Current practice in the management of Rockwood type III acromioclavicular joint dislocations—National survey

Abstract

Purpose: Our aim was to conduct this survey among consultant shoulder surgeons in the United Kingdom to document the current management of Rockwood type III acromioclavicular joint (ACJ) injuries. Methods: British Elbow and Shoulder Society Research Committee-approved online survey was used and 137 responses were collected within 3 months. Results: One hundred percent of responders would treat type III injuries conservatively initially. Routine physiotherapy would be offered by 86% of surgeons. The patient's factors that influence the decision to consider surgery are pre-injury functional demand, current functional deficit, pain and patient request for surgery. Across all groups the mean time to surgical intervention from injury was 3.8 months. About 45% of all consultants would use the same technique for all cases and there were differences between the varieties of techniques used by surgeons, depending on their degree of experience. LockDown was the most widely used technique in all groups of patients. This was followed by Ligament Augmentation & Reconstruction System (LARS), hook plate and Arthroscopic TightRope/DogBone technique for acute injuries. LARS, modified Weaver-Dunn and ACJ resection were used most commonly after LockDown for delayed cases. Conclusion: Our survey revealed the current trends in clinical practice to treat symptomatic Rockwood type III ACJ injuries, but it also confirmed the controversial and complex management differences, which vary among shoulder surgeons in the United Kingdom.

Fifteen-degree clavicular hook plate achieves better clinical outcomes in the treatment of acromioclavicular joint dislocation

“…However, excessive pressure on the acromion induced by the hook can cause unbearable pain in these patients after surgery. 11 , 12 (2) Accidental dislocation of the distal clavicle: When the steel plate is implanted during the surgery, the hook plate and clavicle cannot be naturally matched and fixed. Thus, screws must be implemented to fix the plate to the clavicle.…”

Acromioclavicular joint injuries in overhead athletes: a concise review of injury mechanisms, treatment options, and outcomes

“…A recent national survey in the UK queried shoulder specialists for their preferred method of management of type III injuries [27]. Of the 137 responders, all initially treated conservatively.…”

Treatment of Rockwood Type III Acromioclavicular Joint Dislocation

“…Primary surgical treatment is usually considered for the treatment of type III AC joint dislocation in throwing athletes or manual laborers. Several factors can influence the decision regarding the indication for surgical treatment [ 17 , 18 ], with pre-injury functional demand, current functional deficit, pain, and patient preference for surgery representing the most influential factors; age, sex, and hand dominance generally have small impact on whether or not surgery is offered [ 19 ].…”

“…There is a question as to whether the outcomes of surgical or non-surgical treatment for type III AC joint dislocation, as described above, can be maintained in high-level athletes, who must maintain high levels of physical activity. A national survey from the United Kingdom [ 19 ] revealed that patients with high preinjury functional demand are typically indicated for primary surgical treatment. However, data from studies evaluating treatment outcomes in athletes support both operative and non-operative strategies.…”