Abstract
PurposeTo develop a consensus on diagnosis and treatment of acromioclavicular joint instability.MethodsA consensus process following the modified Delphi technique was conducted. Panel members were selected among the European Shoulder Associates of ESSKA. Five rounds were performed between October 2018 and November 2019. The first round consisted of gathering questions which were then divided into blocks referring to imaging, classifications, surgical approach for acute and chronic cases, conservative treatment. Subsequent rounds consisted of condensation by means of an online questionnaire. Consensus was achieved when ≥ 66.7% of the participants agreed on one answer. Descriptive statistic was used to summarize the data.ResultsA consensus was reached on the following topics. Imaging: a true anteroposterior or a bilateral Zanca view are sufficient for diagnosis. 93% of the panel agreed on clinical override testing during body cross test to identify horizontal instability. The Rockwood classification, as modified by the ISAKOS statement, was deemed valid. The separation line between acute and chronic cases was set at 3 weeks. The panel agreed on arthroscopically assisted anatomic reconstruction using a suspensory device (86.2%), with no need of a biological augmentation (82.8%) in acute injuries, whereas biological reconstruction of coracoclavicular and acromioclavicular ligaments with tendon graft was suggested in chronic cases. Conservative approach and postoperative care were found similarConclusionA consensus was found on the main topics of controversy in the management of acromioclavicular joint dislocation. Each step of the diagnostic treatment algorithm was fully investigated and clarified.Level of evidenceLevel V.
Highlights
Injuries of the acromioclavicular (AC) joint are quite common, accounting for 3–12% of all shoulder injuries [9]
A consensus was reached after the third round (79.3%), that no additional imaging is needed for the assessment of AC joint instability
True AP view or a bilateral Zanca view were deemed sufficient for diagnosis, a separation line between acute and chronic was set at 3 weeks from trauma, arthroscopically assisted anatomic reconstruction using synthetic augmentation has been suggested in acute injuries, whereas the use of biological reconstruction with tendon graft was reserved to chronic
Summary
Injuries of the acromioclavicular (AC) joint are quite common, accounting for 3–12% of all shoulder injuries [9]. The incidence even rises up to 40–50% when it comes to Claudio Rosso and Frank Martetschläger contributed . Knut Beitzel and Giuseppe Milano supervised and contributed . Extended author information available on the last page of the article contact sports [14], with the highest prevalence in men in their second or third decade of life [7]. It seems evident that diagnosis and management of acute and chronic AC joint dislocations need to be well stated. A plethora literature is available, a clear consensus has still not been achieved
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