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- Title
Anatomic reconstruction of the acromioclavicular joint provides the best functional outcomes in the treatment of chronic instability.
- Authors
Sircana, Giuseppe; Saccomanno, Maristella F.; Mocini, Fabrizio; Campana, Vincenzo; Messinese, Piermarco; Monteleone, Andrea; Salvi, Andrea; Scaini, Alessandra; Megaro, Almerico; Milano, Giuseppe
- Abstract
<bold>Purpose: </bold>To systematically review the outcomes of surgical treatments of chronic acromioclavicular joint dislocation.<bold>Methods: </bold>Studies were identified by electronic databases (Ovid, PubMed). All studies reporting functional and radiological outcomes of surgical treatments of chronic acromioclavicular joint dislocations were included. Following data were extracted: authors and year, study design, level of evidence, number of patients, age, classification of acromioclavicular joint dislocation, time to surgery, surgical technique, follow-up, clinical and imaging outcomes, complications and failures. Descriptive statistics was used, when a data pooling was not possible. Comparable outcomes were pooled to generate summary outcomes reported as frequency-weighted values. Quality appraisal was assessed through the MINORS checklist.<bold>Results: </bold>Fourty-four studies were included for a total of 1020 shoulders. Mean age of participants was 38 years. Mean follow-up was 32.9 months. Arthroscopic techniques showed better results than open approach (p < 0.0001). Synthetic reconstructions demonstrated better functional outcomes compared to internal fixation and biologic techniques (p < 0.0001). Among biologic techniques, combined coracoclavicular and acromioclavicular ligaments reconstruction showed better Constant (p = 0.0270) and ASES (p = 0.0113) scores compared to isolated coracoclavicular ligaments reconstruction; anatomic biologic non-augmented graft reconstruction showed better Constant (p < 0.0001), VAS (p < 0.0001) and SSV (p = 0.0177) results compared to augmented techniques. No differences in functional outcomes could be found between anatomic biologic non-augmented graft versus synthetic reconstructions. Overall, methodological quality of the included studies was low.<bold>Conclusion: </bold>Anatomic reconstructions, both synthetic and biologic, showed the best functional results.<bold>Level Of Evidence: </bold>IV.
- Subjects
ACROMIOCLAVICULAR joint; SHOULDER dislocations; SHOULDER joint surgery; JOINT hypermobility; BONE grafting; HEALTH outcome assessment; DESCRIPTIVE statistics; SHOULDER surgery; ARTHROSCOPY; ARTICULAR ligaments; SYSTEMATIC reviews; PLASTIC surgery; RADIOGRAPHY; TREATMENT effectiveness; FRACTURE fixation
- Publication
Knee Surgery, Sports Traumatology, Arthroscopy, 2021, Vol 29, Issue 7, p2237
- ISSN
0942-2056
- Publication type
journal article
- DOI
10.1007/s00167-020-06059-5