gms | German Medical Science

Objectives: To evaluate clinical outcomes as well as return-to-activity (RTA) and -work (RTW) following arthroscopic coracoclavicular stabilization with a suspensory fixation for acromioclavicular (AC) joint instability in patients aged 50 years and older, and to compare these outcome parameters between surgery in the acute and chronic situation.

Methods: Of 55 consecutive cases assessed for eligibility, 44 patients with a mean age of 59.9±7.8 (50–76) years who underwent arthroscopic coracoclavicular stabilization with a suspensory fixation between 01/2010 and 06/2020 were included and a comprehensive chart review was conducted. Outcome measures included the ASES, SANE as well as VAS pain at rest and VAS pain during overhead activity, which were collected at a minimum of 24 months postoperatively. RTA and RTW were comprehensively evaluated by questionnaire. Outcomes were compared between patients who underwent surgery for AC joint instability in the acute (<3 weeks) or chronic (>3 weeks) situation.

Results: Mean follow-up was 74.8 ± 31.4 months (range 37–142). Postoperatively patients reported an ASES of 89.4±15.6 (38–100), a SANE of 89.8±13.9 (40–100) along with a VAS pain of 2.4±1.7 (1–7) during overhead activity at final follow-up. In this case series, there was no revision rate for subsequent recurrent instability. Postoperatively, 87.2% of patients returned to athletic activity after 4.1±2.3 (1–12) months at a comparable exercise volume (9.4±10.6 preoperatively vs. 8.5±11.2 postoperatively, p=0.126) however to fewer disciplines (2.4±1.2 vs. 2.1±1.4 p=0.025). 97% of the patients returned to work at a mean of 7.3±8.8 (0–40) weeks, with 90% reporting a similar or superior working ability. Patients undergoing surgery in the acute situation (n=23) did not indicate a significant difference in the SANE of the operated shoulder compared to the contralateral shoulder (p=0.407), whereas the patients in the chronic situation (n=22) reported significantly inferior SANE scores compared the contralateral shoulder (p=0.024). Patients undergoing surgery in the acute situation returned to more athletic disciplines (p=0.007), in particular overhead sports (p=0.011) and non-shoulder sports (p=0.036), while patients undergoing surgery in the chronic situation returned significantly faster to their activity (p= 0.018), potentially due to their lower preoperative demand.

Conclusion: Patients aged >50 years undergoing arthroscopic coracoclavicular stabilization with a suspensory fixation for AC joint instability experienced favorable clinical outcomes at mid-term follow-up, with high rates of return to athletic activity and work. While outcomes were relatively comparable in patients undergoing surgery in the acute and chronic situation, there is a tendency towards superior clinical and athletic outcomes in active patients >50 years following surgery in the acute phase.