Surgery improves the clinical and radiological outcome in Rockwood type IV dislocations, whereas Rockwood type III dislocations benefit from conservative treatment

Abstract

Purpose Despite the available classiications, diagnostics and treatment of acute acromioclavicular joint (ACJ) injuries are still vague and challenging for trauma and shoulder surgeons. This study aimed to evaluate the dynamic radiographic as well as clinical outcome of operatively and conservatively treated Rockwood (RW) type III and IV ACJ dislocations. All patients with RW type III and IV ACJ dislocations between 2009 and 2016 (n = 226) were included in this retrospective data analysis with a prospective follow-up examination. According to their injury classiication, patients were subdivided in an operative and conservative treatment group. Examiner blinded clinical evaluation including the constant score (CS), American shoulder and elbow surgery (ASES) score, the acromioclavicular joint instability (ACJI) score, visual analog scale (VAS), bilateral force measurements, and posttraumatic/postsurgical sequelae were assessed. Fluoroscopic evaluations including dynamic stability assessment with functional axillary views were performed for every patient. Results For follow-up examination (mean 4.8 years ± 0.3 SEM) 56 patients (29 RW type III, 27 RW type IV) were available. In patients with RW type III ACJ dislocations [operative (n = 10); conservative (n = 19)] prolonged duration of treatment was seen in operatively treated patients (p < 0.05). Clear improvement could be shown for the ACJI score (p < 0.05) and coracoclavicular (CC) and acromioclavicular (AC) distance (p < 0.05) in the operative group. In patients with RW type IV ACJ dislocations [operative (n = 18); conservative (n = 9)] superior clinical results were found in operated patients with highly signiicant diferences for the ACJI score (p < 0.001). Radiographic dynamic horizontal analysis showed nearly normalized anteroposterior translation in operated patients (p < 0.05). No diferences were found regarding arthroscopic or open procedures. Conclusion Accurate diagnostics including suicient dynamic stability assessment with functional axillary views are strongly advised for patients with ACJ dislocations. Conservative treatment should be recommended for patients with RW type III ACJ dislocations, due to shorter duration of treatment with good clinical results but lacking operative risks. In patients with RW type IV ACJ dislocations, surgical treatment is recommended because of superior clinical and radiological results. Level of evidence Level III. Materials and methods

The Morphology of the Acromioclavicular Joint Does Not Influence the Postoperative Outcome Following Acute Stabilization—A Case Series of 81 Patients

“…In accordance, previous studies in the literature reported postoperative ASES scores ranging from 82% to 98% after an arthroscopically assisted technique employing suspensory fixation systems. 3 , 4 , 10 , 11 , 13 The difference noted in this study between SANE scores of isolated C-stabilization and combined CC stabilization and AC cerclage across the study population ( Table 1 ) and VAS rest scores in the non-flat subtype ( Table 3 ) that reach statistical significance do not reach the minimal clinically important difference and are thus not regarded clinically relevant. 25 …”

“… 1 There exists a general consensus throughout the literature that acromioclavicular joint injuries (ACJI) Rockwood type I, II, and IIIA can be managed nonoperatively, whereas ACJI Rockwood type IIIB and IV-VI dislocations should be treated surgically. 2 , 3 , 4 , 5 Surgical management with arthroscopically assisted suspensory fixation for coracoclavicular stabilization may result in favorable outcomes. 3 , 4 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 …”

“… 2 , 3 , 4 , 5 Surgical management with arthroscopically assisted suspensory fixation for coracoclavicular stabilization may result in favorable outcomes. 3 , 4 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 …”

Low rate of substantial loss of reduction immediately after hardware removal following acromioclavicular joint stabilization using a suspensory fixation system

“…Acromioclavicular (AC) joint injuries account for a significant proportion of shoulder injuries, especially in athletes engaging in contact sports [ 1 , 4 , 14 , 27 , 30 , 36 ]. While current literature supports a non-operative management of low-grade AC joint injuries, Rockwood type IIIB and IV-VI dislocations should generally be treated surgically [ 1 , 13 , 29 , 31 ]. With recent literature covering a wide range of open and arthroscopic procedures, a growing body of evidence reports the arthroscopically assisted technique employing suspensory fixation systems to reliably achieve favorable clinical outcomes [ 10 , 13 , 22 , 29 , 37 , 38 , 41 , 43 ].…”

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

“…The AC joint dislocation can be classified according to Rockwood [9]. Most of the Rockwood type IV, V and VI AC joint injuries need to be reduced and stabilized surgically [1, 6, 7, 17]. For the surgical treatment of acute AC joint injuries, there is widespread consensus to perform an arthroscopic anatomic reconstruction with a suspensory device [18].…”