The importance of biomechanical properties in revision acromioclavicular joint stabilization: a scoping review
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Treatment of failed primary reconstruction of the unstable acromioclavicular (AC) joint remains challenging for orthopaedic surgeons. When approaching revision cases, the reason for failure has to be precisely identified. The purpose of this manuscript was to perform a critical review of the literature regarding treatment options for failed AC joint stabilization techniques and to provide a treatment algorithm for salvage procedures.
A thorough search included electronic databases for articles published up to April 15th, 2019. Inclusion criteria were set as (1) studies that reported on clinical outcomes following surgical or conservative treatment of AC joint dislocation; (2) studies reporting on failure or complications of primary treatment; (3) chronic instabilities caused by delayed or secondary treatment as well as (4) revision and salvage procedures.
The search strategy identified a total of 3269 citations. The final dataset comprised 84 studies published between 1954 and 2019. A total of 5605 patients (9.63% females) were involved with a mean age of 34.5 years. Overall, complication rates varied between 5 and 88.9% in patients with AC joint instability.
In the current literature, evidence for treatment of revision AC joint instability is still lacking, however, surgical treatment continues to evolve. The importance of failure analysis and clinically relevant algorithms were highlighted in this review. Adequately restoring native joint biomechanics is needed for ensuring an optimal healing environment that will translate into patient satisfaction and long-term stability.
Level of evidence
KeywordsAC joint Acromioclavicular reconstruction Revision Failure Review
The University of Connecticut Health Center/UConn Musculoskeletal Institute receives direct funding and material support from Arthrex Inc. The company had no influence on study design, data collection, or interpretation of the results or the final manuscript.
Compliance with ethical standards
Conflict of interest
A.D.M. receives research support and consulting fees from Arthrex., A.B.I. has received personal fees outside the submitted work from Arthrex, personal fees from Medi Bayreuth, and personal fees from Arthrosurface. K.B. receives consultant fees for Arthrex. F.M. is a consultant for Arthrex.
This article does not contain any studies with human participants performed by any of the authors.
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