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. 2023 Jan;31(1):161-168.
doi: 10.1007/s00167-022-06929-0. Epub 2022 Mar 22.

Acromioclavicular joint suture button repair leads to coracoclavicular tunnel widening

D Dalos  1   2 , G Huber  3 , Y Wichern  4   3 , K Sellenschloh  3 , K Püschel  5 , K Mader  4 , M M Morlock  3 , K H Frosch  4   6 , T O Klatte  4
Affiliations

Acromioclavicular joint suture button repair leads to coracoclavicular tunnel widening

D Dalos et al. Knee Surg Sports Traumatol Arthrosc. 2023 Jan.

Abstract

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.

Keywords: Acromioclavicular joint; Arthroscopy; Micro-CT; Shoulder surgery; Suture button; Tunnel widening.

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Conflict of interest statement

All Authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Experimental set-up. C clavicle, CC coracoid process, G glenoid, A acromion, m mass
Fig. 2
Fig. 2
Micro-CT imaging of the post-testing tunnel in the distal clavicle including the five defined measurement points: superior (0) and inferior cortex (100), as well as at 25%, 50%, and 75% of the total vertical bone diameter
Fig. 3
Fig. 3
Clavicular tunnel widening in TightRope®, Dog Bone™, and Low Profile groups at each defined measurement point in comparison to each control group. Tunnel widening occurred in all three devices at the inferior clavicular cortex as well as at 75% spongiosa. Differences in tunnel width at measurement point 50% spongiosa are related to the changing drill diameter of the insert button in relation to the diameter of the clavicula
Fig. 4
Fig. 4
Coracoid tunnel widening in TightRope®, Dog Bone™, and Low Profile groups at each defined measurement point in comparison to each control group. Tunnel widening occurred in all three devices at the superior cortex as well as at 25% spongiosa
See this image and copyright information in PMC

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