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Quantitative Assessment of the Distal Clavicle with Its Clinical Implications in Anatomical Reconstruction of the Coracoclavicular Ligament

Year 2025, Volume: 27 Issue: 1, 41 - 47, 30.04.2025
https://doi.org/10.18678/dtfd.1585362

Abstract

Aim: Anatomical reconstruction of the coracoclavicular ligament has recently become popular in the treatment of acromioclavicular joint injuries. To perform this procedure correctly, the anatomy of the conoid tubercle and trapezoid line, which are the attachment sites of the coracoclavicular ligament, should be known accurately. Therefore, this study aimed to evaluate the distal clavicle along with morphometry of the conoid tubercle and trapezoid line.
Material and Methods: In the present study, 77 human dry clavicles (39 right, 38 left) were examined using a digital caliper and digital thickness gauge. The clavicle length, thickness and width of the distal clavicle, morphometric features of the conoid tubercle, and trapezoid line were examined. Measurements were performed by two researchers independently.
Results: The clavicle length was 138.37±10.69 mm. Supero-inferior thickness of the distal clavicle was 9.08±1.69 mm, and the antero-posterior width was 17.70±2.37 mm. Medio-lateral and supero-inferior dimensions of the conoid tubercle were 17.17±3.58 mm and 7.59±1.38 mm, respectively. The distance between the clavicle acromial end and the center of the conoid tubercle was 34.43±5.41 mm. Medio-lateral dimension of trapezoid line was 16.69±2.73 mm, and antero-posterior dimension was 9.61±1.80 mm. The distance between the clavicle acromial end and the center of the trapezoid line was measured as 18.15±2.80 mm.
Conclusion: Accordingly, the tunnels for trapezoid and conoid ligaments should be created 18 mm and 34 mm medial from the clavicle acromial end, respectively. The measurements obtained in this study can be used as a guide for coracoclavicular ligament reconstruction.

