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25.04.2020 | SHOULDER

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

verfasst von: Daniel P. Berthold, Lukas N. Muench, Felix Dyrna, Colin L. Uyeki, Mark P. Cote, Andreas. B. Imhoff, Knut Beitzel, Augustus D. Mazzocca

Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy | Ausgabe 7/2021

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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.
Literatur
1.
Zurück zum Zitat 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 29:387–397CrossRef 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 29:387–397CrossRef
2.
Zurück zum Zitat Beitzel K, Mazzocca AD, Bak K, Itoi E, Kibler WB, Mirzavan R et al (2014) ISAKOS upper extremity committee consensus statement on the need for diversification of the Rockwood classification for acromioclavicular joint injuries. Arthroscopy 30:271–278CrossRef Beitzel K, Mazzocca AD, Bak K, Itoi E, Kibler WB, Mirzavan R et al (2014) ISAKOS upper extremity committee consensus statement on the need for diversification of the Rockwood classification for acromioclavicular joint injuries. Arthroscopy 30:271–278CrossRef
3.
Zurück zum Zitat 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 27:524–533CrossRef 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 27:524–533CrossRef
4.
Zurück zum Zitat Borbas P, Churchill J, Ek ET (2019) Surgical management of chronic high-grade acromioclavicular joint dislocations: a systematic review. J Shoulder Elbow Surg 28:2031–2038CrossRef Borbas P, Churchill J, Ek ET (2019) Surgical management of chronic high-grade acromioclavicular joint dislocations: a systematic review. J Shoulder Elbow Surg 28:2031–2038CrossRef
5.
Zurück zum Zitat Carofino BC, Mazzocca AD (2010) The anatomic coracoclavicular ligament reconstruction: surgical technique and indications. J Shoulder Elbow Surg 19:37–46CrossRef Carofino BC, Mazzocca AD (2010) The anatomic coracoclavicular ligament reconstruction: surgical technique and indications. J Shoulder Elbow Surg 19:37–46CrossRef
6.
Zurück zum Zitat 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 21:1746–1752CrossRef 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 21:1746–1752CrossRef
7.
Zurück zum Zitat Costic RS, Labriola JE, Rodosky MW, Debski RE (2004) Biomechanical rationale for development of anatomical reconstructions of coracoclavicular ligaments after complete acromioclavicular joint dislocations. Am J Sports Med 32:1929–1936CrossRef Costic RS, Labriola JE, Rodosky MW, Debski RE (2004) Biomechanical rationale for development of anatomical reconstructions of coracoclavicular ligaments after complete acromioclavicular joint dislocations. Am J Sports Med 32:1929–1936CrossRef
8.
Zurück zum Zitat Cvetanovich GL, Gowd AK, Liu JN, Nwachukwu BU, Cabarcas BC, Cole BJ et al (2019) Establishing clinically significant outcome after arthroscopic rotator cuff repair. J Shoulder Elbow Surg 28:939–948CrossRef Cvetanovich GL, Gowd AK, Liu JN, Nwachukwu BU, Cabarcas BC, Cole BJ et al (2019) Establishing clinically significant outcome after arthroscopic rotator cuff repair. J Shoulder Elbow Surg 28:939–948CrossRef
9.
Zurück zum Zitat Dumont GD, Russell RD, Knight JR, Hotchkiss WR, Pierce WA, Wilson PL et al (2013) Impact of tunnels and tenodesis screws on clavicle fracture: a biomechanical study of varying coracoclavicular ligament reconstruction techniques. Arthroscopy 29:1604–1607CrossRef Dumont GD, Russell RD, Knight JR, Hotchkiss WR, Pierce WA, Wilson PL et al (2013) Impact of tunnels and tenodesis screws on clavicle fracture: a biomechanical study of varying coracoclavicular ligament reconstruction techniques. Arthroscopy 29:1604–1607CrossRef
11.
Zurück zum Zitat Dyrna F, Imhoff FB, Haller B, Braun S, Obopilwe E, Apostolakos JM et al (2018) Primary stability of an acromioclavicular joint repair is affected by the type of additional reconstruction of the acromioclavicular capsule. Am J Sports Med 46:3471–3479CrossRef Dyrna F, Imhoff FB, Haller B, Braun S, Obopilwe E, Apostolakos JM et al (2018) Primary stability of an acromioclavicular joint repair is affected by the type of additional reconstruction of the acromioclavicular capsule. Am J Sports Med 46:3471–3479CrossRef
12.
