Summary

Early versus delayed arthroscopic treatment of high-grade acromioclavicular joint instability

Abstract

Background

Arthroscopic assisted cortical fixation devices have been increasingly used in the operative management of both acute and chronic cases of acromioclavicular joint instability (ACJI). It has been hypothesized that delayed surgical management leads to inferior clinical and radiological outcomes compared to acute treatment. The purpose of this study is to compare clinical and radiologic outcomes, scapula dyskinesia, and failure/revision rates of arthroscopically treated acute with chronic ACJI.

Methods

This retrospective study of prospectively collected data included all surgically treated patients with chronic ACJI between 2013 and 2017, matched 1:1 to a group of acute ACJI patients treated during the same time period. Chronic ACJI was defined as delayed surgical treatment > 21 days after injury. Chronic cases received an additional hamstring autograft next to the suture pulley systems. Follow-up was obtained at an average of 3.2 years (range: 1.4-6.2). Clinical outcome scores included the Constant Score (CS), Taft Score (TF), Nottingham Clavicle Score (NCS), ACJI Score, Sick Scapula Score (SSS), Subjective Shoulder Value (SSV), Subjective Shoulder Test (SST), American Shoulder and Elbow Score (ASES) and the VAS pain scale. Radiological follow up was obtained pre- and post-operatively and at final follow up. The 2-year results were compared to the results of a 1:1 matched pair group comprising patients that were treated with an acute ACJI during the same period.

Results

33 out of 41 (80.5%) of chronic ACJI cases were available for follow-up and were compared with 33 matched-paired cases of acute ACJI (out of 141).The clinical scores were significantly better in the acute cohort for the CMS (92±8 vs 88±8, p=0.030); ASES (91±13 vs 85±13; p=0.002); SSS (1.4±1.6 vs 3.4±2.5, p=0.0004); NCS (86±13 vs 81±13, p=0.049); TF (9.9±1.9 vs 9.0±2.1, p=0.030) and ACJI (83±13 vs 75±1, p=0.003). In contrast to the chronic cohort, the acute cohort illustrated a significant loss of reduction at follow up (p=0.020).

Conclusion

Based on the results of this study, early arthroscopic assisted operative treatment seems superior to delayed surgical intervention. Furthermore, an additional autograft loop leads to less loss of reduction compared to suture pulley/suspensory loop fixation standalones.
Level of evidence: IV

Keywords:
Acute AC-Joint Instability; Chronic AC-Joint Instability; Scapula Dyskenisa; SICK Scapula Syndrome; Arthroscopic assisted treatment