The coracoidal insertion of the coracoclavicular ligaments: An anatomic study

Background: Current surgical procedures restoring a dislocated acromioclavicular joint aim to perform an anatomically correct and biomechanically stable reconstruction. However, the coracoidal insertions for the coracoclavicular ligaments have not yet been defined. Purpose: The objective was to evaluate dimension and orientation of the coracoclavicular footprints with respect to bony landmarks for use in anatomic reconstruction of the coracoclavicular ligament complex. Study Design: Descriptive laboratory study. Methods: Twenty-three (17 female, 6 male) fresh-frozen cadaveric human shoulders were dissected, and the coracoclavicular ligaments including the coracoid and the lateral clavicle were exposed. After measurement of bony coracoidal dimensions, the ligaments were dissected and the insertion sites as well as the footprint centers were identified and marked. Each coracoclavicular insertion dimension and its distance to the bony landmarks was recorded. Sex-related differences were calculated. Results: The mean total coracoidal length was 43.1 ± 2.2 mm. The distance from the tip of the coracoid to the precipice, the point at which the undersurface of the coracoid changes from a horizontal to a vertical direction, measured 20.3 ± 2.6 mm. The mean distance from the conoidal center to the medial coracoidal boarder and to the precipice was 1.7 ± 0.7 mm and 16.4 ± 2.4 mm, respectively. The mean distance from the trapezoidal center to the medial border and to the precipice was 8.7 ± 3 mm and 10.9 ± 2.4 mm, respectively. The mean distance between the footprint centers was 10.1 ± 4.2 mm. Conclusion: Reproducible dimensions and orientation of the coracoclavicular footprints are given. Clinical Relevance: Coracoidal anatomic landmarks can be used intraoperatively for an anatomic reconstruction of the coracoclavicular ligaments.