Luis Natera Cisneros1,2, Juan Sarasquete Reiriz3,4. 1. Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Sant Quintí 89, 08026, Barcelona, Spain. luisgerardonaterac@gmail.com. 2. Hospital General de Catalunya, Pedro i Pons 1, 08190, Sant Cugat del Vallés, Barcelona, Spain. luisgerardonaterac@gmail.com. 3. Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Sant Quintí 89, 08026, Barcelona, Spain. 4. Hospital Quirón Teknon, Vilana 12, 08022, Barcelona, Spain.
Abstract
PURPOSE: To determine the prevalence of remaining horizontal instability in high-grade acromioclavicular joint (ACJ) injuries surgically managed by means of four different surgical strategies and to assess its relation to the clinical outcomes and the quality of life. METHODS: In this multicentric non-randomized retrospective study, 53 patients with high-grade ACJ injuries surgically managed (by means of open or arthroscopic surgery) were clinically and radiographically assessed at 24 months or more after shoulder surgery. The presence of post-surgical remaining horizontal instability was evaluated by means of Alexander or axillary X-ray views. The study population was divided into two groups: patients with evidence of post-surgical remaining horizontal instability and patients without evidence of post-surgical remaining horizontal instability at the last follow-up visit. The relationship between remaining horizontal instability and the quality-of-life questionnaires was analyzed. RESULTS: 18.87% (10/53) of the Alexander or axillary X-rays views showed post-surgical remaining horizontal instability at the last follow-up visit (INSTAB-group). Results of the questionnaires were: (1) physical SF36 score (INSTAB-group 57.02 ± 3.17 and NO-INSTAB-group 57.66 ± 3.30, p = 0.583); (2) mental SF36 score (INSTAB-group 53.95 ± 3.98 and NO-INSTAB-group 55.71 ± 3.30, p = 0.150); (3) NRS for pain (INSTAB-group 1.30 ± 1.49 and NO-INSTAB-group 0.83 ± 1.08, p = 0.260); (4) DASH questionnaire (INSTAB-group 5.27 ± 5.42 and NO-INSTAB-group 3.06 ± 2.30, p = 0.049); (5) Constant score (INSTAB-group 93.4 ± 3.5 and NO-INSTAB-group 94.83 ± 4.3, p = 0.333); and Global satisfaction (INSTAB-group 8.7 ± 0.95 and NO-INSTAB-group 8.64 ± 1.03, p = 0.874). CONCLUSION: Independently of the type of procedure, post-surgical remaining horizontal instability was present in almost one-fifth of the patients, and this group of patients showed a significantly worse DASH score. The addition of an acromioclavicular augmentation might have to be considered, taking into account that its absence may have a negative impact in terms of shoulder disabilities. LEVEL OF EVIDENCE: Level IV, prognostic case series.
PURPOSE: To determine the prevalence of remaining horizontal instability in high-grade acromioclavicular joint (ACJ) injuries surgically managed by means of four different surgical strategies and to assess its relation to the clinical outcomes and the quality of life. METHODS: In this multicentric non-randomized retrospective study, 53 patients with high-grade ACJ injuries surgically managed (by means of open or arthroscopic surgery) were clinically and radiographically assessed at 24 months or more after shoulder surgery. The presence of post-surgical remaining horizontal instability was evaluated by means of Alexander or axillary X-ray views. The study population was divided into two groups: patients with evidence of post-surgical remaining horizontal instability and patients without evidence of post-surgical remaining horizontal instability at the last follow-up visit. The relationship between remaining horizontal instability and the quality-of-life questionnaires was analyzed. RESULTS: 18.87% (10/53) of the Alexander or axillary X-rays views showed post-surgical remaining horizontal instability at the last follow-up visit (INSTAB-group). Results of the questionnaires were: (1) physical SF36 score (INSTAB-group 57.02 ± 3.17 and NO-INSTAB-group 57.66 ± 3.30, p = 0.583); (2) mental SF36 score (INSTAB-group 53.95 ± 3.98 and NO-INSTAB-group 55.71 ± 3.30, p = 0.150); (3) NRS for pain (INSTAB-group 1.30 ± 1.49 and NO-INSTAB-group 0.83 ± 1.08, p = 0.260); (4) DASH questionnaire (INSTAB-group 5.27 ± 5.42 and NO-INSTAB-group 3.06 ± 2.30, p = 0.049); (5) Constant score (INSTAB-group 93.4 ± 3.5 and NO-INSTAB-group 94.83 ± 4.3, p = 0.333); and Global satisfaction (INSTAB-group 8.7 ± 0.95 and NO-INSTAB-group 8.64 ± 1.03, p = 0.874). CONCLUSION: Independently of the type of procedure, post-surgical remaining horizontal instability was present in almost one-fifth of the patients, and this group of patients showed a significantly worse DASH score. The addition of an acromioclavicular augmentation might have to be considered, taking into account that its absence may have a negative impact in terms of shoulder disabilities. LEVEL OF EVIDENCE: Level IV, prognostic case series.
Authors: Knut Beitzel; Nicholas Sablan; David M Chowaniec; Elifho Obopilwe; Mark P Cote; Robert A Arciero; Augustus D Mazzocca Journal: Am J Sports Med Date: 2011-12-08 Impact factor: 6.202
Authors: Patrick A Dawson; Gregory J Adamson; Marilyn M Pink; Matthew Kornswiet; Steven Lin; James A Shankwiler; Thay Q Lee Journal: J Shoulder Elbow Surg Date: 2008-12-25 Impact factor: 3.019
Authors: Knut Beitzel; Augustus D Mazzocca; Klaus Bak; Eiji Itoi; William B Kibler; Raffy Mirzayan; Andreas B Imhoff; Emilio Calvo; Guillermo Arce; Kevin Shea Journal: Arthroscopy Date: 2014-02 Impact factor: 4.772
Authors: Matthias A Zumstein; Philippe Schiessl; Benedikt Ambuehl; Lilianna Bolliger; Johannes Weihs; Martin H Maurer; Beat K Moor; Michael Schaer; Sumit Raniga Journal: Knee Surg Sports Traumatol Arthrosc Date: 2017-05-25 Impact factor: 4.342