Abstract
Introduction
Despite ongoing discussions for the previous few decades, there is still no consensus regarding the optimal surgical technique for acromioclavicular joint instabilities. The purpose of this study was to determine the impact of various implant materials following arthroscopically assisted stabilization of acromioclavicular joint instabilities on tunnel widening and implant migration. We hypothesized an implant-dependent behavior for tunnel widening and implant migration with differences when comparing acute and chronic acromioclavicular joint instabilities.
Methods
This study compared 105 patients with acromioclavicular joint instabilities that were managed operatively with coracoclavicular double button constructs. Two of the groups containing acute cases were treated with either a double button construct with a wire (TR) or a tape (D) as a central pillar. The two groups with chronic cases were either treated with a wire (T+) or tape D+ as a central pillar and additional hamstring tendon augmentation (+). One central transclavicular–transcoracoidal drill channel was made in the acute cases, while additional medial and lateral drill channels to augment the central pillar with the hamstring tendon were made. The central drill channel in all cases and the medial/lateral drill channels in chronic cases were subsequently radiologically analyzed immediately postoperatively and at follow-up. Following this, additional radiological analysis of the implant migration of the clavicular button took place.
Results
All groups showed significant tunnel widening of the central drill channel at follow-up (p ≤ 0.001). The TR+ technique demonstrated significant widening in both the medial (p ≤ 0.001) and lateral (p ≤ 0.001) drill channels. The D and D+ group displayed significant higher rates of clavicular button migration to a cortical and intraosseous level (p ≤ 0.002).
Conclusion
Tunnel widening and implant migration following arthroscopically assisted management of acromioclavicular joint instabilities are dependent on the chosen implant. The stable tape showed a significantly increased degree of tunnel widening with respect to the central drill channel in comparison with the wire. In contrast, a higher degree of load capacity of the tape ultimately favors a protected intraosseous graft healing for chronic cases, which leads to less tunnel widening of the medial and lateral drill channel. Finally, the D/D+ implant groups showed higher rates of implant migration due to lower contact surface area of the implant at the upper clavicular cortex.
Level of evidence IV.
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Data availability
The datasets analyzed during the current study are included in the published article as well as they are available from the corresponding author on reasonable request.
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Acknowledgements
The authors thank Mr. Robert Maximilian Blach for his organizational and language support.
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RDH was leading the project; principal investigator, data collection and was responsible for writing the manuscript, HEB was the second principal investigator and contributed to the writing of the manuscript, AE was responsible for project management, MH was responsible for project management and data collection, MW was responsible for project management and data collection, BWF was responsible for language edititng and project management, HL was responsible for surgical intervention, participated in the design and conduct of the trial and contributed to the project management, GJ was responsible for project management and contributed to the writing of the manuscript. All authors have revised the manuscript critically for important intellectual content and approved the final version.
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H. Lill is consultant with Arthrex (Naples, USA) and DePuy Synthes (Umkirch, Deutschland). R-O Dey Hazra, H. El Bajjati, A. Ellwein, Brad W Fossum, M. Hanhoff and G. Jensen state that there are no conflicts of interest.
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This study was carried out after consulting with the local institutional ethics committee (Medizinische Hochschule Hannover) and is in accordance with the national legal requirements. All procedures that were performed complied with the ethical standards of the institutional and/or national research committee, as well as with the 1975 Helsinki Declaration and its later amendments or comparable ethical standards.
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Though all patient information is blinded, in this retrospective study, all participants gave their written informed consent to publish the obtained data of the current study.
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Dey Hazra, RO., El Bajjati, H., Hanhoff, M. et al. Implant-dependent behavior of tunnel widening and clavicular button migration after arthroscopic-assisted treatment of acromioclavicular joint instabilities. Eur J Orthop Surg Traumatol 33, 2533–2540 (2023). https://doi.org/10.1007/s00590-022-03466-x
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DOI: https://doi.org/10.1007/s00590-022-03466-x