Department of Orthopaedic Surgery, Dankook University College of Medicine, Manghyangro 201, Dongnam-gu, Cheonan, Chungnam, 330-715, Republic of Korea.
Knee Surg Sports Traumatol Arthrosc. 2019 Dec;27(12):3835-3843. doi: 10.1007/s00167-019-05731-9. Epub 2019 Sep 21.
Despite the high failure rates of techniques used to maintain the reduction of single-tunnel coracoclavicular (CC) fixation, analyses of the etiology of loss of reduction related to surgical techniques are limited. Therefore, it was hypothesized that the initial coracoclavicular tunnel angle was related to loss of reduction in the single-tunnel technique for AC joint dislocation. This study aimed to evaluate the clinical and radiological outcomes of arthroscopic single-tunnel CC suture button fixation according to the initial coracoclavicular tunnel angle.
Thirty-two consecutive patients who underwent arthroscopic single-tunnel CC suture button fixation for AC joint dislocation from 2014 to 2018 were enrolled. The tunneling-first technique was used in the first 11 patients, while the reduction-first technique was used in the remaining 22 consecutive patients. For clinical assessments, the American Shoulder and Elbow Surgeons (ASES) score and Korean Shoulder Score (KSS) were recorded. For radiological evaluation, coracoclavicular distance ratio, coracoclavicular tunnel angle, coracoid, and clavicular tunnel widths were measured.
The ASES score did not differ significantly between the two groups (n.s.). However, the KSS was significantly better in the reduction-first group (p = 0.031). No significant intergroup differences were observed in the pre- and postoperative coracoclavicular distance ratio. However, at the last follow-up, loss of coracoclavicular distance ratio was significantly smaller in the reduction-first group (p < 0.001). At the final follow-up, loss of the coracoclavicular distance ratio was positively correlated with the postoperative coracoclavicular tunnel angle (p < 0.001, Spearman's rho correlation coefficient = 0.602). The final follow-up clavicular tunnel width was also significantly smaller in the reduction-first group (p = 0.002). Finally, the last follow-up clavicular tunnel width was positively correlated with the postoperative coracoclavicular tunnel angle (p = 0.008, Spearman's rho correlation coefficient = 0.459).
The reduction-first technique showed better clinical and radiological outcomes than the tunneling-first technique in single-tunnel CC fixation for AC joint dislocation. A large postoperative coracoclavicular tunnel angle was associated with loss of reduction and clavicular tunnel widening. Therefore, obtaining a straight coracoclavicular tunnel angle is crucial for achieving better outcomes and minimizing loss of reduction.
III.
尽管用于维持单隧道肩锁关节（CC）固定的复位的技术失败率很高，但与手术技术相关的复位丢失的病因分析有限。因此，假设初始 CC 隧道角与 AC 关节脱位的单隧道技术复位丢失有关。本研究旨在根据初始 CC 隧道角评估关节镜下单隧道 CC 缝合纽扣固定的临床和影像学结果。
2014 年至 2018 年间，连续纳入 32 例因 AC 关节脱位行关节镜下单隧道 CC 缝合纽扣固定的患者。前 11 例采用隧道先行技术，后 22 例采用复位先行技术。临床评估采用美国肩肘外科医师（ASES）评分和韩国肩肘评分（KSS）。影像学评估包括 CC 距离比、CC 隧道角、喙突和锁骨隧道宽度。
两组患者的 ASES 评分无显著差异（n.s.）。然而，复位先行组的 KSS 显著更好（p=0.031）。两组患者术前和术后 CC 距离比无显著差异。然而，末次随访时，复位先行组 CC 距离比丢失明显更小（p<0.001）。末次随访时，CC 距离比丢失与术后 CC 隧道角呈正相关（p<0.001，Spearman 相关系数=0.602）。末次随访时，复位先行组锁骨隧道宽度也明显更小（p=0.002）。最后，末次随访时锁骨隧道宽度与术后 CC 隧道角呈正相关（p=0.008，Spearman 相关系数=0.459）。
与隧道先行技术相比，复位先行技术在 AC 关节脱位的单隧道 CC 固定中具有更好的临床和影像学结果。较大的术后 CC 隧道角与复位丢失和锁骨隧道增宽有关。因此，获得直的 CC 隧道角对于获得更好的结果和最小化复位丢失至关重要。
III 级
