Abstract：
BACKGROUND: This systematic review and meta-analysis aimed to (1) estimate the prevalence of clavicular tunnel widening (TW) after coracoclavicular stabilization surgery and its risk factors and (2) assess whether TW is correlated with clavicle fracture or loss of reduction of the acromioclavicular joint (ACJ).
METHODS: In January 2023, 3 electronic databases were searched to collect data on postoperative clavicular TW, its prevalence, magnitude, and correlation with fracture and ACJ loss of reduction. Studies were classified according to the time of surgical intervention, and the clavicular tunnels were categorized by their anatomic location. Mean differences were calculated using a DerSimonian-Laird random-effects model, while binomial outcomes were pooled using the Freeman-Tukey double arcsine transformation. Univariate and multivariate meta-regression analyses were performed to determine the effect of several variables on the proportion of cases with TW.
RESULTS: Fifteen studies (418 shoulders) were included. At the final follow-up, evidence of clavicular TW was found in 70% (95% confidence interval [CI]: 70%-87%; I2 = 89%) of 221 shoulders. Surgeries in acute cases had a lower prevalence of TW (52%) compared to chronic cases (71%) (P < .001). Significant TW was found in the central tunnel (3.2 mm; 95% CI: 1.8-4.6 mm; P < .001; I2 = 72%) for acute injuries and in the medial (1.2 mm; 95% CI: 0.7-1.7 mm; P < .001; I2 = 77%) and lateral (1.5 mm; 95% CI: 0.7-2.3 mm; P < .001; I2 = 77%) tunnels for chronic cases. Single central-tunnel techniques were positively associated with the prevalence of TW (P = .046), while biotenodesis screw fixation was associated with a lower prevalence (P = .004) in chronic cases. Reconstruction of the ACJ ligament complex with tendon grafts or sutures was associated with a higher prevalence of TW (P < .001). Drill sizes between 2.5 and 5 mm were significantly associated with a lower prevalence of TW, regardless of injury chronicity (P = .012). No correlation was found between TW and the loss of ACJ reduction or clavicle fractures.
CONCLUSIONS: This systematic review and meta-analysis explored TW occurrence following coracoclavicular stabilization surgery. TW was observed in 70% of patients at final follow-up, with a higher prevalence in chronic than in acute cases. Modifiable surgical variables, such as single-tunnel tendon graft constructs for acute or chronic injuries and knotted graft procedures for chronic injuries, were significantly associated with TW. Furthermore, the prevalence of TW increased with concomitant surgical treatment of the ACJ ligament complex, and decreased with drill sizes between 2.5 and 5 mm, regardless of lesion chronicity. These surgical variables should be considered when establishing transosseous tunnels for coracoclavicular stabilization. Clavicle fractures and TW mechanisms require further investigation.
METHODS: In January 2023, 3 electronic databases were searched to collect data on postoperative clavicular TW, its prevalence, magnitude, and correlation with fracture and ACJ loss of reduction. Studies were classified according to the time of surgical intervention, and the clavicular tunnels were categorized by their anatomic location. Mean differences were calculated using a DerSimonian-Laird random-effects model, while binomial outcomes were pooled using the Freeman-Tukey double arcsine transformation. Univariate and multivariate meta-regression analyses were performed to determine the effect of several variables on the proportion of cases with TW.
RESULTS: Fifteen studies (418 shoulders) were included. At the final follow-up, evidence of clavicular TW was found in 70% (95% confidence interval [CI]: 70%-87%; I2 = 89%) of 221 shoulders. Surgeries in acute cases had a lower prevalence of TW (52%) compared to chronic cases (71%) (P < .001). Significant TW was found in the central tunnel (3.2 mm; 95% CI: 1.8-4.6 mm; P < .001; I2 = 72%) for acute injuries and in the medial (1.2 mm; 95% CI: 0.7-1.7 mm; P < .001; I2 = 77%) and lateral (1.5 mm; 95% CI: 0.7-2.3 mm; P < .001; I2 = 77%) tunnels for chronic cases. Single central-tunnel techniques were positively associated with the prevalence of TW (P = .046), while biotenodesis screw fixation was associated with a lower prevalence (P = .004) in chronic cases. Reconstruction of the ACJ ligament complex with tendon grafts or sutures was associated with a higher prevalence of TW (P < .001). Drill sizes between 2.5 and 5 mm were significantly associated with a lower prevalence of TW, regardless of injury chronicity (P = .012). No correlation was found between TW and the loss of ACJ reduction or clavicle fractures.
CONCLUSIONS: This systematic review and meta-analysis explored TW occurrence following coracoclavicular stabilization surgery. TW was observed in 70% of patients at final follow-up, with a higher prevalence in chronic than in acute cases. Modifiable surgical variables, such as single-tunnel tendon graft constructs for acute or chronic injuries and knotted graft procedures for chronic injuries, were significantly associated with TW. Furthermore, the prevalence of TW increased with concomitant surgical treatment of the ACJ ligament complex, and decreased with drill sizes between 2.5 and 5 mm, regardless of lesion chronicity. These surgical variables should be considered when establishing transosseous tunnels for coracoclavicular stabilization. Clavicle fractures and TW mechanisms require further investigation.
