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

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

doi:10.1007/s00167-020-05980-z

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

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

Associate Professorship of Sports Orthopaedy

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30 Scopus citations

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 mm_EPO–6.6 ± 0.7 mm_LPO;p < 0.001) and lateral (5.6 ± 0.5 mm_EPO–6.8 ± 1 mm_LPO; p < 0.001) clavicular bone tunnel showed significant widening from EPO to LPO. There was a significant loss of reduction at LPO (CCD_LPO 10.1 ± 4 mm) compared to EPO (CCD_EPO: 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.

Original language	English
Pages (from-to)	2046-2054
Number of pages	9
Journal	Knee Surgery, Sports Traumatology, Arthroscopy
Volume	29
Issue number	7
DOIs	https://doi.org/10.1007/s00167-020-05980-z
State	Published - Jul 2021

Keywords

AC joint
ACCR
Acromioclavicular joint injury
Anatomic coracoclavicular ligament reconstruction
Loss of reduction
Tunnel widening

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10.1007/s00167-020-05980-z

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Berthold, D. P., Muench, L. N., Dyrna, F., Uyeki, C. L., Cote, M. P., Imhoff, A. B., Beitzel, K., & Mazzocca, A. D. (2021). Radiographic alterations in clavicular bone tunnel width following anatomic coracoclavicular ligament reconstruction (ACCR) for chronic acromioclavicular joint injuries. Knee Surgery, Sports Traumatology, Arthroscopy, 29(7), 2046-2054. https://doi.org/10.1007/s00167-020-05980-z

@article{23371e9fdcca49288a05b6e8b8434776,

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

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.",

keywords = "AC joint, ACCR, Acromioclavicular joint injury, Anatomic coracoclavicular ligament reconstruction, Loss of reduction, Tunnel widening",

author = "Berthold, {Daniel P.} and Muench, {Lukas N.} and Felix Dyrna and Uyeki, {Colin L.} and Cote, {Mark P.} and Imhoff, {Andreas B.} and Knut Beitzel and Mazzocca, {Augustus D.}",

note = "Publisher Copyright: {\textcopyright} 2020, European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).",

year = "2021",

month = jul,

doi = "10.1007/s00167-020-05980-z",

language = "English",

volume = "29",

pages = "2046--2054",

journal = "Knee Surgery, Sports Traumatology, Arthroscopy",

issn = "0942-2056",

publisher = "John Wiley and Sons Inc.",

number = "7",

}

Berthold, DP, Muench, LN, Dyrna, F, Uyeki, CL, Cote, MP, Imhoff, AB, Beitzel, K & Mazzocca, AD 2021, 'Radiographic alterations in clavicular bone tunnel width following anatomic coracoclavicular ligament reconstruction (ACCR) for chronic acromioclavicular joint injuries', Knee Surgery, Sports Traumatology, Arthroscopy, vol. 29, no. 7, pp. 2046-2054. https://doi.org/10.1007/s00167-020-05980-z

Radiographic alterations in clavicular bone tunnel width following anatomic coracoclavicular ligament reconstruction (ACCR) for chronic acromioclavicular joint injuries. / Berthold, Daniel P.; Muench, Lukas N.; Dyrna, Felix et al.
In: Knee Surgery, Sports Traumatology, Arthroscopy, Vol. 29, No. 7, 07.2021, p. 2046-2054.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Radiographic alterations in clavicular bone tunnel width following anatomic coracoclavicular ligament reconstruction (ACCR) for chronic acromioclavicular joint injuries

AU - Berthold, Daniel P.

AU - Muench, Lukas N.

AU - Dyrna, Felix

AU - Uyeki, Colin L.

AU - Cote, Mark P.

AU - Imhoff, Andreas B.

AU - Beitzel, Knut

AU - Mazzocca, Augustus D.

PY - 2021/7

Y1 - 2021/7

N2 - 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.

AB - 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.

KW - AC joint

KW - ACCR

KW - Acromioclavicular joint injury

KW - Anatomic coracoclavicular ligament reconstruction

KW - Loss of reduction

KW - Tunnel widening

UR - http://www.scopus.com/inward/record.url?scp=85084082730&partnerID=8YFLogxK

U2 - 10.1007/s00167-020-05980-z

DO - 10.1007/s00167-020-05980-z

M3 - Article

C2 - 32335695

AN - SCOPUS:85084082730

SN - 0942-2056

VL - 29

SP - 2046

EP - 2054

JO - Knee Surgery, Sports Traumatology, Arthroscopy

JF - Knee Surgery, Sports Traumatology, Arthroscopy

IS - 7

ER -

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

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