References

  • Rios CG, Arciero RA, Mazzocca AD. Anatomy of the clavicle and coracoid process for reconstruction of the coracoclavicular ligaments. Am J Sports Med. 2007;35(5):811-7.
  • Berthold DP, Muench LN, Dyrna F, Mazzocca AD, Garvin P, Voss A, et al. Current concepts in acromioclavicular joint (AC) instability - a proposed treatment algorithm for acute and chronic AC-joint surgery. BMC Musculoskelet Disord. 2022;23(1):1078.
  • Lim YW. Triple endobuttton technique in acromioclavicular joint reduction and reconstruction. Ann Acad Med Singap. 2008;37(4):294-9.
  • Bishop JY, Kaeding C. Treatment of the acute traumatic acromioclavicular separation. Sports Med Arthrosc Rev. 2006;14(4):237-45.
  • Standring S. Gray's anatomy e-book: the anatomical basis of clinical practice, 42nd ed. Elsevier Health Sciences; 2021.
  • Mazzocca AD, Arciero RA, Bicos J. Evaluation and treatment of acromioclavicular joint injuries. Am J Sports Med. 2007;35(2):316-29.
  • Marchese RM, Black AC, Bordoni B. Anatomy, shoulder and upper limb, coracoclavicular joint (coracoclavicular ligament). In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025.
  • Moatshe G, Kruckeberg BM, Chahla J, Godin JA, Cinque ME, Provencher MT, et al. Acromioclavicular and coracoclavicular ligament reconstruction for acromioclavicular joint instability: a systematic review of clinical and radiographic outcomes. Arthroscopy. 2018;34(6):1979-95.e8.
  • Panarello NM, Colantonio DF, Harrington CJ, Feeley SM, Bandarra TD, Dickens JF, et al. Coracoid or clavicle fractures associated with coracoclavicular ligament reconstruction. Am J Sports Med. 2021;49(12):3218-25.
  • Cartaya MA, Vargas JM. Use of the pectoralis minor and coracoacromial ligament for a biplanar coracoclavicular and acromioclavicular reconstruction: A cadaveric feasibility study. J Exp Orthop. 2024;11(4):e70032.
  • Kocadal O, Yüksel K, Güven M. Evaluation of the clavicular tunnel placement on coracoclavicular ligament reconstruction for acromioclavicular dislocations: a finite element analysis. Int Orthop. 2018;42(8):1891-6.
  • Celik H, Chauhan A, Flores-Hernandez C, Dorthe E, D'Lima D, Hoenecke H. Sagittal orientation of coracoclavicular ligament reconstruction affects the stability of surgical repair. J Shoulder Elbow Surg. 2020;29(9):1901-11.
  • Sirin E, Aydin N, Mert Topkar O. Acromioclavicular joint injuries: diagnosis, classification and ligamentoplasty procedures. EFORT Open Rev. 2018;3(7):426-33.
  • Frank RM, Cotter EJ, Leroux TS, Romeo AA. Acromioclavicular joint injuries: evidence-based treatment. J Am Acad Orthop Surg. 2019;27(17):e775-88.
  • Takase K, Yamamoto K. Changes in surgical procedures for acromioclavicular joint dislocation over the past 30 years. Orthopedics. 2013;36(10):e1277-82.
  • Mazzocca AD, Santangelo SA, Johnson ST, Rios CG, Dumonski ML, Arciero RA. A biomechanical evaluation of an anatomical coracoclavicular ligament reconstruction. Am J Sports Med. 2006;34(2):236-46.
  • Eisenstein ED, Lanzi JT, Waterman BR, Bader JM, Pallis MP. Medialized clavicular bone tunnel position predicts failure after anatomic coracoclavicular ligament reconstruction in young, active male patients. Am J Sports Med. 2016;44(10):2682-9.
  • Cook JB, Shaha JS, Rowles DJ, Bottoni CR, Shaha SH, Tokish JM. Clavicular bone tunnel malposition leads to early failures in coracoclavicular ligament reconstructions. Am J Sports Med. 2013;41(1):142-8.
  • Boehm TD, Kirschner S, Fischer A, Gohlke F. The relation of the coracoclavicular ligament insertion to the acromioclavicular joint A cadaver study of relevance to lateral clavicle resection. Acta Orthopaedica Scandinavica. 2003;74(6):718-21.
  • Chahla J, Marchetti DC, Moatshe G, Ferrari MB, Sanchez G, Brady AW, et al. Quantitative assessment of the coracoacromial and the coracoclavicular ligaments with 3-dimensional mapping of the coracoid process anatomy: a cadaveric study of surgically relevant structures. Arthroscopy. 2018;34(5):1403-11.
  • Xue C, Song LJ, Zhang M, Zheng TS, Fang JH, Li X. Coracoclavicular ligament attachment regions of the Chinese population: a quantitative anatomic study. Anat Sci Int. 2013;88(4):189-94.
  • Bernat A, Huysmans T, Van Glabbeek F, Sijbers J, Gielen J, Van Tongel A. The anatomy of the clavicle: a three-dimensional cadaveric study. Clin Anat. 2014;27(5):712-23.
  • Ominde BS, Awori KO, Olabu BO, Ogeng’o JA. Anatomical measurements of the distal clavicle in a Kenyan population. Anat J Afr. 2015;4(1):450-6.
  • King PR, Scheepers S, Ikram A. Anatomy of the clavicle and its medullary canal: a computed tomography study. Eur J Orthop Surg Traumatol. 2014;24(1):37-42.
  • Daruwalla ZJ, Courtis P, Fitzpatrick C, Fitzpatrick D, Mullett H. Anatomic variation of the clavicle: A novel three-dimensional study. Clin Anat. 2010;23(2):199-209.
  • Renfree KJ, Riley MK, Wheeler D, Hentz JG, Wright TW. Ligamentous anatomy of the distal clavicle. J Shoulder Elbow Surg. 2003;12(4):355-9.
  • Takase K. The coracoclavicular ligaments: an anatomic study. Surg Radiol Anat. 2010;32(7):683-8.
  • Harris RI, Vu DH, Sonnabend DH, Goldberg JA, Walsh WR. Anatomic variance of the coracoclavicular ligaments. J Shoulder Elbow Surg. 2001;10(6):585-8.
  • Zhu NF, Rui BY, Zhang YL, Chen YF. Anatomic study of coracoclavicular ligaments for reconstruction of acromioclavicular joint dislocations. J Orthop Sci. 2016;21(6):749-52.