摘要：
背景：本系统综述和荟萃分析旨在（1）评估锁骨固定手术后锁骨隧道加宽（TW）的患病率及其危险因素，以及（2）评估TW是否与锁骨骨折或肩锁关节复位丢失（ACJ）相关。
方法：在2023年1月，搜索了3个电子数据库，以收集有关术后锁骨TW的数据，其患病率,量级,与骨折和ACJ复位丢失的相关性。研究根据手术干预的时间进行分类，锁骨隧道按解剖位置分类。使用DerSimonian-Laird随机效应模型计算平均差，而二项结果使用Freeman-Tukey双反正弦变换进行汇总。进行了单变量和多变量荟萃回归分析，以确定几个变量对TW病例比例的影响。
结果：共纳入15项研究（418项）。在最后的后续行动中，锁骨TW的证据在221个肩中的70%(95%置信区间[CI]:70%-87%;I2=89%)被发现.与慢性病例（71％）相比，急性病例的手术TW患病率较低（52％）（P<0.001）。对于急性损伤，在中央隧道（3.2mm；95％CI：1.8-4.6mm；P<.001；I2=72％）中发现了显着的TW，对于慢性病例，在内侧隧道（1.2mm；95％CI：0.7-1.7mm；P<.001；I2=77％）中发现了显着的TW。单中心隧道技术与TW的患病率呈正相关（P=0.046），而在慢性病例中，生物固定术螺钉固定术的患病率较低（P=.004）。使用肌腱移植或缝线重建ACJ韧带复合体与TW的患病率较高相关（P<.001）。钻孔尺寸在2.5和5毫米之间与TW的较低患病率显着相关，不考虑损伤的慢性性（P=0.012）。TW与ACJ复位丢失或锁骨骨折之间无相关性。
结论：本系统综述和荟萃分析探讨了锁骨稳定手术后TW的发生情况。最终随访时，70%的患者出现TW，慢性病例的患病率高于急性病例。可修改的手术变量，例如用于急性或慢性损伤的单隧道肌腱移植物结构和用于慢性损伤的打结移植物程序，与TW显著相关。此外，TW的患病率随着ACJ韧带复合体的手术治疗而增加，并且随着钻头尺寸在2.5到5毫米之间而减小，无论病变的慢性。在建立用于锁骨稳定的跨骨隧道时，应考虑这些手术变量。锁骨骨折和TW机制需要进一步研究。
方法：在2023年1月，搜索了3个电子数据库，以收集有关术后锁骨TW的数据，其患病率,量级,与骨折和ACJ复位丢失的相关性。研究根据手术干预的时间进行分类，锁骨隧道按解剖位置分类。使用DerSimonian-Laird随机效应模型计算平均差，而二项结果使用Freeman-Tukey双反正弦变换进行汇总。进行了单变量和多变量荟萃回归分析，以确定几个变量对TW病例比例的影响。
结果：共纳入15项研究（418项）。在最后的后续行动中，锁骨TW的证据在221个肩中的70%(95%置信区间[CI]:70%-87%;I2=89%)被发现.与慢性病例（71％）相比，急性病例的手术TW患病率较低（52％）（P<0.001）。对于急性损伤，在中央隧道（3.2mm；95％CI：1.8-4.6mm；P<.001；I2=72％）中发现了显着的TW，对于慢性病例，在内侧隧道（1.2mm；95％CI：0.7-1.7mm；P<.001；I2=77％）中发现了显着的TW。单中心隧道技术与TW的患病率呈正相关（P=0.046），而在慢性病例中，生物固定术螺钉固定术的患病率较低（P=.004）。使用肌腱移植或缝线重建ACJ韧带复合体与TW的患病率较高相关（P<.001）。钻孔尺寸在2.5和5毫米之间与TW的较低患病率显着相关，不考虑损伤的慢性性（P=0.012）。TW与ACJ复位丢失或锁骨骨折之间无相关性。
结论：本系统综述和荟萃分析探讨了锁骨稳定手术后TW的发生情况。最终随访时，70%的患者出现TW，慢性病例的患病率高于急性病例。可修改的手术变量，例如用于急性或慢性损伤的单隧道肌腱移植物结构和用于慢性损伤的打结移植物程序，与TW显著相关。此外，TW的患病率随着ACJ韧带复合体的手术治疗而增加，并且随着钻头尺寸在2.5到5毫米之间而减小，无论病变的慢性。在建立用于锁骨稳定的跨骨隧道时，应考虑这些手术变量。锁骨骨折和TW机制需要进一步研究。
