Biomechanical Analysis of Single-, Double-, and Triple-Bundle Configurations for Coracoclavicular Ligament Reconstruction Using Cortical Fixation Buttons With Suture Tapes: A Cadaveric Study

Purpose: To compare the acromioclavicular (AC) joint stability of single-bundle (SB), double-bundle with an anterolateral limb (DBa), double-bundle with a posterolateral limb (DBp), and triple-bundle (TB) coracoclavicular (CC) ligament reconstructions using cortical fixation buttons with suture tapes. Methods: Eight cadaveric shoulders were used. AC joint translation and rotational stability were tested for intact and following 4 different CC reconstruction techniques: SB, DBa, DBp, and TB configurations using cortical fixation buttons with suture tapes. For each reconstruction and native AC joint as control, anteroposterior (AP) and superoinferior translations were quantified using 10- and 15-N translational loads and anterior and posterior rotations were measured using 0.16- and 0.32-Nm rotational torque. Results: DBp reconstruction showed significantly better AP stability compared with SB and DBa reconstruction at 10 and 15 N (DBp: 4.1 ± 0.6 mm, SB: 7.8 ± 1.1 mm, P <.001; DBa: 6.5 ± 0.7 mm, P =.02 at 10 N; DBp: 5.5 ± 0.8 mm, SB: 10.1 ± 1.0 mm, P =.003; DBa: 9.1 ± 0.7 mm, P =.02 at 15 N). The degree of total rotation showed tendency to decrease according to increasing number of bundles; however, there were no significant differences (SB: 43.1 ± 9.2° DBa: 37.9 ± 7.3° DBp: 33.9 ± 6.8° TB: 32.2 ± 6.6° P =.37 at 0.32 Nm). Conclusions: An additional posterolateral clavicular hole for CC ligament reconstruction using cortical fixation buttons with suture tapes resulted in better AP stability compared with SB reconstruction, whereas use of additional anterolateral clavicular hole did not show any improvement compared with SB reconstruction. Reconstruction using both anterolateral and posterolateral clavicular holes did not guarantee better stability compared with SB reconstruction. There was an increasing tendency of rotational stability with number of bundle increases, although they did not reach statistical difference. Clinical Relevance: When surgeons consider double-bundle CC ligament reconstruction using cortical fixation buttons with suture tapes, it is better to position the lateral clavicular hole posteriorly to restore AP stability.