Acromioclavicular Joint

MSc, Frcsc and Bill Ristevski; McKee, Frcsc Michael D.

doi:10.1002/9781444345100.ch37

Cited by 1 publication

(5 citation statements)

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“…30 Today, the use of the Kenny-Howard splint has declined because of poor patient compliance and lack of evidence of its superiority in conservative treatment. 25 In our study, no complications associated with the use of the reducing splint were noted, but all nonoperatively treated ACJs analyzed showed exceptionally prominent or unstable though painless joints (Table 3).…”

Section: Discussionmentioning

confidence: 48%

“…20 However, there is no clear difference in results to recommend one type of operative repair over another for dislocated ACJ. 3,25 The preferred methods to repair acute ACJ dislocation at our institute are anatomic coracoclavicular reconstruction with bone channels or hook-plate fixation, and for delayed or failed conservative cases, augmentation of the anatomic coracoclavicular ligament reconstruction with an autologous semitendinosus graft and AC ligament reconstruction. 3 The K-wire fixation technique used in the OT group in this study is not used anymore because it has proven to have inadequate stability for fixation.…”

Section: Discussionmentioning

confidence: 99%

“…Conservative treatment was recommended for ACJ dislocation of Rockwood type I to III in several recent reviews. 3,24,25 There are no long-term studies of Rockwood types IV to V dislocations including a conservative treatment group, but in 1 study with a 6-year follow-up, half of the patients (8/16) with Rockwood type IV or V dislocation who were initially treated conservatively needed late ACJ reconstruction. 19 In another retrospective analysis concerning Rockwood type III dislocations, conservative Values are reported as mean ± SD.…”

Section: Discussionmentioning

confidence: 99%

“…The optimal treatment of Rockwood types III through V ACJ injuries is still controversial. 3,18,25,29,31,32 In the only published randomized studies comparing operative and nonoperative treatments 2,14 including Rockwood types III through V (Tossy type III) injuries, the authors recommended nonoperative treatment. Some later retrospective studies have also advocated conservative treatment for Rockwood type III injuries, 4 while in other studies, operative treatment has produced better results.…”

mentioning

confidence: 99%

“…3,37 Over 150 different reconstruction techniques have been introduced, 3 without any certain knowledge whether it is necessary to treat a patient operatively for a good recovery. 25,31 Long-term results of operative and nonoperative treatment of Rockwood type III ACJ dislocation are inadequate as well. In 1 study, 30 of 46 conservatively treated patients were reexamined 12.5 years after ACJ dislocation and, despite the subluxed or dislocated ACJ, all patients had a good outcome and functional adaptation was achieved in every case.…”

mentioning

confidence: 99%

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Results of Operative and Nonoperative Treatment of Rockwood Types III and V Acromioclavicular Joint Dislocation

Joukainen

Kröger

Niemitukia

et al. 2014

Orthopaedic Journal of Sports Medicine

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Background:The optimal treatment of acute, complete dislocation of the acromioclavicular joint (ACJ) is still unresolved.Purpose:To determine the difference between operative and nonoperative treatment in acute Rockwood types III and V ACJ dislocation.Study Design:Randomized controlled trial; Level of evidence, 2.Methods:In the operative treatment group, the ACJ was reduced and fixed with 2 transarticular Kirschner wires and ACJ ligament suturing. The Kirschner wires were extracted after 6 weeks. Nonoperatively treated patients received a reduction splint for 4 weeks. At the 18- to 20-year follow-up, the Constant, University of California at Los Angeles Shoulder Rating Scale (UCLA), Larsen, and Simple Shoulder Test (SST) scores were obtained, and clinical and radiographic examinations of both shoulders were performed.Results:Twenty-five of 35 potential patients were examined at the 18- to 20-year follow-up. There were 11 patients with Rockwood type III and 14 with type V dislocations. Delayed surgical treatment for ACJ was used in 2 patients during follow-up: 1 in the operatively treated group and 1 in the nonoperatively treated group. Clinically, ACJs were statistically significantly less prominent or unstable in the operative group than in the nonoperative group (normal/prominent/unstable: 9/4/3 and 0/6/3, respectively; P = .02) and in the operative type III (P = .03) but not type V dislocation groups. In operatively and nonoperatively treated patients, the mean Constant scores were 83 and 85, UCLA scores 25 and 27, Larsen scores 11 and 11, and SST scores 11 and 12 at follow-up, respectively. There were no statistically significant differences in type III and type V dislocations. In the radiographic analysis, the ACJ was wider in the nonoperative than the operative group (8.3 vs 3.4 mm; P = .004), and in the type V dislocations (nonoperative vs operative: 8.5 vs 2.4 mm; P = .007). There was no statistically significant difference between study groups in the elevation of the lateral end of the clavicle. Both groups showed equal levels of radiologic signs of ACJ osteoarthritis and calcification of the coracoclavicular ligaments.Conclusion:Nonoperative treatment was shown to produce more prominent or unstable and radiographically wider ACJs than was operative treatment, but clinical results were equally good in the study groups at 18- to 20-year follow-up. Both treatment methods showed statistically significant radiographic elevations of the lateral clavicle when compared with a noninjured ACJ.

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Section: Discussionmentioning

confidence: 48%