{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T20:27:39Z","timestamp":1790022459469,"version":"4.0.1"},"reference-count":61,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2021,2,24]],"date-time":"2021-02-24T00:00:00Z","timestamp":1614124800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2021,2,24]],"date-time":"2021-02-24T00:00:00Z","timestamp":1614124800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"},{"start":{"date-parts":[[2021,2,24]],"date-time":"2021-02-24T00:00:00Z","timestamp":1614124800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2021,2,24]],"date-time":"2021-02-24T00:00:00Z","timestamp":1614124800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2021,1,11]],"date-time":"2021-01-11T00:00:00Z","timestamp":1610323200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["arthroscopysportsmedicineandrehabilitation.org","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Arthroscopy, Sports Medicine, and Rehabil."],"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To compare the stability and cost of the used implants in nonanatomic and anatomic acromioclavicular joint repair\/reconstruction (ACCR) techniques tested in cadaveric shoulder biomechanical studies during the last decade.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic review and meta\u2010analysis were performed following the Preferred Reporting Items for Systematic Reviews and Meta\u2010Analyses guidelines and prospectively registered in PROSPERO. Two independent reviewers searched PubMed, Embase, and Virtual Health Library databases. Studies evaluating 3\u2010direction stability under 70\u2010N loads and load\u2010to\u2010failure protocols with servohydraulic testing systems were included. A meta\u2010analysis of the mean differences of anterior, posterior, and superior direction; relative stability value in 3 directions; superior direction load\u2010to\u2010failure; stability\/cost index; and load\u2010to\u2010failure\/cost index was performed using a continuous random\u2010effects model and 95% confidence interval.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Eighteen articles were included. Both non\u2010ACCR and ACCR techniques exceeded the minimum acceptable threshold of stability and load\u2010to\u2010failure. ACCR techniques were biomechanically better in terms of anterior stability (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0= .04) and relative stability value (mean difference 64.08%,\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0= .015). However, supraphysiological stability and failure loads were achieved with non\u2010ACCR techniques at a lower cost of implants. Techniques combining 2 clavicular tunnels separated by at least 10 mm, a mean of 2 sutures, and\/or suture tapes had the greatest stability\/cost index and load\u2010to\u2010failure\/cost index among the included techniques (confidence interval 99%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Non\u2010ACCR and ACCR techniques exceeded the minimum acceptable threshold of stability and failure loads in controlled biomechanical testing. However, non\u2010ACCR and techniques combining 2 clavicular tunnels separated by at least 10 mm, a mean of 2 sutures, and\/or suture tapes provide supraphysiologic stability and failure loads at a lower cost of implants.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Relevance<\/jats:title>\n                    <jats:p>Non\u2010ACCR and suture\u2010based techniques may provide more cost\u2010effective and greater value treatment for acromioclavicular joint injury and could be considered in the surgical management of normal activity individuals and cost\u2010sensitive populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1016\/j.asmr.2020.12.007","type":"journal-article","created":{"date-parts":[[2021,2,24]],"date-time":"2021-02-24T09:58:34Z","timestamp":1614160714000},"update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":10,"title":["Nonanatomic and Suture\u2010Based Coracoclavicular Joint Stabilization Techniques Provide Adequate Stability at a Lower Cost of Implants in Biomechanical Studies When Compared With Anatomic Techniques: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1002","volume":"3","author":[{"given":"Theodorakys","family":"Mar\u00edn Ferm\u00edn","sequence":"first","affiliation":[{"name":"Department of Traumatology. Hospital Perif\u00e9rico de Coche \u201cDr. Leopoldo Manrique Terrero, \u201d Caracas Venezuela"},{"name":"TheMIS Orthopaedic Center Thessaloniki Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean Michel","family":"Hovsepian","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Sports