High Early-onset acromioclavicular secondary pathologies after acute arthroscopic joint reduction: a cohort study

Marsalli, Michael; Bistolfi, G; Moran, Nicolás; Cartaya, Marco; Urquidi, Cinthya

doi:10.1007/s00402-021-04123-4

Cited by 9 publications

(3 citation statements)

References 35 publications

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“…ACJ pain was more often seen in patients with osteolysis and loss of reduction of more than 5 mm. 44 In conclusion, there is no consensus that surgical intervention is necessary for acute high-grade lesions classified through a radiological classification system. If a surgical treatment is performed, suture buttons seem to be the favored choice in the acute setting.…”

Section: Resultsmentioning

confidence: 99%

Management of Acromioclavicular Injuries – Current Concepts

Groot¹,

Verstift²,

Heisen³

et al. 2023

ORR

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Introduction Treatment of a patient with acromioclavicular joint (ACJ) injury remains challenging for orthopedic surgeons. To date, there is debate over the optimal management of ACJ injuries. This review provides an overview of assessment, treatment, and future perspectives for the treatment of and research into ACJ. Material and Methods A scoping literature review was performed. The search was built including the following terms: acromioclavicular joint injuries or dislocation, and pathophysiology, etiology, anatomy, treatment, and trauma mechanism. The papers with evidence levels 1–3 were included in the current narrative review. Results A total of 2242 potential relevant studies were identified in the searches. After removal of duplicates, 432 studies were screened on their titles and abstracts, resulting in 35 studies being included in the review, based on the eligibility criteria. Conclusion The management of acute and chronic ACJ injuries is not clarified in the current literature. However, there is currently insufficient high-level evidence for the overall treatment options for ACJ injuries. If surgical intervention is decided upon in consultation with the patient, the complications may not outweigh the benefits. The multitude of existing techniques is indicative of the uncertainty surrounding this issue, and no gold standard has yet been established for treatment methods. An ideal classification would include not only vertical and horizontal instability, but also the severity of kinematic alterations of the shoulder complex. This indicates the need for a new and improved diagnostic tool for the classification of ACJ injuries.

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Section: Resultsmentioning

confidence: 99%

Management of Acromioclavicular Injuries – Current Concepts

Groot¹,

Verstift²,

Heisen³

et al. 2023

ORR

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show abstract

“…This radiological failure was mirrored by a lower Constant Score and higher DASH score [ 4 ]. Marsalli et al noted recently a loss of reduction ≥ 1 mm in 78% of their patient cohort, whereby a loss of reduction > 5 mm increased the risk to develop pain in the AC joint [ 12 ]. Other studies report a clinical loss of reduction rate of 12.5–14% [ 3 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

Acromioclavicular and coracoclavicular ligamentous insertion distances depend on the scapular tilt and decrease with anterior direction of the inferior scapula angle

Sußiek

Wermers

Raschke

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Purpose A variety of reconstruction techniques exist for the operative treatment of a ruptured acromioclavicular and coracoclavicular ligamentous complex. However, the complication rate remains high; between 5 and 89%. The intraoperative distance between the clavicle, acromion and coracoid is important for the refixation quality. In this study, the influence of scapular deflection on coracoclavicular and acromioclavicular distances was analysed. Methods The ligamentous insertions of 24 fresh-frozen human scapulae were exposed. The coracoclavicular and acromioclavicular ligaments were referenced and captured in a rigid body system using a three-dimensional (3D) measurement arm. The inferior angle of the scapula was manually pulled into maximum anterior and posterior deflection, simulating a patient positioning with or without dorsal scapular support, respectively. Based on the rigid body system, the distances between the ligamentous insertions were calculated. Statistical evaluation was performed by setting the distances in anterior deflection to 100% and considering the other distances relative to this position. Results The scapular deflection had a considerable impact on the distance between the ligamentous insertions. Concerning the conoid ligament, the mean distance was almost doubled when the inferior angle pointed posteriorly compared to anterior deflection (195.3 vs 100.0%; p = 0.028). The insertion of the acromioclavicular capsule also showed a significant association with the direction of deflection (posterior = 116.1% vs. anterior = 100%; p = 0.008). Conclusion Dorsal support shifting the inferior angle of the scapula anteriorly reduces the distance between the ligamentous insertions. Therefore, a patient position on a shoulder table with posterior support of the scapula is recommended to reliability reduce the acromioclavicular joint.

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“…Clinical symptoms due to structural changes of one or more parts usually present as a challenge to diagnostics and treatment decisions due to the similarity and variability of symptoms [ 15 , 33 ]. The AC joint is subject to degenerative changes in terms of overload and or traumatic events during fall on the arm and shoulder, inflammatory arthritis and others and is getting more attention as a source of shoulder pain in recent [ 8 , 15 , 16 , 19 , 24 ]. In the early stages of the disease, most of the patients are asymptomatic even with apparent radiological changes and sometimes even advanced joint destruction [ 12 , 29 ].…”

Section: Introductionmentioning

confidence: 99%

Morphology of the acromioclavicular-joint score (MAC)

Fal

Junker

Mader

et al. 2022

Arch Orthop Trauma Surg

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Introduction To date there is no generally accepted specific definition or classification of acromioclavicular (AC) joint osteoarthritis. The aim of this study is to analyze morphological parameters using magnetic resonance imaging (MRI) and to develop a scoring system as a basis for decision making to perform an AC-joint resection. Materials and methods In a retrospective-monocentric matched pair study, healthy and affected subjects were investigated using T2 MRI scans in the transverse plane. There were two groups, group 1 (n = 151) included healthy asymptomatic adults with no history of trauma. In group 2, we included n = 99 patients with symptomatic AC joints, who underwent arthroscopic AC-joint resection. The central and posterior joint space width and the AC angle were measured. Morphological changes such as cartilage degeneration, cysts and bone edema were noted. Malalignment of the joint was defined as: posterior joint space width < 2 mm in conjunction with an AC angle > 12°. A scoring system consisting of the measured morphologic factors was developed. Results Symptomatic and asymptomatic patients showed significant differences in all measured items. We observed a significant difference in the MAC score for symptomatic and asymptomatic patients (mean 10.4 vs. 20.6, p = 0.0001). The ROC (receiver operator characteristic) analysis showed an excellent AUC of 0.899 (p = 0.001). The sensitivity of the MAC score was 0.81 and the specificity 0.86. The MAC score shows a significant moderate correlation with age (r = 0.358; p = 0.001). The correlation of age and the development of symptoms was only weak (r = 0.22, p = 0.001). Symptomatic patients showed significantly more frequent malalignment compared to asymptomatic patients (p = 0.001), but the positive predictive value that a patient with malalignment is also symptomatic is only 55%. Conclusion Patients with symptomatic AC joints showed a typical pattern of morphological changes on axial MRI scans with early posterior contact of the joint surfaces, reduction of joint space and malalignment as the basis for the development of a scoring system. The MAC score shows excellent test characteristics, and therefore, proved to be both an appropriate guidance for clinical practice as well as an excellent tool for comparative studies and is superior to the assessment of malalignment alone. Level of evidence Level IV, retrospective diagnostic study.

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High Early-onset acromioclavicular secondary pathologies after acute arthroscopic joint reduction: a cohort study

Cited by 9 publications

References 35 publications

Management of Acromioclavicular Injuries – Current Concepts

Management of Acromioclavicular Injuries – Current Concepts

Acromioclavicular and coracoclavicular ligamentous insertion distances depend on the scapular tilt and decrease with anterior direction of the inferior scapula angle

Morphology of the acromioclavicular-joint score (MAC)

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