There is direct relationship between bone bridge length and coracoclavicular fixation resistance to failure: Biomechanical study in a porcine model. (June 2021)

• Record Type: Journal Article
• Authors: Vaisman, Alex; Guiloff, Rodrigo; Guzmán, Rodrigo; Convalía, Francisca; De la Cruz, Isidora; Baron, Samuel L.; Toro, Felipe
• Is Part Of: Clinical biomechanics. Volume 86(2021)
• Publication Date: 2021-06
• Subjects: Acromioclavicular joint -- Coracoclavicular fixation -- Clavicular tunnels -- Bone bridge -- Fixation failure; Biomechanics -- Periodicals; Osteopathic medicine -- Periodicals; Biomechanics -- Periodicals; Osteopathic Medicine -- Periodicals; 612.76
• DOI: 10.1016/j.clinbiomech.2021.105386
• Languages: English
• ISSNs: 0268-0033

Abstract

Abstract: Background: This study aims to evaluate the relation between coracoclavicular resistance to failure and the distance between clavicular tunnels. The hypothesis is that a greater clavicular bone bridge between tunnels achieves a stronger coracoclavicular fixation. Methods: Descriptive Laboratory Study. Thirty-six (36) coracoclavicular models were constructed utilizing porcine metatarsals. Coracoclavicular stabilizations were performed using a subcoracoid loop fixation configuration through two clavicular tunnels, tied at the clavicle's superior cortex using a locking knot. Models were randomly assigned to 1 of 3 experimental groups of variable bone bridge length between clavicular tunnels: 5 mm, 10 mm, and 15 mm. Each group had 12 models. Fixation resistance was assessed through the ultimate failure point under an axial load to failure trial. Failure patterns were documented. A one-way ANOVA test was used, and a Tukey post hoc as needed ( P < 0.05). Findings: Mean strength per bone bridge length: 5 mm = 312 N (Range: 182-442 N); 10 mm = 430 N (Range: 368-595 N); 15 mm = 595 N (Range: 441-978 N). The 15 mm group had a significantly higher ultimate failure point than the other two groups: 5 mm ( P < 0.001) and 10 mm ( P < 0.001). All fixations systematically failed by a superior cortex clavicle fracture at the midpoint between tunnels. Interpretation: A direct relationship between bone bridge length and coracoclavicular resistance to failure was demonstrated, being the 15 mm length a significantly higher strength construct in a tied loop model. Highlights: Bone bridge length and coracoclavicular fixation resistance to failure are directly related A bone bridge of 15 mm between clavicular tunnels increases the fixation resistance to failure Bone bridge length should be the critical reference in acromioclavicular surgery The "distance between tunnels" reference should be abandoned