Functional and Radiographic Outcomes After Allograft Anatomic Coracoclavicular Ligament Reconstruction

Baran, Sean; Belisle, Jeffrey; Tashjian, Robert Z.

doi:10.1097/bot.0000000000001079

Cited by 20 publications

(21 citation statements)

References 45 publications

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“…Other authors reported no clavicle fractures with use of similar reconstruction constructs. Baran et al 19) evaluated outcomes of 17 patients after CC reconstructions with hamstring allografts. Tendon was passed under the coracoid and fixed over the clavicle through double tunnels, unlikely in our study.…”

Section: Discussionmentioning

confidence: 99%

Clavicular Tunnel Complications after Coracoclavicular Reconstruction in Acute Acromioclavicular Dislocation: Coracoid Loop versus Coracoid Tunnel Fixation

Jeon

Choi

Ha³

et al. 2022

Clin Orthop Surg

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Background The purpose of this study was to compare clavicular tunnel complications after coracoclavicular (CC) reconstruction between a coracoid loop fixation group and a coracoid tunnel fixation group. We hypothesized that clavicular tunnel complications would be more common in the coracoid loop group. Methods This retrospective study evaluated 24 patients who underwent CC reconstruction using coracoid tunnel fixation (n = 14) and coracoid loop fixation (n = 10). Radiographic measurements included the CC distance and clavicular tunnel diameter. Clavicular tunnel complications such as tunnel widening and clavicular tunnel fractures were investigated. Clinical outcomes were assessed using the American Shoulder and Elbow Surgeons Shoulder score and the University of California at Los Angeles Shoulder score. Results The mean follow-up period was 17.5 months (range, 11–38 months). The final clavicular tunnel diameter and the increase in the clavicular tunnel diameter in millimeter and percentage were significantly greater in the coracoid loop group than in the coracoid tunnel group (all p < 0.05). Clavicular tunnel widening more than 100% was found in 5 patients, all belonging to the coracoid loop group. Clavicular tunnel fractures occurred in 3 patients (all in the coracoid loop group). Fracture was associated with severe tunnel widening (more than 100% increase). The mean value of the final clavicular tunnel diameter in patients with fractures was significantly larger than that in patients without (12.7 ± 3.3 mm vs. 8.4 ± 1.5 mm, p = 0.016). Conclusions Clavicular tunnel complications such as significant tunnel widening and fractures after CC reconstructions in acromioclavicular dislocations were common with the coracoid loop fixation technique. A greater clavicular tunnel widening and resultantly enlarged tunnel diameter might increase the risk of fracture through the clavicular tunnel.

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Section: Discussionmentioning

confidence: 99%

Clavicular Tunnel Complications after Coracoclavicular Reconstruction in Acute Acromioclavicular Dislocation: Coracoid Loop versus Coracoid Tunnel Fixation

Jeon

Choi

Ha³

et al. 2022

Clin Orthop Surg

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“…Although, allografts and autografts such as palmaris longus, 60,82 flexor carpi radialis, 82 peroneus longus, 83 and tibialis anterior tendons 84 have been utilized for the treatment of AC joint dislocations, hamstring tendons are most commonly used. 53,64,77,[84][85][86][87] Tendon grafts are used in both acute and chronic AC joint dislocations, however, they are most beneficial in chronic AC joint injuries, since in order to facilitate healing, biological augmentation is needed. 88 Free tendon grafts have been shown to provide superior biomechanical strength compared to the Weaver-Dunn procedure 65,82,87,89 and similar biomechanical strength to suspensory button devices.…”

