Treatment of acromioclavicular joint separations in Japan: a survey

Abstract

Background Treatment options for acromioclavicular joint (ACJ) separations are highly dependent on severity, as well as the patient’s background. Furthermore, some patients can be switched from conservative to surgical treatment. In this study, we conducted a mail-based questionnaire survey of members of the Japan Shoulder Society on the administration of treatments for ACJ separations. Methods A questionnaire survey with 5 categories was mailed to all 1655 members of the Japan Shoulder Society (including 59 councilors): initial treatment, whether surgery was performed, indications for surgery based on severity, switching from conservative to surgical treatment, and surgical methods. Results Altogether, 183 members, including 56 councilors, responded. Regarding the initial treatment, 17 respondents opted for treatment without immobilization or fixation and 166 opted for immobilization or fixation. Of the members, 11 opted for only conservative treatment whereas 172 chose surgery depending on the case; of the latter, 9 considered it for patients with a Rockwood classification of type 2 or higher; 120, for patients with type 3 or higher; and 172, for patients with types 4-6. Furthermore, 75 of 172 members had experience switching to surgical treatment during conservative treatment. For 64 of 172 members, the modified Cadenat method was the most common surgical method. Conclusions Only 11 members opted for conservative treatment of ACJ separations, and approximately 95% of physicians chose surgery. Furthermore, >70% of physicians considered surgery for an injury classified as type 3 or higher, and 37% of members performed the modified Cadenat method. However, the popularization of arthroscopic surgery may affect the selection of surgical methods in the future.

Operative vs. conservative treatment of AC-Joint Dislocations Rockwood grade ≥ III -An economical and clinical evaluation-

“…One factor in favor of operative treatment may be a remaining visible protrusion of the clavicle [ 11 , 12 ]. There is a variety of operative treatments but there is no gold standard [ 14 , 15 ]. The common techniques are either open surgery or arthroscopically assisted, for example using AC TightRope [ 11 ].…”

“…The fixation can be reinforced in each case by additive material (anchors, sutures). The method of choice depends mainly on the preoperative situation, the medical center and the surgeons experience [ 3 , 13 , 14 ].…”

“…Nevertheless, these injuries are up to day frequently operated. Decision making is here often influenced by patient-specific aspects (traumatic hematoma, initial pain, cosmetic aspects, sports-activities [ 3 , 13 , 14 ].…”

Coracoid process transfer and distal clavicle resection for chronic acromioclavicular separation

“… 13 Many surgical techniques have been reported for the treatment of chronic AC separation, but there is no gold standard, ideal technique. 15 , 17 …”

Clavicular hook plate for acute high-grade acromioclavicular dislocation involving Rockwood type V: clinical and radiological outcomes and complications evaluation

“…So far, no standard technique has been established and a few complications have been described for these approaches. In a nationwide survey in Germany, the hook plate appeared to have become “standard therapy” for acute unstable acromioclavicular dislocations for the past few years [ 9 ].…”