Anatomic Reduction is not essential for Good Functional Outcome in Surgical Treatment of Acromioclavicular Dislocation (Quality of the Reduction in Ac Dislocation)

Abstract

Guillaume Villatte, Hicham Riouach, Roger Erivan, Aurelien Mulliez, Pierre Metais, Stephane Descamps and Stephane Boisgard

Background: Treatment of displaced acromioclavicular disjunction is not consensual. The goal is to evaluate the concordance between clinical and radiological results in acute displaced acromioclavicular joint dislocation (ACD) at a minimum 1 year’s follow-up.

Methods: Fourteen patients underwent open coracoclavicular and acromioclavicular ligament reconstruction by artificial ligament (Acrolig™, Fx Solutions) and twelve underwent arthroscopic coracoclavicular ligament reconstruction by a single paired endobutton (Zip Tight™, Zimmer Biomet). Shoulder function was assessed by an independent examiner with objective and subjective international validated scores. Frontal acromioclavicular displacement was measured all along the follow-up, and reduction quality at last follow-up was assessed frontally and laterally, and globally according to 5 groups of reduction, by 2 examiners.

Results: Rockwood classification distribution was: grade 3 (61.6%), grade 4 (30.8%) and grade 5 (15.4%). Mean follow-up was 26.6±8.2 months. All objective and subjective scores were “good” or “very good” at last follow-up (Constant-Murley = 94.1±4.8). Radiologic analysis according to reduction quality showed that anatomic reduction was twice as frequent in the frontal plane (23.1%) as in the sagittal plane (11.5%). Analysis of global reduction quality found 42% anatomic or good reduction, and 58% partial or poor reduction. There were no significant differences in any clinical scores according to reduction quality (on the different views). Comparison between groups “anatomic and good reduction” and “moderate and poor reduction” found no significant differences on any clinical scores neither.

Conclusion: Anatomic reduction would not seem to be mandatory for good functional results in displaced acute ACD.

PDF