Anatomic reconstruction of the acromioclavicular joint provides the best functional outcomes in the treatment of chronic instability

Abstract

Purpose To systematically review the outcomes of surgical treatments of chronic acromioclavicular joint dislocation. Methods Studies were identified by electronic databases (Ovid, PubMed). All studies reporting functional and radiological outcomes of surgical treatments of chronic acromioclavicular joint dislocations were included. Following data were extracted: authors and year, study design, level of evidence, number of patients, age, classification of acromioclavicular joint dislocation, time to surgery, surgical technique, follow-up, clinical and imaging outcomes, complications and failures. Descriptive statistics was used, when a data pooling was not possible. Comparable outcomes were pooled to generate summary outcomes reported as frequency-weighted values. Quality appraisal was assessed through the MINORS checklist. Results Fourty-four studies were included for a total of 1020 shoulders. Mean age of participants was 38 years. Mean followup was 32.9 months. Arthroscopic techniques showed better results than open approach (p < 0.0001). Synthetic reconstructions demonstrated better functional outcomes compared to internal fixation and biologic techniques (p < 0.0001). Among biologic techniques, combined coracoclavicular and acromioclavicular ligaments reconstruction showed better Constant (p = 0.0270) and ASES (p = 0.0113) scores compared to isolated coracoclavicular ligaments reconstruction; anatomic biologic non-augmented graft reconstruction showed better Constant (p < 0.0001), VAS (p < 0.0001) and SSV (p = 0.0177) results compared to augmented techniques. No differences in functional outcomes could be found between anatomic biologic nonaugmented graft versus synthetic reconstructions. Overall, methodological quality of the included studies was low. Conclusion Anatomic reconstructions, both synthetic and biologic, showed the best functional results. Level of evidence IV.

Is coracoclavicular ossification a complication or a good prognostic factor after surgical treatment of acromioclavicular joint injury?

“…However, reports that favored addition of an AC fixation due to superior clinical outcomes have also been published. 25 In our study, no statistically significant difference was observed in terms of clinical outcomes (ASES, CS, SSV, VAS) between the two surgical techniques.…”

Management of Acromioclavicular Injuries – Current Concepts

“…Combined CC and AC ligament reconstruction showed better Constant and American Shoulder and Elbow Surgeons (ASES) scores compared to isolated CC ligament reconstruction. 48 However, conclusions were drawn based on studies with low levels of evidence. The systematic review by Borbas et al compared a non-biological fixation between the coracoid and clavicle, a biological reconstruction of the CC ligament, and ligament and/or tendon transfer.…”

Arthroscopic Treatment of Chronic Acromioclavicular Dislocation With Semitendinosus Autograft and Coracoclavicular Suspension Fixation

“…It is in these patients that surgical treatment of chronic ACC dislocation is indicated. 6 , 7 , 20 , 21 …”