PDF herunterladen
Osteosynthesis and Trauma Care 2005; 13(3): 154-159
DOI: 10.1055/s-2005-836559
Original Article

© Georg Thieme Verlag Stuttgart · New York

Biomechanical Analysis of Different Operative Techniques for Complete Acromioclavicular Joint Disruptions

C. Fialka1 , W. Michlits1 , P. Stampfl1 , G. Oberleitner1 , P. Funovic2 , W. Schmidt3 , A. Aharinejad4 , V. Vécsei1
  • 1Department of Traumatology, Medical University of Vienna, Austria
  • 2Department of Orthopedics, Medical University of Vienna, Austria
  • 3Department of Radiooncology, Danube Hospital, Vienna, Austria
  • 4Department of Anatomy, Medical University of Vienna, Austria
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
23. August 2005 (online)

    Lizenzen und Reprints

Abstract

The goal of this study was to evaluate three different operative techniques for acromioclavicular joint fixation: trans-articular K-wire fixation; ligament reconstruction along with a synthetic augmentation device (LARS®); and coracoclavicular Bosworth screw. Mechanical properties were tested in a cadaver study in order to determine the primary mechanical stability during repetitive passive motion. Eighteen fresh cadavers were used to test a cyclic load (50 000 cycles). Secondary joint dislocation and the rate of implant loosening were monitored by standard AP stress X-ray. Metal markers in the coracoid, the acromion, and the lateral clavicle were used to measure the acromioclavicular distance increase (Δ-AC) and the coracoclavicular distance increase (Δ-CC). The range of motion was set on 30-90° of abduction for the first 25 000 cycles and then was raised to 60-120°. The least amount of vertical dislocation was seen in the K-wire and the LARS® group (mean Δ-CC 0.3 mm; range: 0-1.3 mm and 1.5 mm; range 0-6.7 mm, respectively). The Bosworth group showed significantly higher dislocation rates (4.2 mm; range 2.3-7.1 mm; p = 0.005). This was true especially when the abduction range was extended to a maximum of 120°. The rate of implant loosening in the K-wire group was higher than that in the other two groups. This study shows that the LARS® procedure and the K-wires technique give equal results concerning stability after repetitive passive motion, but with a high rate of implant loosening in the K-wire group. According to our findings, abduction should be limited to 90° after implanting a Bosworth screw in order to prevent loosening or failure of the hardware.

