Prognostic factors to succeed in surgical treatment of chronic acromioclavicular dislocations - 24/11/15
, F. Duparc b, L. Baverel a, J. Bahurel c, B. Toussaint c, S. Bertiaux b, P. Clavert d, O. Gastaud e, N. Brassart f, E. Beaudouin g, P. De Mourgues h, D. Berne i, M. Duport j, N. Najihi k, P. Boyer l, B. Faivre m, A. Meyer n, G. Nourissat o, S. Poulain p, F. Bruchou q, J.F. Ménard rthe Société Française d’Arthroscopie
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Abstract |
Introduction |
Treatment of chronic acromioclavicular joint dislocation (ACJD) remains a poorly known and controversial subject. Given the many surgical options, it is not always easy to determine which steps are indispensable.
Methods |
This article reports a multicenter prospective study. The clinical and radiological follow-up involved a comparative analysis of the preoperative and postoperative data at 1 year, including pain (visual analogue scale), subjective functional incapacity (QuickDASH), and the objective Constant score, as well as a comparative analysis of vertical and horizontal movements measured on simple x-rays.
Results |
Based on a series of 140 operated ACJDs, we included 24 chronic ACJDs. The mean time to surgery was 46 weeks (range, 1 month to 4 years). The patients’ mean age was 41 years, with a majority of males (75%), 72% of whom participated in recreational sports. Professionally, 40% of the subjects had jobs involving manual labor. We noted 40% grade III, 24% grade IV, and 36% grade V injury according to the Rockwood classification. In 92% of cases, coracoclavicular stabilization was provided by a double button implant, reinforced with a biological graft in 88% of the cases. In 29%, millimeters to centimeters of the distal clavicle were resected and acromioclavicular stabilization was associated in 54%. We observed complications in 33% of the cases. At 1 year postoperative, 21 patients underwent clinical and radiological follow-up (87.5%). Only 35% of the patients were satisfied or very satisfied, whereas 100% of them would recommend the operation. Full-time work was resumed in 91% of the cases and all sports could be resumed in 86%. The pre- and postoperative values at 1 year changed as follows: the mean Constant score improved from 61 to 87 (p=0.00002); the subjective QuickDASH score decreased from 41 to 9 (p=0.00002); and radiologically significant reduction of the initial displacement was observed in the vertical plane (p<10−3) and the horizontal plane (p=0.022).
Conclusion |
In this study, the favorable prognostic factors found were: time to surgery less than 3 months (p=0.02), associated acromioclavicular stabilization, and postoperative immobilization with a sling extended to 6 weeks. However, resection of the distal clavicle did not influence the final result.
Level of proof |
Level II prospective non-randomized comparative study.
El texto completo de este artículo está disponible en PDF.Keywords : Chronic acromioclavicular dislocation, Surgical treatment, Prognostic factors
Esquema
Vol 101 - N° 8S
P. S305-S311 - décembre 2015 Regresar al número
Artículo precedente
- Is coracoclavicular stabilisation alone sufficient for the endoscopic treatment of severe acromioclavicular joint dislocation (Rockwood types III, IV, and V)?
- J. Barth, F. Duparc, K. Andrieu, M. Duport, B. Toussaint, S. Bertiaux, P. Clavert, O. Gastaud, N. Brassart, E. Beaudouin, P. De Mourgues, D. Berne, J. Bahurel, N. Najihi, P. Boyer, B. Faivre, A. Meyer, G. Nourissat, S. Poulain, F. Bruchou, J.-F. Ménard, the French Society of Arthroscopy (SFA)
- Complication rates and types of failure after arthroscopic acute acromioclavicular dislocation fixation. Prospective multicenter study of 116 cases
- P. Clavert, A. Meyer, P. Boyer, O. Gastaud, J. Barth, F. Duparc, the SFA
Bienvenido a EM-consulte, la referencia de los profesionales de la salud.