# 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.

## Key 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.