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. 2021 Jul;29(7):2175-2193.
doi: 10.1007/s00167-020-06217-9. Epub 2020 Aug 14.

Biologic and synthetic ligament reconstructions achieve better functional scores compared to osteosynthesis in the treatment of acute acromioclavicular joint dislocation

Maristella F Saccomanno  1 , Giuseppe Sircana  2 , Valentina Cardona  2 , Valeria Vismara  2 , Alessandra Scaini  3 , Andrea G Salvi  3 , Stefano Galli  4 , Giacomo Marchi  4 , Giuseppe Milano  3   4
Affiliations

Biologic and synthetic ligament reconstructions achieve better functional scores compared to osteosynthesis in the treatment of acute acromioclavicular joint dislocation

Maristella F Saccomanno et al. Knee Surg Sports Traumatol Arthrosc. 2021 Jul.

Abstract

Purpose: To systematically review the outcomes of surgical treatments of acute acromioclavicular joint dislocation.

Methods: Studies were identified by electronic databases (Ovid, PubMed). All studies reporting functional and radiological outcomes of surgical treatments of acute 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: One hundred and thirty-three studies were included for a total of 4473 shoulders. Mean age of participants was 36.9 years. Mean follow-up was 42.06 months. Arthroscopy showed better ASES (p < 0.0001) and lower VAS pain score (p = 0.0249) compared to an open approach. Biologic and synthetic reconstructions demonstrated better results over osteosynthesis techniques. Biologic techniques showed overall better Constant (p = 0.0001) and DASH (p = 0.0215) scores, while synthetic reconstruction showed better UCLA score (p = 0.0001). Among suture buttons, triple button showed overall better results in Constant (p = 0.0001) and VAS (p = 0.0001) scores, while better results in DASH score (p = 0.0003) were achieved by 2 double button techniques. Overall, the level of evidence was low.

Conclusion: Biological and synthetic reconstructions achieved better functional scores compared to osteosynthesis. Among suture buttons, the triple button showed better functional performance.

Level of evidence: IV.

Keywords: Acromioclavicular; Acromioclavicular ligament; Biologic; Coracoclavicular ligament; Dislocation; Instability; Plate; Reconstruction; Screws; Synthetic; Tendon graft.

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