Work

Biomechanical impact of sagittal plane clavicle hook plate positioning on subacromial stress

Year: 2026

Type: article

Abstract: Introduction: In open reduction and hook plate fixation for high-grade acromioclavicular (AC) joint dislocation, proper placement of the hook plate is crucial in preventing subacromial osteolysis and improving clinical outcomes. This study aimed to identify the optimal sagittal plane positioning of the hook plate to minimize subacromial stress and erosion. Materials and methods: Six pairs of artificial bone models, designed to mimic human clavicle and scapula anatomy, were used to assess the biomechanical effects of three hook plate positions: anterior (group A), neutral (group N), and posterior (group P). Each model was equipped with a 5-hole clavicle hook plate secured with 3.5-mm locking screws. A pressure sensor measured contact pressures and areas under sagittal rotations. The clavicle and scapula were fixed in customized jigs, and physiological loading conditions were simulated with a preload of 20 N and a 70 N upward force on the clavicle. Clavicular rotations of 15° internal and external were applied to evaluate their effect on contact pressures. Results: , p < 0.01). Clavicular rotations significantly increased subacromial pressure and contact area at all plate positions compared to the neutral position (p < 0.01). Conclusion: Posterior position of the hook plate in the sagittal plane significantly reduced subacromial pressure and contact area compared to neutral or anterior positions. Additionally, internal and external rotations of the clavicle further increased subacromial stress, indicating the importance of considering clavicular movement in clinical settings. Within the biomechanical test, these findings suggest that posterior positioning of the hook plate may help attenuate subacromial stress and could thereby have the potential to reduce the likelihood of subacromial bone erosion; however, further clinical or finite-element validation is warranted before this can be translated into a clinical recommendation for the surgical treatment of high-grade AC joint dislocations.

Source: Asia-Pacific Journal of Sports Medicine Arthroscopy Rehabilitation and Technology

DOI: 10.1016/j.asmart.2026.08.004

Authors: Jung-Min Lee, Jae-Hoo Lee

Institutions: Inje University Ilsan Paik Hospital, Keimyung University Dongsan Hospital

Language: English

Topic: Shoulder and Clavicle Injuries

Subfield: Orthopedics and Sports Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $1,000