Zurück zum Zitat Dyrna FGE, Imhoff FB, Voss A, Braun S, Obopilwe E, Apostolakos JM et al (2018) The integrity of the acromioclavicular capsule ensures physiological centering of the acromioclavicular joint under rotational loading. Am J Sports Med 46:1432–1440CrossRef Dyrna FGE, Imhoff FB, Voss A, Braun S, Obopilwe E, Apostolakos JM et al (2018) The integrity of the acromioclavicular capsule ensures physiological centering of the acromioclavicular joint under rotational loading. Am J Sports Med 46:1432–1440CrossRef
13.
Zurück zum Zitat Geaney LE, Beitzel K, Chowaniec DM, Cote MP, Apostolakos J, Arciero RA et al (2013) Graft fixation is highest with anatomic tunnel positioning in acromioclavicular reconstruction. Arthroscopy 29:434–439CrossRef Geaney LE, Beitzel K, Chowaniec DM, Cote MP, Apostolakos J, Arciero RA et al (2013) Graft fixation is highest with anatomic tunnel positioning in acromioclavicular reconstruction. Arthroscopy 29:434–439CrossRef
14.
Zurück zum Zitat Gowd AK, Liu JN, Cabarcas BC, Cvetanovich GL, Garcia GH, Manderle BJ et al (2019) Current concepts in the operative management of acromioclavicular dislocations: a systematic review and meta-analysis of operative techniques. Am J Sports Med 47:2745–2758CrossRef Gowd AK, Liu JN, Cabarcas BC, Cvetanovich GL, Garcia GH, Manderle BJ et al (2019) Current concepts in the operative management of acromioclavicular dislocations: a systematic review and meta-analysis of operative techniques. Am J Sports Med 47:2745–2758CrossRef
15.
Zurück zum Zitat Grover DM, Howell SM, Hull ML (2005) Early tension loss in an anterior cruciate ligament graft. A cadaver study of four tibial fixation devices. J Bone Joint Surg Am 87:381–390CrossRef Grover DM, Howell SM, Hull ML (2005) Early tension loss in an anterior cruciate ligament graft. A cadaver study of four tibial fixation devices. J Bone Joint Surg Am 87:381–390CrossRef
16.
Zurück zum Zitat Grutter PW, Petersen SA (2005) Anatomical acromioclavicular ligament reconstruction: a biomechanical comparison of reconstructive techniques of the acromioclavicular joint. Am J Sports Med 33:1723–1728CrossRef Grutter PW, Petersen SA (2005) Anatomical acromioclavicular ligament reconstruction: a biomechanical comparison of reconstructive techniques of the acromioclavicular joint. Am J Sports Med 33:1723–1728CrossRef
17.
Zurück zum Zitat Harris JD, Brand JC, Cote MP, Faucett SC, Dhawan A (2017) Research pearls: the significance of statistics and perils of pooling. Part 1: Clinical versus statistical significance. Arthroscopy 33:1102–1112CrossRef Harris JD, Brand JC, Cote MP, Faucett SC, Dhawan A (2017) Research pearls: the significance of statistics and perils of pooling. Part 1: Clinical versus statistical significance. Arthroscopy 33:1102–1112CrossRef
18.
Zurück zum Zitat Koo TK, Li MY (2016) A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med 15:155–163CrossRef Koo TK, Li MY (2016) A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med 15:155–163CrossRef
19.
Zurück zum Zitat Mazzocca AD, Conway JE, Johnson S, Rios CG, Dumonski ML, Santangelo SA et al (2004) The anatomic coracoclavicular ligament reconstruction. Oper Tech Sports Med 12:56–61CrossRef Mazzocca AD, Conway JE, Johnson S, Rios CG, Dumonski ML, Santangelo SA et al (2004) The anatomic coracoclavicular ligament reconstruction. Oper Tech Sports Med 12:56–61CrossRef
20.
Zurück zum Zitat Mazzocca AD, Santangelo SA, Johnson ST, Rios CG, Dumonski ML, Arciero RA (2006) A biomechanical evaluation of an anatomical coracoclavicular ligament reconstruction. Am J Sports Med 34:236–246CrossRef Mazzocca AD, Santangelo SA, Johnson ST, Rios CG, Dumonski ML, Arciero RA (2006) A biomechanical evaluation of an anatomical coracoclavicular ligament reconstruction. Am J Sports Med 34:236–246CrossRef
21.
Zurück zum Zitat Millett PJ, Horan MP, Warth RJ (2015) Two-year outcomes after primary anatomic coracoclavicular ligament reconstruction. Arthroscopy 31:1962–1973CrossRef Millett PJ, Horan MP, Warth RJ (2015) Two-year outcomes after primary anatomic coracoclavicular ligament reconstruction. Arthroscopy 31:1962–1973CrossRef
23.
Zurück zum Zitat Richards RR, An K-N, Bigliani LU, Friedman RJ, Gartsman GM, Gristina AG et al (1994) A standardized method for the assessment of shoulder function. J Shoulder Elbow 3:347–352CrossRef Richards RR, An K-N, Bigliani LU, Friedman RJ, Gartsman GM, Gristina AG et al (1994) A standardized method for the assessment of shoulder function. J Shoulder Elbow 3:347–352CrossRef
