Medialized Clavicular Bone Tunnel Position Predicts Failure After Anatomic Coracoclavicular Ligament Reconstruction in Young, Active Male Patients

Eisenstein, Emmanuel D.; Lanzi, Joseph T.; Waterman, Brian R.; Bader, Julia M.; Pallis, Mark

doi:10.1177/0363546516651613

Cited by 30 publications

(26 citation statements)

References 26 publications

(63 reference statements)

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“…The surgeon should avoid medializing the clavicular tunnel. 8,10 Cook et al 8 reported that no failures occurred if the conoid tunnel was <25% of the clavicular length from the lateral edge of the clavicle. In the current study, we created the trapezoid and conoid clavicular bone tunnels at 1.5 mm and 2.5 mm from the lateral edge of the clavicle, respectively.…”

Section: Discussionmentioning

confidence: 99%

Functional and Radiographic Outcomes of Intraoperatively Decreasing the Coracoclavicular Distance to 50% of the Unaffected Side in Stabilization of Acute Acromioclavicular Joint Injury: A Retrospective Evaluation

Klabklay

Chuaychoosakoon

2021

Orthopaedic Journal of Sports Medicine

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Background: The postoperative failure rate of acromioclavicular (AC) joint fixation using the coracoclavicular (CC) stabilization technique is high. Studies have reported that compared with normal intraoperative anatomic reduction, intraoperative overreduction of the AC joint is more successful in achieving a satisfactory anatomic radiographic outcome at 1- to 2-year follow-up. Purpose: To evaluate the functional and radiographic outcomes and complications in patients with acute AC joint injury who underwent combined CC stabilization and AC capsular repair in which the CC distance was intraoperatively decreased to 50% of the unaffected side. Study Design: Case series; Level of evidence, 4. Methods: In this retrospective study, we collected and analyzed the data of patients with an acute AC joint injury (Rockwood type 5) who underwent combined CC stabilization and AC capsular repair during which the CC distance was decreased 50% compared with the unaffected side. At 2-year follow-up, we evaluated functional outcomes (American Shoulder and Elbow Surgeons [ASES] score), radiographic outcomes (alignment of the AC joint in the vertical and horizontal planes, tunnel widening), and complications (infection, clavicular fracture). Results: The study included 20 patients with a mean ± SD age of 42.20 ± 10.10 years. The mean follow-up period was 33.75 ± 11.50 months. At the 2-year follow-up, the mean ASES score was 95.13 ± 5.61. The overreduction alignment, anatomic alignment, and loss reduction alignment rates were 0% (0/20 patients), 95% (19/20 patients), and 5% (1/ 20 patients), respectively. No statistically significant difference was found in the mean CC distance between the affected and unaffected sides on radiographic evaluation. The mean medial clavicular tunnel width and lateral clavicular tunnel width were 5.03 ± 0.68 mm and 4.47 ± 0.67 mm, respectively. None of the patients experienced fractures or infections. Conclusion: Excellent functional and radiographic outcomes and no complications were seen at 2-year follow-up in patients with acute AC joint injury who underwent combined CC stabilization and AC capsular repair with the CC distance intraoperatively decreased to 50% of the unaffected side.

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Section: Discussionmentioning

confidence: 99%

Functional and Radiographic Outcomes of Intraoperatively Decreasing the Coracoclavicular Distance to 50% of the Unaffected Side in Stabilization of Acute Acromioclavicular Joint Injury: A Retrospective Evaluation

Klabklay

Chuaychoosakoon

2021

Orthopaedic Journal of Sports Medicine

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“…In this context, Cook JB et al [12] recommend through a series of 130 patients the positioning of the conoid tunnel at 25% and trapezoid tunnel at 17% of the total clavicular length from its lateral border. Eisenstein ED et al [13] considered that the optimal ratio of the conoid tunnel should be between 0.20 and 0.25 and the ratio of trapezoid tunnel should be less than 0.16. In addition, anteroposterior stability remains poorly controlled with this procedure, as reported by several authors [14,15] who describe a partial loss of reduction which is accompanied by a decrease in the functional score.…”

