The Journal of Bone and Joint Surgery (American) 83:1344-1351 (2001)
© 2001 The Journal of Bone and Joint Surgery, Inc.
Effect of Capsular Injury on Acromioclavicular Joint Mechanics
Richard E. Debski, PhD,
I. M. Parsons, IV, MD,
Savio L-Y. Woo, PhD and
Freddie H. Fu, MD
Investigation performed at the Department of Orthopaedic Surgery,
Musculoskeletal Research Center, University of Pittsburgh, Pittsburgh,
Pennsylvania
Richard E. Debski, PhD
I.M. Parsons IV, MD
Savio L-Y. Woo, PhD
Freddie H. Fu, MD
Department of Orthopaedic Surgery, Musculoskeletal Research Center,
University of Pittsburgh, 210 Lothrop Street, E1641 BST, P.O. Box
71199, Pittsburgh, PA 15213. E-mail address for R.E. Debski: genesis1{at}pitt.edu
In support of their research or preparation of this manuscript, one
or more of the authors received grants or outside funding from the
American Shoulder and Elbow Society. None of the authors received
payments or other benefits or a commitment or agreement to provide
such benefits from a commercial entity. No commercial entity paid
or directed, or agreed to pay or direct, any benefits to any research
fund, foundation, educational institution, or other charitable or
nonprofit organization with which the authors are affiliated or
associated.
A commentary is available with the electronic versions of this article,
on our web site (www.jbjs.org) and on our CD-ROM (call 781-449-9780,
ext. 140, to order).
Background: Traumatic disruption of the acromioclavicular
joint capsule is associated with pain and instability after the
injury and may lead to degenerative joint disease. The objective
of this study was to quantify the effect of transection of the acromioclavicular
joint capsule on the kinematics and the in situ forces in the coracoclavicular
ligaments in response to external loading conditions.
Methods: Eleven fresh-frozen human cadaveric shoulders
were tested with use of a robotic/universal force-moment
sensor testing system. The shoulders were subjected to three loading
conditions (an anterior, posterior, and superior load of 70 N) in
their intact state and after transection of the acromioclavicular
joint capsule.
Results: Transection of the capsule resulted in
a significant (p < 0.05) increase in anterior translation
(6.4 mm) and posterior translation (3.6 mm) but not in superior
translation (1.6 mm). The effect of capsule transection on the forces
in the coracoclavicular ligaments was also significant (p < 0.05)
in response to anterior and posterior loading but not in response
to superior loading. However, differences were found between the
forces in the trapezoid and conoid ligaments. Under an anterior
load, the mean in situ force (and standard deviation) in the trapezoid
increased from 14 ± 14 N to 25 ±
19 N, while the mean force in the conoid increased from 15 ±
14 N to 49 ± 23 N, or 227%. In contrast,
in response to a posterior load, the mean in situ force in the trapezoid
increased from 23 ± 15 N to 38 ±
23 N, or 66% (p < 0.05), while the mean force
in the conoid increased only 9%.
Conclusions and Clinical Relevance: The large differences
in the change of force in the conoid and trapezoid ligaments suggest
that these ligaments should not be considered as one structure when
surgical treatment is considered. Furthermore, transection of the
capsule resulted in a shift of load to the coracoclavicular ligaments,
which may render the intact coracoclavicular ligaments more likely
to fail with anterior or posterior loading. The results of the present study
also suggest that the intact coracoclavicular ligaments cannot compensate
for the loss of capsular function during anterior-posterior loading
as occurs in type-II acromioclavicular joint injuries.
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