Acute unstable acromioclavicular joint injuries: quality of life comparison between patients managed operatively with a coracoclavicular suspension device arthroscopically placed versus patients managed non-operatively

Abstract

The main aim was to compare the quality of life (QoL) of patients with acute unstable acromioclavicular joint (ACJ) injuries (grade IIIB-V according to the ISAKOS diversification of the Rockwood classification), managed operatively with a coracoclavicular suspension device arthroscopically placed versus the QoL of patients managed non-operatively, 24 months or more after shoulder injury. The secondary aims were to describe the prevalence of scapular dyskinesis in each group of treatment and to assess its relation to the magnitude of shoulder pain. Patients with acute unstable ACJ injuries managed operatively or non-operatively, between 2008 and 2012 were included. Grade IIIA and IIIB injuries were differentiated. Grade IIIA injuries were excluded. The QoL was evaluated by means of the Health Survey questionnaire (SF36), the visual analogue scale (VAS) for pain, the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, assessed at the initial visit post-injury and at the last follow-up visit. The difference between values registered at these different moments was calculated. The Constant score, the global satisfaction (scale from 0 to 10), and the presence of scapular dyskinesis were assessed at the last follow-up visit. The VAS was stratified according to the presence or absence of scapular dyskinesis. Comparison between groups was performed. In the SURG-group, the development of secondary displacements was radiologically evaluated. Forty-one patients were included: 21 CONS-group (4 Rockwood IIIB and 17 V) and 20 SURG-group (3 Rockwood IIIB, 3 IV, and 14 V). The mean age was 37 [19–55] years, and the mean follow-up was 36 [24–90] months. The difference between the questionnaires assessed at the last follow-up visit and at the initial visit post-injury was: (1) physical SF36 score (CONS-group 18.6 ± 6.1 and SURG-group 28.1 ± 6.9, p = 0.001); (2) mental SF36 score (CONS-group 10.8 ± 11.2 and SURG-group 10.6 ± 6.8, p = 0.960); (3) VAS (CONS-group −7.3 ± 1.7 and SURG-group −7.7 ± 1.2, p = 0.412); (4) DASH questionnaire (CONS-group −55.7 ± 9.8 and SURG-group −77.4 ± 9,5, p = 0.020). The mean Constant score assessed at the last follow-up visit was (CONS-group 91.1 ± 7.4 and SURG-group 95.3 ± 2.5, p = 0.020). The mean global satisfaction registered at the last follow-up visit was (CONS-group 8.5 ± 1.7 and SURG-group 8.9 ± 0.9, p = 0.371). There was evidence of scapular dyskinesis in 52.4 % (11/21) of the patients of the CONS-group and in 15 % (3/20) of the patients of the SURG-group (p = 0.030). The mean VAS registered at the last follow-up visit in the group of patients that developed scapular dyskinesis was 2 ± 0.96 and in the group of patients with normal scapular motion 0.3 ± 0.47 (p = 0.000). In the SURG-group, anatomic reduction of the ACJ was finally achieved in 60 % (12/20) of the patients; vertical subluxations were observed in 20 % (4/20); and complete dislocations were observed in 20 % (4/20). Patients with acute unstable ACJ injuries managed operatively with a coracoclavicular suspension device arthroscopically placed have a better quality of life in terms of the physical SF36, DASH, and Constant score, than patients managed non-operatively, 24 months or more after shoulder injury. Although the global satisfaction is not different between groups, the prevalence of scapular dyskinesis is greater in the group of patients managed non-operatively and the scapular dyskinesis is significantly associated to a higher pain. Level of evidence: level III, retrospective cohort study