Background: Lack of uniformity in reported outcomes makes comparisons between acromioclavicular joint (ACJ) injury studies challenging. Knowledge of common outcome measures and standardization will help orthopaedic surgeons report and compare outcomes more consistently. Purpose: To identify the most commonly reported outcome measures for ACJ injuries. Study Design: Systematic review. Methods: A systematic review was performed to identify all English-language original articles assessing any type of management of ACJ injuries (acute and chronic) in PubMed and Scopus from 2007 to 2017. Review articles, meta-analyses, studies with less than 5 patients, pediatric studies, technique articles, and biomechanical studies were excluded. The 100 top orthopaedic journals in the English literature were selected for review. Included studies were assessed for patient characteristics and the use of outcome variables, including range of motion (ROM), strength, patient-reported outcomes (PROs), satisfaction, return to work, return to sport, and complications. Results: A total of 605 unique articles were identified; 92 met the inclusion criteria. The average number of ACJ injuries per study was 37, with a mean weighted patient age of 36 years (range, 20.1-57.3 years). The mean follow-up was 36 months (range, 5-290 months). Acute injuries were reported in 59% of studies. ROM and strength measurements were reported in 22.8% and 5.4% of studies. Sixteen different PRO instruments were used. The most commonly reported measures were Constant score (75%), visual analog scale for pain (VAS-pain; 33%) score, American Shoulder and Elbow Surgeons (ASES) score (21%), Simple Shoulder Test (SST) score (19%), and University of California Los Angeles (UCLA; 17%) shoulder score. An average of 2.5 outcome measures per study were reported. The use of 4 or more outcome scores was associated with publication in higher–impact factor journals. Conclusion: Inconsistent reporting of multiple outcome measures is present in the ACJ injury literature. The best scoring system for assessing ACJ injury and treatment has not yet been agreed upon. Until improved scoring systems come into general use, we recommend that future literature on ACJ injuries use at least 4 outcome scores and include the commonly used outcome measures (Constant, VAS-pain, ASES, and SST scores) to enable future comparison of patient outcomes across publications.
This study aimed to evaluate the outcome measures that the current isolated capitellar and trochlear fracture literature has used. Methods: A systematic literature review identified capitellar and/or trochlear fracture treatment articles published between January 1, 2006 and December 31, 2016. Exclusion criteria included review articles, meta-analyses, technique articles, and biomechanical/anatomic studies. Included studies were reviewed for patient demographics and reports of range of motion, outcome measures, satisfaction rate, return to previous level of activity, complication rate, and reoperation rate. The use of different outcome measures was compared among smaller and larger case series and in journals with higher and lower impact factors. Results: Of 285 articles, 45 met inclusion criteria. Mean number of capitellum and/or trochlea fractures per study was 11.3 (mean patient age, 34.6 years). Average follow-up was 29.4 months. Eight outcome measures were used, the most common of which were the Mayo Elbow Performance Score (MEPS), Disabilities of the Arm, Shoulder, and Hand/QuickeDisabilities of the Arm, Shoulder, and Hand, and American Shoulder and Elbow Surgeons scores. An average of 1.09 outcome measures were reported per study; 15% of studies reported a satisfaction rate. Larger studies were associated with more outcome measures and used the MEPS more often. Studies in journals with an impact factor of 1 or greater had more patients, more reported outcome scores, and higher use of the MEPS compared with studies with an impact factor of less than 1. Conclusions: Capitellum and trochlea fracture studies have major outcome-measure reporting inconsistencies. The MEPS is the most frequently reported measure. Higher-level journals and studies with 5 or more fractures reported more outcome scores. Future studies should include commonly reported outcome measures to allow for cross-study comparison. Type of study/level of evidence: Therapeutic IV.
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