Modified coracoid tunnel-free suspended bridge for coracoclavicular ligament injuries leads to improved clinical and radiological outcomes: a cohort study with a minimum 2-year follow-up

TL;DR

A new surgical technique for treating shoulder ligament injuries shows better results and fewer complications than older methods.

Contribution

A modified tunnel-free surgical technique for coracoclavicular ligament injuries is introduced and shown to be effective.

Findings

34 patients had good to excellent shoulder function scores after the procedure.

No tunnel-related complications were observed, and no revisions were needed.

AC joint displacement occurred early but did not cause pain or instability.

Abstract

Coracoclavicular ligament injuries are common in the sports population. Coracoid tunnel techniques showed a negative influence on outcomes with some literature reporting tunnel-related fractures occurring early or late after surgery. The aim of this study is to analyze the clinical and radiological outcomes of modified coracoid tunnel-free suspended bridge in coracoclavicular ligament injury patients with a minimum follow-up of 2 years.

This retrospective study reviewed patients with coracoclavicular ligament injuries who were treated with modified coracoid tunnel-free suspended bridge between January 2019 and February 2023 at the authors’ institution. Clinical outcomes were patient-reported subjective and objective functional scores, including Visual Analogue Score (VAS), Oxford Shoulder Score (OSS) and Constant-Murley Score (CMS). Radiological assessments were performed immediately after surgery, as well as at 1 month, 3 months, 6 months, 1 year postoperatively, and at the final follow-up. The radiological complications were recorded at final follow-up, including loss of AC (acromioclavicular) joint reduction, recurrent dislocation of AC joint, tunnel widening, or tunnel-related fractures.

A total of 34 patients who were treated with modified coracoid tunnel-free suspended bridge technique were included in the study. All patients completed the final follow-up, with an average follow-up of 30.9 ± 6.8 months. At the final follow-up, these patients achieved good to excellent functional outcomes with the mean Oxford Shoulder score of 13.9 ± 1.9 points and the mean Constant Murley score of 89.7 ± 6.2 points. Two of 34 patients (5.9%) had a loss of AC joint reduction at the final follow-up, but did not report AC joint pain or instability. AC joint showed a trend of secondary displacement within 3 months after surgery. The side-to-side difference of coracoclavicular distance significantly increased from 0.2 mm one month after surgery to 1.6 mm three months after surgery (p = 0.004). However, no tunnel-related complications were observed and no patient required revision.

The modified coracoid tunnel-free suspended bridge is a safe procedure that can significantly improve clinical and radiological outcomes of coracoclavicular ligament injuries. This technique could be considered a reliable method for acromioclavicular joint reconstruction.

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