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Background: This study assessed the feasibility of anatomical coracoclavicular (CC) ligaments reconstruction, using three-dimensional (3D) measurement and virtual drilling., Methods: One-hundred-and-five 3D shoulder models were constructed using SuperImage software, based on computed tomography (CT) scan data. For each model the attachment sites and footprint dimensions of the CC ligaments were defined and adjusted according to constant anatomical ratios and individual measurement results. Different drilling techniques and 3D measurements were carried out separately on each model., Results: The collinear drilling technique with one bundle was used to breach the clavicle and/or coracoid process bone cortex in 38 of 105 models (36.2%); the percentage with two bundles was 90.5% (95/105). No cortical breach was observed using the non-collinear drilling technique., Conclusions: The non-collinear drilling technique provides the capability to prepare bony tunnels without any risk of cortical breach., (Copyright © 2014 John Wiley & Sons, Ltd.)

Background: In this paper we describe and assess the feasibility of a computer-assisted method which could be useful to investigate the mechanism of subacromial impingment of the shoulder., Methods: The relationship between the infraspinatus and supraspinatus and the coracoacromial (CA) arch during passive elevation and abduction are described. The methodology is based on the use of a tracker for recording surfaces and passive movements and data elaboration using dedicated software., Results: In four cadavers, we observed that the minimal distances between the rotator cuff insertions and CA arch were realized at 45 degrees abduction between the acromion and infraspinatus, at 50-90 degrees elevation between the acromion and supraspinatus and also at 45-70 degrees abduction between the CA ligament and supraspinatus. This study showed that the proposed method is able to provide repeatable kinematic data (ICC > or = 0.90), numerical anatomical data comparable with the literature and, moreover, individual measurements on the shoulder joint., Conclusions: This preliminary results support the extension of the methodology to an in vivo protocol to be used during computer-assisted arthroscopic surgery., ((c) 2008 John Wiley & Sons, Ltd.)

There have been several reports about the clavicular and acromioclavicular motion, but a precise motion has been unknown. The purpose of this study was to analyze the 3D kinematics of the clavicle and acromioclavicular joint during arm abduction, using 3D MR images obtained by a vertically open MRI. Seven subjects participated in this investigation, which included 14 shoulders. From a seated position, we obtained MR images of their shoulder in seven abducted positions of the arm in the coronal plane. We evaluated the 3D movements of each bone in the shoulder using the volume-based registration technique, and analyzed the clavicular positions relative to the lung and the scapular positions relative to the clavicle. During arm abduction, the clavicular motion relative to the lung showed 30.6 degrees retraction, 7.3 degrees elevation, and 33.2 degrees posterior axial rotation. During arm abduction, the scapular motion relative to the clavicle showed 15.6 degrees protraction, 21.5 degrees upward rotation, and 22.2 degrees posterior tilting. This study succeeded in describing the 3D clavicular and acromioclavicular motion including the axial rotation of the clavicle, and it revealed that both motions had large degrees of rotations.

Many researchers have evaluated the motions of the shoulder girdle, especially scapular and humeral motion. However, few reports exist that describe motions of the acromioclavicular joint. The purpose of the present study was to analyze the 3D kinematics of the acromioclavicular joint during arm abduction using 3D MR images obtained by a vertically open MRI. Fourteen shoulders of seven volunteers were examined in seven static positions from 0 degrees to the maximum abduction in a seated position. 3D surface models of the clavicle and scapula were created, and the movements of the acromioclavicular joint from 0 degrees to each position were calculated using the volume-based registration technique. From these calculations, the translations were evaluated and the rotational motions were analyzed using the concept of the screw axis. In the anteroposterior direction, the clavicle translated most posteriorly (-1.9 +/- 1.3 mm) at 90 degrees of abduction and most anteriorly (1.6 +/- 2.7 mm) at maximum abduction. In the superoinferior direction, the clavicle translated slightly superiorly (0.9 +/- 1.9 mm). When analyzing relative motion of the scapula with respect to the clavicle, the scapula generally rotated about a specific screw axis passing through the insertions of both the acromioclavicular and the coracoclavicular ligaments on the coracoid process. The average rotation was 34.9 +/- 8.4 degrees.