Unstable acromioclavicular joint injuries: Is there really a difference between surgical management in the acute or chronic setting?

Natera, Luis; Reiriz, Juan Sarasquete

doi:10.1016/j.jor.2016.10.011

Cited by 14 publications

(22 citation statements)

References 30 publications

(55 reference statements)

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“…A recent study by Natera et al also suggests that there are no significant differences between acute and chronic repair of AC joint dislocations if all other aspects of treatment are similar. 14…”

Section: Discussionmentioning

confidence: 99%

Acromioclavicular joint disruptions: A comparison of two surgical approaches ‘hook’ and ‘rope’

Athar

Ashwood

Arealis

et al. 2018

J Orthop Surg (Hong Kong)

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Despite the fact that both methods yielded similar results and have statistically similar number of complications, the type of postoperative complications was different between groups. The plate group had more postoperative pain and worse function but both aspects improved after plate removal. The rope group had more complex complications including deep infection and recurrence of deformity and fracture. These differences should be taken into consideration when consenting the patient regarding possible treatment.

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Section: Discussionmentioning

confidence: 99%

Acromioclavicular joint disruptions: A comparison of two surgical approaches ‘hook’ and ‘rope’

Athar

Ashwood

Arealis

et al. 2018

J Orthop Surg (Hong Kong)

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“…Several recent studies have recommended using the ISAKOS subdivision for imaging evaluation throughout the decision-making process for evaluating AC joint injuries. 3 , 17 , 18 , 27 , 30 , 31 , 34 Recently, the panel members of the European Society of Sports Traumatology, Knee Surgery & Arthroscopy agreed that the Rockwood classification, modified by the ISAKOS statement, is the most appropriate and comprehensive classification to date to guide treatment choice. 40 However, to our knowledge, no study has shown the reliability of categorizing AC joint injuries using the ISAKOS proposal.…”

Section: Discussionmentioning

confidence: 99%

“…Numerous studies have adopted this new approach in their clinical practice, 3 , 17 , 18 , 27 , 30 , 31 , 34 and it has been accepted as a comprehensive classification system. 40 However, the reliability of the modified classification has not been demonstrated.…”

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confidence: 99%

Reliability of the ISAKOS Modification to Subclassify Rockwood Type III Acromioclavicular Joint Injuries

Garcia

Abdo

2022

Orthopaedic Journal of Sports Medicine

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Background: To improve clinical management, the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) developed a specific subclassification of Rockwood type III acromioclavicular (AC) injuries: IIIA (no overriding distal clavicle) and IIIB (overriding distal clavicle). Purpose/Hypothesis: The study aimed to determine the inter- and intraobserver reliability of the radiographic classification proposed by ISAKOS for AC injuries. It was hypothesized that the strength of agreement for the ISAKOS modification will be substantial to almost perfect. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: We evaluated 40 radiographs of all types of AC joint injuries from patients at a single institution. The images were distributed to 6 shoulder and elbow fellowship–trained orthopaedic surgeons, along with standardized assessment questionnaires. The evaluators measured the bilateral coracoclavicular distance and the coracoclavicular ratio and classified the severity of the injuries according to the modified ISAKOS Rockwood classification. Four of the surgeons repeated the evaluation 6 weeks later to calculate intraobserver agreement. The kappa (κ) statistic was calculated for categorical inter- and intraobserver reliability. Intraclass correlation coefficient (ICC) estimates were calculated for the reliability of the coracoclavicular distance measurement. A 2-tailed test was performed to assess statistical significance. Results: Overall interobserver agreement was substantial (κ = 0.637; 95% CI, 0.595-0.680) among the 6 evaluators, and intraobserver agreement was also substantial among the 4 evaluators (κ = 0.616; 95% CI, 0.549-0.638). The interobserver agreement for evaluating types IIIA and IIIB was fair (κ = 0.215; 95% CI, 0.135-0.295) and moderate (κ = 0.473; 95% CI, 0.393-0.553), respectively. The agreement on the coracoclavicular distance measurements was excellent among the 6 evaluators on both the affected side (ICC, 0.982; 95% CI, 0.970-0.990) and the unaffected side (ICC, 0.930; 95% CI, 0.894-0.958). Conclusion: Substantial agreement was found when categorizing AC joint injuries using the ISAKOS modification of the Rockwood classification, with excellent reliability demonstrated for the quantitative assessment of vertical displacement of the clavicle. Visual examination was unreliable in differentiating type IIIA injuries from type IIIB injuries.

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“…Type I and II injuries are typically treated nonoperatively owing to partial injury to the AC and/or CC ligaments, whereas type IV to VI injuries are most often treated surgically owing to complete disruption of the AC and CC ligaments leading to instability, pain, and disability 2 . Treatment of type III injuries remains controversial, with a trend toward nonoperative management and rehabilitation 3, 4, 5. The ISAKOS Terminology Project suggested a revision to the Rockwood classification by further subdividing the type III AC joint injuries into type IIIA (stable) and type IIIB (unstable) 6 .…”

mentioning

confidence: 99%

“… 2 Treatment of type III injuries remains controversial, with a trend toward nonoperative management and rehabilitation. 3 , 4 , 5 The ISAKOS Terminology Project suggested a revision to the Rockwood classification by further subdividing the type III AC joint injuries into type IIIA (stable) and type IIIB (unstable). 6 Type IIIA injuries are defined as those with no overriding of the clavicle on a cross-body abduction radiograph and with no significant scapular dysfunction, whereas unstable type III injuries demonstrate therapy-resistant scapular dysfunction and persistent pain after 3 to 6 weeks of conservative management with overriding of the clavicle on the cross-body abduction radiograph.…”

mentioning

confidence: 99%

Primary Acromioclavicular-Coracoclavicular Reconstruction Using 2 Allografts, TightRope, and Stabilization to the Acromion

Haber

Golijanin

Stone

et al. 2019

Arthroscopy Techniques

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Acromioclavicular (AC) joint injuries are a common cause of shoulder pain, particularly among young athletes participating in contact sports. Injuries to the AC joint most commonly occur from direct impact at the acromion and are classified as types I to VI. Although most AC joint injuries can be treated nonoperatively, types IV to VI are best treated with surgery, with type III being controversial and most surgeons recommending an initial trial of nonoperative treatment. Although numerous surgical techniques have been described, no gold standard technique has been established. Biomechanical testing suggests that anatomic reconstruction of both the AC and coracoclavicular ligaments results in a superior surgical construct. The objective of this Technical Note is to describe our preferred technique for the primary treatment of AC joint instability in the acute and chronic setting. Using 2 free tendon grafts in combination with a cortical button suspensory device combines the advantages of a nonrigid biologic and anatomic AC and coracoclavicular ligament reconstruction while benefiting from the strength of a cortical suspensory device in resisting displacement of the AC joint.

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Unstable acromioclavicular joint injuries: Is there really a difference between surgical management in the acute or chronic setting?

Abstract: Level III, retrospective cohort study.

Cited by 14 publications

References 30 publications

Acromioclavicular joint disruptions: A comparison of two surgical approaches ‘hook’ and ‘rope’

Acromioclavicular joint disruptions: A comparison of two surgical approaches ‘hook’ and ‘rope’

Reliability of the ISAKOS Modification to Subclassify Rockwood Type III Acromioclavicular Joint Injuries

Primary Acromioclavicular-Coracoclavicular Reconstruction Using 2 Allografts, TightRope, and Stabilization to the Acromion

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