Article
Concomitant glenohumeral pathologies in patients with acromioclavicular joint separations: How do acute and chronic instabilities differ?
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Authors
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Manije Massih
- Charité Universitätsmedizin Berlin, Virchow Klinikum, Klinik für Unfall- und Wiederherstellungschirurgie, Berlin, Germany
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Nina Maziak
- Charité Universitätsmedizin Berlin, Virchow Klinikum, Klinik für Unfall- und Wiederherstellungschirurgie, Berlin, Germany
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Alex Marzel
- Schulthess Klinik, Schulter- und Ellenbogenchirurgie, Zürich, Switzerland
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Felix Massen
- Schulthess Klinik, Schulter- und Ellenbogenchirurgie, Zürich, Switzerland
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Markus Scheibel
- Charité Universitätsmedizin Berlin, Virchow Klinikum, Klinik für Unfall- und Wiederherstellungschirurgie, Berlin, Germany
| Published: | October 26, 2021 |
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Outline
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Objectives: It is known that concomitant glenohumeral pathologies are common and can occur in up to 50% of AC joint dislocations. This study aims to evaluate and compare concomitant glenohumeral pathologies (CGP) of acute and chronic acromioclavicular separations (Rockwood type III-V). It also aims to investigate the impact of prior surgical treatment in patients with chronic ACJ instabilities on the prevalence of CGPs.
Methods: This retrospective cross-sectional binational bicentric study included all patients that underwent arthroscopically-assisted stabilization for higher grade (Rockwood III-V) acute or chronic AC joint dislocation between September 2007 and April 2019. Demographic and clinical data concerning the injury, as well as intraoperative findings and additionally performed procedures were extracted from the patients' files. Attention was given on whether concomitant lesions were addressed by debridement only or if reconstructive measures were necessary.
Results: A total of 540 patients (69 women and 471 men) with a mean age of 39.4 (SD 12.1) years were included in this study, out of which 410 (76%) were treated within 21 days after injury and were defined as acute (group A), while the remaining 130 (24%) were defined as chronic (group C).
Overall, 30.7% had a CGP with the most common being supraspinatus tendon (SSP) lesions (14.8%) followed by labral lesions (14.4%).
There was no difference between group A and C in the overall prevalence of CGPs (A=29.3% vs. C=35.4%, p=0.19). However, SSP lesions were more common in chronic patients (22% vs. 13%, p=0.016). The SSP lesions were also more frequently left untreated in group C as compared to group A (75% (A) vs. 19.2%(B), p= <0.001). CGPs in group C were significantly more frequent in surgery-naïve (45.7% vs 18.4%, p=0.002). In these conservatively treated patients of group C, CGPs were seen more often in patients that underwent open than arthroscopic surgery (17.9% vs 6.2%). This difference however did not reach statistical significance (p=0.392) due to the small number of chronic patients with a previous operation (n=44).
Conclusion: This study with the - to our knowledge - largest sample size to date, confirms the high rate of CGPs in acute and chronic ACJ instabilities. It also shows that CGPs are significantly more common in patients with chronic ACJ instability after prior conservative treatment than after surgical treatment, which could suggest that CGPs may be a cause of persistent symptoms.
