Nina Maziak1, Laurent Audige2, Carmen Hann1, Marvin Minkus1, Markus Scheibel1,2. 1. Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin Berlin, Berlin, Germany. 2. Department of Shoulder and Elbow Surgery, Schulthess Clinic, Zurich, Switzerland.
Abstract
BACKGROUND: Factors influencing the outcome after arthroscopically assisted stabilization of acute high-grade acromioclavicular (AC) joint dislocations remain poorly investigated. PURPOSE: To identify determinants of the radiological outcome and investigate associations between radiological and clinical outcome parameters. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: The authors performed a retrospective analysis of patients who underwent arthroscopically assisted stabilization for acute high-grade AC joint dislocations. The following potential determinants of the radiological outcome were examined using univariable and multivariable regression analyses: timing of surgery, initial AC joint reduction, isolated coracoclavicular (CC) versus combined CC and AC stabilization, ossification of the CC ligaments, age, and overweight status. In addition, associations between radiological (ie, CC difference, dynamic posterior translation [DPT]) and clinical outcome parameters (Subjective Shoulder Value, Taft score [TS] subjective subcategory, and Acromioclavicular Joint Instability Score [ACJI] pain subitem) were evaluated using univariable analysis. RESULTS: One hundred four patients with a mean (±SD) age of 38.1 ± 11.5 years were included in this study. The mean postoperative follow-up was 2.2 ± 0.9 years. Compared with patients with an overreduced AC joint after surgery, the CC difference was 4.3 mm (95% CI, 1.3-7.3; P = .006) higher in patients with incomplete reduction. Patients with anatomic reduction were 3.1 times (95% CI, 1.2-7.9; P = .017) more likely to develop DPT than those with an overreduced AC joint. An incompletely reduced AC joint was 5.3 times (95% CI, 2.1-13.4; P < .001) more likely to develop DPT versus an overreduced AC joint. Patients who underwent isolated CC stabilization were 4.8 times (95% CI, 1.1-21.0; P = .039) more likely to develop complete DPT than patients with additional AC stabilization. Significantly higher CC difference values were noted for patients who reported pain on the subjective TS (P = .025). Pain was encountered more commonly in patients with DPT (PTS = .049; PACJI = .038). CONCLUSION: Clinicians should consider overreduction of the AC joint because it may lead to favorable radiological results. Because of its association with superior radiographic outcomes, consideration should also be given to the use of additional AC cerclage.
BACKGROUND: Factors influencing the outcome after arthroscopically assisted stabilization of acute high-grade acromioclavicular (AC) joint dislocations remain poorly investigated. PURPOSE: To identify determinants of the radiological outcome and investigate associations between radiological and clinical outcome parameters. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: The authors performed a retrospective analysis of patients who underwent arthroscopically assisted stabilization for acute high-grade AC joint dislocations. The following potential determinants of the radiological outcome were examined using univariable and multivariable regression analyses: timing of surgery, initial AC joint reduction, isolated coracoclavicular (CC) versus combined CC and AC stabilization, ossification of the CC ligaments, age, and overweight status. In addition, associations between radiological (ie, CC difference, dynamic posterior translation [DPT]) and clinical outcome parameters (Subjective Shoulder Value, Taft score [TS] subjective subcategory, and Acromioclavicular Joint Instability Score [ACJI] pain subitem) were evaluated using univariable analysis. RESULTS: One hundred four patients with a mean (±SD) age of 38.1 ± 11.5 years were included in this study. The mean postoperative follow-up was 2.2 ± 0.9 years. Compared with patients with an overreduced AC joint after surgery, the CC difference was 4.3 mm (95% CI, 1.3-7.3; P = .006) higher in patients with incomplete reduction. Patients with anatomic reduction were 3.1 times (95% CI, 1.2-7.9; P = .017) more likely to develop DPT than those with an overreduced AC joint. An incompletely reduced AC joint was 5.3 times (95% CI, 2.1-13.4; P < .001) more likely to develop DPT versus an overreduced AC joint. Patients who underwent isolated CC stabilization were 4.8 times (95% CI, 1.1-21.0; P = .039) more likely to develop complete DPT than patients with additional AC stabilization. Significantly higher CC difference values were noted for patients who reported pain on the subjective TS (P = .025). Pain was encountered more commonly in patients with DPT (PTS = .049; PACJI = .038). CONCLUSION: Clinicians should consider overreduction of the AC joint because it may lead to favorable radiological results. Because of its association with superior radiographic outcomes, consideration should also be given to the use of additional AC cerclage.
Authors: Bastian Scheiderer; Sonja Obmann; Matthias J Feucht; Sebastian Siebenlist; Hannes Degenhardt; Andreas B Imhoff; Marco-Christopher Rupp; Jonas Pogorzelski Journal: Arthrosc Sports Med Rehabil Date: 2022-04-15
Authors: Dirk Maier; Lars-Rene Tuecking; Anke Bernstein; Gernot Lang; Ferdinand Christian Wagner; Martin Jaeger; Peter Ogon; Norbert Paul Südkamp; Kaywan Izadpanah Journal: BMC Musculoskelet Disord Date: 2020-09-04 Impact factor: 2.362
Authors: Marco-Christopher Rupp; Pavel M Kadantsev; Sebastian Siebenlist; Maximilian Hinz; Matthias J Feucht; Jonas Pogorzelski; Bastian Scheiderer; Andreas B Imhoff; Lukas N Muench; Daniel P Berthold Journal: Knee Surg Sports Traumatol Arthrosc Date: 2022-04-22 Impact factor: 4.114