Section: Reconstruction With Allo-and Autograftsmentioning

confidence: 99%

<p>Optimal Management of Acromioclavicular Dislocation: Current Perspectives</p>

Nolte¹,

Lacheta²,

Dekker³

et al. 2020

ORR

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Injuries to the acromioclavicular (AC) joint are common and mostly involve younger, male individuals. Whereas the majority of AC joint dislocations can be treated nonoperatively with a trial of immobilization, pain medication, cryotherapy, and physiotherapy, there are patients that do not respond well to conservative management and may require surgical treatment. Identifying and treating these patients according to the type and chronicity of AC joint dislocation is paramount. To date, a myriad of surgical techniques have been proposed to address unstable AC joint dislocations and are indicative of the uncertainty that exists in optimal management of these injuries. Historically research has focused on the restoration of the coracoclavicular ligament complex. However, recently the importance of the acromioclavicular capsule and ligaments has been emphasized. This review aims to provide the reader with an overview of current treatment strategies and research, as well as future perspectives.

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“…Several biomechanical studies have demonstrated that large tunnels are associated with an increased fracture risk and with reduced load to failure [ 6 , 7 , 10 , 26 ]. Furthermore, in several studies, progressive tunnel widening was observed during the postoperative course, with differing results regarding loss of reduction [ 1 , 2 , 9 , 16 , 23 , 25 , 28 ]. Influencing factors might be the material and type of AC repair device and associated micro-motions between the bone and suture material as well as heat-induced osteolysis due to the bone drilling.…”

Section: Introductionmentioning

confidence: 99%

Acromioclavicular joint suture button repair leads to coracoclavicular tunnel widening

Dalos

Huber

Wichern

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Purpose Biomechanical evaluation of three different suture button devices used in acromioclavicular joint repair and analysis of their effect on post-testing tunnel widening. Methods Eighteen human shoulder girdles were assigned into three groups with a similar mean bone mineral density. Three different single-tunnel acromioclavicular repair devices were tested: (1) AC TightRope® with FiberWire; (2) AC Dog Bone™ Button with FiberTape; (3) Low Profile AC Repair System. Biomechanical testing was performed simulating the complex movement of the distal clavicle as follows. A vertical load of 80 N was applied continuously. The rotation of the clavicle about its long axis was set at 10° anterior and 30° posterior for 2500 cycles at 0.25 Hz. The horizontal translation of the clavicle was set at 6 mm medial and 6 mm lateral for 10,000 cycles at 1 Hz. The coracoclavicular distance was measured before and after testing. After testing, each sample underwent micro-CT analysis. Following 3D reconstruction, the area of the bone tunnels was measured at five defined cross sections. Results In TightRope® and Dog Bone™ groups, all samples completed testing, whereas in the Low Profile group, three out of six samples showed system failure. The mean absolute difference of coracoclavicular distance after testing was significantly greater in the Low Profile group compared to TightRope® and Dog Bone™ groups (4.3 ± 1.3 mm vs 1.9 ± 0.7 mm vs 1.9 ± 0.8 mm; p = 0.001). Micro-CT analysis of the specimens demonstrated significant tunnel widening in the inferior clavicular and superior coracoid regions in all three groups (p < 0.05). Conclusion Significant tunnel widening can be observed for all devices and is primarily found in the inferior parts of the clavicle and superior parts of the coracoid. The Low Profile AC Repair System showed inferior biomechanical properties compared to the AC TightRope® and AC Dog Bone™ devices. Therefore, clinicians should carefully select the type of acromioclavicular repair device used and need to consider tunnel widening as a complication.

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Functional and Radiographic Outcomes After Allograft Anatomic Coracoclavicular Ligament Reconstruction

Abstract: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Cited by 20 publications

References 45 publications

Clavicular Tunnel Complications after Coracoclavicular Reconstruction in Acute Acromioclavicular Dislocation: Coracoid Loop versus Coracoid Tunnel Fixation

Clavicular Tunnel Complications after Coracoclavicular Reconstruction in Acute Acromioclavicular Dislocation: Coracoid Loop versus Coracoid Tunnel Fixation

<p>Optimal Management of Acromioclavicular Dislocation: Current Perspectives</p>

Acromioclavicular joint suture button repair leads to coracoclavicular tunnel widening

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