Acromioclavicular third degree dislocation: surgical treatment in acute cases

Journal of Orthopaedic Surgery and Research

Andrea Ferretti¹  Pierpaolo Rota¹  Domenico Lupariello¹  Alessandro Ciompi¹  Riccardo Maria Lanzetti¹  Angelo De Carli¹ 

[1] Orthopaedic Unit and “Kirk Kilgour” Sports Injury Centre, S. Andrea Hospital, University of Rome “La Sapienza”, Italy, Via di Grottarossa 1035, Rome, 00189, Italy

关键词: Shoulder;    Rockwood type III dislocation;    TightRope;    Acromioclavicular joint dislocation;   

Others  :  1144203
DOI  :  10.1186/s13018-014-0150-z

 received in 2014-09-17, accepted in 2014-12-30,  发布年份 2015

【 摘 要 】

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.

【 授权许可】

   
2015 De Carli et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

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