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Conversion to anatomic coracoclavicular ligament reconstruction (ACCR) shows similar clinical outcomes compared to successful non-operative treatment in chronic primary type III to V acromioclavicular joint injuries

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To compare the clinical outcomes of patients who underwent successful nonoperative treatment for type III-V acromioclavicular joint (ACJ) injuries to those who eventually required conversion to anatomic coracoclavicular ligament reconstruction (ACCR) at a minimum 5-year follow-up.

Methods

Patients with primary, chronic type III-V ACJ injuries who either underwent successful conservative treatment or conversion to ACCR after failing a trail of conservative management between 2003 and 2014 with a minimum 5-year follow-up were included in the study. Clinical outcome measures comprised the American Shoulder and Elbow Surgeons (ASES) and Simple Shoulder Test (SST) score, collected preoperatively and at final visit for the ACCR group. Outcome scores for patients with successful conservative treatment were only collected at final visit. A Self- Assessment Numeric Evaluation (SANE) score was obtained at terminal follow-up for both groups.

Results

Twenty-two patients (mean age: 40.1 ± 15.6 years) with successful nonoperative treatment and twenty-one patients (mean age: 43.6 ± 12.0 years) who required conversion to ACCR were included in the study. At final follow-up, patients with successful non-operative treatment achieved similar ASES (93.0±12.0NonOP vs. 86.1±16.8ACCR), SST (11.2±1.4NonOP vs. 10.7±2.0ACCR) and SANE scores (80.9±19.7NonOPvs. 90.5±14.7ACCR) compared to those who were converted to ACCR. Additionally, patients who underwent conversion to ACCR showed significant improvement in ASES (49.8±18.1pre vs. 86.1±16.8post; Δ36.3±19.7) and SST scores (6.5±3.2prevs. 10.7±2.0post; Δ4.2±4.0) from pre- to postoperative.

Conclusion

At a minimum 5-year follow-up, patients with successful non-operative treatment for type III-V ACJ injuries achieved similar clinical outcomes compared to those who were converted to ACCR. In patients with chronic severe ACJ dislocation a trial of conservative treatment may be attempted, astime from injuryto eventual conversion to ACCR had no significant influence on postoperative clinical outcomes.

Level of evidence

Level IV.

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Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, UConn Health, Farmington, CT, USA

    Lukas N. Muench, Daniel P. Berthold, Colin Uyeki, Cameron Kia, Mark P. Cote & Augustus D. Mazzocca

  2. Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany

    Lukas N. Muench, Daniel P. Berthold, Andreas B. Imhoff & Knut Beitzel

  3. Department of Shoulder Surgery, ATOS Clinic, Cologne, Germany

    Knut Beitzel

  4. Department of Medicine, Health Sciences Vincenzo Tiberio. University of Molise, Campobasso, Italy

    Katia Corona

  5. Casa di Cura Villa Betania, Rome, Italy

    Simone Cerciello

  6. Marrelli Hospital, Crotone, Italy

    Simone Cerciello

Authors
  1. Lukas N. Muench
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  2. Daniel P. Berthold
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  3. Colin Uyeki
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  4. Cameron Kia
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  5. Mark P. Cote
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  6. Andreas B. Imhoff
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  7. Knut Beitzel
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  8. Katia Corona
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  9. Augustus D. Mazzocca
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  10. Simone Cerciello
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Corresponding author

Correspondence to Katia Corona.

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The author declare that they have no conflict of interest.

Funding

ADM receives research support and consulting fees from Arthrex Inc. (Naples, FL). KB is a consultant for Arthrex Inc. (Naples, FL). MPC receives personal fees from the Arthroscopy Association of North America (AANA) for the Arthroscopy Journal. The authors LNM, DPB, CU, CK, ABI, and SC have nothing to disclose.

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Muench, L.N., Berthold, D.P., Uyeki, C. et al. Conversion to anatomic coracoclavicular ligament reconstruction (ACCR) shows similar clinical outcomes compared to successful non-operative treatment in chronic primary type III to V acromioclavicular joint injuries. Knee Surg Sports Traumatol Arthrosc 29, 2264–2271 (2021). https://doi.org/10.1007/s00167-020-06159-2

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