Arthroscopically assisted acromioclavicular joint stabilization leads to significant clavicular tunnel widening in the early post-operative period
- 140 Downloads
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
KeywordsArthroscopy 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.
Institutional Review Board (IRB) or Ethical Committee approval obtained at Technical University of Munich (number 233/14).
- 1.Balke M (2017) Diagnosis and treatment of acute acromioclavicular joint injuries. Arch Trauma Res 2017:1–7Google Scholar
- 3.Barth J, Duparc F, Andrieu K, Duport M, Toussaint B, Bertiaux S et al (2015) French Society of Arthroscopy. Is coracoclavicular stabilisation alone sufficient for the endoscopic treatment of severe acromioclavicular joint dislocation (Rockwood types III, IV, and V). Orthop Traumatol Surg Res 101(8 Suppl):S297–303PubMedGoogle Scholar
- 4.Baumgarten KM, Altchek DW, Cordasco FA (2006) Arthroscopically assisted acromioclavicular joint reconstruction. Arthroscopy 22(2):2281e1–3228Google Scholar
- 5.Beitzel K, Cote MP, Apostolakos J, Solovyova O, Judson CH, Ziegler CG et al (2013) Current concepts in the treatment of acromioclavicular joint dislocations. Arthroscopy 29(2):387–397Google Scholar
- 17.Gowd AK, Liu JN, Cabarcas BC, Cvetanovich GL, Garcia GH, Manderle BJ et al (2018) Current concepts in the operative management of acromioclavicular dislocations: a systematic review and meta-analysis of operative techniques. Am J Sports Med 2018:1–15Google Scholar
- 18.Hou Z, Graham J, Zhang Y, Strohecker K, Feldmann D, Bowen TR et al (2014) Comparison of single and two-tunnel techniques during open treatment of acromioclavicular joint disruption. BMC Surg 14(53):1–7Google Scholar
- 20.Kraus N, Haas NP, Scheibel M, Gerhardt C (2013) Arthroscopically assisted stabilization of acute high-grade acromioclavicular joint separations in a coracoclavicular Double-Tight Rope technique: V-shaped versus parallel drill hole orientation. Arch Orthop Trauma Surg 133(10):1431–1440PubMedGoogle Scholar
- 22.Li X, Ma R, Bedi A et al (2014) Management of acromioclavicular joint injuries. J Bone Jt Surg Am 96(1):73–84Google Scholar
- 30.Rockwood CJ, Williams G, Young D (2004) Disorders of the acromioclavicular joint. In: Rockwood CA, Matsen FA, Wirth MA, Lippitt SB (eds) The shoulder, 3rd edn. WB Saunders, Philadelphia, pp 521–595Google Scholar
- 38.Thangaraju S, Tauber M, Habermeyer P, Martetschläger F (2019) Clavicle and coracoid process periprosthetic fractures as late post-operative complications in arthroscopically assisted acromioclavicular joint stabilization. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-019-05482-7 CrossRefPubMedGoogle Scholar
- 40.Virtanen KJ, Savolainen V, Tulikoura I, Remes V, Haapamäki V, Pajarinen J et al (2014) Surgical treatment of chronic acromioclavicular joint dislocation with autogenous tendon grafts. Springerplus 3(420):1–8Google Scholar
- 42.Wellmann M, Zantop T, Petersen W (2007) Minimally invasive coracoclavicular ligament augmentation with a flip button/polydioxanone repair for treatment of total acromioclavicular joint dislocation. Arthroscopy 23(10):1132.e1–5Google Scholar
- 44.Woodmass JM, Esposito JG, Ono Y, Nelson AA, Boorman RS, Thornton GM et al (2015) Complications following arthroscopic fixation of acromioclavicular separations: a systematic review of the literature. Open Access J Sports Med 10(6):97–107Google Scholar