Summary

Patients who underwent ACJ stabilization using coracoclavicular suspensory fixation with an additional acromioclavicular cerclage for isolated type V ACJ injuries in the acute setting achieved similar mid-term functional outcomes and failure rates to those who underwent delayed surgery with additional biologic augmentation using a hamstring autograft >/= 3 weeks after injury.

Abstract

Background

The urgency of surgical intervention is a critical factor in the shared decision-making process in patients with Rockwood type V acromioclavicular joint (ACJ) injuries. However, there is limited evidence pertaining to comparative studies examining functional outcomes following ACJ stabilization in either acute or chronic settings for these injuries. Thus, the purpose of the study was to compare functional outcomes of patients undergoing isolated arthroscopically assisted ACJ stabilization for acute or chronic type V ACJ injuries. It was hypothesized that patients who underwent delayed ACJ stabilization in the chronic setting would achieve similar functional outcomes at mid-term follow-up compared to those who underwent surgery in the acute setting.

Methods

Consecutive patients who underwent ACJ stabilization using coracoclavicular suspensory fixation with an additional acromioclavicular cerclage for isolated acute or chronic type V ACJ injuries between 01/2015 to 08/2021 and had a minimum follow-up of two years were analyzed. Chronic ACJ injuries were defined as an interval of >/= 3 weeks from injury to surgery according to the ISAKOS consensus statement, while acute injuries were defined as < 3 weeks after injury. Patients with chronic injuries received an additional biological augmentation using a hamstring autograft. Functional outcome measures included the Constant-Murley (CM), American Shoulder and Elbow Surgeons (ASES), and Nottingham Clavicle (NC) score as well as the Visual Analogue Scale (VAS) for pain, which were compared between groups at final follow-up. Where appropriate, the t-test or Mann-Whitney test were used to compare independent groups, while the Fisher’s exact test or Chi-square test were used for categorical variables and the correlations were assessed using the Pearson or Spearman correlation coefficient.

Results

A total of 82 patients (mean age at surgery: 40.3±12.7 years; 54 acute and 28 chronic injuries) with a mean follow-up of 5.5±2.0 years (range: 2.0–9.9 years) were included in the study. There were no significant differences between groups regarding age at surgery (acute: 38.4±12.2 years; chronic: 43.7±13.0 years; P=0.08), sex (acute: 13.0%; chronic: 14.3%; P=0.87), or follow-up time (acute: 5.5±1.8 years; chronic: 5.5±2.5 years; P=0.83). At final follow-up, patients with acute or chronic injuries showed similar CM (acute: 85.3±13.3; chronic: 85.5±12.0; P=0.98), ASES (94.3±10.1; chronic: 93.5±14.4; P=0.69), and NC scores (acute: 85.6±14.2; chronic: 86.8±14.0; P=0.68). Further, there was no difference in VAS for pain (acute: 1.9±1.1; chronic: 2.0±1.6; P=0.47). Neither age at surgery nor follow-up time was correlated with any of the functional outcome scores (P>0.05, respectively). Five patients in the acute group and 2 patients in the chronic group failed and underwent revision surgery (acute: 9.3%; chronic: 7.1%; P=0.75).

Conclusion

Patients who underwent ACJ stabilization using coracoclavicular suspensory fixation with an additional acromioclavicular cerclage for isolated type V ACJ injuries in the acute setting achieved similar mid-term functional outcomes and failure rates to those who underwent delayed surgery with additional biologic augmentation using a hamstring autograft >/= 3 weeks after injury. These data may serve as a reference point for shoulder surgeons in guiding discussions with their patients about the timing of surgical intervention within the context of personalized decision-making.