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Acromioclavicular third degree dislocation: surgical treatment in acute cases.

De Carli A, Lanzetti RM, Ciompi A, Lupariello D, Rota P, Ferretti A - J Orthop Surg Res (2015)

Bottom Line: The subjective parameters significantly differed between the two groups.Constant, ASES and UCLA scores were similar in both groups (P > 0.05), whereas ACJI results favoured the surgical group (group A, 72.4; group B, 87.9; P < 0.05).All measurements of radiographic evaluation were significantly reduced in the surgical group compared with the conservative group.

View Article: PubMed Central - PubMed

Affiliation: Orthopaedic Unit and "Kirk Kilgour" Sports Injury Centre, S. Andrea Hospital, University of Rome "La Sapienza", Italy, Via di Grottarossa 1035, 00189, Rome, Italy. angelo.decarli@gmail.com.

ABSTRACT

Background: The management of acute Rockwood type III acromioclavicular joint (ACJ) dislocation remains controversial, and the debate about whether patients should be conservatively or surgically treated continues. This study aims to compare conservative and surgical treatment of acute type III ACJ injuries in active sport participants (<35 years of age) by analysing clinical and radiological results after a minimum of 24 months follow-up.

Methods: The records of 72 patients with acute type III ACJ dislocations who were treated from January 2006 to December 2011 were retrospectively evaluated. Patients were categorised into two groups. group A included 25 patients treated conservatively, and group B included 30 patients treated surgically with the TightRope™ system. Seventeen patients were lost to follow-up. All patients were evaluated at final follow-up with these clinical scores: Constant, University of California Los Angeles scale (UCLA), American Shoulder and Elbow Surgeons Scale (ASES) and Acromioclavicular Joint Instability (ACJI) and with a subjective evaluation of the patient satisfaction, aesthetic results and shoulder function. The distance between the acromion and clavicle and between the coracoid process and clavicle were evaluated radiographically and compared with preoperative values. Δ, the difference in mm between the distance at the final follow-up and at T0 in the injured shoulder, and α, the side-to-side difference in mm at follow-up, were calculated. Heterotopic ossification and postoperative osteolysis were evaluated in both groups.

Results: There were no major intraoperative complications in the surgical group. The subjective parameters significantly differed between the two groups. Constant, ASES and UCLA scores were similar in both groups (P > 0.05), whereas ACJI results favoured the surgical group (group A, 72.4; group B, 87.9; P < 0.05). All measurements of radiographic evaluation were significantly reduced in the surgical group compared with the conservative group. In group A, we detected calcifications in 30% of patients; in group B we detected two cases of moderate osteolysis and calcifications in 70% of patients.

Conclusion: Although better subjective and radiographic results were achieved in surgically treated patients, traditional objective scores did not show significant differences between the two groups. Our results cannot support routine use of surgery to treat type III ACJ dislocations.

No MeSH data available.


Related in: MedlinePlus

Radiological examination. Green line shows the distance between the acromion and lateral clavicle (ACD); red line shows the distance between the coracoid process and clavicle (CCD).
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Fig1: Radiological examination. Green line shows the distance between the acromion and lateral clavicle (ACD); red line shows the distance between the coracoid process and clavicle (CCD).

Mentions: The radiological examination consisted of AP and axillary radiographs for each shoulder and bilateral stress radiographs [29]. At the final follow-up visit, an Alexander view radiograph was obtained to calculate the ACJI score as described by Scheibel et al. [25]. The distance between the acromion and lateral clavicle (ACD) and the distance between the coracoid process and clavicle (CCD) were measured (Figure 1). The ACD was measured between the centre of the medial aspect of the acromion and the centre of the lateral aspect of the clavicle. The CCD was measured between the coracoid and inferior cortex of the clavicle [30]. All measurements were performed on the injured and healthy side in stress radiographs at admission (T0) and at the final follow-up visit.Figure 1


Acromioclavicular third degree dislocation: surgical treatment in acute cases.