Ligamentum Coracoclaviculare’nin Anatomik Rekonstruksiyonunda Klinik Etkisi Olan Distal Clavicula’nın Kantitatif Değerlendirilmesi

Year 2025, Volume: 27 Issue: 1, 41 - 47, 30.04.2025
https://doi.org/10.18678/dtfd.1585362

Abstract

Amaç: Articulatio acromioclaviculare yaralanmalarının tedavisinde, ligamentum coracoclaviculare’nin anatomik rekonstrüksiyonu son zamanlarda popüler hale gelmiştir. Bu işlemin doğru şekilde yapılabilmesi için ligamentum coracoclaviculare’nin yapışma yerleri olan tuberculum conoideum ve linea trapezoidea’nın anatomisinin doğru şekilde bilinmesi gerekir. Bu nedenle, bu çalışmada tuberculum conoideum ve linea trapezoidea’nın morfometrisi ile birlikte distal clavicula’nın değerlendirilmesi amaçlandı.
Gereç ve Yöntemler: Bu çalışmada, 77 insan kuru clavicula kemiği (39 sağ, 38 sol) dijital kumpas ve dijital kalınlık ölçer kullanılarak incelendi. Clavicula uzunluğu, distal clavicula kalınlığı ve genişliği, tuberculum conoideum ve linea trapezoidea’nın morfometrik özellikleri incelendi. Ölçümler iki araştırmacı tarafından bağımsız olarak gerçekleştirildi.
Bulgular: Clavicula uzunluğu 138,37±10,69 mm idi. Distal clavicula’nın supero-inferior kalınlığı 9,08±1,69 mm ve antero-posterior genişliği ise 17,70±2,37 mm bulundu. Tuberculum conoideum’un medio-lateral ve supero-inferior boyutları sırasıyla 17,17±3,58 mm ve 7,59±1,38 mm idi. Clavicula extremitas acromialis’i ile tuberculum conoideum’un merkezi arasındaki mesafe 34,43±5,41 mm olarak ölçüldü. Linea trapezoidea’nın medio-lateral uzunluğu 16,69±2,73 mm ve antero-posterior uzunluğu ise 9,61±1,80 mm idi. Clavicula extremitas acromialis’i ile linea trapezoidea’nın merkezi arasındaki mesafe 18,15±2,80 mm olarak ölçüldü.
Sonuç: Bu çalışmadaki ölçümlere göre, ligamentum trapezoideum ve ligamentum conoideum için açılacak tüneller clavicula’nın extremitas acromialis’inden sırasıyla 18 mm ve 34 mm medialde oluşturulmalıdır. Bu çalışmadan elde edilen ölçümler, ligamentum coracoclaviculare’nin anatomik rekonstrüksiyonunda bir kılavuz olarak kullanılabilir.