Medicine Chirurgisches Klinikum M\u00fcnchen S\u00fcd Munich Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V\u00edctor Miguel","family":"Rodrigues Fernandes","sequence":"additional","affiliation":[{"name":"Department of Traumatology Cl\u00ednica Santa Mar\u00eda de la Asunci\u00f3n Tolosa Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioannis","family":"Terzidis","sequence":"additional","affiliation":[{"name":"TheMIS Orthopaedic Center Thessaloniki Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanouil","family":"Papakostas","sequence":"additional","affiliation":[{"name":"TheMIS Orthopaedic Center Thessaloniki Greece"},{"name":"Aspetar Orthopedic and Sports Medicine Hospital Doha Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Koh","sequence":"additional","affiliation":[{"name":"NorthShore University Health System Evanston; University of Chicago Pritzker School of Medicine Chicago; and Northwestern University School of Engineering. Evanston Illinois U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,2,24]]},"reference":[{"key":"e_1_2_3_2_2","unstructured":"Skjaker SA Enger M Engebretsen L Brox JI B\u00f8e B. Young men in sports are at highest risk of acromioclavicular joint injuries: A prospective cohort study [published online April 8 2020].Knee Surg Sports Traumatol Arthrosc.https:\/\/doi.org\/10.1007\/s00167\u2010020\u201005958\u2010x."},{"key":"e_1_2_3_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2020.04.029"},{"key":"e_1_2_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jseint.2020.01.009"},{"key":"e_1_2_3_5_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546518795147"},{"key":"e_1_2_3_6_2","doi-asserted-by":"publisher","DOI":"10.5435\/JAAOS-D-17-00105"},{"key":"e_1_2_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcot.2019.03.020"},{"key":"e_1_2_3_8_2","doi-asserted-by":"publisher","DOI":"10.1148\/rg.2020200039"},{"key":"e_1_2_3_9_2","doi-asserted-by":"crossref","unstructured":"Lee J El\u2010Daou H Alkoheji M Carlos A Di Mascio L Amis A. Ligamentous and capsular restraints to anterior posterior and superior inferior laxity of the acromioclavicular joint\u2014a biomechanical study [published online September 30 2020].J Shoulder Elbow Surg.https:\/\/doi.org\/10.1016\/j.jse.2020.09.006.","DOI":"10.1016\/j.jse.2020.09.006"},{"key":"e_1_2_3_10_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546518758287"},{"key":"e_1_2_3_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2019.03.005"},{"key":"e_1_2_3_12_2","doi-asserted-by":"publisher","DOI":"10.1080\/13696998.2019.1620245"},{"key":"e_1_2_3_13_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00590-016-1797-4"},{"key":"e_1_2_3_14_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10195-017-0451-1"},{"key":"e_1_2_3_15_2","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0000000000001004"},{"key":"e_1_2_3_16_2","first-page":"CD007429","article-title":"Surgical versus conservative interventions for treating acromioclavicular dislocation of the shoulder in adults","volume":"10","author":"Tamaoki M.J.S.","year":"2019","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_3_17_2","doi-asserted-by":"publisher","DOI":"10.1093\/bmb\/ldx003"},{"key":"e_1_2_3_18_2","volume-title":"Tracking universal health coverage: 2017 global monitoring report","year":"2017"},{"key":"e_1_2_3_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2018.04.027"},{"key":"e_1_2_3_20_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00402-019-03137-3"},{"key":"e_1_2_3_21_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546505281795"},{"key":"e_1_2_3_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2018.01.016"},{"key":"e_1_2_3_23_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.98B4.35935"},{"key":"e_1_2_3_24_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-014-3198-8"},{"key":"e_1_2_3_25_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-018-5152-7"},{"key":"e_1_2_3_26_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-019-05674-1"},{"key":"e_1_2_3_27_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-019-05408-3"},{"key":"e_1_2_3_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2015.10.053"},{"key":"e_1_2_3_29_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546509359064"},{"key":"e_1_2_3_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.eats.2015.02.012"},{"key":"e_1_2_3_31_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-013-2569-x"},{"key":"e_1_2_3_32_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2011.10.029"},{"key":"e_1_2_3_33_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2019.07.021"},{"key":"e_1_2_3_34_2","doi-asserted-by":"publisher","DOI":"10.1186\/1754-9493-7-18"},{"key":"e_1_2_3_35_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2018.04.017"},{"key":"e_1_2_3_36_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.eats.2017.01.009"},{"key":"e_1_2_3_37_2","doi-asserted-by":"publisher","DOI":"10.1177\/2309499017749984"},{"key":"e_1_2_3_38_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2019.06.007"},{"key":"e_1_2_3_39_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546508315200"},{"key":"e_1_2_3_40_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2012.11.023"},{"key":"e_1_2_3_41_2","doi-asserted-by":"publisher","DOI":"10.18637\/jss.v049.i05"},{"key":"e_1_2_3_42_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546517752673"},{"key":"e_1_2_3_43_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546511416784"},{"key":"e_1_2_3_44_2","doi-asserted-by":"publisher","DOI":"10.1177\/2325967119836751"},{"key":"e_1_2_3_45_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546518770603"},{"key":"e_1_2_3_46_2","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000000193"},{"key":"e_1_2_3_47_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2019.11.017"},{"key":"e_1_2_3_48_2","doi-asserted-by":"publisher","DOI":"10.1177\/2325967116674668"},{"key":"e_1_2_3_49_2","doi-asserted-by":"publisher","DOI":"10.1051\/sicotj\/2016013"},{"key":"e_1_2_3_50_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10195-015-0346-y"},{"key":"e_1_2_3_51_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-015-3920-1"},{"key":"e_1_2_3_52_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-012-2067-6"},{"key":"e_1_2_3_53_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546513484892"},{"key":"e_1_2_3_54_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2010.05.023"},{"key":"e_1_2_3_55_2","doi-asserted-by":"publisher","DOI":"10.3928\/01477447-20130724-22"},{"key":"e_1_2_3_56_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2015.06.005"},{"key":"e_1_2_3_57_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2020.04.008"},{"key":"e_1_2_3_58_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546510374447"},{"key":"e_1_2_3_59_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1058-2746(99)90003-4"},{"key":"e_1_2_3_60_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0278-5919(02)00104-7"},{"key":"e_1_2_3_61_2","unstructured":"Ruiz Ib\u00e1n MA Moreno Romero MS Diaz Heredia J Ruiz D\u00edaz R Muriel A L\u00f3pez\u2010Alcalde J. The prevalence of intraarticular associated lesions after acute acromioclavicular joint injuries is 20%. A systematic review and meta\u2010analysis [published online March 16 2020].Knee Surg Sports Traumatol Arthrosc.https:\/\/doi.org\/10.1007\/s00167\u2010020\u201005917\u20106."},{"key":"e_1_2_3_62_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-019-05436-z"}],"container-title":["Arthroscopy, Sports Medicine, and Rehabilitation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2666061X21000018?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2666061X21000018?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1016\/j.asmr.2020.12.007","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/full-xml\/10.1016\/j.asmr.2020.12.007","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1016\/j.asmr.2020.12.007","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,15]],"date-time":"2026-03-15T08:52:29Z","timestamp":1773564749000},"score":1,"resource":{"primary":{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/10.1016\/j.asmr.2020.12.007"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,24]]},"references-count":61,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2021,4]]}},"alternative-id":["10.1016\/j.asmr.2020.12.007"],"URL":"https:\/\/doi.org\/10.1016\/j.asmr.2020.12.007","archive":["Portico"],"relation":{},"ISSN":["2666-061X","2666-061X"],"issn-type":[{"value":"2666-061X","type":"print"},{"value":"2666-061X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,24]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Nonanatomic and Suture-Based Coracoclavicular Joint Stabilization Techniques Provide Adequate Stability at a Lower Cost of Implants in Biomechanical Studies When Compared With Anatomic Techniques: A Systematic Review and Meta-Analysis","name":"articletitle","label":"Article Title"},{"value":"Arthroscopy, Sports Medicine, and Rehabilitation","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.asmr.2020.12.007","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2021 The Authors. Published by Elsevier Inc. on behalf of the Arthroscopy Association of North America.","name":"copyright","label":"Copyright"}]}}