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

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusion

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

IV

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Acknowledgements

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

Funding

No funding was received for the present study.

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Authors and Affiliations

  1. Centre for Shoulder and Elbow Surgery, ATOS Clinic Munich, Effnerstr 38, 81925, Munich, Germany

    Siva Thangaraju, Serdar Cepni, Mark Tauber, Peter Habermeyer & Frank Martetschläger

  2. Arthroscopy and Sports Injury Unit, Department of Orthopaedic and Traumatology, Hospital Kuala Lumpur, Jalan Pahang, Wilayah Persekutuan, 50586, Kuala Lumpur, Malaysia

    Siva Thangaraju

  3. Bakırkoy Medical Centre, Istanbul, Turkey

    Serdar Cepni

  4. ATOS Clinic, Bismarck Str 9-15, 69115, Heidelberg, Germany

    Petra Magosch

  5. Department of Traumatology and Sports Injuries, Paracelsus Medical University, Salzburg, Austria

    Mark Tauber

  6. Department for Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str 22, 80333, Munich, Germany

    Frank Martetschläger

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  1. Siva Thangaraju
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  2. Serdar Cepni
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Correspondence to Frank Martetschläger.

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Thangaraju, S., Cepni, S., Magosch, P. et al. Arthroscopically assisted acromioclavicular joint stabilization leads to significant clavicular tunnel widening in the early post-operative period. Knee Surg Sports Traumatol Arthrosc 27, 3821–3826 (2019). https://doi.org/10.1007/s00167-019-05662-5

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