Summary

Our findings revealed no statistically significant difference in clinical outcomes between open and arthroscopically assisted procedures. Arthroscopically assisted procedure may have the ability to identify concomitant injuries not initially seen on imaging or when a complete imaging evaluation is not available

Abstract

Introduction

Injury to the acromioclavicular (AC) joint, accounting for 9% of all shoulder injuries, is most common in men between the ages of 20 and 39 years. The literature describes a plethora of open or arthroscopically assisted techniques to address AC joint injuries, with newer methods like arthroscopically assisted anatomical coracoclavicular (CC) ligament reconstruction with the use of button fixation gaining popularity. Nevertheless, despite the increasing number of comparative studies between open and arthroscopically assisted techniques available, the potential superiority of an arthroscopically assisted approach needs to be determined.

Aim

This study comprehensively analyzes the outcomes of surgical management of AC joint dislocation using either arthroscopically assisted or open procedures in a specialized sports medicine center and additionally compares the clinical outcomes between acute and chronic cases.

Material And Methods

We conducted a retrospective study of all patients with AC joint dislocation who underwent open or arthroscopically assisted coracoclavicular ligament reconstruction from 2013 to 2022. Clinical and functional outcomes were assessed postoperatively using the Subjective Shoulder Value (SSV) and Visual Analogue Scale (VAS) for pain scores and complication and reoperation rates.

Results

A total of 41 patients were enrolled in the study, with Rockwood classifications III, IV, and V. The patients were separated into two groups based on injury acuity: acute (n=18) with a mean age of 31.7 years (16 to 50 years) and chronic (n=23) with a mean age of 37.6 years (19 to 66 years). The average duration of follow-up was comparable between the two groups (33.1 months vs. 33.3 months, respectively, p=0.97). The clinical outcomes as demonstrated by SSV (82.6±8 vs. 80.4±7.3) and VAS for pain (0.9±0.8 vs. 1.8±1) were marginally better for the acute cases; however, no statistically significant difference was observed; with p values of 0.70 and 0.20, respectively. The two groups demonstrated similar results in terms of complications and reoperation rates (p=0.85 and 0.57, respectively). Distal clavicle excision was performed more often in the chronic group (p<0.05).
The 41 patients were then separated into two groups based on type of surgery, open (n=14) and arthroscopically assisted (n=27). Once again, no statistically significant differences were observed between the two groups in terms of SSV (p=0.89), VAS for pain (p=0.44), complications (p=0.51), and reoperations (p=0.07). Nevertheless, arthroscopically assisted demonstrated its effectiveness as a valuable intraoperative diagnostic tool, successfully identifying concomitant injuries in numerous cases (55.5%).

Conclusion

Our findings revealed no statistically significant difference in clinical outcomes between open and arthroscopically assisted procedures. Arthroscopically assisted may have the ability to identify concomitant injuries not initially seen on imaging or when a complete imaging evaluation is not available. In chronic cases, while arthroscopically assisted can be performed with similar outcomes, surgeons should be aware that distal clavicle excision may be necessary to reduce the AC joint adequately and should be considered at the time of surgery if the joint is irreducible. However, our study underscores the need for prospective multicenter research to further evaluate these procedures and their outcomes.