The deltotrapezial fascia stabilizes the AC-Joint and its reconstruction restores the horizontal stability in AC-joint separations-a biomechanical comparison.

AC joint acromioclavicular biomechanics deltotrapezoid muscle complex fascia deltotrapezoidalis shoulder

Journal

Journal of shoulder and elbow surgery
ISSN: 1532-6500
Titre abrégé: J Shoulder Elbow Surg
Pays: United States
ID NLM: 9206499

Informations de publication

Date de publication:
20 Sep 2024
Historique:
received: 18 03 2024
revised: 24 07 2024
accepted: 25 07 2024
medline: 23 9 2024
pubmed: 23 9 2024
entrez: 22 9 2024
Statut: aheadofprint

Résumé

Various techniques are available for the reconstruction of acromioclavicular joint (ACJ) dislocations, with the main focus being on restoration of the AC capsule or coracoclavicular (CC) ligaments. Recent research has underlined the significance of the deltotrapezial fascia (DTF) and related muscles as dynamic stabilizers of the ACJ. Reconstruction of the DTF increases the stability of the ACJ in the horizontal plane more than a complete transection of the fascia, while not restoring the stability of the native state. Five pairs of human cadaveric shoulders including the torsos were included in the study and underwent cyclic anterior-posterior loading using an electromechanical testing machine. The shoulders were put into three groups: group N (n = 10): native ACJ; group T (n = 10): ACJ with transected DTF; group R (n = 10): ACJ with reconstruction of the DTF after transection. The dislocation was recorded with an 3D optical measuring system. Group N showed a mean horizontal displacement of 2.94 mm (± 1.26), group T showed a mean anterior displacement of 3.33 mm (± 1.37) and group R showed a mean anterior displacement of 2.95 mm (± 1.08). The mean anterior displacement for group T was significantly higher after every measured number of cycles compared with groups N and R. There was no significant difference in mean anterior displacement between groups N and R. The transection of the DTF results in significantly reduced stability in the horizontal plane of the ACJ. A reconstruction of the DTF restores the stability of the native ACJ in the horizontal plane. Further clinical and biomechanical investigations should focus on reconstruction techniques of the DTF.

Sections du résumé

BACKGROUND BACKGROUND
Various techniques are available for the reconstruction of acromioclavicular joint (ACJ) dislocations, with the main focus being on restoration of the AC capsule or coracoclavicular (CC) ligaments. Recent research has underlined the significance of the deltotrapezial fascia (DTF) and related muscles as dynamic stabilizers of the ACJ.
HYPOTHESIS OBJECTIVE
Reconstruction of the DTF increases the stability of the ACJ in the horizontal plane more than a complete transection of the fascia, while not restoring the stability of the native state.
METHODS METHODS
Five pairs of human cadaveric shoulders including the torsos were included in the study and underwent cyclic anterior-posterior loading using an electromechanical testing machine. The shoulders were put into three groups: group N (n = 10): native ACJ; group T (n = 10): ACJ with transected DTF; group R (n = 10): ACJ with reconstruction of the DTF after transection. The dislocation was recorded with an 3D optical measuring system.
RESULTS RESULTS
Group N showed a mean horizontal displacement of 2.94 mm (± 1.26), group T showed a mean anterior displacement of 3.33 mm (± 1.37) and group R showed a mean anterior displacement of 2.95 mm (± 1.08). The mean anterior displacement for group T was significantly higher after every measured number of cycles compared with groups N and R. There was no significant difference in mean anterior displacement between groups N and R.
CONCLUSION CONCLUSIONS
The transection of the DTF results in significantly reduced stability in the horizontal plane of the ACJ. A reconstruction of the DTF restores the stability of the native ACJ in the horizontal plane. Further clinical and biomechanical investigations should focus on reconstruction techniques of the DTF.

Identifiants

DOI: 10.1016/j.jse.2024.07.041 PMID: 39307386
pubmed: 39307386
pii: S1058-2746(24)00641-4
doi: 10.1016/j.jse.2024.07.041
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.

Auteurs

Tobias Schöbel (T)

Department of Orthopedic, Trauma, and Plastic Surgery, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany. Electronic address: tobias.schoebel@medizin.uni-leipzig.de.

Toni Wendler (T)

Department of Orthopedic, Trauma, and Plastic Surgery, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany; ZESBO - Center for Research on Musculoskeletal Systems, Semmelweisstrasse 14, 04103 Leipzig, Germany.

Robin Heilmann (R)

Department of Orthopedic, Trauma, and Plastic Surgery, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany; ZESBO - Center for Research on Musculoskeletal Systems, Semmelweisstrasse 14, 04103 Leipzig, Germany.

Jean-Pierre Fischer (JP)

Department of Orthopedic, Trauma, and Plastic Surgery, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany; ZESBO - Center for Research on Musculoskeletal Systems, Semmelweisstrasse 14, 04103 Leipzig, Germany.

Stefan Schleifenbaum (S)

Department of Orthopedic, Trauma, and Plastic Surgery, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany; ZESBO - Center for Research on Musculoskeletal Systems, Semmelweisstrasse 14, 04103 Leipzig, Germany; Fraunhofer Institute for Machine Tools and Forming Technology, Nöthnitzer Straße 44, 01187 Dresden, Germany.

Jan Theopold (J)

Department of Orthopedic, Trauma, and Plastic Surgery, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany.

Pierre Hepp (P)

Department of Orthopedic, Trauma, and Plastic Surgery, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany.

Classifications MeSH