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Archives of Orthopaedic and Trauma Surgery

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Open Access 28-03-2022 | Shoulder Arthroscopy | Arthroscopy and Sports Medicine

Bone tunnel placement influences shear stresses at the coracoid process after coracoclavicular ligament reconstruction: a finite element study and radiological analysis

Authors: Benjamin Bockmann, L. Dankl, G. Kucinskaite, A. Kumar, J. J. Timothy, G. Meschke, A. J. Venjakob, T. L. Schulte

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 2/2023

Abstract

Introduction

Coracoid fractures after arthroscopic treatment of acromioclavicular (AC) joint separations lead to poor clinical outcomes. In this study, different configurations of bone tunnels in the lateral clavicle and coracoid were examined concerning the amount of stress induced in the coracoid.

Methods

An authentic 3D finite element model of an ac joint was established. Three 2.4 mm bone tunnels were inserted in the lateral clavicle, which were situated above, medially and laterally of the coracoid. Then, two 2.4 mm bone tunnels were inserted in the latter, each simulating a proximal and a distal suture button position. Von Mises stress analyses were performed to evaluate the amount of stress caused in the coracoid process by the different configurations. Then, a clinical series of radiographs was examined, the placement of the clavicle drill hole was analyzed and the number of dangerous configurations was recorded.

Results

The safest configuration was a proximal tunnel in the coracoid combined with a lateral bone tunnel in the clavicle, leading to an oblique traction at the coracoid. A distal bone tunnel in the coracoid and perpendicular traction as well as a proximal tunnel in the coracoid with medial traction caused the highest stresses. Anatomical placement of the clavicle drill hole does lead to configurations with smaller stresses.

Conclusion

The bone tunnel placement with the smallest amount of shear stresses was found when the traction of the suture button was directed slightly lateral, towards the AC joint. Anatomical placement of the clavicle drill hole alone was not sufficient in preventing dangerous configurations.

Level of evidence

Controlled laboratory study.

Zumstein MA, Schiessl P, Ambuehl B et al (2018) New quantitative radiographic parameters for vertical and horizontal instability in acromioclavicular joint dislocations. Knee Surg Sports Traumatol Arthrosc 26:125–135. https://doi.org/10.1007/s00167-017-4579-6CrossRefPubMed

Yeranosian M, Rangarajan R, Bastian S et al (2020) Anatomic reconstruction of acromioclavicular joint dislocations using allograft and synthetic ligament. JSES Int 4:515–518. https://doi.org/10.1016/j.jseint.2020.04.001CrossRefPubMedPubMedCentral

Banffy MB, van Eck CF, ElAttrache NS (2018) Clinical outcomes of a single-tunnel technique for coracoclavicular and acromioclavicular ligament reconstruction. J Shoulder Elbow Surg 27:S70–S75. https://doi.org/10.1016/j.jse.2017.11.032CrossRefPubMed

Hann C, Kraus N, Minkus M et al (2018) Combined arthroscopically assisted coraco- and acromioclavicular stabilization of acute high-grade acromioclavicular joint separations. Knee Surg Sports Traumatol Arthrosc 26:212–220. https://doi.org/10.1007/s00167-017-4643-2CrossRefPubMed

Beitzel K, Cote MP, Apostolakos J et al (2013) Current concepts in the treatment of acromioclavicular joint dislocations. Arthroscopy 29:387–397. https://doi.org/10.1016/j.arthro.2012.11.023CrossRefPubMed

Borbas P, Churchill J, Ek ET (2019) Surgical management of chronic high-grade acromioclavicular joint dislocations: a systematic review. J Shoulder Elbow Surg 28:2031–2038. https://doi.org/10.1016/j.jse.2019.03.005CrossRefPubMed

Gerhardt DC, VanDerWerf JD, Rylander LS et al (2011) Postoperative coracoid fracture after transcoracoid acromioclavicular joint reconstruction. J Shoulder Elbow Surg 20:e6-10. https://doi.org/10.1016/j.jse.2011.01.017CrossRefPubMed

Milewski MD, Tompkins M, Giugale JM et al (2012) Complications related to anatomic reconstruction of the coracoclavicular ligaments. Am J Sports Med 40:1628–1634. https://doi.org/10.1177/0363546512445273CrossRefPubMed

Panarello NM, Colantonio DF, Harrington CJ et al (2021) Coracoid or clavicle fractures associated with coracoclavicular ligament reconstruction. Am J Sports Med 49:3218–3225. https://doi.org/10.1177/03635465211036713CrossRefPubMed

10.

