Biomechanical comparison of two biplanar and one monoplanar reconstruction techniques of the acromioclavicular joint

  • Michael O. SchärEmail author
  • Stefanie Jenni
  • Gion Fessel
  • Jess G. Snedeker
  • Markus Scheibel
  • Matthias A. Zumstein
Trauma Surgery



The purpose of this proof-of-concept study was to investigate the biomechanical performance of two surgical techniques, namely (1) the double Tight-Rope fixation with an additional acromioclavicular FiberTape fixation (DTRC) and (2) the fixation of the clavicle to the acromion and coracoid in a bipodal manner (Bipod) using a Poly-Tape and FiberTape. Both techniques intend to address vertical and horizontal instability after acromioclavicular dislocation. They were compared with the commonly used (3) double Tight-Rope (DTR) technique, which only stabilizes the clavicle to the coracoid.

Materials and methods

The acromioclavicular joint (ACJ) of 18 composite Sawbone shoulder specimens (6 per reconstruction group) were tested for posterosuperior elongation (70N cyclical load, 1500 cycles), load-to-failure and stiffness.


After 1500 cycles, the DTRC, Bipod and DTR group showed an elongation of 0.45 mm (SD 0.14 mm), 1.19 mm (SD 0.54 mm), and 0.46 mm (SD 0.15 mm), respectively. Although the elongation of the Bipod group was increased when compared to the other two groups (Bipod versus DTRC p = 0.008; Bipod versus DTR p = 0.006), the difference was less than 0.7 mm. The DTRC showed a higher load-to-failure of 656.1N (SD 58.1 N) compared to the Bipod [531.1 N (SD 108.2N) (p = 0.039)] and DTR group [522.8 N (SD 32.8 N) (p = 0.033)].


The DTRC and the DTR group resulted in similar low elongation, while the elongation in the Bipod technique was slightly higher. Even though this difference of 0.7 mm shows statistical significance, it most likely has no clinical relevance. When testing in posterosuperior direction, which is the clinically relevant load vector, an additional fixation of the clavicle to the acromion did not reduce elongation in this study. It is, furthermore, questionable if the benefit of an increased load-to-failure in combination with no improvement in elongation and stiffness as seen in the DTRC group outweighs the possible risks and increased costs coming with the DTRC refixation.


Acromioclavicular joint dislocation Arthroscopically assisted Bipod Double Tight-Rope Tight-Rope Rockwood Cerclage 



Acromioclavicular joint








Double Tight-Rope


Double Tight-Rope fixation with an additional acromioclavicular FiberTape fixation




Standard deviation



The authors thank Arthrex (Naples, Fl, USA) for donating the double Tight-Ropes, FiberTapes and Sawbones, and Poly-Tapes (Leeds, UK) for donating the tapes used in this study. The authors thank Talmadge Eyre for revising the manuscript for grammar and syntax.

Authors’ contributions

MOS carried out the study design, participated in data acquisition, performed the statistical analysis, and drafted the manuscript. SJ conceived the testing setup, participated in data acquisition, and performed the statistical analysis. GF conceived the testing setup and participated in data acquisition. JGS carried out the study design, conceived the testing setup and revised the manuscript critically. MS conceived and carried out the study design, was involved in clinical interpretation of the data, and revised the manuscript critically. MAS conceived and carried out the study design, gave substantial contribution in interpretation of data, and drafted the manuscript. All authors read and approved the final manuscript.


There is no funding source.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Michael O. Schär
    • 1
    Email author
  • Stefanie Jenni
    • 1
  • Gion Fessel
    • 2
  • Jess G. Snedeker
    • 2
  • Markus Scheibel
    • 3
  • Matthias A. Zumstein
    • 1
  1. 1.Department of Orthopaedic Surgery and TraumatologyInselspital, University of BernBernSwitzerland
  2. 2.Department of OrthopaedicsUniversity of ZurichBalgristSwitzerland
  3. 3.Department of Shoulder and Elbow Surgery, Center for Musculoskeletal SurgeryCharité- Universitaetsmedizin BerlinBerlinGermany

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