Clavicular Tunnel Widening After Acromioclavicular Stabilization Shows Implant-Dependent Correlation With Postoperative Loss of Reduction

Bellmann, Frederik; Eckl, Larissa; Vetter, Petra; Audigé, Laurent; Scheibel, Markus

doi:10.1016/j.arthro.2023.05.014

Cited by 8 publications

(1 citation statement)

References 41 publications

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“…Osteolysis with the use of nonabsorbable PEEK suture anchors also occurs, although at a lower rate compared with bioabsorbable counterparts 21,22 . Separately, suspensory fixation has been associated with tunnel widening in acromioclavicular stabilization procedures but is suspected to be due to a windshield wiper effect from the suture on bone 23 . Implant selection is a modifiable risk factor that plays a role in both regaining stability but also decreasing the risk of fracture postoperatively.…”

Section: Discussionmentioning

confidence: 99%

Proximal Tibia Fracture Through Suture Augmentation Sites Following ACL/MCL Repairs

Feeley,

Kamali,

Colantonio

et al. 2024

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Case: A 35-year-old man sustained a proximal tibia fracture from a low-energy mechanism 1 year after anterior cruciate and medial collateral ligament repairs with suture augmentation (SA). The fracture propagated through both tibial SA anchor sites. Following intramedullary tibial nailing, he returned to his prior level of function. Conclusion: While complications of SA for ligamentous procedures are rare, these techniques are being implemented more frequently and the full complication profile is yet to be determined. Our report documents a new complication and potential risk factors that surgeons should consider when performing SA for multiligament knee surgery in active individuals.

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Section: Discussionmentioning

confidence: 99%

Proximal Tibia Fracture Through Suture Augmentation Sites Following ACL/MCL Repairs

Feeley,

Kamali,

Colantonio

et al. 2024

JBJS Case Connector

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Clavicular tunnel widening in chronic acromioclavicular joint instabilities after primary versus revision arthroscopically‐assisted acromio‐ and coracoclavicular stabilization

Vetter,

Bellmann,

Eckl

et al. 2024

J. exp. orthop.

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PurposeTo evaluate joint reduction (loss of reduction [LOR]; dynamic posterior translation [DPT]) and clavicular tunnel widening (cTW) in patients treated with arthroscopically‐assisted acromioclavicular joint (ACJ) stabilization after previously failed nonoperative versus surgical treatment.MethodsPatients undergoing arthroscopically‐assisted ACJ stabilization (bidirectional tendon allograft with a low‐profile TightRope) after previously failed nonoperative versus surgical treatment were included retrospectively. Bilateral anteroposterior stress views served for evaluating LOR (side‐comparative coracoclavicular distance [CCD]) and cTW at a 6‐weeks‐ and 6‐months‐follow‐up (FU) and for evaluating the filling ratio (FR, vertical device insertion depth relative to clavicle height) at the 6‐weeks‐FU. Postoperative DPT was assessed on Alexander's views.ResultsTwenty‐seven patients (20 male, mean age 46.1 ± 14.8 years) were included (prior treatment: nonoperative: n = 15; surgical: n = 12). There were no differences in LOR, DPT or cTW between groups postoperatively. Initial CCD‐symmetry at the 6‐weeks‐FU (CCD: −0.1 mm [95% confidence interval, CI, −2 to 1.4 mm]) was followed by LOR at the 6‐months‐FU (CCD: −3.5 mm [95% CI, −5.2 to −1.9 mm]; p < 0.001). cTW increased towards the inferior cortex, compared to the superior cortex and the intermediate level (p < 0.001, respectively). cTW at the inferior cortex was associated with more LOR (r = −0.449; p = 0.024) and DPT (r = 0.421; p = 0.036), dependent on a smaller FR (r = −0.430; p = 0.032).ConclusionPatients undergoing arthroscopically‐assisted ACJ stabilization for chronic bidirectional ACJ instabilities showed comparable radiologic results after previous nonoperative versus surgical treatment. cTW increased towards the inferior cortex and was associated with recurrent vertical and horizontal instability, related to a smaller FR. More research into reduced cTW, for example, by a more filling device, should be performed.Level of EvidenceLevel III, retrospective comparative study.

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Tendon graft through the coracoid tunnel versus under the coracoid for coracoclavicular/acromioclavicular reconstruction shows no difference in radiographic or patient-reported outcomes

Ranne,

Kainonen,

Kanto

et al. 2024

Arch Orthop Trauma Surg

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Introduction The purpose of this prospective study was to report the outcomes of two different methods in CC and AC reconstruction for the treatment of AC separation using a tendon graft and knot-hiding titanium clavicular implant. Materials and methods Twenty-seven patients with Rockwood grade III and V acromioclavicular (AC) separations were randomized into two groups. The primary outcome was whether taking the tendon graft through the coracoid risked a fracture. The following were secondary outcomes: follow-up of clavicular wound healing and Nottingham Clavicle score, Constant score, and Simple Shoulder Test results obtained preoperatively and 24 months postoperatively. The anteroposterior radiographic change between the clavicular and coracoid cortexes and the clavicular tunnel diameter was measured postoperatively and 24 months postoperatively. General patient satisfaction with the outcome (poor, fair, good, or excellent) was assessed 2 years postoperatively. Results No coracoid fractures were detected. No issues in clavicular wound healing were detected. The mean Nottingham Clavicle score increased from a preoperative mean of 42.42 ± 13.42 to 95.31 ± 14.20 (P < 0.00). The Constant score increased from a preoperative mean of 50.81 ± 17.77 to 96.42 ± 11.51 (P < 0.001). The Simple Shoulder Test score increased from a preoperative mean of 7.50 ± 2.45 to 11.77 ± 1.18 (P < 0.001). The changes were significant. The coracoclavicular distance increased from 11.88 ± 4.00 to 14.19 ± 4.71 mm (P = 0.001), which was significant. The clavicular drill hole diameter increased from 5.5 to a mean of 8.00 ± 0.75 mm. General patient satisfaction was excellent. Conclusions There were no significant differences between the two groups. There were no implant related complications in the clavicular wound healing. The results support the notion that good results are achieved by reconstructing both the CC and AC ligaments with a tendon graft. Study registration This clinical trial was registered on Clinicaltrials.gov.

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Clavicular Tunnel Widening After Acromioclavicular Stabilization Shows Implant-Dependent Correlation With Postoperative Loss of Reduction

Cited by 8 publications

References 41 publications

Proximal Tibia Fracture Through Suture Augmentation Sites Following ACL/MCL Repairs

Proximal Tibia Fracture Through Suture Augmentation Sites Following ACL/MCL Repairs

Clavicular tunnel widening in chronic acromioclavicular joint instabilities after primary versus revision arthroscopically‐assisted acromio‐ and coracoclavicular stabilization

Tendon graft through the coracoid tunnel versus under the coracoid for coracoclavicular/acromioclavicular reconstruction shows no difference in radiographic or patient-reported outcomes

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