC) were measured.

Results

In all navigated K-wires a 100 % first-pass accuracy was observed. In three of the eight (37.5 %) specimens of the drill guide-based group, drilling had to be repeated. One of them had to be repeated twice, resulting in eight versus twelve drillings for the navigated versus conventional group, respectively (p = 0.021). K-wire trajectory showed an MC orientation in most of the specimen (n = 9, group NP 4, group CP 5).

Conclusions

Image-free navigated coracoclavicular drilling for the repair of acromioclavicular joint dislocation has higher first-pass accuracy in comparison to conventional drill guide-based placement and, therefore, may enable a precise anatomic position of the drill holes and reduce the risk of an iatrogenic coracoid fracture.

Costic RS, Labriola JE, Rodosky MW, Debski RE (2004) Biomechanical rationale for development of anatomical reconstructions of coracoclavicular ligaments after complete acromioclavicular joint dislocations. Am J Sports Med 32(8):1929–1936PubMedCrossRef

Grutter PW, Petersen SA (2005) Anatomical acromioclavicular ligament reconstruction: a biomechanical comparison of reconstructive techniques of the acromioclavicular joint. Am J Sports Med 33(11):1723–1728PubMedCrossRef

Mazzocca AD, Arciero RA, Bicos J (2007) Evaluation and treatment of acromioclavicular joint injuries. Am J Sports Med 35(2):316–329PubMedCrossRef

Walz L, Salzmann GM, Fabbro T, Eichhorn S, Imhoff AB (2008) The anatomic reconstruction of acromioclavicular joint dislocations using 2 TightRope devices: a biomechanical study. Am J Sports Med 36(12):2398–2406PubMedCrossRef

Mazzocca AD, Santangelo SA, Johnson ST, Rios CG, Dumonski ML, Arciero RA (2006) A biomechanical evaluation of an anatomical coracoclavicular ligament reconstruction. Am J Sports Med 34(2):236–246PubMedCrossRef

Salzmann GM, Walz L, Buchmann S, Glabgly P, Venjakob A, Imhoff AB (2010) Arthroscopically assisted 2-bundle anatomical reduction of acute acromioclavicular joint separations. Am J Sports Med 38(6):1179–1187PubMedCrossRef

Kim AC, Matcuk G, Patel D, Itamura J, Forrester D, White E, Gottsegen CJ (2012) Acromioclavicular joint injuries and reconstructions: a review of expected imaging findings and potential complications. Emerg Radiol 19(5):399–413PubMedCrossRef

Martetschläger F, Horan MP, Warth RJ, Millett PJ (2013) Complications after anatomic fixation and reconstruction of the coracoclavicular ligaments. Am J Sports Med 41(12):2896–2903PubMedCrossRef

Cook JB, Shaha JS, Rowles DJ, Bottoni CR, Shaha SH, Tokish JM (2013) Clavicular bone tunnel malposition leads to early failures in coracoclavicular ligament reconstructions. Am J Sports Med 41(1):142–148PubMedCrossRef

10.

Ferreira JV, Chowaniec D, Obopilwe E, Nowak MD, Arciero RA, Mazzocca AD (2012) Biomechanical evaluation of effect of coracoid tunnel placement on load to failure of fixation during repair of acromioclavicular joint dislocations. Arthrosc J Arthrosc Rel Surg Off Pub Arthrosc Assoc North Am Int Arthrosc Assoc 28(9):1230–1236CrossRef

11.

Gras F, Marintschev I, Kahler DM, Klos K, Muckley T, Hofmann GO (2011) Fluoro-Free navigated retrograde drilling of osteochondral lesions. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 19(1):55–59CrossRef

12.

Citak M, Kendoff D, Kfuri M Jr, Pearle A, Krettek C, Hufner T (2007) Accuracy analysis of Iso-C3D versus fluoroscopy-based navigated retrograde drilling of osteochondral lesions: a pilot study. J Bone Joint Surg Br 89(3):323–326PubMedCrossRef

13.

Muller M, Gras F, Marintschev I, Muckley T, Hofmann GO (2009) Radiation- and reference base-free navigation procedure for placement of instruments and implants: application to retrograde drilling of osteochondral lesions of the knee joint. Comput Aided Surg Off J Int Soc Comp Aided Surg 14(4–6):109–116CrossRef

14.

