Current practice in the management of acromioclavicular joint dislocations; a national survey in the Netherlands

Abstract

The aim of this study was to investigate current practice in the management of acromioclavicular joint dislocations in the Netherlands. Methods A 36-item literature-based and expert consensus survey was developed. If available, one orthopaedic and one trauma surgeon for every hospital (n = 82) in the Netherlands was asked to complete the online questionnaire. Only complete data sets were included in the analysis. Descriptive analysis was performed using SPSS. Results Of 149 invited surgeons, 106 (71%) fully completed the survey. The diagnosis of ACJ injury was mainly based on physical examination (91%) and radiographs (95%). The vast majority of patients with ACJ injuries was treated non-operatively. The decision for operative treatment was mainly based on the surgeon's experience and available literature. Patientrelated factors that contributed most to the decision to operate or not, were mainly functional needs and age. Cosmesis and gender contributed less to this decision. Rockwood II and III ACJ injuries were usually treated non-operatively, whereas Rockwood IV and V ACJ injuries were usually treated operatively. For primary and secondary operative treatment, a flexible implant was preferred over rigid fixation techniques. All respondents agreed that nonoperative treatment of Rockwood II ACJ injuries leads to satisfactory results and that secondary operative treatment is only rarely required. Also the majority of patients with Rockwood III ACJ injuries is treated non-operatively, although failure rates are considered higher. Conclusion This survey showed a significant individual variation on diagnosis and treatment strategies among surgeons in the Netherlands. The majority of the Dutch surgeons concern a flexible implant the best available technique for patients who require operative treatment.

The V angle compliments radiographic assessment of acute acromioclavicular joint dislocations by differentiating between Rockwood types III versus V and by considering dynamic horizontal translation in coronal radiographs

“…Ultimately, the V angle comprises several aspects that are indicative of increased joint laxity and higher risk of functional impairment [11, 12, 20, 21], which represent injury severity and may facilitate therapeutic decisions (non‐operative/operative) in light of vague surgical indications according the radiological aspect of CC distance alone [3, 4].…”

“…The relevance of precise measurements is given by the implications on therapy. Recent evidence favors non‐operative treatment for Rockwood type III injuries [4, 6, 18], while type V is usually treated surgically [4, 25].…”

Inestabilidad acromioclavicular crónica tratada mediante reconstrucción anatómica de los ligamentos coracoclaviculares: plastia tipo Mazzocca

“…Por tal motivo es importante seguir el protocolo radiográfico antes mencionado. [13][14][15] El uso de las escalas funcionales debe realizarse previo al manejo y posterior al mismo.…”

A Self‐Designed Endobutton Installation Device for Coracoclavicular Stabilization in Acute Rockwood Type III Acromioclavicular Joint Dislocation

“…3,4 As a result, nonsurgical treatment of acute Rockwood type III ACJ dislocation may result in high rates of pain and shoulder dysfunction. 5,6 Therefore, surgery is recommended for acute Rockwood type III ACJ dislocation, especially in young active patients. 7 The surgical techniques used to treat acute Rockwood type III ACJ dislocation include temporary K-wire transfixation, CC screw fixation, hook plate fixation, and Endobutton placement.…”

“…In acute Rockwood type III ACJ dislocation, the coracoclavicular (CC) ligament is completely torn; this disruption of the CC ligament leads to vertical instability because of the downward pull of the weight of the arm and the superior pull of the trapezius muscle 3,4 . As a result, nonsurgical treatment of acute Rockwood type III ACJ dislocation may result in high rates of pain and shoulder dysfunction 5,6 . Therefore, surgery is recommended for acute Rockwood type III ACJ dislocation, especially in young active patients 7 …”