Section: Discussionmentioning

confidence: 99%

Acromioclavicular Joint Dislocation Type 3 Managed Using the Tightrope System in Open Procedure: A Case Report

Abid¹,

Idrissi²,

Ibrahimi³

et al. 2020

SASJS

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“…Several studies have demonstrated increased failure rates with a medialized clavicular bone tunnel position in AC ligament reconstruction. 4,7 Cook et al 4 demonstrated early radiographic failure in a young military population (sex was not specified) with a conoid tunnel ratio of greater than 0.3 and recommended placing the conoid tunnel at 25% of the total clavicular length. Eisenstein et al 7 reviewed 38 male patients in whom 20 radiographic failures were noted; the investigators recommended that optimal tunnel placement would be between 20% and 25% of total clavicular length.…”

Section: Discussionmentioning

confidence: 99%

Sex-Based Differences in Optimal Tunnel Placement for Acromioclavicular Joint Reconstruction

Benavent

Zhang

Matzkin

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Tunnel placement is important for outcomes after acromioclavicular (AC) joint reconstruction, yet little has been written on sex-based differences in optimal tunnel positioning. Hypothesis: No sex-based or anatomic differences will be found in ideal tunnel position based on radiographic measurements. Study Design: Cross-sectional study; Level of evidence, 3. Methods: The records of 2382 patients were retrospectively examined for clavicle radiographs over a 20-year period. A random set of radiographs were reviewed until 200 radiographs from each sex met inclusion criteria per a priori power analysis. Anteroposterior clavicle radiographs were used to collect (1) length from lateral clavicle to lateral coracoid (LCLC), (2) length from lateral clavicle to medial coracoid (LCMC), (3) clavicle length (CL), and (4) clavicular depth at the midcoracoid (MCCD). The Student t test was used to compare differences between male and female patients. The Pearson correlation coefficient was used to measure linear correlations. Variables with a P < .1 were included in a multiple regression model. Results: The cohort included 200 men and 200 women. LCLC and LCMC were significantly greater for men than for women ( P < .0001). Clavicle length was significantly correlated with LCLC ( r = 0.63; P < .0001) and LCMC ( r = 0.74; P < .0001). MCCD was significantly correlated with LCLC ( r = 0.32; P < .0001) and LCMC ( r = 0.43; P < .0001). The approximate placement for the trapezoid tunnel was found to be 22.1 mm in women and 26.6 mm in men. The approximate placement for the conoid tunnel was found to be 40 mm in women and 46.6 mm in men. The ratios (LCLC:CL and LCMC:CL) were also significantly different between female and male patients. The LCLC:CL was 0.144 in women and 0.154 in men ( P < .0001). The LCMC:CL was 0.261 in women and 0.271 in men ( P < .0006). Conclusion: Significant sex-based differences are found in the position of the coracoid relative to the lateral edge of the clavicle. Coracoid position relative to the lateral edge of the clavicle is correlated with anatomic parameters, most strongly with clavicle length.

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Medialized Clavicular Bone Tunnel Position Predicts Failure After Anatomic Coracoclavicular Ligament Reconstruction in Young, Active Male Patients

Cited by 30 publications

References 26 publications

Functional and Radiographic Outcomes of Intraoperatively Decreasing the Coracoclavicular Distance to 50% of the Unaffected Side in Stabilization of Acute Acromioclavicular Joint Injury: A Retrospective Evaluation

Functional and Radiographic Outcomes of Intraoperatively Decreasing the Coracoclavicular Distance to 50% of the Unaffected Side in Stabilization of Acute Acromioclavicular Joint Injury: A Retrospective Evaluation

Acromioclavicular Joint Dislocation Type 3 Managed Using the Tightrope System in Open Procedure: A Case Report

Sex-Based Differences in Optimal Tunnel Placement for Acromioclavicular Joint Reconstruction

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