High degree of consensus achieved regarding diagnosis and treatment of acromioclavicular joint instability among ESA-ESSKA members

Abstract

Purpose To develop a consensus on diagnosis and treatment of acromioclavicular joint instability. Methods A consensus process following the modified Delphi technique was conducted. Panel members were selected among the European Shoulder Associates of ESSKA. Five rounds were performed between October 2018 and November 2019. The first round consisted of gathering questions which were then divided into blocks referring to imaging, classifications, surgical approach for acute and chronic cases, conservative treatment. Subsequent rounds consisted of condensation by means of an online questionnaire. Consensus was achieved when ≥ 66.7% of the participants agreed on one answer. Descriptive statistic was used to summarize the data. Results A consensus was reached on the following topics. Imaging: a true anteroposterior or a bilateral Zanca view are sufficient for diagnosis. 93% of the panel agreed on clinical override testing during body cross test to identify horizontal instability. The Rockwood classification, as modified by the ISAKOS statement, was deemed valid. The separation line between acute and chronic cases was set at 3 weeks. The panel agreed on arthroscopically assisted anatomic reconstruction using a suspensory device (86.2%), with no need of a biological augmentation (82.8%) in acute injuries, whereas biological reconstruction of coracoclavicular and acromioclavicular ligaments with tendon graft was suggested in chronic cases. Conservative approach and postoperative care were found similar Conclusion A consensus was found on the main topics of controversy in the management of acromioclavicular joint dislocation. Each step of the diagnostic treatment algorithm was fully investigated and clarified. Level of evidence Level V.

Center of pressure (COP) measurement in patients with confirmed successful outcomes following shoulder surgery show significant sensorimotor deficits

“…A retrospective chart review was performed on patients undergoing surgery of the upper limb between 01/2012 and 06/2015 at the author’s institution. Patients were eligible for inclusion if they underwent either acute (primary) ACJ reconstruction after sustaining a Rockwood IV or V injury [ 10 , 11 ], primary rotator cuff repair, or primary Bankart repair after suffering from anterior instability of the glenohumeral joint without a significant bone loss (defined as < 15%) [ 12 ], and had confirmed successful postoperative outcomes, defined as the absence of restrictions in clinical outcome scores and pain. Patients were excluded if they had injuries of the contralateral shoulder, neurovascular injuries, fractures, concomitant injuries to the upper limb other than ACJ instabilities (Rockwood IV, V), reconstructable isolated supraspinatus rotator cuff tears, or Bankart lesions or if they had any kind of restricting pain in their shoulders, wrists, elbows, or upper back.…”

Arthroscopically Assisted Double-Loop Suture Repair for Acute Acromioclavicular Joint Disruption

“…For the controversial type IIIB injury, clavicle overriding in the cross-body adduction, Alexander view, the activity level, and demands of the patient are taken in consideration to suggest operative treatment. 4 , 5 …”

“…3 For the controversial type III injuries, consensus has arisen more recently giving emphasis to the component of horizontal instability that differentiates between subtypes IIIA and IIIB, and authors advocate early surgical reconstruction for type IIIB especially in select high-functioning patients, such as manual laborers and overhead-throwing athletes. 4 , 5 …”

Evolving concepts and consensus in challenging shoulder problems: a European perspective

“…A detailed description of the ESA-ESSKA Consensus Project on the AC joint and its outcomes can be found in this special issue [4]. In particular, the consensus document clearly states that a true anteroposterior view or a bilateral Zanca radiograph without loading of the arm is sufficient for correct diagnosis and classification of AC joint dislocation.…”