{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,15]],"date-time":"2026-03-15T19:17:25Z","timestamp":1773602245487,"version":"3.50.1"},"reference-count":46,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2021,12,14]],"date-time":"2021-12-14T00:00:00Z","timestamp":1639440000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2021,12,14]],"date-time":"2021-12-14T00:00:00Z","timestamp":1639440000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"},{"start":{"date-parts":[[2021,12,14]],"date-time":"2021-12-14T00:00:00Z","timestamp":1639440000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2021,12,14]],"date-time":"2021-12-14T00:00:00Z","timestamp":1639440000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"}],"content-domain":{"domain":["arthroscopyjournal.org","clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Arthroscopy"],"published-print":{"date-parts":[[2022,6]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To measure the multiaxial stability of the acromioclavicular joint before and after transection of the acromioclavicular capsule and coracoclavicular ligaments and after sequential repair of acromioclavicular and coracoclavicular ligaments.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Biomechanical testing was performed on fresh\u2010frozen human cadaveric shoulders (N\u00a0= 6). Translational and rotational stability in the vertical and horizontal planes was measured in intact specimens, after transecting the acromioclavicular and coracoclavicular ligaments, and after sequentially performing the following procedures: single\u2010bundle coracoclavicular repair (CCR), modified Weaver\u2013Dunn procedure (WD), and acromioclavicular stabilization (ACS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Resecting the acromioclavicular and coracoclavicular significantly reduced translational stiffness in the inferior and anteroposterior directions, as well as rotational stiffness about the vertical and anteroposterior axes. All 3 surgical procedures increased inferior translational stiffness relative to the intact condition (Intact: 38 \u00b1 9 N\/mm, CCR: 54 \u00b1 23 N\/mm (\n                      <jats:italic>P<\/jats:italic>\n                      = .03), CCR+WD 52 \u00b1 20 N\/mm (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0= .07), CCR \u00b1 WD+ACS 50 \u00b1 21 N\/mm (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0= .17)). However, the combination of CCR, modified WD, and ACS resulted in the greatest increase in stiffness in internal rotation (Intact: 12.5 \u00b1 7.4 cNm\/deg, CCR: 1.2 \u00b1 1.1 cNm\/deg, CCR+WD 7.2 \u00b1 3.0 N\u2217m\/deg [\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0= .023], CCR+WD+ACS 11.6 \u00b1 4.9 cNm\/deg [\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0= .055]).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The cumulative stability of CCR, WD reconstruction, and ACS appears to be additive. Our findings provide a biomechanical justification for combining all three techniques. Biomechanical studies assessing the performance of various acromioclavicular repairs and reconstructions should therefore incorporate multiaxial testing in their protocols.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Relevance<\/jats:title>\n                    <jats:p>Multiple points of fixation that provide multidirectional stability have the potential to improve clinical outcomes and reduce failure rates of acromioclavicular joint repair or stabilization.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1016\/j.arthro.2021.11.051","type":"journal-article","created":{"date-parts":[[2021,12,14]],"date-time":"2021-12-14T12:07:54Z","timestamp":1639483674000},"page":"1774-1783","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":6,"title":["Combination of Surgical Techniques Restores Multidirectional Biomechanical Stability of Acromioclavicular Joint"],"prefix":"10.1002","volume":"38","author":[{"given":"Thomas","family":"Goodine","sequence":"first","affiliation":[{"name":"Scripps Clinic Medical Group Scripps Health La Jolla California U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haluk","family":"Celik","sequence":"additional","affiliation":[{"name":"Shiley Center for Orthopaedic Research &amp; Education at Scripps Clinic Scripps Health La Jolla California U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cesar","family":"Flores\u2010Hernandez","sequence":"additional","affiliation":[{"name":"Shiley Center for Orthopaedic Research &amp; Education at Scripps Clinic Scripps Health La Jolla California U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Darryl","family":"D\u2019Lima","sequence":"additional","affiliation":[{"name":"Shiley Center for Orthopaedic Research &amp; Education at Scripps Clinic Scripps Health La Jolla California U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heinz","family":"Hoenecke","sequence":"additional","affiliation":[{"name":"Scripps Clinic Medical Group Scripps Health La Jolla California 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