Elsevier

Journal of Shoulder and Elbow Surgery

Volume 13, Issue 1, January–February 2004, Pages 51-56
Journal of Shoulder and Elbow Surgery

Original article
Mechanical properties of regenerated coracoacromial ligament after subacromial decompression

https://doi.org/10.1016/j.jse.2003.09.016Get rights and content

Abstract

Recent publications suggest that the coracoacromial ligament regenerates after it has been partially excised during subacromial decompression or acromioplasty. This observation may aid the understanding of the successes and failures of this very commonly performed surgical procedure. This study determines the mechanical properties of the apparently regenerated ligament. Eight regenerated coracoacromial ligaments were excised during revision surgery after subacromial decompression and were taken for mechanical testing. It appears that the ligament does have the ability to re-form relatively quickly after subacromial decompression or acromioplasty but takes time to regain strength. The results indicate that the ligament may possibly regain normal mechanical properties after regeneration times in excess of 3 years.

Section snippets

Materials and methods

During a series of primary open acromioplasty procedures, 7 CALs were excised for mechanical testing as controls. There were 2 female and 5 male patients in this group with a mean age of 59 years (range, 48-66 years). Four of these specimens included part of the acromial bone, whereas the other three had no bone attached to the CAL. Specimens from this group will be referred to as primary ligaments. Eight patients underwent revision surgery with open rotator cuff repair for persistent shoulder

Results

The measured mechanical properties for the primary CALs are shown in Table I. For comparison purposes, the properties of CALs in cadaveric shoulders with rotator cuff tears reported in a previous study11 have been included in Table I. Values determined in the current study are reasonably similar to those reported by Soslowsky et al,11 although the mechanical properties of the primary ligaments in our study tend to be somewhat lower than their reported values. This trend is expected, if we

Discussion

It appears that the CAL does have the ability to re-form relatively quickly after decompression, but it does not regain its normal strength and elasticity for at least 2 or 3 years. A close-up view of the regenerated ligaments revealed a variation in the macroscopic appearance through the thickness of the ligament in several cases (Figure 10). The bursal side of these ligaments seemed in parts to consist of shiny white fibrous tissue. Hypothetically, this may represent emerging normal ligament

Acknowledgements

The authors would like to thank Dr Peter Reily and Mr Roger Emery for providing specimens for the study.

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Supported by the Arthritis and Research Campaign via an equipment grant.

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