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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
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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

Keywords

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

Notes

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.

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).

References

  1. 1.
    Balke M (2017) Diagnosis and treatment of acute acromioclavicular joint injuries. Arch Trauma Res 2017:1–7Google Scholar
  2. 2.
    Baran S, Belisle JG, Granger EK, Tashjian RZ (2018) Functional and radiographic outcomes after allograft anatomic coracoclavicular ligament reconstruction. J Orthop Trauma 32(4):204–210CrossRefGoogle Scholar
  3. 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):S297–303CrossRefGoogle Scholar
  4. 4.
    Baumgarten KM, Altchek DW, Cordasco FA (2006) Arthroscopically assisted acromioclavicular joint reconstruction. Arthroscopy 22(2):2281e1–3228CrossRefGoogle Scholar
  5. 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):387–397CrossRefGoogle Scholar
  6. 6.
    Beitzel K, Obopilwe E, Chowaniec DM, Niver GE, Nowak MD, Hanypsiak BT et al (2011) Biomechanical comparison of arthroscopic repairs for acromioclavicular joint instability: suture button systems without biological augmentation. Am J Sports Med 39(10):2218–2225CrossRefGoogle Scholar
  7. 7.
    Bhullar R, Habib A, Zhang K, de Sa D, Horner NS, Duong A et al (2019) Tunnel osteolysis post-ACL reconstruction: a systematic review examining select diagnostic modalities, treatment options and rehabilitation protocols. Knee Surg Sports Traumatol Arthrosc 27(2):524–533CrossRefGoogle Scholar
  8. 8.
    Braun S, Beitzel K, Buchmann S, Imhoff AB (2015) Arthroscopically assisted treatment of acute dislocations of the acromioclavicular joint. Arthrosc Tech 4(6):e681–e685CrossRefGoogle Scholar
  9. 9.
    Chen YC, Tu YK, Tsai YJ, Tsai YS, Yen CY, Yang SC et al (2018) Assessment of thermal necrosis risk regions for different bone qualities as a function of drilling parameters. Comput Methods Programs Biomed 162:253–261CrossRefGoogle Scholar
  10. 10.
    Chernchujit B, Tischer T, Imhoff AB (2006) Arthroscopic reconstruction of the acromioclavicular joint disruption: surgical technique and preliminary results. Arch Orthop Trauma Surg 126(9):575–581CrossRefGoogle Scholar
  11. 11.
    Clavert P, Meyer A, Boyer P, Gastaud O, Barth J, Duparc F, SFA (2015) Complication rates and types of failure after arthroscopic acute acromioclavicular dislocation fixation. Prospective multicentre study of 116 cases. Orthop Traumatol Surg Res 101(8 Suppl):S313–316CrossRefGoogle Scholar
  12. 12.
    Cook JB, Shaha JS, Rowles DJ, Bottoni CR, Shaha SH, Tokish JM (2012) Early failures with single clavicular transosseous coracoclavicular ligament reconstruction. J Shoulder Elbow Surg 21(12):1746–1752CrossRefGoogle Scholar
  13. 13.
    DeBerardino TM, Pensak MJ, Ferreira J, Mazzocca AD (2010) Arthroscopic stabilization of acromioclavicular joint dislocation using the AC graftrope system. J Shoulder Elbow Surg 19:47–52CrossRefGoogle Scholar
  14. 14.
    El Sallakh SA (2012) Evaluation of arthroscopic stabilization of acute acromioclavicular joint dislocation using the Tight-Rope system. Orthopedics 35:e18–e22CrossRefGoogle Scholar
  15. 15.
    Fauno P, Kaalund S (2005) Tunnel widening after hamstring anterior cruciate ligament reconstruction is influenced by the type of graft fixation used: a prospective randomized study. Arthroscopy 21(11):1337–1341CrossRefGoogle Scholar
  16. 16.
    Gerhardt C, Kraus N, Pauly S, Scheibel M (2013) Arthroscopically assisted stabilization of acute injury to the acromioclavicular joint with the double TightRope™ technique: one-year results. Unfallchirurg 116(2):125–130CrossRefGoogle Scholar
  17. 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. 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
  19. 19.
    Kippe MA, Demetropoulos CK, Baker KC, Jurist KA, Guettler JH (2009) Failure of coracoclavicular artificial graft reconstructions from repetitive rotation. Arthroscopy 25(9):975–982CrossRefGoogle Scholar
  20. 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):1431–1440CrossRefGoogle Scholar
  21. 21.
    Lee S, Bedi A (2016) Shoulder acromioclavicular joint reconstruction options and outcomes. Curr Rev Musculoskelet Med 9(4):368–377CrossRefGoogle Scholar
  22. 22.
    Li X, Ma R, Bedi A et al (2014) Management of acromioclavicular joint injuries. J Bone Jt Surg Am 96(1):73–84CrossRefGoogle Scholar
  23. 23.
