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. 2021 Jul;29(7):2325-2332.
doi: 10.1007/s00167-020-06286-w. Epub 2020 Sep 26.

High degree of consensus achieved regarding diagnosis and treatment of acromioclavicular joint instability among ESA-ESSKA members

Claudio Rosso #  1   2   3 , Frank Martetschläger #  4   5   6 , Maristella F Saccomanno  7   6 , Andreas Voss  5   8   6 , Lucca Lacheta  5   9   6 ; ESA DELPHI Consensus Panel; Knut Beitzel #  6   10 , Giuseppe Milano #  6   11   12
Collaborators, Affiliations

High degree of consensus achieved regarding diagnosis and treatment of acromioclavicular joint instability among ESA-ESSKA members

Claudio Rosso et al. Knee Surg Sports Traumatol Arthrosc. 2021 Jul.

Abstract

Purpose: To develop a consensus on diagnosis and treatment of acromioclavicular joint instability.

Methods: A consensus process following the modified Delphi technique was conducted. Panel members were selected among the European Shoulder Associates of ESSKA. Five rounds were performed between October 2018 and November 2019. The first round consisted of gathering questions which were then divided into blocks referring to imaging, classifications, surgical approach for acute and chronic cases, conservative treatment. Subsequent rounds consisted of condensation by means of an online questionnaire. Consensus was achieved when ≥ 66.7% of the participants agreed on one answer. Descriptive statistic was used to summarize the data.

Results: A consensus was reached on the following topics. Imaging: a true anteroposterior or a bilateral Zanca view are sufficient for diagnosis. 93% of the panel agreed on clinical override testing during body cross test to identify horizontal instability. The Rockwood classification, as modified by the ISAKOS statement, was deemed valid. The separation line between acute and chronic cases was set at 3 weeks. The panel agreed on arthroscopically assisted anatomic reconstruction using a suspensory device (86.2%), with no need of a biological augmentation (82.8%) in acute injuries, whereas biological reconstruction of coracoclavicular and acromioclavicular ligaments with tendon graft was suggested in chronic cases. Conservative approach and postoperative care were found similar CONCLUSION: A consensus was found on the main topics of controversy in the management of acromioclavicular joint dislocation. Each step of the diagnostic treatment algorithm was fully investigated and clarified.

Level of evidence: Level V.

Keywords: Ac joint; Ac joint instability; Acromioclavicular joint; Consensus; Delphi; Diagnosis; European shoulder associates; Instability; Treatment.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Graphical illustration of radiographic evaluation. Consensus was found after round 2 and 3, respectively. Panoramic views with true a.p. radiographs without additional imaging (MRI, CT, etc.) were found to be sufficient
Fig. 2
Fig. 2
Graphical illustration of the classification system. Consensus was found after round 3 and 4, respectively. The Rockwood classification was recommended by the panel
Fig. 3
Fig. 3
Graphical illustration of acute cases. Consensus was found after round 3 and 5, respectively. It was consented to use a stabilization with a suspensory device in acute cases
Fig. 4
Fig. 4
Graphical illustration of chronic cases. Consensus was found after round 3, 4 and 5, respectively. It was consented to use a tendon augmentation wrapped around the coracoid and addressing the AC joint capsule
Fig. 5
Fig. 5
Graphical illustration of postoperative treatment. Consensus was found after round 3 and 4, respectively
See this image and copyright information in PMC

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