Siva Thangaraju1,2, Serdar Cepni1,3, Petra Magosch4, Mark Tauber1,5, Peter Habermeyer1, Frank Martetschläger6,7. 1. Centre for Shoulder and Elbow Surgery, ATOS Clinic Munich, Effnerstr 38, 81925, Munich, Germany. 2. Arthroscopy and Sports Injury Unit, Department of Orthopaedic and Traumatology, Hospital Kuala Lumpur, Jalan Pahang, Wilayah Persekutuan, 50586, Kuala Lumpur, Malaysia. 3. Bakırkoy Medical Centre, Istanbul, Turkey. 4. ATOS Clinic, Bismarck Str 9-15, 69115, Heidelberg, Germany. 5. Department of Traumatology and Sports Injuries, Paracelsus Medical University, Salzburg, Austria. 6. Centre for Shoulder and Elbow Surgery, ATOS Clinic Munich, Effnerstr 38, 81925, Munich, Germany. frank.martetschlaeger@atos.de. 7. Department for Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str 22, 80333, Munich, Germany. frank.martetschlaeger@atos.de.
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.
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.
Authors: Xinning Li; Richard Ma; Asheesh Bedi; David M Dines; David W Altchek; Joshua S Dines Journal: J Bone Joint Surg Am Date: 2014-01-01 Impact factor: 5.284
Authors: Matthew D Milewski; Marc Tompkins; Juan M Giugale; Eric W Carson; Mark D Miller; David R Diduch Journal: Am J Sports Med Date: 2012-05-02 Impact factor: 6.202
Authors: Jarret M Woodmass; John G Esposito; Yohei Ono; Atiba A Nelson; Richard S Boorman; Gail M Thornton; Ian Ky Lo Journal: Open Access J Sports Med Date: 2015-04-10
Authors: Daniel P Berthold; Lukas N Muench; Knut Beitzel; Simon Archambault; Aulon Jerliu; Mark P Cote; Bastian Scheiderer; Andreas B Imhoff; Robert A Arciero; Augustus D Mazzocca Journal: Orthop J Sports Med Date: 2020-09-16
Authors: Daniel P Berthold; Lukas N Muench; Felix Dyrna; Colin L Uyeki; Mark P Cote; Andreas B Imhoff; Knut Beitzel; Augustus D Mazzocca Journal: Knee Surg Sports Traumatol Arthrosc Date: 2020-04-25 Impact factor: 4.342
Authors: Juha O Ranne; Severi O Salonen; Terho U Kainonen; Jussi A Kosola; Lasse L Lempainen; Mika T Siitonen; Pekka T Niemi Journal: Arthrosc Sports Med Rehabil Date: 2021-08-27
Authors: Marco-Christopher Rupp; Pavel M Kadantsev; Sebastian Siebenlist; Maximilian Hinz; Matthias J Feucht; Jonas Pogorzelski; Bastian Scheiderer; Andreas B Imhoff; Lukas N Muench; Daniel P Berthold Journal: Knee Surg Sports Traumatol Arthrosc Date: 2022-04-22 Impact factor: 4.114