References

  • Rios CG, Arciero RA, Mazzocca AD. Anatomy of the clavicle and coracoid process for reconstruction of the coracoclavicular ligaments. Am J Sports Med. 2007;35(5):811-7.
  • Berthold DP, Muench LN, Dyrna F, Mazzocca AD, Garvin P, Voss A, et al. Current concepts in acromioclavicular joint (AC) instability - a proposed treatment algorithm for acute and chronic AC-joint surgery. BMC Musculoskelet Disord. 2022;23(1):1078.
  • Lim YW. Triple endobuttton technique in acromioclavicular joint reduction and reconstruction. Ann Acad Med Singap. 2008;37(4):294-9.
  • Bishop JY, Kaeding C. Treatment of the acute traumatic acromioclavicular separation. Sports Med Arthrosc Rev. 2006;14(4):237-45.
  • Standring S. Gray's anatomy e-book: the anatomical basis of clinical practice, 42nd ed. Elsevier Health Sciences; 2021.
  • Mazzocca AD, Arciero RA, Bicos J. Evaluation and treatment of acromioclavicular joint injuries. Am J Sports Med. 2007;35(2):316-29.
  • Marchese RM, Black AC, Bordoni B. Anatomy, shoulder and upper limb, coracoclavicular joint (coracoclavicular ligament). In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025.
  • Moatshe G, Kruckeberg BM, Chahla J, Godin JA, Cinque ME, Provencher MT, et al. Acromioclavicular and coracoclavicular ligament reconstruction for acromioclavicular joint instability: a systematic review of clinical and radiographic outcomes. Arthroscopy. 2018;34(6):1979-95.e8.
  • Panarello NM, Colantonio DF, Harrington CJ, Feeley SM, Bandarra TD, Dickens JF, et al. Coracoid or clavicle fractures associated with coracoclavicular ligament reconstruction. Am J Sports Med. 2021;49(12):3218-25.
  • Cartaya MA, Vargas JM. Use of the pectoralis minor and coracoacromial ligament for a biplanar coracoclavicular and acromioclavicular reconstruction: A cadaveric feasibility study. J Exp Orthop. 2024;11(4):e70032.
  • Kocadal O, Yüksel K, Güven M. Evaluation of the clavicular tunnel placement on coracoclavicular ligament reconstruction for acromioclavicular dislocations: a finite element analysis. Int Orthop. 2018;42(8):1891-6.
  • Celik H, Chauhan A, Flores-Hernandez C, Dorthe E, D'Lima D, Hoenecke H. Sagittal orientation of coracoclavicular ligament reconstruction affects the stability of surgical repair. J Shoulder Elbow Surg. 2020;29(9):1901-11.
  • Sirin E, Aydin N, Mert Topkar O. Acromioclavicular joint injuries: diagnosis, classification and ligamentoplasty procedures. EFORT Open Rev. 2018;3(7):426-33.
  • Frank RM, Cotter EJ, Leroux TS, Romeo AA. Acromioclavicular joint injuries: evidence-based treatment. J Am Acad Orthop Surg. 2019;27(17):e775-88.
  • Takase K, Yamamoto K. Changes in surgical procedures for acromioclavicular joint dislocation over the past 30 years. Orthopedics. 2013;36(10):e1277-82.
  • Mazzocca AD, Santangelo SA, Johnson ST, Rios CG, Dumonski ML, Arciero RA. A biomechanical evaluation of an anatomical coracoclavicular ligament reconstruction. Am J Sports Med. 2006;34(2):236-46.
  • Eisenstein ED, Lanzi JT, Waterman BR, Bader JM, Pallis MP. Medialized clavicular bone tunnel position predicts failure after anatomic coracoclavicular ligament reconstruction in young, active male patients. Am J Sports Med. 2016;44(10):2682-9.
  • Cook JB, Shaha JS, Rowles DJ, Bottoni CR, Shaha SH, Tokish JM. Clavicular bone tunnel malposition leads to early failures in coracoclavicular ligament reconstructions. Am J Sports Med. 2013;41(1):142-8.
  • Boehm TD, Kirschner S, Fischer A, Gohlke F. The relation of the coracoclavicular ligament insertion to the acromioclavicular joint A cadaver study of relevance to lateral clavicle resection. Acta Orthopaedica Scandinavica. 2003;74(6):718-21.
  • Chahla J, Marchetti DC, Moatshe G, Ferrari MB, Sanchez G, Brady AW, et al. Quantitative assessment of the coracoacromial and the coracoclavicular ligaments with 3-dimensional mapping of the coracoid process anatomy: a cadaveric study of surgically relevant structures. Arthroscopy. 2018;34(5):1403-11.
  • Xue C, Song LJ, Zhang M, Zheng TS, Fang JH, Li X. Coracoclavicular ligament attachment regions of the Chinese population: a quantitative anatomic study. Anat Sci Int. 2013;88(4):189-94.
  • Bernat A, Huysmans T, Van Glabbeek F, Sijbers J, Gielen J, Van Tongel A. The anatomy of the clavicle: a three-dimensional cadaveric study. Clin Anat. 2014;27(5):712-23.
  • Ominde BS, Awori KO, Olabu BO, Ogeng’o JA. Anatomical measurements of the distal clavicle in a Kenyan population. Anat J Afr. 2015;4(1):450-6.
  • King PR, Scheepers S, Ikram A. Anatomy of the clavicle and its medullary canal: a computed tomography study. Eur J Orthop Surg Traumatol. 2014;24(1):37-42.
  • Daruwalla ZJ, Courtis P, Fitzpatrick C, Fitzpatrick D, Mullett H. Anatomic variation of the clavicle: A novel three-dimensional study. Clin Anat. 2010;23(2):199-209.
  • Renfree KJ, Riley MK, Wheeler D, Hentz JG, Wright TW. Ligamentous anatomy of the distal clavicle. J Shoulder Elbow Surg. 2003;12(4):355-9.
  • Takase K. The coracoclavicular ligaments: an anatomic study. Surg Radiol Anat. 2010;32(7):683-8.
  • Harris RI, Vu DH, Sonnabend DH, Goldberg JA, Walsh WR. Anatomic variance of the coracoclavicular ligaments. J Shoulder Elbow Surg. 2001;10(6):585-8.
  • Zhu NF, Rui BY, Zhang YL, Chen YF. Anatomic study of coracoclavicular ligaments for reconstruction of acromioclavicular joint dislocations. J Orthop Sci. 2016;21(6):749-52.
There are 29 citations in total.

