Differences between Coracoclavicular, Acromioclavicular, or Combined Reconstruction Techniques on the Kinematics of the Shoulder Girdle

Abstract

Background: Although the coracoclavicular (CC) ligaments are classically reconstructed after acromioclavicular (AC) joint injuries, biomechanical studies over the past decade have indicated the importance of an additional reconstruction of the AC ligaments. To date, no kinematic study has investigated the kinematic differences between these reconstruction strategies. Purpose: To evaluate the restoration of shoulder motion after an AC injury using a CC ligament, an AC ligament, or a combined reconstruction technique. Study Design: Controlled laboratory study. Methods: After creating a Rockwood grade V lesion in 14 cadaveric shoulders, the AC joint injury was treated with either a CC ligament reconstruction using a suspension device, an in situ AC ligament reconstruction using 2 coupled soft tissue anchors, or a combination of these 2 techniques. Joint motions were registered during humerothoracic elevation in the coronal plane and protraction in the intact shoulder in a Rockwood V lesion and after the 3 reconstruction strategies. An optical navigation system measured 3-dimensional rotation in the sternoclavicular and scapulothoracic joints, and both rotation and translation were analyzed in the AC joint. Results: In the sternoclavicular joint, the CC and combined reconstruction techniques adequately restored clavicular axial rotation, while the AC reconstruction technique showed a better correction of clavicular elevation. Scapulothoracic joint rotations were best restored by reconstructing the AC ligaments. In the AC joint, the relative tilting position and the lateral rotation of the scapula compared with the clavicle were best restored by the suspension device and combined reconstruction. The AC ligament reconstruction technique demonstrated a better restoration of the relative protracted position and resulted in a better correction of the translation of the scapula relative to the clavicle. Conclusion: This study illustrates that there are kinematic differences between AC, CC, or combined ligament reconstruction strategies. Although each technique was able to restore different elements of the joint kinematics, none of the strategies completely restored the shoulder girdle to its preinjured state. Clinical Relevance: Humerothoracic movements after Rockwood V lesions are best restored using the CC reconstruction technique, and scapulothoracic movements are best restored using the AC ligament reconstruction technique.