Measuring the OL is a convenient way for quantifying DPT in modified Alexander views. It showed significant correlation with clinical scores, indicating the relevance of DPT in patients with AC-joint injury.
Background: Factors influencing the outcome after arthroscopically assisted stabilization of acute high-grade acromioclavicular (AC) joint dislocations remain poorly investigated. Purpose: To identify determinants of the radiological outcome and investigate associations between radiological and clinical outcome parameters. Study Design: Cohort study; Level of evidence, 3. Methods: The authors performed a retrospective analysis of patients who underwent arthroscopically assisted stabilization for acute high-grade AC joint dislocations. The following potential determinants of the radiological outcome were examined using univariable and multivariable regression analyses: timing of surgery, initial AC joint reduction, isolated coracoclavicular (CC) versus combined CC and AC stabilization, ossification of the CC ligaments, age, and overweight status. In addition, associations between radiological (ie, CC difference, dynamic posterior translation [DPT]) and clinical outcome parameters (Subjective Shoulder Value, Taft score [TS] subjective subcategory, and Acromioclavicular Joint Instability Score [ACJI] pain subitem) were evaluated using univariable analysis. Results: One hundred four patients with a mean (±SD) age of 38.1 ± 11.5 years were included in this study. The mean postoperative follow-up was 2.2 ± 0.9 years. Compared with patients with an overreduced AC joint after surgery, the CC difference was 4.3 mm (95% CI, 1.3-7.3; P = .006) higher in patients with incomplete reduction. Patients with anatomic reduction were 3.1 times (95% CI, 1.2-7.9; P = .017) more likely to develop DPT than those with an overreduced AC joint. An incompletely reduced AC joint was 5.3 times (95% CI, 2.1-13.4; P < .001) more likely to develop DPT versus an overreduced AC joint. Patients who underwent isolated CC stabilization were 4.8 times (95% CI, 1.1-21.0; P = .039) more likely to develop complete DPT than patients with additional AC stabilization. Significantly higher CC difference values were noted for patients who reported pain on the subjective TS ( P = .025). Pain was encountered more commonly in patients with DPT ( PTS = .049; PACJI = .038). Conclusion: Clinicians should consider overreduction of the AC joint because it may lead to favorable radiological results. Because of its association with superior radiographic outcomes, consideration should also be given to the use of additional AC cerclage.
BackgroundAcute acromioclavicular (AC) dislocation is classified according to Rockwood (RW). Although of clinical relevance, dynamic horizontal translation (DHT) is not listed in this classification or in frequently used clinical evaluation tools. The aim of this study was (a) to evaluate vertical and horizontal AC joint instabilities and assess their combined occurrence and clinical appearance in a consecutive group of patients, as well as (b) to develop a new classification of acute AC joint dislocation.MethodA consecutive group of 61 patients (seven female, 54 male) with a mean age of 34.5 years (18.9–60.1) were included in the study. All patients underwent posttraumatic clinical—Taft Score (TF), Acromioclavicular Joint Instability Score (ACJI), Constant Score (CS), Subjective Shoulder Value (SSV)—and radiological (bilateral anteroposterior stress and bilateral Alexander views) evaluation.ResultsAccording to the RW classification, the following AC dislocations were present: eight (13.1%) type I, nine (14.8%) type II, 22 (36.1%) type III, and 22 (36.1%) type V. Based on the clinical and radiographic results, a new classification is proposed: Type I instabilities show only a partial vertical displacement (≤30% coracoclavicular distance [CCD]) and type II a complete vertical displacement (>30% CCD). Both type I and II are further graded into none or partial (A) and complete DHT (B) as seen on bilateral Alexander views.ConclusionDHT can be found in low-grade instabilities and lead to inferior clinical results in the posttraumatic situation.
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