Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 27, Issue 12, pp 3821–3826 | Cite as

Arthroscopically assisted acromioclavicular joint stabilization leads to significant clavicular tunnel widening in the early post-operative period

  • Siva Thangaraju
  • Serdar Cepni
  • Petra Magosch
  • Mark Tauber
  • Peter Habermeyer
  • Frank MartetschlägerEmail author



Arthroscopically assisted acromioclavicular joint (ACJ) stabilization techniques use bone tunnels in the clavicle and coracoid process. The tunnel size has been shown to have an impact on the fracture risk of clavicle and coracoid. The aim of the present study was to radiographically evaluate the alterations of the clavicular tunnel size in the early post-operative period. It was hypothesized that there would be a significant increase of tunnel size.


Twenty consecutive patients with acute high-grade ACJ (Rockwood type IV–V) injury underwent arthroscopic-assisted ACJ stabilization. The median age of the patients was 40 (26–66) years. For all patients, a single tunnel button–tape construct was used along with an additional ACJ tape cerclage. Radiologic measurements were undertaken on standardized Zanca films at two separate time points, immediate post-operative examination (IPO) and at late post-operative examination (> 4 months; LPO). The LPO radiographs were taken at a median follow-up period of 4.5 (3–6) months. Clavicular tunnel width (CT) and coracoclavicular distance (CCD) were measured using digital calipers by two independent examiners and the results are presented as median, range, and percentage.


The median CCD increased significantly from 9.5 (8–13) mm at IPO to 12 (7–20) mm at LPO (p < 0.05). Median tunnel size showed significant difference from 3 (3–4) mm at IPO to 5 (4–7) mm at LPO (p < 0.05). Despite a significant increase of 2 mm (66.6%) of the initial tunnel size, there was no correlation between tunnel widening and loss of reduction.


Arthroscopic ACJ stabilization with the use of bone tunnels led to a significant increase of clavicular tunnel size in the early post-operative period. This phenomenon carries a higher fracture risk, especially in high-impact athletes, which needs to be considered preoperatively.

Level of evidence



Arthroscopy Acromioclavicular joint Acromioclavicular joint stabilization Acute acromioclavicular joint dislocation Clavicle tunnel widening Clavicle Radiography 



The first author acknowledges the fellowship provided by the Ministry of Health, Malaysia which enabled the attachment at the ATOS Clinic in Munich.


No funding was received for the present study.

Compliance with ethical standards

Conlict of interest

The authors declare that there is no conflict of interest.

Ethical approval

Institutional Review Board (IRB) or Ethical Committee approval obtained at Technical University of Munich (number 233/14).


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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  1. 1.Centre for Shoulder and Elbow SurgeryATOS Clinic MunichMunichGermany
  2. 2.Arthroscopy and Sports Injury Unit, Department of Orthopaedic and TraumatologyHospital Kuala LumpurKuala LumpurMalaysia
  3. 3.Bakırkoy Medical CentreIstanbulTurkey
  4. 4.ATOS ClinicHeidelbergGermany
  5. 5.Department of Traumatology and Sports InjuriesParacelsus Medical UniversitySalzburgAustria
  6. 6.Department for Orthopaedic Sports MedicineTechnical University of MunichMunichGermany

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