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Anatomic reconstruction of the acromioclavicular joint provides the best functional outcomes in the treatment of chronic instability

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To systematically review the outcomes of surgical treatments of chronic acromioclavicular joint dislocation.

Methods

Studies were identified by electronic databases (Ovid, PubMed). All studies reporting functional and radiological outcomes of surgical treatments of chronic acromioclavicular joint dislocations were included. Following data were extracted: authors and year, study design, level of evidence, number of patients, age, classification of acromioclavicular joint dislocation, time to surgery, surgical technique, follow-up, clinical and imaging outcomes, complications and failures. Descriptive statistics was used, when a data pooling was not possible. Comparable outcomes were pooled to generate summary outcomes reported as frequency-weighted values. Quality appraisal was assessed through the MINORS checklist.

Results

Fourty-four studies were included for a total of 1020 shoulders. Mean age of participants was 38 years. Mean follow-up was 32.9 months. Arthroscopic techniques showed better results than open approach (p < 0.0001). Synthetic reconstructions demonstrated better functional outcomes compared to internal fixation and biologic techniques (p < 0.0001). Among biologic techniques, combined coracoclavicular and acromioclavicular ligaments reconstruction showed better Constant (p = 0.0270) and ASES (p = 0.0113) scores compared to isolated coracoclavicular ligaments reconstruction; anatomic biologic non-augmented graft reconstruction showed better Constant (p < 0.0001), VAS (p < 0.0001) and SSV (p = 0.0177) results compared to augmented techniques. No differences in functional outcomes could be found between anatomic biologic non-augmented graft versus synthetic reconstructions. Overall, methodological quality of the included studies was low.

Conclusion

Anatomic reconstructions, both synthetic and biologic, showed the best functional results.

Level of evidence

IV.

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Authors and Affiliations

  1. Orthopaedics Institute, Fondazione Policilinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy

    Giuseppe Sircana, Maristella F. Saccomanno, Fabrizio Mocini, Vincenzo Campana, Piermarco Messinese & Andrea Monteleone

  2. Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy

    Andrea Salvi, Alessandra Scaini & Giuseppe Milano

  3. Department of Bone and Joint Surgery, Spedali Civili, Brescia, Italy

    Almerico Megaro & Giuseppe Milano

Authors
  1. Giuseppe Sircana
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  2. Maristella F. Saccomanno
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  3. Fabrizio Mocini
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  4. Vincenzo Campana
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Correspondence to Maristella F. Saccomanno.

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Sircana, G., Saccomanno, M.F., Mocini, F. et al. Anatomic reconstruction of the acromioclavicular joint provides the best functional outcomes in the treatment of chronic instability. Knee Surg Sports Traumatol Arthrosc 29, 2237–2248 (2021). https://doi.org/10.1007/s00167-020-06059-5

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