Reconstruction of the Acromioclavicular Ligament Complex Using Dermal Allograft: A Biomechanical Analysis

Abstract

To analyze the posterior translational and rotational stability of the acromioclavicular (AC) joint following reconstruction of the superior acromioclavicular ligament complex (ACLC) using dermal allograft. Six fresh-frozen cadaveric shoulders were used (mean age of 65.3 ± 6.9years). The resistance force against posterior translation (10mm) and torque against posterior rotation (20°) was measured. Specimens were first tested with both the intact ACLC and coracoclavicular ligaments. The ACLC and coracoclavicular ligaments were then transected so simulate a Type III/V AC joint dislocation. Each specimen then underwent 3 testing conditions, performed in the following order: (1) ACLC patch reconstruction alone, (2) ACLC patch with an anatomic coracoclavicular reconstruction (ACCR) using semitendinosus allograft, and (3) the transected ACLC with an ACCR only. Differences in posterior translational and rotational torque across testing conditions were analyzed with a one-way repeated analysis of variance analysis. Mean resistance against posterior translation in the intact condition was 65.76 ± 23.8N. No significant difference found between the intact condition compared with specimens with the ACLC-patch only (44.2 ± 11.3N, P= .06). The ACCR technique, when tested alone, had significantly less posterior translational resistance compared with the intact condition (38.5 ± 8.94N, P= .008). ACLC patch in combination with an ACCR was closest in restoring native posterior translation (57.1 ± 19.2N, P= .75). For rotational resistance, only the addition of the ACLC patch with an ACCR (0.51 ± 0.07 N-m) demonstrated similar torque compared with the intact joint (0.89 ± 0.5 N-m, P= .06). The ACLC-patch plus ACCR technique was able to closest restore the percent of normal posterior translational and rotational stability. Recurrent posterior instability of the AC joint is a potential complication after coracoclavicular reconstruction surgery. In the invitro setting, this study demonstrated increased AC joint stability with the addition of an ACLC reconstruction using dermal allograft.