Abstract
Purpose
The aim of this retrospective cohort study was to radiographically describe, quantify
and compare clavicular tunnel widening (cTW) of two different types of stabilization
devices and investigate a possible correlation between cTW and loss of reduction.
Methods
In a retrospective analysis of single-center registry data, we compared patients who
were treated for an acute AC dislocation (Rockwood types III to V) with either the
AC Dog Bone (DB) or low-profile AC (LP) repair systems. On 6-week and 6-month postoperative
radiographs, we measured clavicle height and tunnel diameter. We calculated the button/clavicle
filling (B/C) ratio to quantify how much of the clavicular tunnel height is covered
by the low-profile inlet. The association between B/C ratio and the extent of cTW
was defined, and we also compared cTW between treatment groups. Reduction of the AC
joint was graded as either stable, partially dislocated or dislocated depending on
the AC ratio. A two-sample t-test was used for comparing cTW progression between the
two groups. For continuous variables between more than two groups, the Kruskal-Wallis
test was used.
Results
Of 65 eligible patients, there were 37 and 28 included in the DB and LP groups, respectively.
Overall, cTW was conically shaped with transclavicular widening noted in the DB group
and cTW developing strictly inferior to the button in the LP group. For both implants,
mean maximal cTW was 7.1mm and located at the inferior cortex; the B/C ratio was not
associated with increased inferior cTW (r=-0.23, P=0.248). Only LP patients with complete
loss of reduction had significantly increased cTW (P=0.049).
Conclusion
Conical-shaped cTW is a common implant-independent phenomenon after AC stabilization
using suture-button devices. It occurs only at the suture-bone interface and is less
excessive for the LP implant. There is an association between increased cTW and loss
of reduction specific to the LP implant only.
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Article info
Publication history
Accepted:
May 10,
2023
Received in revised form:
February 28,
2023
Received:
November 22,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Support for this research was provided by: Schulthess Clinic
Financial disclaimer: Professor Markus Scheibel is a consultant for Arthrex
Institutional Review Board/Ethics Committee Approval was granted by the following institutions: Cantonal Ethics Committee of Zurich. Approval for the study (BASEC 2021-00675) was granted on 21.06.2022
Acknowledgments: The authors thank Laurent Audigé, Marije de Jong, Martina Wehrli, Daniela Brune, Tim Schneller and Beatrice Weber for data administration and Melissa Wilhelmi for copyediting this article.
Social Media: LinkedIn
Frederik Bellmann: www.linkedin.com/in/frederik-bellmann
Larissa Eckl: https://www.linkedin.com/in/larissa-eckl-995698240/
Laurent, Laurent Audige: https://www.linkedin.com/in/laurent-audigé-101b2b/
Markus Scheibel: https://www.linkedin.com/in/markus-scheibel-35a49154
Level of Evidence: Therapeutic study, Level III
Identification
Copyright
© 2023 Published by Elsevier on behalf of the Arthroscopy Association of North America
