Clavicle and coracoid process drilling technique for truly anatomic coracoclavicular ligament reconstruction
Section snippets
Computer model
We collected the whole-body computed tomography (CT) scan data of 196 patients suffering from multiple associated injuries due to a fall or a traffic accident between April 2008 and December 2012. Digital Imaging and Communications in Medicine (DICOM) data of 105 normal shoulders (51 left and 54 right) were chosen from these cases. The mean age was 32 years (range, 18–41 years), and 60 male and 45 female patients were included. Exclusion criteria included fracture of the clavicle and/or scapula
Results
The collinear drilling technique was noted to breach the bone cortex of the clavicle and/or the coracoid process in 95 of 105 virtual models (90.5%). No cortical breach was observed using the non-collinear drilling technique. The anteversion angulation of the conoid–coracoid tunnel ranged from 10° to 15° (mean value 12.4°). The extraversion angulation of the conoid–coracoid tunnel varied from 5° to 10° (mean value 6.8°). The anteversion angulation of the trapezoid–coracoid tunnel ranged from
Discussion
The first purpose of this study was to assess the technical feasibility of TACCR, which restored the native footprint anatomy of the conoid and trapezoid ligaments. The second goal of this study was to determine the risk of cortical breach and the corresponding drilling parameter using a CT-based, validated computer model.
The results of our study showed that the collinear drilling technique was characterised by an unacceptably high incidence of cortical breach (90.5%), while the non-collinear
Conclusion
The results of the current study suggest that the collinear drilling technique is not technically feasible for TACCR. For this reason, we recommend the non-collinear drilling technique, which provides the ability to prepare bony tunnels without any risk of cortical breach.
Conflict of interest
None.
Acknowledgements
The work was supported by the National Natural Science Foundation of China (No. 81071518), the Key Project Funded by Department of Public Health of Jiangsu Province (No. H200906) and the Project Funded by the Priority Academic Programme Development of Jiangsu Higher Education Institutions (JX10231801).
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Cited by (23)
Transcoracoid Drilling for Coracoclavicular Ligament Reconstructions in Patients With Acromioclavicular Joint Dislocations Result in Eccentric Tunnels
2023, Arthroscopy, Sports Medicine, and RehabilitationTruly anatomic coracoclavicular ligament reconstruction with 2 EndoButton devices for acute Rockwood type V acromioclavicular joint dislocations: 5-year findings
2022, Journal of Shoulder and Elbow SurgerySagittal orientation of coracoclavicular ligament reconstruction affects the stability of surgical repair
2020, Journal of Shoulder and Elbow SurgeryCitation Excerpt :In a CT-based study, Coale et al8 showed that attempting to restore the footprints of the conoid and trapezoid ligaments using an anatomic transclavicular-transcoracoid drilling technique introduces significant risk of cortical breach and coracoid fracture. Knowing the orientation of the native ligaments is important because a true anatomic reconstruction using those angles is likely not possible using current techniques.38 Therefore, we measured the variability of the native anatomy and its effect on the orientation and stability of CC reconstructions in the sagittal plane.
Anatomic Tunnel Placement Is Not Feasible by Transclavicular-Transcoracoid Drilling Technique for Coracoclavicular Reconstruction: A Cadaveric Study
2018, Arthroscopy - Journal of Arthroscopic and Related SurgeryCitation Excerpt :Recently, 2 studies have reported the limitations of the transclavicular-transcoracoid drilling technique for CC ligament reconstruction. Xue et al.11 analyzed virtual tunnel models that were generated from 3-dimensional computed tomography scan data and noted that the collinear drilling technique, similar to our technique, breached the bone cortex of the clavicle and/or the coracoid process in 90.5% of models. Using similar computed tomography virtual models, Coale et al.12 reported a 91.3% rate of medial cortical breaching of the coracoid process.
Comparison of hook plate with versus without double-tunnel coracoclavicular ligament reconstruction for repair of acute acromioclavicular joint dislocations: A prospective randomized controlled clinical trial
2018, International Journal of SurgeryCitation Excerpt :The muscle fibers were carefully trimmed from the transposed tendon and 3-0 antibacterial Vicryl sutures were used to whipstitch the tendon to enhance load strength. Tunnels were made using a 1.5-mm reamer at the insertion sites of the trapezoid and conical ligaments, as described by Xue et al. [6]. Double-loaded number 2 Ethibond sutures (Ethicon, Inc., Somerville, NJ, USA) were placed through the tunnels in the clavicle.