Claudio Rosso1,2,3, Frank Martetschläger4,5,6, Knut Beitzel6,7, Giuseppe Milano6,8,9, Maristella F Saccomanno10,6, Andreas Voss5,11,6, Lucca Lacheta5,12,6. 1. ARTHRO Medics, Shoulder and Elbow Center, Thannerstrasse 45, 4054, Basel, Switzerland. C.Rosso@arthro.ch. 2. University of Basel, Basel, Switzerland. C.Rosso@arthro.ch. 3. European Shoulder Associates, European Society of Sport Traumatology, Knee Surgery and Arthroscopy, ESSKA, Luxembourg, Luxembourg. C.Rosso@arthro.ch. 4. German Center of Shoulder Surgery, ATOS Clinic Munich, Munich, Germany. 5. Department of Sports Orthopedics, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany. 6. European Shoulder Associates, European Society of Sport Traumatology, Knee Surgery and Arthroscopy, ESSKA, Luxembourg, Luxembourg. 7. Atos Orthoparc Clinic, Cologne, Germany. 8. Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy. 9. Department of Bone and Joint Surgery, Spedali Civili, Brescia, Italy. 10. Orthopaedics Institute, Fondazione Policilinico Universitario A. Gemelli IRCCS, Rome, Italy. 11. Department of Trauma Surgery, University Medical Center, Regensburg, Germany. 12. Center for Musculoskeletal Surgery, Charitè Universitaetsmedizin Berlin, Berlin, Germany.
Abstract
PURPOSE: To develop a consensus on diagnosis and treatment of acromioclavicular joint instability. METHODS: A consensus process following the modified Delphi technique was conducted. Panel members were selected among the European Shoulder Associates of ESSKA. Five rounds were performed between October 2018 and November 2019. The first round consisted of gathering questions which were then divided into blocks referring to imaging, classifications, surgical approach for acute and chronic cases, conservative treatment. Subsequent rounds consisted of condensation by means of an online questionnaire. Consensus was achieved when ≥ 66.7% of the participants agreed on one answer. Descriptive statistic was used to summarize the data. RESULTS: A consensus was reached on the following topics. Imaging: a true anteroposterior or a bilateral Zanca view are sufficient for diagnosis. 93% of the panel agreed on clinical override testing during body cross test to identify horizontal instability. The Rockwood classification, as modified by the ISAKOS statement, was deemed valid. The separation line between acute and chronic cases was set at 3 weeks. The panel agreed on arthroscopically assisted anatomic reconstruction using a suspensory device (86.2%), with no need of a biological augmentation (82.8%) in acute injuries, whereas biological reconstruction of coracoclavicular and acromioclavicular ligaments with tendon graft was suggested in chronic cases. Conservative approach and postoperative care were found similar CONCLUSION: A consensus was found on the main topics of controversy in the management of acromioclavicular joint dislocation. Each step of the diagnostic treatment algorithm was fully investigated and clarified. LEVEL OF EVIDENCE: Level V.
PURPOSE: To develop a consensus on diagnosis and treatment of acromioclavicular joint instability. METHODS: A consensus process following the modified Delphi technique was conducted. Panel members were selected among the European Shoulder Associates of ESSKA. Five rounds were performed between October 2018 and November 2019. The first round consisted of gathering questions which were then divided into blocks referring to imaging, classifications, surgical approach for acute and chronic cases, conservative treatment. Subsequent rounds consisted of condensation by means of an online questionnaire. Consensus was achieved when ≥ 66.7% of the participants agreed on one answer. Descriptive statistic was used to summarize the data. RESULTS: A consensus was reached on the following topics. Imaging: a true anteroposterior or a bilateral Zanca view are sufficient for diagnosis. 93% of the panel agreed on clinical override testing during body cross test to identify horizontal instability. The Rockwood classification, as modified by the ISAKOS statement, was deemed valid. The separation line between acute and chronic cases was set at 3 weeks. The panel agreed on arthroscopically assisted anatomic reconstruction using a suspensory device (86.2%), with no need of a biological augmentation (82.8%) in acute injuries, whereas biological reconstruction of coracoclavicular and acromioclavicular ligaments with tendon graft was suggested in chronic cases. Conservative approach and postoperative care were found similar CONCLUSION: A consensus was found on the main topics of controversy in the management of acromioclavicular joint dislocation. Each step of the diagnostic treatment algorithm was fully investigated and clarified. LEVEL OF EVIDENCE: Level V.
Entities:
Keywords:
Ac joint; Ac joint instability; Acromioclavicular joint; Consensus; Delphi; Diagnosis; European shoulder associates; Instability; Treatment
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