The acromioclavicular capsule as a restraint to posterior translation of the clavicle: A biomechanical analysis

Klimkiewicz, John J.; Williams, Gerald R.; Sher, Jerry S.; Karduna, Andrew; Des Jardins, John D.; Iannotti, Joseph P.

« Previous Next »Journal of Shoulder and Elbow Surgery
Volume 8, Issue 2 , Pages 119-124, March 1999

The acromioclavicular capsule as a restraint to posterior translation of the clavicle: A biomechanical analysis

John J. Klimkiewicz, MD
- Department of Orthopaedic Surgery, Hospital of University of Pennsylvania Philadelphia, Pa, USA
- Orthopaedic Specialists of Miami Beach Miami, Fla, USA
- Department of Physical Therapy, Allegheny University Philadelphia, Pa, USA
- the Department of Orthopaedic Surgery, Johns Hopkins University Baltimore, Md, USA
Gerald R. Williams, MD
- Department of Orthopaedic Surgery, Hospital of University of Pennsylvania Philadelphia, Pa, USA
- Orthopaedic Specialists of Miami Beach Miami, Fla, USA
- Department of Physical Therapy, Allegheny University Philadelphia, Pa, USA
- the Department of Orthopaedic Surgery, Johns Hopkins University Baltimore, Md, USA
Jerry S. Sher, MD
- Department of Orthopaedic Surgery, Hospital of University of Pennsylvania Philadelphia, Pa, USA
- Orthopaedic Specialists of Miami Beach Miami, Fla, USA
- Department of Physical Therapy, Allegheny University Philadelphia, Pa, USA
- the Department of Orthopaedic Surgery, Johns Hopkins University Baltimore, Md, USA
Andrew Karduna, PhD
- Department of Orthopaedic Surgery, Hospital of University of Pennsylvania Philadelphia, Pa, USA
- Orthopaedic Specialists of Miami Beach Miami, Fla, USA
- Department of Physical Therapy, Allegheny University Philadelphia, Pa, USA
- the Department of Orthopaedic Surgery, Johns Hopkins University Baltimore, Md, USA
John D. Des Jardins, MS
- Department of Orthopaedic Surgery, Hospital of University of Pennsylvania Philadelphia, Pa, USA
- Orthopaedic Specialists of Miami Beach Miami, Fla, USA
- Department of Physical Therapy, Allegheny University Philadelphia, Pa, USA
- the Department of Orthopaedic Surgery, Johns Hopkins University Baltimore, Md, USA
Joseph P. Iannotti, MD, PhD
- Reprint requests: Joseph P. Iannotti, MD, PhD, Professor of Orthopaedic Surgery, Chief of Shoulder and Elbow Service, Hospital of the University of Pennsylvania, Philadelphia, Pa.
- Department of Orthopaedic Surgery, Hospital of University of Pennsylvania Philadelphia, Pa, USA
- Orthopaedic Specialists of Miami Beach Miami, Fla, USA
- Department of Physical Therapy, Allegheny University Philadelphia, Pa, USA
- the Department of Orthopaedic Surgery, Johns Hopkins University Baltimore, Md, USA

Abstract

Excessive posterior translation of the residual clavicle after distal clavicle resection can be associated with significant postoperative pain. Although the acromioclavicular capsule has been identified as the primary restraint to translation of the clavicle along this axis, the individual contributions of the anterior, posterior, superior, and inferior components of the capsular ligament have not been established. The purpose of this study was to define the relative roles of the individual acromioclavicular capsular ligaments in preventing posterior translation of the distal clavicle in normal acromioclavicular joints in a human cadaver model. Six fresh-frozen human cadaveric acromioclavicular joints were mounted on a specially designed apparatus which, when attached to a standard servohydraulic materials testing device, allowed translation of the distal clavicle along the anteroposterior axis of the acromioclavicular joint (ie, parallel to the articular surface). Resistance to posterior displacement was measured for standardized displacements in the normal specimens and after serial sectioning of each of the acromioclavicular ligaments was performed. Sectioning of the anterior and inferior capsular ligaments had no significant effect on posterior translation at the 5% significance level. However, sectioning of the superior and posterior ligaments had statistically significant effects (P < .05). These capsular structures contributed 56% ± 23% (±SEM) and 25% ± 16%, respectively, of the force required to achieve a given posterior displacement. To avoid excessive posterior translation of the clavicle after distal clavicle excision, surgical techniques that spare the posterior and superior acromioclavicular capsular ligaments should be used.

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