Virk MS, Lederman E, Stevens C et al (2017) Coracoid bypass procedure: surgical technique for coracoclavicular reconstruction with coracoid insufficiency. J Shoulder Elbow Surg 26:679–686. https://doi.org/10.1016/j.jse.2016.09.031CrossRefPubMed

11.

Campbell ST, Heckmann ND, Shin S-J et al (2015) Biomechanical evaluation of coracoid tunnel size and location for coracoclavicular ligament reconstruction. Arthroscopy 31:825–830. https://doi.org/10.1016/j.arthro.2014.11.037CrossRefPubMed

12.

Bathe K-J (2006) Finite element procedures. Bathe, Boston

13.

Huiskes R, Chao EYS (1983) A survey of finite element analysis in orthopedic biomechanics: the first decade. J Biomech 16:385–409. https://doi.org/10.1016/0021-9290(83)90072-6CrossRefPubMed

14.

Kluess D (2012) Finite element analysis in orthopaedic biomechanics. Intech Open

15.

Janssen SJ, Jayakumar P, Ter Meulen DP et al (2019) Quantitative 3-dimensional computerized tomography modeling of isolated greater tuberosity fractures with and without shoulder dislocation. Arch Bone Jt Surg 7:24–32PubMedPubMedCentral

16.

http://www.sketchfab.com, retrieved 4th Oct 2020

17.

Fritsch A, Hellmich C (2007) “Universal” microstructural patterns in cortical and trabecular, extracellular and extravascular bone materials: micromechanics-based prediction of anisotropic elasticity. J Theor Biol 244:597–620. https://doi.org/10.1016/j.jtbi.2006.09.013CrossRefPubMed

18.

Wriggers P (2001) Nichtlineare finite-element-methoden. Springer, BerlinCrossRef

19.

Gunther SB, Lynch TL, O’Farrell D et al (2012) Finite element analysis and physiologic testing of a novel, inset glenoid fixation technique. J Shoulder Elbow Surg 21:795–803. https://doi.org/10.1016/j.jse.2011.08.073CrossRefPubMed

20.

Rios CG, Arciero RA, Mazzocca AD (2007) Anatomy of the clavicle and coracoid process for reconstruction of the coracoclavicular ligaments. Am J Sports Med 35:811–817. https://doi.org/10.1177/0363546506297536CrossRefPubMed

21.

Salzmann GM, Paul J, Sandmann GH et al (2008) The coracoidal insertion of the coracoclavicular ligaments: an anatomic study. Am J Sports Med 36:2392–2397. https://doi.org/10.1177/0363546508322887CrossRefPubMed

22.

Gumina S, Postacchini F, Orsina L et al (1999) The morphometry of the coracoid process—its aetiologic role in subcoracoid impingement syndrome. Int Orthop 23:198–201. https://doi.org/10.1007/s002640050349CrossRefPubMedPubMedCentral

23.

Coale RM, Hollister SJ, Dines JS et al (2013) Anatomic considerations of transclavicular–transcoracoid drilling for coracoclavicular ligament reconstruction. J Shoulder Elbow Surg 22:137–144. https://doi.org/10.1016/j.jse.2011.12.008CrossRefPubMed

Title: Bone tunnel placement influences shear stresses at the coracoid process after coracoclavicular ligament reconstruction: a finite element study and radiological analysis
Authors: Benjamin Bockmann
L. Dankl
G. Kucinskaite
A. Kumar
J. J. Timothy
G. Meschke
A. J. Venjakob
T. L. Schulte
Publication date: 28-03-2022
Publisher: Springer Berlin Heidelberg
Keyword: Shoulder Arthroscopy
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 2/2023
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-022-04382-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Bone tunnel placement influences shear stresses at the coracoid process after coracoclavicular ligament reconstruction: a finite element study and radiological analysis

Abstract

Introduction

Methods

Results

Conclusion

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

Level of evidence

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