Key words

AC joint - biomechanics - anatomical study

References

  • 1 Babe J G, Valle M, Couceiro J. Treatment of acromioclavicular disruptions: trial of a simple surgical approach.  Injury. 1988;  19 159-161
    CrossrefPubMedGoogle Scholar
  • 2 Bannister G C, Wallace W A, Stableforth P G, Hutson M A. The management of acute acromioclavicular dislocation. A randomised prospective controlled trial.  J Bone Joint Surg [Br]. 1989;  71 848-850
    PubMedGoogle Scholar
  • 3 Bateman J E. Athletic injuries about the shoulder in throwing and body-contact sports.  Clin Orthop. 1962;  23 75-83
    PubMedGoogle Scholar
  • 4 Bosworth B M. Acromioclavicular separation: new method of repair.  Surg Gynecol Obstet. 1941;  73 866-871
    PubMedGoogle Scholar
  • 5 Colosimo A J, Hummer C D, Heidt R S. Aseptic foreign body reaction to Dacron graft material used for coracoclavicular ligament reconstruction after type III acromioclavicular dislocation.  Am J Sports Med. 1996;  24 561-563
    PubMedGoogle Scholar
  • 6 Dittmer H, Jauch K W, Wening V. [Management of acromioclavicular dislocations with the Balser plate].  Unfallheilkunde. 1984;  87 216-222
    PubMedGoogle Scholar
  • 7 Fialka C, Hexel M, Stampfl P, Oberleitner G, Vécsei V. Operative treatment of AC joint dislocations, using an artificial polyethylen augmentation device (LARS) - preliminary results 2003. (unpublished data)
    Google Scholar
  • 8 Fialka C, Stampfl P, Oberleitner G, Vécsei V. Traumatic acromioclavicular joint separations - current concepts.  European Surgery. 2004;  36 20-24
    PubMedGoogle Scholar
  • 9 Fukuda K, Craig E V, An K N, Cofield R H, Chao E Y. Biomechanical study of the ligamentous system of the acromioclavicular joint.  J Bone Joint Surg [Am]. 1986;  68 434-440
    PubMedGoogle Scholar
  • 10 Habernek H, Weinstabl R, Schmid L, Fialka C. A crook plate for treatment of acromioclavicular joint separation: indication, technique, and results after one year.  J Trauma. 1993;  35 893-901
    PubMedGoogle Scholar
  • 11 Hessmann M, Gotzen L, Gehling H, Ruschenpohler D. Acromioclavicular reconstruction augmented with polydioxyanone-sulphate bands.  Unfallchirurg. 1997;  100 193-197
    CrossrefPubMedGoogle Scholar
  • 12 Hohlbach G, Vatankhah M, Naser M. [Surgical treatment of fresh acromioclavicular luxation with the Bosworth screw].  Unfallchirurgie. 1983;  9 6-13
    PubMedGoogle Scholar
  • 13 Inman V T, McLaughlin H D, Nevaiser J, Rove C. Treatment of complete acromioclavicular dislocation.  J Bone Joint Surg [Am]. 1962;  44 1008-1011
    PubMedGoogle Scholar
  • 14 Jari R, Costic R S, Rodosky M W, Debski R E. Biomechanical function of surgical procedures for acromioclavicular joint dislocations.  Arthroscopy - the Journal of Arthroscopic and Related Surgery. 2004;  20 237-245
    PubMedGoogle Scholar
  • 15 Jerosch J. Acromioclavicular-joint.  Orthopäde. 2000;  29 895-908
    CrossrefPubMedGoogle Scholar
  • 16 Jerosch J, Filler T, Peuker E, Greig M, Siewering U. Which stabilization technique corrects anatomy best in patients with AC-separation? An experimental study.  Knee Surgery Sports Traumatology Arthroscopy. 1999;  7 365-372
    CrossrefPubMedGoogle Scholar
  • 17 Kappakas G S, McMaster J H. Repair of acromioclavicular separation using a dacron prosthesis graft.  Clin Orthop. 1978;  131 247-251
    PubMedGoogle Scholar
  • 18 Kiefer H, Claes L, Burri C, Holzwarth J. The stabilizing effect of various implants on the torn acromioclavicular joint. A biomechanical study.  Arch Orthop Trauma Surg. 1986;  106 42-46
    CrossrefPubMedGoogle Scholar
  • 19 Kutschera H P, Kotz R I. Bone-ligament transfer of coracoacromial ligament for acromioclavicular dislocation. A new fixation method used in 6 cases.  Acta Orthop Scand. 1997;  68 246-248
    PubMedGoogle Scholar
  • 20 Lancaster S, Horowitz M, Alonso J. Complete acromioclavicular separations. A comparison of operative methods.  Clin Orthop. 1987;  216 80-88
    PubMedGoogle Scholar
  • 21 Mazet R. Migration of a Kirschner wire from the shoulder region into the lung.  J Bone Joint Surg [Am]. 1943;  25 477-483
    PubMedGoogle Scholar
  • 22 Mlasowsky B, Brenner P, Duben W, Heymann H. Repair of complete acromioclavicular dislocation (Tossy stage III) using Balser's hook plate combined with ligament sutures.  Injury. 1988;  19 227-232
    CrossrefPubMedGoogle Scholar
  • 23 Neviaser J S. Acromioclavicular dislocation treated by transference of the coracoacromial ligament. A long-term follow-up in a series of 112 cases.  Clin Orthop. 1968;  58 57-68
    PubMedGoogle Scholar
  • 24 Orthner E, Weinstabl R, Schabus R, Scharf W, Kwasny O. Evaluation of the AC joint motion following coracoclavicular screw fixation and acromioclavicular tension-band fixation in an experimental model. 7th Munich Symposium on Experimental Orthopedics. Thieme Verlag, Stuttgart, New York 1985, 26-37
    Google Scholar
  • 25 Park J Y, Levine W N, Marra G, Pollock R G, Flatow E L, Bigliani L U. Portal-extension approach for the repair of small and medium rotator cuff tears.  Am J Sports Med. 2000;  28 312-316
    PubMedGoogle Scholar
  • 26 Renfree K J, Wright T W. Anatomy and biomechanics of the acromioclavicular and sternoclavicular joints.  Clinics in Sports Medicine. 2003;  22 219-237
    CrossrefPubMedGoogle Scholar
  • 27 Rockwood Jr C A, Young D C. Disorders of the Acromioclavicular Joint. WB Saunders, Philadelphia 1990; 413-476
    Google Scholar
  • 28 Salter E G, Nasca R J, Shelley B S. Anatomical observations on the acromioclavicular joint and supporting ligaments.  Am J Sports Med. 1987;  15 199-206
    PubMedGoogle Scholar
  • 29 Schabus R, Beer R, Reissner R, Kwasny O, Weinstabl R, Wagner M. Experimental study on the qualification of the load on coracoclavicular screw fixation.  Hefte zur Unfallheilk. 1986;  181 1001-1003
    PubMedGoogle Scholar
  • 30 Weaver J K, Dunn H K. Treatment of acromioclavicular injuries, especially complete acromioclavicular separation.  J Bone Joint Surg [Am]. 1972;  54 1187-1194
    PubMedGoogle Scholar
  • 31 Weinstabl R. Biomechanical considerations and therapy of acromioclavicular dislocations.  Acta Chir Austriaca. 1990;  84 24-28
    PubMedGoogle Scholar

C. FialkaM. D. 

Department of Traumatology · Medical University of Vienna · General Hospital Vienna

Währinger Gürtel 18-20

1090 Vienna

Austria

Telefon: +43/4 04 00/59 59

Fax: +43/4 04 00/59 39

eMail: c.fialka@netway.at