High-grade Acromioclavicular Joint Injuries: Is Operative Intervention Really Better?

Author(s):  
Daniel Davis ◽  
Luke Austin
2019 ◽  
Vol 47 (11) ◽  
pp. 2670-2677 ◽  
Author(s):  
Nina Maziak ◽  
Laurent Audige ◽  
Carmen Hann ◽  
Marvin Minkus ◽  
Markus Scheibel

Background: Factors influencing the outcome after arthroscopically assisted stabilization of acute high-grade acromioclavicular (AC) joint dislocations remain poorly investigated. Purpose: To identify determinants of the radiological outcome and investigate associations between radiological and clinical outcome parameters. Study Design: Cohort study; Level of evidence, 3. Methods: The authors performed a retrospective analysis of patients who underwent arthroscopically assisted stabilization for acute high-grade AC joint dislocations. The following potential determinants of the radiological outcome were examined using univariable and multivariable regression analyses: timing of surgery, initial AC joint reduction, isolated coracoclavicular (CC) versus combined CC and AC stabilization, ossification of the CC ligaments, age, and overweight status. In addition, associations between radiological (ie, CC difference, dynamic posterior translation [DPT]) and clinical outcome parameters (Subjective Shoulder Value, Taft score [TS] subjective subcategory, and Acromioclavicular Joint Instability Score [ACJI] pain subitem) were evaluated using univariable analysis. Results: One hundred four patients with a mean (±SD) age of 38.1 ± 11.5 years were included in this study. The mean postoperative follow-up was 2.2 ± 0.9 years. Compared with patients with an overreduced AC joint after surgery, the CC difference was 4.3 mm (95% CI, 1.3-7.3; P = .006) higher in patients with incomplete reduction. Patients with anatomic reduction were 3.1 times (95% CI, 1.2-7.9; P = .017) more likely to develop DPT than those with an overreduced AC joint. An incompletely reduced AC joint was 5.3 times (95% CI, 2.1-13.4; P < .001) more likely to develop DPT versus an overreduced AC joint. Patients who underwent isolated CC stabilization were 4.8 times (95% CI, 1.1-21.0; P = .039) more likely to develop complete DPT than patients with additional AC stabilization. Significantly higher CC difference values were noted for patients who reported pain on the subjective TS ( P = .025). Pain was encountered more commonly in patients with DPT ( PTS = .049; PACJI = .038). Conclusion: Clinicians should consider overreduction of the AC joint because it may lead to favorable radiological results. Because of its association with superior radiographic outcomes, consideration should also be given to the use of additional AC cerclage.


Author(s):  
Peter A. Gustafson ◽  
Mark Omwansa ◽  
Andrew G. Geeslin ◽  
Vani J. Sabesan

Finite element models are used for qualitative comparison of the risk of fracture associated with clavicle tunnels in reconstruction of the coracoclavicular ligaments for treatment of high-grade acromioclavicular joint (ACJ) injury. The two-tunnel reconstruction technique is found likely to have higher fracture risk than the less anatomic single tunnel reconstruction. The models suggest that four point bending is more likely than three point bending, cantilever bending, or axial loading to differentiate the reconstruction techniques in a laboratory experiment. The results must be narrowly interpreted only in a laboratory context due to the limitations of the study.


2014 ◽  
Vol 17 (3) ◽  
pp. 114-119 ◽  
Author(s):  
Kyung Cheon Kim ◽  
Yoo Sun Jeon

BACKGROUND: To evaluate clinical and radiological outcome using AO hook locking plate in acute acromioclavicular joint injuries.METHODS: This study was based on patients with Rockwood type 3 or 5 acromioclavicular joint injuries who received surgery with AO hook locking plate from June 2008 until June 2009. Among the 22 patients, 19 of them were male and 3 were female, the mean age was 44.4 +/- 15.57 years (20-72 years) and follow-up period was 15.5 +/- 3.90 months (12-23 months). Preoperatively, postoperatively, and at the final follow-up after the plate removal, both coracoclavicular distances were measured from the anteroposterior radiograph. Also, the Shoulder Rating Scale of the University of California at Los Angeles scores (UCLA scores), the American Shoulder and Elbow Surgeons scores (ASES scores), Constant scores, and the Korean Shoulder Society scores (KSS scores) were measured at the final follow-up to evaluate the function of the shoulder joint.RESULTS: At the time of injury, the mean coracoclavicular distance of the injured side was 17.69 +/- 4.23 mm (9.57-27.82 mm) and the unaffected side was 7.55 +/- 2.20 mm (3.24-13.05 mm). The mean coracoclavicular distance measured postoperatively and at the final follow-up was 6.87 +/- 2.34 mm (4.07-14.13 mm) and 8.47 +/- 2.96 mm (4.37-17.48 mm), respectively. The mean UCLA, ASES, Constant, and KSS scores measured in the final follow-up were 33.5 +/- 1.30 (31-35), 90.8 +/- 8.36 (72-100), 78.6 +/- 8.80 (62-100), and 94.4 +/- 5.08 (84-100) each.CONCLUSIONS: From this short-term research, the surgical treatment using AO hook locking plates in acute acromioclavicular joint injuries is clinically and radiographically satisfying and considered as a useful treatment method.


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