De Carli A, Lanzetti RM, Ciompi A, Lupariello D, Rota P, Ferretti A - J Orthop Surg Res (2015)

Radiological examination. Green line shows the distance between the acromion and lateral clavicle (ACD); red line shows the distance between the coracoid process and clavicle (CCD).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4318207&req=5

Fig1: Radiological examination. Green line shows the distance between the acromion and lateral clavicle (ACD); red line shows the distance between the coracoid process and clavicle (CCD).
Mentions: The radiological examination consisted of AP and axillary radiographs for each shoulder and bilateral stress radiographs [29]. At the final follow-up visit, an Alexander view radiograph was obtained to calculate the ACJI score as described by Scheibel et al. [25]. The distance between the acromion and lateral clavicle (ACD) and the distance between the coracoid process and clavicle (CCD) were measured (Figure 1). The ACD was measured between the centre of the medial aspect of the acromion and the centre of the lateral aspect of the clavicle. The CCD was measured between the coracoid and inferior cortex of the clavicle [30]. All measurements were performed on the injured and healthy side in stress radiographs at admission (T0) and at the final follow-up visit.Figure 1

Bottom Line: The subjective parameters significantly differed between the two groups.Constant, ASES and UCLA scores were similar in both groups (P > 0.05), whereas ACJI results favoured the surgical group (group A, 72.4; group B, 87.9; P < 0.05).All measurements of radiographic evaluation were significantly reduced in the surgical group compared with the conservative group.

View Article: PubMed Central - PubMed

Affiliation: Orthopaedic Unit and "Kirk Kilgour" Sports Injury Centre, S. Andrea Hospital, University of Rome "La Sapienza", Italy, Via di Grottarossa 1035, 00189, Rome, Italy. angelo.decarli@gmail.com.

ABSTRACT

Background: The management of acute Rockwood type III acromioclavicular joint (ACJ) dislocation remains controversial, and the debate about whether patients should be conservatively or surgically treated continues. This study aims to compare conservative and surgical treatment of acute type III ACJ injuries in active sport participants (<35 years of age) by analysing clinical and radiological results after a minimum of 24 months follow-up.

Methods: The records of 72 patients with acute type III ACJ dislocations who were treated from January 2006 to December 2011 were retrospectively evaluated. Patients were categorised into two groups. group A included 25 patients treated conservatively, and group B included 30 patients treated surgically with the TightRope™ system. Seventeen patients were lost to follow-up. All patients were evaluated at final follow-up with these clinical scores: Constant, University of California Los Angeles scale (UCLA), American Shoulder and Elbow Surgeons Scale (ASES) and Acromioclavicular Joint Instability (ACJI) and with a subjective evaluation of the patient satisfaction, aesthetic results and shoulder function. The distance between the acromion and clavicle and between the coracoid process and clavicle were evaluated radiographically and compared with preoperative values. Δ, the difference in mm between the distance at the final follow-up and at T0 in the injured shoulder, and α, the side-to-side difference in mm at follow-up, were calculated. Heterotopic ossification and postoperative osteolysis were evaluated in both groups.

Results: There were no major intraoperative complications in the surgical group. The subjective parameters significantly differed between the two groups. Constant, ASES and UCLA scores were similar in both groups (P > 0.05), whereas ACJI results favoured the surgical group (group A, 72.4; group B, 87.9; P < 0.05). All measurements of radiographic evaluation were significantly reduced in the surgical group compared with the conservative group. In group A, we detected calcifications in 30% of patients; in group B we detected two cases of moderate osteolysis and calcifications in 70% of patients.

Conclusion: Although better subjective and radiographic results were achieved in surgically treated patients, traditional objective scores did not show significant differences between the two groups. Our results cannot support routine use of surgery to treat type III ACJ dislocations.

No MeSH data available.


Related in: MedlinePlus