    Lim TK, Oh WK (2019) Intraoperative and postoperative complications after arthroscopic coracoclavicular stabilization. Clin Orthop Surg 11(1):103–111CrossRefGoogle Scholar
  24. 24.
    Martetschläger F, Horan MP, Warth RJ, Millett PJ (2013) Complications after anatomic fixation and reconstruction of the coracoclavicular ligaments. Am J Sports Med 41(12):2896–2903CrossRefGoogle Scholar
  25. 25.
    Martetschläger F, Saier T, Weigert A, Herbst E, Winkler M, Henschel J et al (2016) Effect of coracoid drilling for acromioclavicular joint reconstruction techniques on coracoid fracture risk: a biomechanical study. Arthroscopy 32(6):982–987CrossRefGoogle Scholar
  26. 26.
    Martetschläger F, Tauber M, Habermeyer P, Hawi N (2016) Arthroscopically assisted acromioclavicular and coracoclavicular ligament reconstruction for chronic acromioclavicular joint instability. Arthrosc Tech 5(6):e1239–e1246CrossRefGoogle Scholar
  27. 27.
    Milewski MD, Tompkins M, Giugale JM, Carson EW, Miller MD, Diduch DR (2012) Complications related to anatomic reconstruction of the coracoclavicular ligaments. Am J Sports Med 40(7):1628–1634CrossRefGoogle Scholar
  28. 28.
    Millett PJ, Horan MP, Warth RJ (2015) Two-year outcomes after primary anatomic coracoclavicular ligament reconstruction. Arthroscopy 31(10):1962–1973CrossRefGoogle Scholar
  29. 29.
    Pallis M, Cameron KL, Svoboda SJ, Owens BD (2012) Epidemiology of acromioclavicular joint injury in young athletes. Am J Sports Med 40:2072–2077CrossRefGoogle Scholar
  30. 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
  31. 31.
    Salzmann GM, Walz L, Buchmann S, Glabgly P, Venjakob A, Imhoff AB (2010) Arthroscopically assisted 2-bundle anatomical reduction of acute acromioclavicular joint separations. Am J Sports Med 38(6):1179–1187CrossRefGoogle Scholar
  32. 32.
    Scheibel M, Dröschel S, Gerhardt C, Kraus N (2011) Arthroscopically assisted stabilization of acute high-grade acromioclavicular joint separations. Am J Sports Med 39(7):1507–1516CrossRefGoogle Scholar
  33. 33.
    Shin SJ, Kim NK (2015) Complications after arthroscopic coracoclavicular reconstruction using a single adjustable-loop-length suspensory fixation device in acute acromioclavicular joint dislocation. Arthroscopy 31(5):816–824CrossRefGoogle Scholar
  34. 34.
    Singh B, Mohanlal P, Bawale R (2016) Early failure of coracoclavicular ligament reconstruction using TightRope system. Acta Orthop Belg 82(1):119–123Google Scholar
  35. 35.
    Spiegl UJ, Smith SD, Euler SA, Dornan GJ, Millett PJ, Wijdicks CA (2014) Biomechanical consequences of coracoclavicular reconstruction techniques on clavicle strength. Am J Sports Med 42(7):1724–1730CrossRefGoogle Scholar
  36. 36.
    Sun LJ, Lu D, Tao ZY, Yu XB, Hu W, Ma YF et al (2019) Analysis of risk factors for loss of reduction after acromioclavicular joint dislocation treated with the suture-button. J Orthop Sci 1:4.  https://doi.org/10.1016/j.jos.2019.01.014 Google Scholar
  37. 37.
    Tauber M (2013) Management of acute acromioclavicular joint dislocations: current concepts. Arch Orthop Trauma Surg 133(7):985–995CrossRefGoogle Scholar
  38. 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 Google Scholar
  39. 39.
    Venjakob AJ, Salzmann GM, Gabel F, Buchmann S, Walz L, Spang JT et al (2013) Arthroscopically assisted 2-bundle anatomic reduction of acute acromioclavicular joint separations: 58-month findings. Am J Sports Med 41(3):615–621CrossRefGoogle Scholar
  40. 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
  41. 41.
    Voss A, Beitzel K, Alaee F, Dukas A, Herbst E, Obopilwe E et al (2016) A Biomechanical analysis of different clavicular tunnel diameters in anatomic acromioclavicular ligament reconstruction. Arthroscopy 32(8):1551–1557CrossRefGoogle Scholar
  42. 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.e1–5CrossRefGoogle Scholar
  43. 43.
    Wolf EM, Pennington WT (2001) Arthroscopic reconstruction for acromioclavicular joint dislocation. Arthroscopy 17(5):558–563CrossRefGoogle Scholar
  44. 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
  45. 45.
    Wylie JD, Johnson JD, DiVenere J, Mazzocca AD (2018) Shoulder acromioclavicular and coracoclavicular ligament injuries: common problems and solutions. Clin Sports Med 37(2):197–207CrossRefGoogle Scholar
  46. 46.
    Yoo JC, Choi NH, Kim SY, Lim TK (2006) Distal clavicle tunnel widening after coracoclavicular ligament reconstruction with semitendinosus tendon: a case report. J Shoulder Elbow Surg 15(2):256–259CrossRefGoogle Scholar

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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