Hoffmann M, Petersen JP, Schroder M, Hartel M, Kammal M, Rueger JM, Ruecker AH (2012) Accuracy analysis of a novel electromagnetic navigation procedure versus a standard fluoroscopic method for retrograde drilling of osteochondritis dissecans lesions of the knee. Am J Sports Med 40(4):920–926PubMedCrossRef

15.

Gras F, Marintschev I, Muller M, Klos K, Lindner R, Muckley T, Hofmann GO (2010) Arthroscopic-controlled navigation for retrograde drilling of osteochondral lesions of the talus. Foot Ankle Int Am Orthop Foot Ankle Soc Swiss Foot Ankle Soc 31(10):897–904CrossRef

16.

Thiel W (1992) The preservation of the whole corpse with natural color. Ann Anat Anatomischer Anzeiger Off Organ Anatomische Gesellschaft 174(3):185–195CrossRef

17.

Coale RM, Hollister SJ, Dines JS, Allen AA, Bedi A (2013) Anatomic considerations of transclavicular–transcoracoid drilling for coracoclavicular ligament reconstruction. J Shoulder Elbow Surg Am Shoulder Elbow Surg 22(1):137–144CrossRef

18.

Salzmann GM, Paul J, Sandmann GH, Imhoff AB, Schottle PB (2008) The coracoidal insertion of the coracoclavicular ligaments: an anatomic study. Am J Sports Med 36(12):2392–2397PubMedCrossRef

19.

Xue C, Zhang M, Zheng TS, Zhang GY, Fu P, Fang JH, Li X (2013) Clavicle and coracoid process drilling technique for truly anatomic coracoclavicular ligament reconstruction. Injury 44(10):1314–1320PubMedCrossRef

20.

Harris RI, Vu DH, Sonnabend DH, Goldberg JA, Walsh WR (2001) Anatomic variance of the coracoclavicular ligaments. J Shoulder Elbow Surg Am Shoulder Elbow Surg 10(6):585–588CrossRef

21.

Rios CG, Arciero RA, Mazzocca AD (2007) Anatomy of the clavicle and coracoid process for reconstruction of the coracoclavicular ligaments. Am J Sports Med 35(5):811–817PubMedCrossRef

22.

Scheibel M, Droschel S, Gerhardt C, Kraus N (2011) Arthroscopically assisted stabilization of acute high-grade acromioclavicular joint separations. Am J Sports Med 39(7):1507–1516PubMedCrossRef

23.

Stübig T, Jahnisch T, Reichelt A, Krettek C, Citak M, Meller R (2013) Navigated vs arthroscopic-guided drilling for reconstruction of acromioclavicular joint injuries: accuracy and feasibility. Int J Med Robot Comput Assist Surg MRCAS 9(3):359–364CrossRef

24.

Kraus M, Dehner C, Riepl C, Bischoff M, Gebhard F, Scholl H (2012) Image-based guidance in shoulder traumatology. Initial clinical experience. Der Unfallchirurg 115(3):214–219PubMedCrossRef

25.

Hoffmann M, Hartel M, Schroeder M, Reinsch O, Spiro AS, Ruecker AH, Grossterlinden L, Briem D, Rueger JM, Petersen JP (2014) Electromagnetic navigation provides high accuracy for transcoracoid–transclavicular drilling. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 22(9):2237–2242CrossRef

Title: Image-free navigated coracoclavicular drilling for the repair of acromioclavicular joint dislocation: a cadaver study
Authors: Jan Theopold
Kevin Weihs
Sabine Löffler
Bastian Marquass
Nikolaus von Dercks
Christoph Josten
Pierre Hepp
Publication date: 01-08-2015
Publisher: Springer Berlin Heidelberg
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 8/2015
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-015-2243-5

At a glance: The STEP trials

Springer Medicine

Image-free navigated coracoclavicular drilling for the repair of acromioclavicular joint dislocation: a cadaver study

Abstract

Background

Materials and methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Materials and methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 8/2015

The natural history of rotator cuff tears: a systematic review

Total knee arthroplasty in patients with skeletal dysplasia

Is there a rationale to use a dual mobility poly insert for failed Birmingham metal-on-metal hip replacements? A retrieval analysis

Effect of irrigation fluid temperature on core body temperature and inflammatory response during arthroscopic shoulder surgery

Effect of patient position on measurement of patellar height ratio

Radiographic diagnosis of sagittal plane rotational displacement in pelvic fractures: a cadaveric model and clinical case study