24.
Zurück zum Zitat Rockwood C (1998) Disorders of the acromioclavicular joint. In: Rockwood CA, Matsen FA (eds) The shoulder, vol 1. WB Saunders Company, Pennsylvania Rockwood C (1998) Disorders of the acromioclavicular joint. In: Rockwood CA, Matsen FA (eds) The shoulder, vol 1. WB Saunders Company, Pennsylvania
25.
Zurück zum Zitat Rolf O, von Weyhern AH, Ewers A, Boehm TD, Gohlke F (2008) Acromioclavicular dislocation Rockwood III–V: results of early versus delayed surgical treatment. Arch Orthop Trauma Surg 128:1153–1157CrossRef Rolf O, von Weyhern AH, Ewers A, Boehm TD, Gohlke F (2008) Acromioclavicular dislocation Rockwood III–V: results of early versus delayed surgical treatment. Arch Orthop Trauma Surg 128:1153–1157CrossRef
26.
Zurück zum Zitat Roos PJ, Hull ML, Howell SM (2004) Lengthening of double-looped tendon graft constructs in three regions after cyclic loading: a study using Roentgen stereophotogrammetric analysis. J Orthop Res 22:839–846CrossRef Roos PJ, Hull ML, Howell SM (2004) Lengthening of double-looped tendon graft constructs in three regions after cyclic loading: a study using Roentgen stereophotogrammetric analysis. J Orthop Res 22:839–846CrossRef
27.
Zurück zum Zitat 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 42:1724–1730CrossRef 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 42:1724–1730CrossRef
28.
Zurück zum Zitat Taketomi S, Inui H, Sanada T, Yamagami R, Tanaka S, Nakagawa T (2014) Eccentric femoral tunnel widening in anatomic anterior cruciate ligament reconstruction. Arthroscopy 30:701–709CrossRef Taketomi S, Inui H, Sanada T, Yamagami R, Tanaka S, Nakagawa T (2014) Eccentric femoral tunnel widening in anatomic anterior cruciate ligament reconstruction. Arthroscopy 30:701–709CrossRef
29.
Zurück zum Zitat Tauber M, Eppel M, Resch H (2007) Acromioclavicular reconstruction using autogenous semitendinosus tendon graft: results of revision surgery in chronic cases. J Shoulder Elbow Surg 16:429–433CrossRef Tauber M, Eppel M, Resch H (2007) Acromioclavicular reconstruction using autogenous semitendinosus tendon graft: results of revision surgery in chronic cases. J Shoulder Elbow Surg 16:429–433CrossRef
32.
Zurück zum Zitat Tohyama H, Beynnon BD, Johnson RJ, Renstrom PA, Arms SW (1996) The effect of anterior cruciate ligament graft elongation at the time of implantation on the biomechanical behavior of the graft and knee. Am J Sports Med 24:608–614CrossRef Tohyama H, Beynnon BD, Johnson RJ, Renstrom PA, Arms SW (1996) The effect of anterior cruciate ligament graft elongation at the time of implantation on the biomechanical behavior of the graft and knee. Am J Sports Med 24:608–614CrossRef
33.
Zurück zum Zitat 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 32:1551–1557CrossRef 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 32:1551–1557CrossRef
34.
Zurück zum Zitat Yoo JC, Choi NH, Kim SY, Lim TK (2006) Distal clavicle tunnel widening after coracoclavicular ligament reconstruction with semitendinous tendon: a case report. J Shoulder Elbow Surg 15:256–259CrossRef Yoo JC, Choi NH, Kim SY, Lim TK (2006) Distal clavicle tunnel widening after coracoclavicular ligament reconstruction with semitendinous tendon: a case report. J Shoulder Elbow Surg 15:256–259CrossRef
35.
Zurück zum Zitat Zanca P (1971) Shoulder pain: involvement of the acromioclavicular joint. (Analysis of 1,000 cases). Am J Roentgenol Radium Ther Nucl Med 112:493–506CrossRef Zanca P (1971) Shoulder pain: involvement of the acromioclavicular joint. (Analysis of 1,000 cases). Am J Roentgenol Radium Ther Nucl Med 112:493–506CrossRef
Metadaten
Titel
Radiographic alterations in clavicular bone tunnel width following anatomic coracoclavicular ligament reconstruction (ACCR) for chronic acromioclavicular joint injuries
verfasst von
Daniel P. Berthold
Lukas N. Muench
Felix Dyrna
Colin L. Uyeki
Mark P. Cote
Andreas. B. Imhoff
Knut Beitzel
Augustus D. Mazzocca
Publikationsdatum
25.04.2020
Verlag
Springer Berlin Heidelberg
Erschienen in
Knee Surgery, Sports Traumatology, Arthroscopy / Ausgabe 7/2021
Print ISSN: 0942-2056
Elektronische ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-020-05980-z

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