Details

Primary Language English
Subjects Anatomy
Journal Section Research Article
Authors

Hilal Akdemir Aktaş 0000-0002-7353-8069

Helin Yücedağ Gündoğdu 0000-0001-7724-6031

Early Pub Date March 24, 2025
Publication Date April 30, 2025
Submission Date November 14, 2024
Acceptance Date February 25, 2025
Published in Issue Year 2025 Volume: 27 Issue: 1

Cite

APA Akdemir Aktaş, H., & Yücedağ Gündoğdu, H. (2025). Quantitative Assessment of the Distal Clavicle with Its Clinical Implications in Anatomical Reconstruction of the Coracoclavicular Ligament. Duzce Medical Journal, 27(1), 41-47. https://doi.org/10.18678/dtfd.1585362
AMA Akdemir Aktaş H, Yücedağ Gündoğdu H. Quantitative Assessment of the Distal Clavicle with Its Clinical Implications in Anatomical Reconstruction of the Coracoclavicular Ligament. Duzce Med J. April 2025;27(1):41-47. doi:10.18678/dtfd.1585362
Chicago Akdemir Aktaş, Hilal, and Helin Yücedağ Gündoğdu. “Quantitative Assessment of the Distal Clavicle With Its Clinical Implications in Anatomical Reconstruction of the Coracoclavicular Ligament”. Duzce Medical Journal 27, no. 1 (April 2025): 41-47. https://doi.org/10.18678/dtfd.1585362.
EndNote Akdemir Aktaş H, Yücedağ Gündoğdu H (April 1, 2025) Quantitative Assessment of the Distal Clavicle with Its Clinical Implications in Anatomical Reconstruction of the Coracoclavicular Ligament. Duzce Medical Journal 27 1 41–47.
IEEE H. Akdemir Aktaş and H. Yücedağ Gündoğdu, “Quantitative Assessment of the Distal Clavicle with Its Clinical Implications in Anatomical Reconstruction of the Coracoclavicular Ligament”, Duzce Med J, vol. 27, no. 1, pp. 41–47, 2025, doi: 10.18678/dtfd.1585362.
ISNAD Akdemir Aktaş, Hilal - Yücedağ Gündoğdu, Helin. “Quantitative Assessment of the Distal Clavicle With Its Clinical Implications in Anatomical Reconstruction of the Coracoclavicular Ligament”. Duzce Medical Journal 27/1 (April2025), 41-47. https://doi.org/10.18678/dtfd.1585362.
JAMA Akdemir Aktaş H, Yücedağ Gündoğdu H. Quantitative Assessment of the Distal Clavicle with Its Clinical Implications in Anatomical Reconstruction of the Coracoclavicular Ligament. Duzce Med J. 2025;27:41–47.
MLA Akdemir Aktaş, Hilal and Helin Yücedağ Gündoğdu. “Quantitative Assessment of the Distal Clavicle With Its Clinical Implications in Anatomical Reconstruction of the Coracoclavicular Ligament”. Duzce Medical Journal, vol. 27, no. 1, 2025, pp. 41-47, doi:10.18678/dtfd.1585362.
Vancouver Akdemir Aktaş H, Yücedağ Gündoğdu H. Quantitative Assessment of the Distal Clavicle with Its Clinical Implications in Anatomical Reconstruction of the Coracoclavicular Ligament. Duzce Med J. 2025;27(1):41-7.