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. 2021 Oct;47(5):1417-1427.
doi: 10.1007/s00068-020-01414-0. Epub 2020 Jun 13.

Current practice in the management of acromioclavicular joint dislocations; a national survey in the Netherlands

Philippe P De Rooij  1 , Esther M M Van Lieshout  2 , Ivo J Schurink  1 , Michael H J Verhofstad  1 ; ACJ injury study group
Affiliations

Current practice in the management of acromioclavicular joint dislocations; a national survey in the Netherlands

Philippe P De Rooij et al. Eur J Trauma Emerg Surg. 2021 Oct.

Abstract

Purpose: The aim of this study was to investigate current practice in the management of acromioclavicular joint dislocations in the Netherlands.

Methods: A 36-item literature-based and expert consensus survey was developed. If available, one orthopaedic and one trauma surgeon for every hospital (n = 82) in the Netherlands was asked to complete the online questionnaire. Only complete data sets were included in the analysis. Descriptive analysis was performed using SPSS.

Results: Of 149 invited surgeons, 106 (71%) fully completed the survey. The diagnosis of ACJ injury was mainly based on physical examination (91%) and radiographs (95%). The vast majority of patients with ACJ injuries was treated non-operatively. The decision for operative treatment was mainly based on the surgeon's experience and available literature. Patient-related factors that contributed most to the decision to operate or not, were mainly functional needs and age. Cosmesis and gender contributed less to this decision. Rockwood II and III ACJ injuries were usually treated non-operatively, whereas Rockwood IV and V ACJ injuries were usually treated operatively. For primary and secondary operative treatment, a flexible implant was preferred over rigid fixation techniques. All respondents agreed that nonoperative treatment of Rockwood II ACJ injuries leads to satisfactory results and that secondary operative treatment is only rarely required. Also the majority of patients with Rockwood III ACJ injuries is treated non-operatively, although failure rates are considered higher.

Conclusion: This survey showed a significant individual variation on diagnosis and treatment strategies among surgeons in the Netherlands. The majority of the Dutch surgeons concern a flexible implant the best available technique for patients who require operative treatment.

Keywords: ACJ injury; Acromio-clavicular joint; Rockwood; Shoulder; Survey; Trauma.

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Conflict of interest statement

PP. De Rooij, E.M.M. Van Lieshout, I.J. Schurink, and M.H.J. Verhofstad declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Diagnostics used for diagnosing ACJ injuries. The number of respondents is given next to the bars
Fig. 2
Fig. 2
Number of patients annually treated for a Rockwood II, b Rockwood III, and c Rockwood V ACJ injuries. The number of respondents is given above the bars
Fig. 3
Fig. 3
Percentage of patients with any ACJ injury treated operatively within 2 weeks after trauma. The number of respondents is given above the bars
Fig. 4
Fig. 4
Physician-related (a) and patient-specific (b) factor contributing to the decision for operative treatment of any ACJ injuries. The number of respondents is given above the bars
Fig. 5
Fig. 5
Type of preferred primary treatment for Rockwood II, III, IV, and V ACJ injuries. The number of respondents is given above the bars
Fig. 6
Fig. 6
a Top 3 of treatment strategies, b flexible implants, and c need for distal clavicle resection for primary and secondary operative treatment strategies used for ACJ injuries. The number of respondents is given next to the bars
Fig. 7
Fig. 7
Respondents’ opinion on the proportion of patients that are satisfied with the functional and cosmetic results at 1 year after nonoperative treatment of ACJ injuries. For Rockwood II ACJ-injuries, seven respondents reported to be undecided. The number of respondents is given above the bars
Fig. 8
Fig. 8
Respondents’ opinions on the proportion of patients that require secondary operative treatment after failed nonoperative management of a Rockwood II or III of ACJ injury. The number of respondents is given above the bars
Fig. 9
Fig. 9
Respondents’ opinions regarding four statements: Statement A: “Primary surgical treatment is not indicated for a Rockwood II ACJ injury”; Statement B: “Healthy active patients with a Rockwood III ACJ injury should primarily be treated operatively”; Statement C: “Healthy active patients with a Rockwood IV ACJ injury should primarily be treated operatively”; Statement D: “With current surgical techniques, cosmetic complaints of an ACJ injury with a good shoulder function, should also be an indication for operative treatment”. The number of respondents is given above the bars
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