Summary

This study found delayed surgical management of ACJ injuries using a modern device has comparable functional outcome and is not associated with a higher incidence of fixation failure or major complications.

Abstract

Background

Management of displaced acromioclavicular joint (ACJ) injuries remain contentious. It is unclear if delayed versus acute reconstruction has an increased risk of fixation failure and complications. The primary aim of this study was to compare complications of early versus delayed reconstruction. The secondary aim was to determine modes of failure of ACJ reconstruction requiring revision surgery.

Methods

A retrospective study was performed on all patients who underwent operative reconstruction of ACJ injuries over a 10-year period (Rockwood III-V) using tunnelled suspensory devices with or without hamstring allograft. Reconstruction was classed as early (<12 weeks from injury) or delayed (=12 weeks). Patient demographics, fixation method and post-operative complications were noted, with one-year follow-up a minimum requirement for inclusion. Patient reported outcomes with the QuickDASH and EQ-5D were undertaken. Fixation failure was defined as loss of reduction requiring revision surgery.

Results

104 patients were analysed (n=59 early and n=45 delayed). Mean age was 42.0 (SD 11.2, 17-70 years), 84.6% male and 15.4% were smokers. No difference was observed between fixation failure (p=0.39) or deep infection (p=0.13) with regards to acute versus delayed reconstruction. No patient demographic or timing of surgery was predictive of fixation failure on regression modelling.
Overall, eleven patients underwent revision surgery for loss of reduction and implant failure (n=5 suture fatigue, n=2 endo-button escape, n=2 coracoid stress fracture and n=2 deep infection). The EQ-5D (p=0.084) and QuickDASH (p=0.062) was comparable for early and delayed groups respectively and below the minimal clinical important difference.

Conclusion

This study found delayed surgical management of ACJ injuries using a modern device has comparable functional outcome and is not associated with a higher incidence of fixation failure or major complications.