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Radiographic alterations in clavicular bone tunnel width following anatomic coracoclavicular ligament reconstruction (ACCR) for chronic acromioclavicular joint injuries

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To evaluate tunnel widening and its relationship in loss of reduction and clinical outcomes in patients undergoing anatomic coracoclavicular ligament reconstruction (ACCR) using free tendon grafts for chronic acromioclavicular (AC) joint injuries.

Methods

A retrospective chart review was performed on patients undergoing ACCR for type III–VI AC joint injuries between January 2003 and December 2017. For radiographic analysis, pre- and post-operative coracoclavicular distance (CCD) and tunnel width of the medial and lateral clavicular bone tunnel were measured at the earliest (EPO) and latest postoperative follow-up (LPO). To determine the clinical relevance of improvement in clinical outcome score (American Shoulder and Elbow Surgeons score) substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) thresholds were used.

Results

Twenty-four patients with a mean clinical follow-up of 37 ± 35 months (mean age 44.7 ± 13.4) were included in the study. Both the medial (5.6 ± 0.2 mmEPO–6.6 ± 0.7 mmLPO; p < 0.001) and lateral (5.6 ± 0.5 mmEPO–6.8 ± 1 mmLPO; p < 0.001) clavicular bone tunnel showed significant widening from EPO to LPO. There was a significant loss of reduction at LPO (CCDLPO 10.1 ± 4 mm) compared to EPO (CCDEPO: 6.2 ± 3.8 mm) (p < 0.001). No significant correlation between loss of reduction and medial (p = 0.45; r = − 0.06) or lateral (p = 0.69; r = − 0.06) tunnel widening was found. Alterations in tunnel width were shown having no influence on clinical outcomes.

Conclusion

Patients who underwent ACCR using a free tendon graft for the treatment of chronic type III–VI ACJ injuries showed significant clavicular bone tunnel widening during the postoperative course. No correlation between tunnel widening and loss of reduction was shown with radiographic findings having no influence on clinical benefit and satisfaction.

Study design

Case Series; Level of evidence, IV.

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Funding

The University of Connecticut Health Center/UConn Musculoskeletal Institute has received direct funding and material support from Arthrex Inc. (Naples. Fl). The company had no influence on study design, data collection, or interpretation of the results or the final manuscript.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA

    Daniel P. Berthold, Lukas N. Muench, Colin L. Uyeki, Mark P. Cote & Augustus D. Mazzocca

  2. Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany

    Daniel P. Berthold, Lukas N. Muench, Andreas. B. Imhoff & Knut Beitzel

  3. Arthroscopy and Orthopedic Sportsmedicine, ATOS Orthoparc Clinic, Cologne, Germany

    Knut Beitzel

  4. Department of Trauma, Hand and Reconstructive, Surgery University Hospital Muenster, Muenster, Germany

    Felix Dyrna

Authors
  1. Daniel P. Berthold
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  2. Lukas N. Muench
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  3. Felix Dyrna
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  4. Colin L. Uyeki
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  8. Augustus D. Mazzocca
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Contributions

All authors contributed to the conception and design of the study. DPB, LMM, FU were responsible for acquisition of data and wrote the manuscript. DPB, FD, MPC contributed to analysis and interpretation of data. KB, ABI and ADM contributed as important reviewers of the manuscript. All authors approved the final version of this manuscript.

Corresponding author

Correspondence to Daniel P. Berthold.

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Conflict of interest

Authors Berthold DP., Muench LM, Uyeki CU., Dyrna F., Imhoff AB. declare that they have no conflict of interest. Mazzocca ADM reports research grants from Arthrex Inc., is a consultant for Arthrex Inc. and receives royalties from Arthrex Inc. Cote MP. receives personal fees from Arthroscopy Association of North America (AANA). K.B. is consultant for Arthrex.

Ethical approval

Ethical approval was obtained via Human Research Determination Form to the institutional review board (IRB) of the University of Connecticut (IRB # 17-066-3).

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Berthold, D.P., Muench, L.N., Dyrna, F. et al. Radiographic alterations in clavicular bone tunnel width following anatomic coracoclavicular ligament reconstruction (ACCR) for chronic acromioclavicular joint injuries. Knee Surg Sports Traumatol Arthrosc 29, 2046–2054 (2021). https://doi.org/10.1007/s00167-020-05980-z

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