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. 2021 Jul;29(7):2264-2271.
doi: 10.1007/s00167-020-06159-2. Epub 2020 Jul 24.

Conversion to anatomic coracoclavicular ligament reconstruction (ACCR) shows similar clinical outcomes compared to successful non-operative treatment in chronic primary type III to V acromioclavicular joint injuries

Lukas N Muench  1   2 , Daniel P Berthold  1   2 , Colin Uyeki  1 , Cameron Kia  1 , Mark P Cote  1 , Andreas B Imhoff  2 , Knut Beitzel  2   3 , Katia Corona  4 , Augustus D Mazzocca  1 , Simone Cerciello  5   6
Affiliations

Conversion to anatomic coracoclavicular ligament reconstruction (ACCR) shows similar clinical outcomes compared to successful non-operative treatment in chronic primary type III to V acromioclavicular joint injuries

Lukas N Muench et al. Knee Surg Sports Traumatol Arthrosc. 2021 Jul.

Abstract

Purpose: To compare the clinical outcomes of patients who underwent successful nonoperative treatment for type III-V acromioclavicular joint (ACJ) injuries to those who eventually required conversion to anatomic coracoclavicular ligament reconstruction (ACCR) at a minimum 5-year follow-up.

Methods: Patients with primary, chronic type III-V ACJ injuries who either underwent successful conservative treatment or conversion to ACCR after failing a trail of conservative management between 2003 and 2014 with a minimum 5-year follow-up were included in the study. Clinical outcome measures comprised the American Shoulder and Elbow Surgeons (ASES) and Simple Shoulder Test (SST) score, collected preoperatively and at final visit for the ACCR group. Outcome scores for patients with successful conservative treatment were only collected at final visit. A Self- Assessment Numeric Evaluation (SANE) score was obtained at terminal follow-up for both groups.

Results: Twenty-two patients (mean age: 40.1 ± 15.6 years) with successful nonoperative treatment and twenty-one patients (mean age: 43.6 ± 12.0 years) who required conversion to ACCR were included in the study. At final follow-up, patients with successful non-operative treatment achieved similar ASES (93.0±12.0NonOP vs. 86.1±16.8ACCR), SST (11.2±1.4NonOP vs. 10.7±2.0ACCR) and SANE scores (80.9±19.7NonOPvs. 90.5±14.7ACCR) compared to those who were converted to ACCR. Additionally, patients who underwent conversion to ACCR showed significant improvement in ASES (49.8±18.1pre vs. 86.1±16.8post; Δ36.3±19.7) and SST scores (6.5±3.2prevs. 10.7±2.0post; Δ4.2±4.0) from pre- to postoperative.

Conclusion: At a minimum 5-year follow-up, patients with successful non-operative treatment for type III-V ACJ injuries achieved similar clinical outcomes compared to those who were converted to ACCR. In patients with chronic severe ACJ dislocation a trial of conservative treatment may be attempted, astime from injuryto eventual conversion to ACCR had no significant influence on postoperative clinical outcomes.

Level of evidence: Level IV.

Keywords: AC joint; ACCR; Acromioclavicular joint injury; Anatomic coracoclavicular ligament reconstruction; conservative treatment.

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References

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    1. Beitzel K, Mazzocca AD, Bak K, Itoi E, Kibler WB, Mirzavan R et al (2014) ISAKOS upper extremity committee consensus statement on the need for diversification of the Rockwood classification for acromioclavicular joint injuries. Arthroscopy 30:271–278 - DOI
    1. Berthold DP, Muench LN, Dyrna F, Uyeki CL, Cote MP, Imhoff AB et al (2020) Radiographic alterations in clavicular bone tunnel width following anatomic coracoclavicular ligament reconstruction (ACCR) for chronic acromioclavicular joint injuries. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-020-05980-z - DOI - PubMed
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    1. Carofino BC, Mazzocca AD (2010) The anatomic coracoclavicular ligament reconstruction: surgical technique and indications. J Shoulder Elbow Surg 19:37–46 - DOI

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